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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

[1].  How long does this last?  We don’t know, but I imagine it is highly variable, with some children ceasing to be stressed early, and others taking far longer.  We also know that self-soothing, or as it really should be called, emotional regulation, is actually linked to responsiveness to distress in terms of development[2][3].  Now, of course parents can be responsive often and doing CIO doesn’t mean that you are never responsive, but, as so eloquently stated by John Hoffman here, CIO and CC (controlled crying) are “disruption[s] of the social process by which babies learn to self-soothe” (and I strongly recommend you read the entire Hoffman piece).

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.