Feature

When Jodi Mindell, PhD, was a graduate student at the State University of New York at Albany in the mid-1980s, her adviser, V. Mark Durand, PhD, came to her one day bleary-eyed and desperate for any information on babies and sleep. His newborn son, Jonathan, wasn't sleeping at night--so neither were he and his wife.

"Exhausted, he told me to 'go to the journals, and find whatever you can on this,'" Mindell recalls. To their surprise, there was little research on pediatric sleep in the psychology journals. The "crying-it-out" theory of Harvard pediatrician Richard Ferber, MD, had just gained national attention, but psychologists hadn't jumped on the bandwagon yet. "So we decided--to his wife's chagrin--to experiment a little on Jonathan," she says.

What started as brainstorming ways to help Jonathan sleep led to a groundbreaking career in pediatric sleep for Mindell, who is now the associate director of the Sleep Disorders Center at Children's Hospital of Philadelphia, where she treats infants, children and teenagers. Through her research and clinical work, Mindell--who is also a professor of psychology at St. Joseph's University--has established a reputation for having one of the most successful techniques for getting children to sleep soundly through the night. And through her public education efforts with companies like Johnson & Johnson and Parents magazine, she has been able to share her expertise with thousands of parents and children's health professionals.

"She is, in my mind, the foremost expert on babies and sleep," says psychologist James Maas, PhD, an expert on adult sleep disorders at Cornell University. "And what's more, she is able to bridge the gap between the researcher and the academic journals and jargon and the general public and their right, and need, to know."

Solving sleep problems

After graduate school, Mindell had no trouble shaping her career around her newfound passion for infant and toddler sleep. Parents aren't the only ones thirsty for sleep solutions: Pediatricians and other children's health professionals grapple with sleep problems daily in their practice, and research shows that nearly 25 percent of young children experience some kind of sleep problem that can significantly affect their functioning and well-being.

Mindell's early research focused on the basics: What helps children fall asleep? How do they stay asleep through the night? What she found was that within two weeks of infants and children being able to fall asleep independently at bedtime, they naturally begin sleeping through the night. In other words, once a child is able to fall asleep without parental assistance--such as being rocked or nursed to sleep--the same skill generalizes to naturally occurring night-wakings. "All children wake during the night," she says. "The real issue is whether they can return to sleep on their own."

Mindell has turned her research findings into practice through her work at Children's Hospital in Philadelphia, where she is part of a team that runs a half-day sleep disorders clinic for children 0 to 18 years old once a week. The multidisciplinary team includes professionals from pulmonology, neurology and psychiatry.

They treat a range of disorders, including sleep terrors, night-waking and sleep apnea, and Mindell estimates that about 30 to 40 percent of the problems they see are behavior-related. For example, an inconsistent bedtime routine, need for parental presence after lights out or expectation of being lulled to sleep in the car can interfere with natural patterns, says Mindell. Other sleep problems have medical causes such as breathing abnormalities, sleep terrors or narcolepsy--problems Mindell and her colleagues check children for during overnight monitoring in their sleep lab.

Once she and her colleagues have targeted the issue and map out a treatment plan--which may involve adjustments to bedtime routine, medications or surgery for enlarged tonsils or adenoids--they often see changes in their patients in as little as three days. It's an aspect of the work that has kept Mindell going over the years.

"It's amazing how quickly parents see a difference in their children's sleep and how grateful they are," she says.

Mindell's current research focuses on sleep patterns and disorders in internationally adopted children and foster children, and she's also supervising a postdoc's work on sleep problems among caregivers of children with chronic illness. Moreover, in an effort to help pediatricians--who she says are on the front lines, encountering sleep-deprived children and parents every day--she is involved in studies of which medications are being used to treat children's sleep disorders and which are most effective.

"Pediatricians recommend everything from benadryl to hypnotics to chamomile tea," she says. "So we are trying to get a sense of what works and what recommendations need to be made."

She's also chairing a team that is involved in developing the American Academy of Sleep Medicine's practice parameters for pediatricians, child psychologists and other health professionals who treat infant and toddler sleep problems.

Educating the public

In an effort to help more parents and their children sleep, Mindell outlined her bedtime self-soothing strategies and other research in the book "Sleeping Through the Night: How Infants, Toddlers and their Parents Can Get a Good Night's Sleep" (HarperCollins, 1997). Practically overnight, the book brought Mindell national attention from parenting groups and organizations, which Mindell attributes in part to the fact that "parents could read it in a sleep-deprived state and still understand it."

However, there is some controversy among parents and others who were alarmed and concerned that the self-soothing she describes in the book involves letting infants cry.

"All parents have a choice, and I am very supportive of that," Mindell says, adding that research has shown that crying to fall asleep causes no type of long-term trauma for children. "I am just trying to give parents who are looking for a solution an approach that really works."

Criticism notwithstanding, the publicity led Mindell to become a consultant on sleep issues for Parents magazine and its Web site and for the parenting Web site BabyCenter.com. In addition, Johnson & Johnson has asked her to work on a public education campaign on children's sleep, and she's chairing the National Sleep Foundation's annual "Sleep in America" poll, which is focused this year on children's sleep and will be released on March 29.

Ironically, the book that sparked these efforts came out three weeks before she gave birth to her first child, who is now six years old. Naturally, the burning question on the minds of every colleague and book critic was whether the baby sleep expert had a successfully snoozing infant of her own.

"Everyone asked me that, and in fact I found that there was nothing I would change in my book or about my theories as a result of being a parent," Mindell says. "Having a baby myself just reinforced how accurate they are."

Further Reading

* Mindell, J.A. (1999). Empirically supported treatments in pediatric psychology: Bedtime refusal and night wakings in young children. Journal of Pediatric Psychology, 24(6), 465-481.

* Mindell, J.A., & Owens, J.A. (2003). A clinical guide to pediatric sleep: Diagnosis and management of sleep problems. Philadelphia: Lippincott Williams & Wilkins.