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I regularly post against the extinction sleep training methods, namely cry-it-out (CIO) or controlled crying (CC). It should be no surprise it’s a practice I really don’t like, mostly because I believe the bit of evidence we have suggests it is not great for babies (even if they do recover, though not all do) and add to that it’s often ineffective. Whenever I post these though, you can bet I get more than my fair share of comments and emails from parents who have used CIO or CC and are ready to tear everything to shreds. The research isn’t good enough, no one has really shown long-term damage, with their own experiences outweighing everything.
What they want, or so I hear, is that we provide massively longitudinal studies looking at outcomes, sleep problems, cortisol, etc. If you can think of it, they want it. After all, children are resilient and can overcome a lot. So a bit of sleep training? That’s nothing and why are we even talking about this when it helps families so much?
And this is where I get lost.
Why care? Because the research we do have suggests that sleep training is stressful on an infant. And we know that at least when they start to sleep without crying, they are stressed and that this experience breaks the synchrony they have built up with a trusted caregiver
There are many adults who have memories of the CIO experience as a toddler. Adults who have problems falling asleep, sleeping next to people, speaking up for themselves, all of which they attribute at least in part to their experiences of CIO or CC. Perhaps they are the ones who were most at risk for negative reactions to these methods, but no one told their parents that the risk was ever increased. And if they had, would their parents have tried something else?
There are many gentle methods that can help families guide their children to longer sleep, to falling asleep alone, or to self-settle in the middle of the night. Methods that don’t include leaving your child to cry for periods of time, either extended or with random “checks” every 10 minutes. And in fact, having a nuanced bedtime routine has been found to be one of the most effective methods in aiding sleep[4]. So why are we not advocating that parents try these methods?
For those claiming that children are resilient and thus they’ll “get over” their bout of sleep training, why on earth would we propose a method that forces them to use their resiliency when there are methods that don’t? We know resiliency isn’t unlimited, so why force it? Why fall back on the idea that they’ll get over it when there needn’t be anything to get over? Gentler methods may take time, longer than CIO, unless you’re one of the nearly half of people for whom even CIO doesn’t work, but they work just as well (if not better). If you went into parenting expecting a quick fix to all problems, I recommend you take a long look at what you’ve signed up for again.
So given all this, why is the onus on us who speak out against CIO to prove it does no harm? Doctors don’t get to hand out treatments that haven’t been proven safe. Pharmaceutical companies need to test and retest their medications and prove their safety before use. We can’t even implement new teaching techniques without having them tested. Now, there are obvious failures in these systems (we all know this and I bet everyone can come up with an example where harm was hidden or found out after the fact), but the system we have adhered to as a society puts the onus of do no harm on those who are acting. If you want to act against what we know to be what infants need and are asking for, namely responsiveness, should it not be you who has to prove no harm? Should the rest of us not just sit back and wait until this has been proven beyond a shadow of a doubt before even suggesting families do this?
I am a parent and it is my job to try to do no harm. It is my job to not increase the risk of harm to my child. So why on earth would I not care about a method that from what we can tell, does harm? Even if only temporarily for some children? It should not be up to me to prove harm, it should be up to you to prove no harm. Our children deserve that.
If you are looking for gentle resources, you can find them here.
[1] Middlemiss W, Granger DA, Goldberg WA, Nathans L. Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Early Human Development 2012; 88: 227-232.
[2] Davidov M & Grusec JE. Untangling the links of parental responsiveness to distress and warmth to child outcomes. Child Development 2006; 77: 44-58.
[3] Leerkes EM, Blankson AN, & O’Brien M. Differential effects of maternal sensitivity to infant distress and nondistress on socio-emotional functioning. Child Development 2009; 80: 762-775.
[4] Mindell JA, Telofski LS, Weigand B, Kurtz ES. A nightly bedtime routine: impact on sleep in young children and maternal mood. Sleep 2009; 32: 599-606.
So what DO you DO if not CC or CIO? I mean, come on. I want a SOLUTION not just damnation and judgement.
I haven’t tried CC or CIO yet but I think I have to. I have tried EVERYTHING else! We have a bedtime routine! We are on board with Pantley but she is not helping us. We have seen every doctor, naturopath, osteopath etc on the block. My 8 month old has never slept longer than three hours in his life, most nights he sleeps in stretches of 1-2 hours. He is cranky and tired because he s not getting enough sleep and I am LOSING it because I am not getting enough sleep. For.eight.months. I love all of the attachment parenting philosophies but I am beginning to resent and get very angry at the expectation and the pressure, that you just have to co-sleep, feed on demand, wait it out until sleep starts improving. When will that be? When? Two years? Three? Of only sleeping a broken one to two hours at a time? Really? If my little one regularly did 4 or even 5 hour stretches at night, I would happily co-sleep, feed all hours etc, and never think about CC. But he doesn’t! I NEED to start helping him to sleep for longer stretches f time. It isn’t a desire born out of selfishness, I genuinely feel like it will be better for both of us in the long run. You can’t seriously tell me that I have to survive on this little sleep for the next two years! I’ll be in a mental home by then.
Maybe instead of spending so much time judging people who use these practices, you could instead write some helpful articles to support people who can’t carry on, who need a solution desperately.
I’m very sorry you’re clearly so stressed. First I will say your child’s sleep patterns sound normal, but if it’s stressing you out (and thus most likely him), then yes, you need to work at it. I often recommend Pantley, but you say it’s not working for you (how long have you been at it). Pinky McKay has wonderful books on helping guide sleep gently (see Sleeping Like a Baby) as does Sarah Ockwell-Smith (Baby Calm). I would recommend you try those individuals as well. There are also some pieces on here to deal with sleep at different ages:
https://gku.flm.mybluehost.me/evolutionaryparenting.com/simple-ways-to-calm-a-crying-baby/
https://gku.flm.mybluehost.me/evolutionaryparenting.com/understanding-and-helping-toddler-sleep-part-iii/
https://gku.flm.mybluehost.me/evolutionaryparenting.com/routines-vs-schedules/
I would also recommend reading some of the reasons babies cry and wake – food in particular may be an issue for you. If your child has any food intolerance, it will manifest in fitful sleep and crankiness. Dairy, wheat, and soy are the most common and going undiagnosed can lead to hell for many parents. Often once the offending food(s) are removed from baby’s and mom’s diet (if breastfeeding), within a couple weeks (it takes that long for most foods to fully go through our system), parents report noticing massive differences in child behaviour and sleep. Your child may also have undiagnosed reflux – or silent reflux – or may have a very hard time with teething. All reasons to look into these explanations fully before jumping to CIO.
https://gku.flm.mybluehost.me/evolutionaryparenting.com/reasons-babies-cry-and-wake-at-night/
Good luck and if I can be of any more assistance, please let me know!
Your childs sleeping is perfecrly normal. As a single mother I know how terrible that seems but its true. My daughter was waking every hour in the night at 3mths old for months… slowly getting to 2-3hrs. At 15mths old she was still waking 3-6x in a night (remember that that is from 7pm-7am so waking at 9pm or 11pm was not bad but 2am or 4am was difficult.). My daughter is 2 now and aside from teething pains or illness she sleeps all night. No CIO. My daughter had extreme seperation anxiety so that would have made her 10x worse.
I also think this sounds very judgemental. What are your credentials, doctor or therapist? What makes you an expert on parenting styles? I don’t think what the lady who posted the top comment is going through is normal. I can relate because I am also a single parent and am the sole person waking at night. My son is 20 months old now, but at 8 months he was not waking every 2-3 hours. He was going to bed at 7pm and only waking at 11pm, 5 am, and then would wake at 9 am. I only was able to get him to sleep in his crib after letting him lay and sleep with me for 2 hours. Which I loved, but I also had to get things done around the house and I’m a nursing student. At 9 months old I implemented a modified version of cry it out. My son now is the best sleeper. He goes down right away. It has worked well for both of us. I did my research and there was no evidence of crying it out being harmful to children. I think every parent had the right to choose which method without being judged.
Abby,
Although it was clearly stressful for Cath, it actually is not necessarily abnormal (based on large-scale, longitudinal studies on night wakings). However, checking things like food intolerances, reflux, tongue-tie, etc. are all things that should be done to ensure that there isn’t an underlying reason for the waking.
I’m not sure how this was judgmental as it was aimed at those promoting a method, not those using it, but take of it what you will. My credentials are: MA in Clinical Psychology and finishing up my PhD in Developmental Psychology. As for your comment about “no evidence of crying it out being harmful”, it’s a bit of a mix there. There’s no real research on long-term effects AT ALL. And the short term research suggests high stress. Of course each baby will be different, but to say no evidence implies it’s been looked at, which it hasn’t.
And if you believe you have a right to select anything without being judged, you’re really asking for universal approval which will never happen. Just as I don’t expect no one to judge me for bedsharing and nursing on demand, I reserve the right to judge *actions*, such as CIO. If you want to change someone’s mind, present the evidence and see if you can do it. Or just accept that not everyone will agree or support your choices.
T
yes i have met a few breast feeding mums who’s baby started sleeping when they stopped eating gluten. Gluten can ,in some people, create neurological issues like sleeping issues, depression etc…..many are sceptical when i suggest it but he ones who give it a try are really surprised how well it worked! it is free advice, will not cost you anything why not giving it a go?
To Cath, I understand what you are going through. My son (who is now28mo) was a frequent waker & it would take me 1-3 hours a night to get him to sleep for 1-3 hours so I could get some time w/ my fiancee. He was no help at all. I never had luck w/ Pantley either, who can keep a sleep journal at 1,2 & 3am when you can barely open your eyes or pick up your child for the 10th time that night.
Now that I’m single I co-sleep w/ my son in bed, but for the first 19mo I would sleep w/ him in a recliner or else I would be in & out of bed all night. And even then I still was because I wanted to sleep in my own bed w/ my partner. I would have preferred to co-sleep in a bed but our bed was too small for all 3 of us to sleep in safely. Like you I was desperate for sleep. I tried CIO 3 different times & it never really worked. It would last a few days or few weeks & then back to waking & difficulty sleeping again. I tried it at about 9mo, 13mo & 17mo it was heartbreaking, physically painful & frustrating listening to him cry and call out for me (never his Dad). At 17mo he was able to climb out of his crib & bang on the door, following the cio method I didn’t open it. He finally gave up & fell asleep on the floor next to his crib. The CIO sessions are the worse I’ve ever felt as a parent. The guilt of causing my son pain, the shame that I felt thinking I was a failed parent because my son wasn’t a good sleeper, the anger I felt at myself & him for not sleeping, anger at my partner for not helping or being very supportive.
At 9mo I weaned off night feedings by adding more solids but still pumping & bfing during the day. I also stopped feeding on demand. I would time his feedings (and instructed the daycare staff to do the same, he was in daycare 6-11mo while I finished school) to be about every 2-3hrs. This helped a little and he would sleep for 2-4hrs instead of 1-3, he never took very good naps either, unless sleeping on me. But nothing really did the trick until it finally dawned on me at 19mo that my son & I could safely sleep on the couch together w/ all the cushions removed (except the ones we lay on of course). By this time I had gotten his bedtime routine down to 1hr, from the time I said “bedtime” to when I was actually putting him in his crib to sleep. He would/will sleep for about 2-3hrs & wake up (now at 28mo he sometimes sleeps 4-5hrs in his crib), I would go get him & go lay down on the couch w/ him & we would sleep peacefully the rest of the night. We’ve been co-sleeping in a bed since we moved out 4mo ago. Co-sleeping is the only thing that has ever worked for me to get sleep.
What are your issues w/ co-sleeping? Space? Your partner’s reluctance? Safety? You said you would co-sleep if only he would sleep for longer stretches, does that mean you haven’t tried co-sleeping yet? That you are hoping he will sleep for longer stretches & then you will try co-sleeping? Perhaps you should just give it a try & see how it goes. You may be surprised how well you both sleep once you are in the same spot. Sorry if co-sleeping is not the solution you were hoping for but it’s what worked for me. Sorry for the long post.
Thanks for your comments Abby and Amy. I wrote the original post some months ago and so things have changed a bit so I thought it would be interesting to comment on how things have changed.
I was co-sleeping with DS who was waking every 1-2-3 hours all night, taking ages to get down and was often wide awake for stretches of time in the middle of the night. The only way he knew how to sleep was on the trusty boob, and I was so tired I couldn’t carry on.
So we did sleep train him in the end. Now I know this is a very contentious issue for Attachment Parents everywhere, and I know that they imagine sleep training to be this- closing the door on your little snowflake at 7pm, and not going back in all night no matter how much they cry and scream.
I do agree that this sounds horrible! I just want to say that like everything in life, it’s all about balance. If sleep isn’t working for you, you need to do something about it, and not all sleep training is so awful. There is no actual evidence that it does harm anyway, but I couldn’t bring myself to do cry it our or controlled crying, so we followed a programme where we put DS in cot and we stayed in the room with him, comforting him as much as we wanted, but ultimately he had to learn to put himself to sleep. It took a long time (a month) and we still have bad nights, but he now sleeps for stretches of time, and I have cut down the night feelings to two maximum. We are all so much happier for it. If he cries in the night, I still go to him and rub his back and comfort him until he falls asleep. It’s not perfect, but it works for us.
Anyway, I think that the Attachment parent community promoting co-sleeping and feeding on demand is absolutely NOT for everyone. If I had carried on waking up and feeding my son 8 or more times a night, I would have lost it due to sheer exhaustion. I actually think people like Tracey are IRRESPONSIBLE for promoting feeding on demand at all hours for all mums, the danger of having an exhausted mum, who can’t cope anymore and who is on the verge of a nervous breakdown is not going to do any babies any favours!!! I know Tracy envisions this wonderful world where women have lots of support in their role is mothers, but for many of us, we do not have this in reality with families living further and further apart, husbands working in shifts as mine does. We have to do the best we can do- for everyone- not just baby, and we have to find some balance. My take away message I suppose is that sleep training doesn’t have to be cruel, shutting the door and ignoring all cries. But I think in many cases, some sleep training IS beneficial for everyone. My son is certainly much happier now that he is sleeping better, and I am a better and more responsive mother too. Attachment parenting is at a danger of making martyrs of mothers. I have seen it on the forums! Getting up 15 times a night to breastfeed your baby- you are such a great mum, doing a great job….uh NO! ! That can’t be doing anyone any good, never mind the so called risks of doing CC or CIO, what about the risks of having a chronically sleep deprived child and mother?
Cath,
Where you’re wrong is that I only promote feeding on demand at all hours, etc. Here are two pieces that you may find interesting given your view of how irresponsible I am…
Gentle Sleep Resources (for parents who want to guide sleep but not use the more common sleep training that’s out there):
https://gku.flm.mybluehost.me/evolutionaryparenting.com/gentle-sleep-resources/
Are We Setting Parents Up to Sleep Train? (a focus on looking at how we talk about sleep training and what it means for individual families):
https://gku.flm.mybluehost.me/evolutionaryparenting.com/are-we-setting-up-parents-to-sleep-train/
Is Bedsharing For You? (questions parents can ask to find out if it is something that will work for them):
https://gku.flm.mybluehost.me/evolutionaryparenting.com/is-bed-sharing-for-you/
Note that nowhere in Do No Harm did I suggest all parents have to be sleep deprived and nurse on demand all night. In fact, this is from the piece you’re so adamantly against:
“There are many gentle methods that can help families guide their children to longer sleep, to falling asleep alone, or to self-settle in the middle of the night. Methods that don’t include leaving your child to cry for periods of time, either extended or with random “checks” every 10 minutes. And in fact, having a nuanced bedtime routine has been found to be one of the most effective methods in aiding sleep[4]. So why are we not advocating that parents try these methods?”
It seems your taking issue with things that have never been written, possibly because someone else has suggested that’s what the site or piece is about; I don’t know.
Tracy
p.s. I also noticed that I provided you with other solutions which you never seemed to respond to but I hope they were somewhat helpful if you did look at them.
What is stressful is an infant who doesn’t know how to sleep on their own. After three nights of CIO (for 30 mins each night) my son has slept 12 hours a night since 4.5 months of age and takes 3 naps a day which fell into place after he learned to self soothe. And never cries when we put him down or when he wakes up in the am. I doubt anyone’s “gentle” method produces as few tears in the long term. The judgment and non scientific research out there scaring parents into feeling guilty for getting their babies and themselves more sleep is outrageous and unjust.
Let’s be clear – he learned to self-settle, not self-soothe. Two very different processes and from all we can tell, CIO inhibits self-soothing even if it leads to self-settling. The problem is that often an infant who doesn’t sleep well has a secondary issue that is causing this problem. CIO ignores that. People working in the field have found that all their cases in the first 6 months of babies with bad sleep are attributable to feeding issues (be it tongue-tie, food sensitivity, reflux – silent or regular) or medical issues (like sleep apnea). When we ignore these, we’re not helping the baby – they may sleep more, but it’s not dealing with the underlying issue.
Furthermore, the promotion of CIO ignores individual temperaments. Some babies will suffer short-term trauma (cortisol research shows us that at least this is true) that they can recover from quickly, but for some children there will be long-term trauma. Parents don’t necessarily know how their child will respond. As such, we should be focusing on promoting methods that are considerate of the child. And even as Dr. Ferber has argued, nothing before six months of age.
I agree with you CIOisgentletoo! If I hadn’t gently sleep trained my baby ( at 9 months) I would probably still be getting up to feed him 8-10 times a night, still suffering from exhaustion and depression and not feeling like I was the mum I wanted to be because I was so flipping exhausted. We didn’t do CIO where we left the room, but we did start putting him in his cot awake so that he learned how to fall asleep on his own. There were tears involved but we never left him alone. There is a middle ground to everything.
Yes cortisol levels have been shown to rise in sleep trained infants, but Tracy fails to mention that infants who are sleep deprived (as mine no doubt was) have high cortisol levels anyway. You have to use your common sense and do what you think is right. Having a chronically exhausted mother and infant is not healthy or feasible, and not realistic to expect mothers to just ‘suck it up’ and surviving on 3 hours of broken sleep for many months or years cannot be better than a week of sleep training, however you chose to do it, leading to improved sleep, better mood, health for both mum and baby.
And yes Tracy, I looked at your gentle sleep suggestions, but they didn’t actually contain any suggestions, apart from waiting it out, and educating yourself on normal sleep. So what do you suggest I should have done, baby waking 8-10 times a night, I had to go back to work, not much help given from family and friends, do you really suggest that I should have carried on getting up all night? Driving to work (30 mins ech way) in a chronically exhausted state? Crying every day because I was so tired?
I’m not seeking your approval – we definitely made the right choice four our family and sleep training was absolutely the best thing for us all. My mood improved dramatically once I started sleeping more than 4 hours a night and I am a much better and more responsive mother.
I am just interested to hear what you would suggest that someone in my absolutely desperate situation should do.
I have an entire post on them you can see here: https://gku.flm.mybluehost.me/evolutionaryparenting.com/gentle-sleep-resources/
The links at the end are the many practices as I refuse to write up someone else’s work as if I did it so credit remains with those that have developed and tested these gentle methods. Did you check out all of the links at the end?
However, I would also add the same caveat I made before: Most sleep problems have a basis in another problem – feeding or medical. Ignoring the underlying issue is not a practice I would promote at all. I would agree that true chronically sleep-deprived babies are stressed, but likely due to the underlying reason for the sleep deprivation. However, chronic sleep deprivation is quite rare in infants – it’s us adults who can’t handle it well, especially in our society.