Among the most common sources of suffering for new parents – sleep deprivation- may lead to a desperate search for certainty. Lack of sleep can strain relationships between parents, siblings, and grandparents. It may aggravate or even precipitate depression. Once parents find their way to my pediatrics practice where I specialize in infant-parent mental health, they have typically tried all sorts of methods and prepackaged sets of instructions. They ask “What do you think of Suzie Expert’s blog? How about Dr. Authority’s book? When we relax into the open space of not knowing, we make important discoveries.

In my decades practicing pediatrics while studying and teaching contemporary developmental science, I have come to understand uncertainty as the force that drives healthy individuals and healthy relationships forward. Throughout our lives, waves of not knowing are followed by calm of knowing, followed by another wave of uncertainty in an ongoing process of growth and change over time.

“I know he will cry” said Milo’s father Paul “I’m certain of it,” said Paul’s husband, Charlie. They had come to see me for help with sleep.  I learned that for Paul, letting his two-year–old son cry for even a moment provoked painful memories of being left alone by his mother who struggled with severe mental illness. His cracking voice revealed the still raw grief as this new being who completely depended on him provoked painful memories. Charlie, who had just launched his own business, could not bear the combination of lack of sleep with lack of support from Paul. Charlie felt Milo needed to become independent, while Paul still mourned the loss of the tiny infant who easily fell asleep in his arms.

Even as Milo approached his second birthday, Paul held him on his lap until he fell asleep. The process typically took over an hour. Paul placed him in his crib, tiptoed out of the room only to repeat a variation on the theme several more times when Milo woke through the night. Charlie tried to be patient but expressed concern about Milo’s inability to fall asleep without being held, particularly as he would soon enter daycare. Their strained marriage, fraying around the edges due to the grip of the prolonged sleep ritual and severe sleep deprivation, motivated them to seek my help in teaching Milo to fall asleep on his own.

Milo added his voice when he came to the office. He shared his favorite phrase “by self,” clapped his hands gleefully when I mentioned the possibility of a “big boy bed.” My observations suggested to me that he was ready to sleep independently, but I met Milo’s parents’ certainty with my uncertainty. “I don’t know what will happen, but he may surprise you.” As they both seemed motivated to go forward with teaching Milo to fall asleep on his own, I agreed to support them through the process. We set up an appointment with a plan that they would try for several nights preceding the date. Milo’s longstanding resistance to going to sleep, while in part a result of habit, represented his communication to his dads “you need to work out this conflict before I can feel calm enough to leave you for the night.”

For both child and parent, the moment of birth launches parallel journeys of becoming and letting go. The wondrous process of development proceeds both gradually and relentlessly. As relationships evolve a child finds joy in an emerging sense of “me,” while a parent discovers over time an adult self that incorporates the new identity of “parent.” A sense of loss with an element of poignancy naturally occurs in parallel as captured in Joni Mitchell’s popular song “The Circle Game.” But loss of other kinds- in current or past relationships- when unacknowledged and unexpressed may color the process.

Sleep itself represents among the earliest forms of separation. While sleep disruption inevitably accompanies new parenthood, when families suffer to the point that they find their way to my office, usually they are grappling with a deep sense of loss. A search for certainty becomes an obstacle to exploring the source(s) of their pain. Time and a safe space for listening offers families opportunity to express grief and to reclaim joy.

Paul began our planned follow-up with an apology. “We haven’t really changed anything.” Charlie expressed his surprise at how hard it had been for him to leave Milo at daycare. His bravado around encouraging independence- and with it the main source of conflict with his husband- collapsed. No longer at odds with each other, they could navigate the bedtime routine. The nighttime struggles subsided and the urgency to teach Milo to sleep independently faded. They assured me that when the time came if they needed help, they would reach out to me. Just as they were getting ready to leave the office, Paul shared with obvious sense of pride that when Milo started daycare, he insisted on leaving his pacifier at home. Charlie added joyfully, “He’s such a big boy.”