Problems with the 45-minute intruder portions of the 2001
by Laurie Moody
First let me say that I'm not just being negative here.
I'm sincerely grateful that there has been an attempt
to provide some cautionary clarification with regard to
feeding problems masked as sleeping problems in the Babywise
book. While I applaud the effort, I would be remiss if
I did not say that the effort is too little and too late.
For background information, readers should know that
on the old GFI message board called "The Forum,"
which now exists only as a read-only format, this 45-minute
intruder used to be called the "45-minute monster."
While this term was not used in any of the Babywise editions
that I'm aware of, this term was used regularly on "The
Forum" when responding to mothers' questions about
mid-nap interruptions. Until the 2001 edition of Babywise
was released, mid-nap waking was always considered a sleeping
problem. Not until critics began drawing attention to
repeated problems with infant weight gain and loss in
maternal milk supply around the 4 month mark did contact
moms begin to question moms on whether milk supply was
adequate when mid-nap waking was a problem.
I'm going to list the problems with the following quotes
from the 2001 edition of Babywise as I see them. First
the quotes from the book and then the commentary:
"Then there is the
45-minute intruder. Most mothers tell us this intruder
sneaks in around seven or eight weeks, and four-months
[sic] of age, popping up all of a sudden and out
of the blue. Your baby has been doing great on her
3 1/2 hour routine, feeding and sleeping like the
book says. And then, all of a sudden around week
seven, she wakes 45 minutes into her nap. You know
that she just had a full feeding so you begin to
wonder if the problem is sleep related. That might
be the cause, but equally, if might be that she
is hungry and in need of another full feeding. If
that is the case, feed her again, and then readjust
her routine over the next TWO FEEDINGS [emphasis
mine]. You will know it is not hunger if she is
not interested in eating or only nurses for a minute."
"It [waking early out
of a sound nap] might also also be the 45-minute
intruder mentioned in Chapter Six [quoted above].
One day your baby just begins to wakeup [sic] 45
minutes early, because she is hungry even though
your last feeding was a full feeding. We find the
intruder appearing between seven and eight weeks
and at four months of age. It might stick around
one or two days or up to two weeks. What should
you do if the intruder visits your baby? Our emphasis
and encouragement is to first approach the 45-minute
intruder as a hunger problem, not a sleep adjustment
problem. Try feeding your baby first. If the problem
is really sleep-related, your baby will be disinterested
in feeding or will not feed well. But if your baby
takes a full feeding, you have your answer. Feed
the baby during these growth spurts and adjust your
daily routine to allow for a few more feedings during
the day. It is important to properly recognize the
intruder because it can affect more than a single
sleep cycle. While more research needs to be done
in this area, it appears a link may exist between
the 45-minute intruder and breast-feeding [sic]
problems. If your baby, whether she be at two or
four months of age, demonstrates a need to feed
more often by waking out of a sound nap, it may
be an indicator of a decrease in your milk supply
or the quality of your milk. The downward spiral
begins. The baby is waking early in the nap. Mother
assumes it is a sleep problem. This continues for
several days. Meanwhile, the baby is not getting
adequate daytime sleep so she is not nursing proficiently.
The end result in a week's time is two-fold: Mother's
decreasing milk supply and a fussy baby who might
possibly over a week's time begin to lose weight."
- Both portions quoted indicate this as a problem related
to growth spurts within a specific time frame only:
approximately 2 months and 4 months. The authors of
Babywise are COMPLETELY MISSING THE PROBLEM. Every authoritative
medical source I can find lists growth spurts as occurring
at or near 10 days to 3 weeks of age, 6 weeks of age,
3 months of age, and 6 months of age, but also clarifies
that it is normal and acceptable for them to be at other
ages as well. What happens with Babywise is NOT that
a growth spurt at 2 months or 4 months causes the 45-minute
intruder to appear. What happens is that because of
unresponsive breastfeeding, a mother likely misses a
growth spurt, which eventually causes a baby to deviate
from previously established patterns of sleep. Even
if a mother accepts the warning offered by the 2001
edition of Babywise, her baby is likely hungry and uncomfortable
for an extended period of time before the mother realizes
it by way of the "45-minute intruder." In
addition, the most commonly noted periods of weight
loss in Babywise babies that I have documented (and
others as well) show up at the 2 month and 4 month well
baby checks further giving support to the conclusion
that healthy growth is probably affected well before
the magic 2 and 4 month age guidelines given in Babywise.
- Babywise here gives mothers a false confidence that
her greatest need for caution with regard to sleeping
interruptions needs to take place only at these two
"common" ages: 2 and 4 months. The newborn
period is the most critical time for the establishment
of milk supply and mother's responsiveness to her baby.
- These sections also give mothers a false confidence
that she only needs caution with her schedule if her
baby is waking mid-nap. Yet some babies will learn to
settle for less caloric intake than they need, and will
shut down and sleep more, not less. In lactation literature,
babies like this are referred to as "content to
- Babywise indicates that at seven weeks a baby is "doing
great on her 3 1/2 hour routine, feeding and sleeping
like the book says."
In my opinion this part of Babywise inadvertently reveals
a predilection for young babies to be on long-interval
feeding schedules early on, which is consistent with
overt directives in earlier versions. Read carefully:
to be "doing great" AT seven weeks, this indicates
that the baby would likely be moving into a 3.5 hour
schedule at the end of the newborn period. The AAP recommends
that a newborn be fed 8-12 times in a 24-hour period.
A baby being fed every 3.5 hours is only being fed at
most 7 times.
- Babywise indicates that at seven weeks a baby is
"doing great on her 3 1/2 hour routine, feeding
and sleeping like the book says."
Yes, MORE from this one quote. It says "feeding
and sleeping like the book says." This is just
ONE OF MANY statements throughout the book that lead
moms to think that the patterns described in the book
are normative and should be expected. When the baby
ISN'T doing it "like the book says" the mother
is told to find out what is causing the baby's "uncooperative
stance". Babywise doesn't indicate that the method
itself could be flawed, it blames the mother or the
- Babywise says, "You know that she just had a
JUST had a FULL feeding is a dangerous statement to
make for a few reasons. First of all, "just"
would indicate by most definitions to be a relatively
recent event. In the 3.5 hour routine as described by
Babywise, the baby waking 45 minutes into a nap would
have been fed anywhere from 2 hours and 15 minutes earlier
to 2 hours and 45 minutes earlier depending on waketime.
By any reasonable definition of "just had,"
that time interval is NOT recent. Secondly, Babywise
says "a full feeding." Babywise gives moms
a false confidence about this idea of "full feedings."
Babies whose cues are being ignored cannot adequately
tell a mother's body how much milk to produce (which
will eventually cause a decrease in milk supply). Not
all moms can store the same amount of milk and not all
babies can take in the same amount of milk to satisfy
them for certain feeding intervals. Not all moms have
the same caloric or fat content to their milk, and not
all babies have the same metabolism for how quickly
they use up calories. It stands to reason that quieter,
calmer babies will not use up calories as quickly as
fidgety, active babies.
- Babywise says, "you begin to wonder if the problem
is sleep related. That might be the cause, but equally,
if might be that she is hungry and in need of another
full feeding... Mother assumes it is a sleep problem."
This is another example of "blame the mother."
Moms are told that if they follow the book they will
get the stated results. Mothers are told to evaluate
cries and figure out what the baby needs before responding.
I see this section for some moms as one that would lead
them to doubt their ability to evaluate what the baby
needs, especially for a mother who begins losing her
milk supply or who has a baby who isn't gaining weight
adequately. The Babywise book is not the problem, but
the mother's apparent inability to determine what the
baby really needs. HOGWASH.
- More on this quote, "you begin to wonder if
the problem is sleep related. That might be the cause,
but equally, if might be that she is hungry and in need
of another full feeding."
Why is it ONLY possible that hunger is causing sleeping
"problems" at 2 months and 4 months. Why isn't
this 45-minute intruder considered earlier in the newborn
period as well? Could it be because the authors of Babywise
don't really believe in true routine but really believe
in a schedule instead? Could it be that they really
don't want moms to be "too flexible?" Consider
this quote from the 2001 edition of Babywise, page 109.
" But what is flexibility?
Many times we hear new moms say they want to be
flexible. What does this look like? The word flexibility
means the ability to bend or be pliable. When
you think of a flexible item, you think of something
with a particular shape that can bend and then
return to its original shape. Returning is perhaps
the most crucial element of flexing. During the
critical first weeks of stabilization you are
giving your baby's routine its shape. Too much
flexibility in these weeks is viewed by a baby
as inconsistency. Routine must first be established.
After that, when necessary deviations are made,
baby will bounce back to the original routine.
Doing so, however, may require your firm guidance.
The flexibility you desire will come, but give
yourself time to develop your child's routine.
And remember, true flexibility is not a lack of
routine, but a temporary alteration of what you
Considering that parents read this statement FIRST,
before reading about the 45-minute intruder, it is
reasonable to believe that most moms would be focused
then on "normal" sleeping patterns as defined
by Babywise up until the possibility of a 45-minute
intruder sometime after 7 weeks.
- The solution Babywise suggests is inadequate. Both
quoted passages suggested temporary modification of
the feeding schedule by adding in a few feedings. This
idea of the temporary alteration of the "routine"
is based on the assumption that only feeding at certain
predefined, acceptable intervals is safe for every mom
and baby to start with. Yes, adding in more feedings
temporarily may solve the short-term problem, but it
may not solve the problem long-term. Why? Restating
what I said in #6 above: Babies whose cues are being
ignored cannot adequately tell a mother's body how much
milk to produce (which will eventually cause a decrease
in milk supply). Not all moms can store the same amount
of milk and not all babies can take in the same amount
of milk to satisfy them for certain feeding intervals.
Not all moms have the same caloric or fat content to
their milk, and not all babies have the same metabolism
for how quickly they use up calories. It stands to reason
that quieter, calmer babies will not use up calories
as quickly as fidgety, active babies. Additionally,
the mother may not be able to consistently produce enough
milk after weeks and months on end of giving her body
mixed signals. The AAP says that the best schedule for
a breastfed baby is the one he/she designs for him/herself.
Babies can develop a pattern or routine and parents
can work with baby to influence that pattern, but it
can and should be done with more medical safety and
more respectfully than the Babywise approach.
- Both passages say this in one form or another, so
I'll just quote one of them. Babywise says, "If
the problem is really sleep-related, your baby will
be disinterested in feeding or will not feed well."
I have personally worked with moms during my former
Contact Mom status with GFI whose babies were so conditioned
to be fed only at certain intervals or times of day
that they were unwilling to nurse at other times. These
were babies who were losing weight and clearly needed
to be fed more often, yet were unwilling to do so. Along
the same line, there have been babies who were so conditioned
to only receive a small amount of breastmilk at a time
and were unwilling to take more at once. The story of
the Hseigh baby (see the story at http://www.ezzo.info/Voices/hsieh.htm
) is probably the most serious one of which I'm aware
that illustrates my point. Weight loss and interruption
in typical sleeping patterns are evidence of a problem
that has already existed for some time. Babywise ignores
this in its suggestion of a solution and its cursory
dismissal of a possible response by the baby to the
- Babywise says, "If your baby, whether she be
at two or four months of age, demonstrates a need to
feed more often by waking out of a sound nap, it may
be an indicator of a decrease in your milk supply OR
THE QUALITY OF YOUR MILK." [emphasis mine]
Notice the conjunction OR. Here the authors of Babywise
introduce, not so subtly, that the problem could, after
all, just be the QUALITY of the mother's milk. No, the
method cannot possibly be at fault, just the mother's
ability to analyze her baby's needs and the quality
of her milk. When all else fails, blame the MOTHER.
MORE HOGWASH! There are no peer reviewed medical studies
to back up this assertion by Babywise that in the midst
of not following the AAP's recommendation for cue feeding
her baby, a mother should assume the quality of her
milk could be at fault in her baby's inability to follow
the Babywise method.
- Babywise says, "While more research needs to
be done in this area, it appears a link may exist between
the 45-minute intruder and breast-feeding [sic] problems."
In America we don't do this kind of research--purposely
withhold food from babies to see what kind of problems
it causes! This kind of proposal for research would
never make it past a peer review board. It could only
be done by a retrospective study, which as those who
have done serious research know has its own set of problems
(very difficult to sort and define variables, very difficult
to establish how much of the protocol was followed and
how it was actually implemented).
If more research needs to be done to determine the relationship
of the "45-mintue intruder" and the Babywise
method, then WHY are the Ezzos continuing to publish
their book? If only a few babies injured due to defects
in a car seat involved in an auto accident results in
the recall of that car seat, then WHY don't the Ezzos
see their own liability with regard to the problems
many families have had with the Babywise method? Why
don't they act responsibly and remove the Babywise book
from the shelves in a full recall?
- Babywise says, "Meanwhile, the baby is not getting
adequate daytime sleep so she is not nursing proficiently."
I believe this statement is meant to express something
similar that I said to the Ezzos when I resigned as
a contact mom: that poor feeding can lead to poor sleeping
which can in turn lead to poor feeding, thus creating
a vicious cycle. I'll give the benefit of the doubt
on that portion of material I quoted. Babywise is still
neglecting to consider with this statement that the
method itself could be at fault.
I've already said it once and I'll say it again. The
added cautions in the book are offset by admonitions
to mothers to not be "too flexible too often."
I don't see the paragraphs about the 45-minute intruder
to be enough of a change in the overall pattern of the
book to make it a safer method to follow.
Laurie Moody is the mother of 4 children
and a certified lactation counselor.