By Tracy G. Cassels
One of the things I’ve realized recently, whether it be through comments on this site or comments in daily interactions, is that when people find out you’re anti-cry-it-out they usually have the following to say about either why they did it or why it can be good: “My baby just gets overtired and needs to cry to get all that extra energy out before she sleeps.” Sound familiar? Have you heard that or uttered it yourself? Before you scoff or roll your eyes, here’s the thing—it’s kind of true. Many babies, when overtired, will cry because it’s a natural way for them to release their frustration. And when they do this they typically don’t respond to things like nursing as a means to comfort. As adults we do a similar thing, typically getting frustrated or upset when overtired and we need to get that out of our systems before we can sleep properly. But somewhere along the line people started believing that if you don’t let your child CIO you must somehow be stimulating them when they cry to get them to stop. And that is simply not true. The one thing these people don’t consider is that needing to cry does not equal needing to cry-it-out.
Let me start by using my daughter as an example… My daughter is known for keeping herself up whenever possible. If we’re over at her best friend’s house, she will be awake forever out of fear of missing something, even if he falls asleep. On those days, when we get home, I know she needs to sleep and I know that frustrated cry that comes from her as she fights it. What do I do? Let me first say that I don’t let her stay up and I don’t stimulate her to get her to stop crying. I get her to bed (we bedshare), offer the boob (rejected), tell her it’s time for sleep and let her flail on the bed in her frustration. And the most amazing thing happens—though frustrated and clearly needing sleep, every 30 seconds or so, she flails back to me for a cuddle (and sometimes nurse). During that time, I hold her, stroke her hair, or offer whatever comfort she allows until she either starts crying again to get more out of her system or comes for the final milk and cuddles to fall asleep. The whole process? It’s never taken longer than 8 minutes (yes, I timed it). I’ve spent WAAYYY more time trying to get to her to sleep when she wasn’t tired than trying to get her to sleep when overtired (and I typically fail in the former situations). There are no hours of screaming at the door while I felt my heart break and no looks of, ‘How could you do this to me?’ Just some honest hard work on her behalf to get that energy out while simultaneously getting love and affection from me.
I don’t know why parents who use CIO and advocates of the method seem to think that those of us who don’t use it either never let our kids cry at all or constantly stimulate them or distract them in order to keep them from crying. Although people’s experiences will inevitably differ from my own, I know from talking to other non-CIO parents that they do similar things. So while we do let our kids cry, we don’t allow our kids to cry without responding to them. It’s a rather critical distinction. As I’ve talked about elsewhere, crying is a very natural thing for infants to do as it’s their primary way of communication, but the reasons they stop crying can be very diverse and have very different effects (see Educating the Experts – Lesson One for more information). I don’t think any parent expects their child to never cry as that is how we learn from them what they need; without crying, figuring out your child would be that much harder. But CIO isn’t about learning from your child or getting them to release their frustration—it’s about ignoring their needs. There are a select few times when CIO for a period is necessary, such as when mom suffers from post-partum depression and can’t handle an infant’s cries and is at-risk of harming her infant. Anytime a parent is at risk of physically harming their child because of his or her cries, putting them down and walking away is always the better scenario (although best would be to pass the baby off to someone else to hold, but that’s not always possible). But these are rare situations that are certainly not the norm (though sadly becoming more so as we treat new mothers with indifference and a lack of support, but that’s a topic for another day). Most of the time CIO comes down to a parent telling a child that they are not there to comfort them in order to teach a schedule or lesson, usually resulting in the child becoming even more distressed. 
My 8 minutes of crying with my daughter is a fraction of what most CIO parents go through with theirs because their lack of comfort seems to increase the crying response, especially when a baby is in that over-tired state.
At this point, many parents will say something along the lines of, “But my child cried for an hour after getting shots/getting a stomach flu/having cramps! How is CIO any different?” And this is a very important question to ask. After all, doesn’t it seem funny that those of us against CIO typically ignore the issue of other bouts of prolonged crying? Well, I’m not going to ignore it so here comes your answer… there’s a huge freaking difference. Let me elaborate.
Outside of sleep, when our children cry, it tends to be out of pain and we respond in kind. Whether it be cramping (also sometimes known as colic), shots, or other ailments, when our babies are screaming during the day, we attribute it to a physical malady and do what we can to alleviate the pain, or at worst, simply provide comfort. It turns out that this comfort is exactly what makes the difference between these bouts of crying and CIO methods used typically at night. In a thorough and enlightening review of the neurological evidence surrounding crying in infancy, Megan Gunnar of the University of Minnesota discusses the research on what happens when infants are distressed (for her review, see [1]). It turns out that it’s not as simple as simply being distressed or not, despite what many would have us believe and what we might intuitively think. For a bit of background, let me explain the stress response. The basis for a stress response lies in the HPA axis (hypothalamic-pituitary-adrenal axis) which activates when a human experiences high distress and releases cortisol into the system (among other functions, such as regulating sleep/wake cycles and digestion)[2]. When infants are distressed for prolonged periods, they release cortisol into their system which has an effect on their neurological development. Specifically, after around 20 minutes of crying alone, infants’ cortisol levels spike[3], indicative of a stress response. If this occurs too frequently, infants develop what has been termed a “stress-reactive” neurological profile, meaning their default response to novel situations becomes one involving what we would deem to be a physiologically stressful response[1].
But for those parents with infants who have allergies, reflux, bad reactions to shots, and any other physical ailment that causes pain and therefore crying, there is good news. It turns out that the activation of the HPA-axis doesn’t happen when an infant is being comforted. This is why I said that bouts of crying in pain and CIO are so distinct—when our child is in physical pain, we are much more likely to provide comfort, thus eliminating the stress effect, even when our child continues to cry. Gunnar’s work and that of others she cites have shown this to be the case and it explains why a child with a difficult physical condition can grow and thrive despite many periods of pain and discomfort that lead to prolonged bouts of crying, as long as someone is there to provide comfort. So when you sit with your child who is in pain (physical OR psychological), you are actually serving as a buffer against a stressful reaction, even if your child continues to cry. So the release of cortisol to the brain that has been found to accompany prolonged crying refers to infants who are not being comforted at the time (the condition in which the research was initially done). It may be due to the effects of oxytocin[4], which is released during close contact, or some other mechanism, but regardless, we know that the effects of crying can be deleterious or rather benign, depending on how we, as caregivers, respond.
All this is to say that not only do us non-CIO parents have children that cry, but because of our responsiveness their crying is going to be distinctly different than those children who are left alone while distressed with no one to offer comfort. We don’t stimulate our children, in fact, we understand their physiological reactions to being tired quite well, thank you very much. We just choose to respond to their distress with touch and affection, and in turn, they don’t have to respond with stress.
[1] Gunnar, M. R. (2006). Social regulation of stress in early childhood. In K. McCartney & D. Phillips (Eds.), Blackwell Handbook of Early Childhood Development (pp. 106-125). Malden: Blackwell Publishing.
[2] http://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93adrenal_axis (Accessed October 10, 2011)
[3] Anders TF, Sachar EJ, Kream J, Roffwarg HP, & Hellman L. Behavior state and plasma cortisol response in the human newborn. Pediatrics 1970; 46: 532-537.
[4] Uvnas-Moberg K. The Oxytocin Factor: Tapping the Hormone of Calm, Love, and Healing (2003). Da Capo Press: Cambridge, MA.
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Sally
Interesting. Our worst situation isvcar journeys. It’s the one time I can’t always be present to comfort him. Reassures me for the occasions when I’m a pasenger and can sit with him whilst he cries though.
Kendra
Love if description of the overly tired baby working herself to sleep. My dd currently 5 months does the same thing. Although I have to add she will usually growl in addition to sleepy cries. She has never cried longer than14 min with out comfort and that one was on the freeway where stopping wojld have been a hazard. Can we have you and the analytical armadillo teach all the baby trainers plz?
Tracy
Sally – The car trips are our worst times too. Sounds like it’s so much for the comfort of driving a baby around, eh?
And Kendra – Do you think the baby trainers would listen? Sadly, I think not!
Andréia C. K. Mortensen
Great post, Tracy.
We have always discussed the different types or crying with the mothers in my ‘Brazilian’ sleep community. That not every cry is the same, but all deserve respect, empathy, and comfort. That crying in a loving parent’s arms is a lot different than crying alone in a crib. This is so important.
I will check Megan Gunnar’s review, thanks for this info.
Andreia
mooreamalatt
Actually, I do think many of the sleep trainers will eventualy listen and it is our job to keep publishing pieces like this and talking to people and maybe even sending articles to sleep trainers! I hate to say this about one of my own professions but many sleep trainers are postpartum doulas, we are often the ones teaching CIO methods to parents and helping them along, holding thier hands in the process. Other sleep trainers should be challenged with evidence and fact at thier small groups and workshops. But eventually, and possibly soon, the anthropological and scientific evidence will make CIO obsolete.
Jespren
Good article (as usual). I’m really jealous of the 8 minutes though! My little ones just take longer and longer to go to sleep the more over-tired they are. I’ve spent 2 hours doing my level best to get an overtired baby to sleep. Crying (stopping midcry to yawn of course), nursing, cuddling, in the crib, in the bed, stuffed animals, blankets, and kicking, lots of kicking. My youngest kicks her feet, banging both heels on the bed, when she is too wound up. So, yeah, I envy you.
Tracy
I should say these are not pleasant 8 minutes – there’s LOTS of kicking and flailing amongst the cuddles, but she does go down well. We struggle tons if I try to get her down before she’s ready though. No way she’d take to a set bedtime. I imagine it could get worse as she gets older, but being happy of the way it is now
Even if she does go to bed way late (at least she sleeps in) as I wait for her to get tired enough.
Cindy
My pediatrician diagnosed my newborn as having colic. Nothing I did could get him to stop crying. I would rock him, put him in a swing, put his carrier on top of a dryer, and nothing seemed to work. I also have a two year old so driving him around in the car was not very convenient, especially if it interfered with the toddler’s nap schedule.
Then a friend of mine recommended the Baby Roll Asleep. At first I was skeptical because it looked very much like a low stroller to me, and putting him the stroller didn’t work. But I was desperate so I ordered one. Much to my surprise, a few minutes after putting him in the Baby Roll Asleep, he quieted down and fell asleep very quickly. It seems that by having the baby low to the ground, the vibration from the wheels creates a soothing effect.
I highly recommend this product for all moms (and dads) who have fussy colicky babies.
Jessica Menon
I love your site! I am trying to find information and research about when, on average, co-sleeping and breastfed babies/ toddlers begin to self-wean from co-sleeping and breastfeeding. There’s so much information on the co-sleeping/ breastfeeding vs. CIO debate. I am just curious as someone who has from day 1 chosen co-sleeping and breastfeeding during the night…when might I expect that to happen *on average*? I only see benefits of co-sleeping and breastfeeding as needed, whether 1am or 3am (and quite frankly, I think I get more sleep as I just wake long enough to settle her on my breast and fall back asleep), and intend on continuing as long as my daughter needs, but I just sort of want to know when I might expect that to be?
Tracy
Hi Jessica,
I’m glad you like the site! I’ll be honest I don’t know that there is information on averages as it is SO variable. I too have been co-sleeping and breastfeeding since day 1 and my daughter (19 months) still rouses to feed regularly. I use rouse as she never fully wakes up to feed, just latches, feeds, and unlatches – eyes never open. I’ve heard of kids self-weaning for night at 15 months (even while still co-sleeping) and others much much later. I think a big factor will be how much food they start taking in – my daughter is still not huge on solids so breastmilk provides her with a lot of her nutritional needs. The more they start eating, the more likely it is they’ll begin to self-wean at night! As for leaving the bed, other cultures list an average of around 4-5 years of age, but in many cases the children have their own beds before that. Hope that helps!
Tracy
Jessica Menon
Thanks, Tracy! That does help, at least to know that what we’re experiencing is common among breastfed, co-sleeping babes. Sometimes I feel like like she’s “abnormal” when I hear other parents talking about the amount of solids their baby eats, or sleeping through the night. My daughter at 14 months still prefers the breast and eats little solid food (which I have been worried about but finally have accepted that it’s ok as she’s perfectly healthy), and still “rouses” as you say 2-4 times per night to feed. We’re going to keep with the breastfeeding and co-sleeping as long as she needs and wants. My husband who is Indian has two nephews (ages 10 and 8) that just moved into their own bedroom from their parents’ beds. Sometimes when we wake up and our daughter is horizontal between us and we’re both falling off the bed we agree we probably won’t make it til age 10, though
. Thanks!
Tracy
Jessica,
I’m glad you feel a bit better. Perfect timing too of you writing back because Peggy O’Mara at mothering magazine posted a great article yesterday on sleeping through the night. Here it is: http://mothering.com/peggyomara/breastfeeding-2/when-do-babies-sleep-through-the-night
Hopefully it makes you feel that much better!!)
Tracy
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Elizabeth
HI Tracy,
I love your site and refer to it often, as I am now, for advice and ideas. I’m wondering about using a modified 8 minute routine (for lack of a better term!) for our daughter who almost 5 months? We had a great thing going, a nice bedtime routine around the same time every night with both my husband and myself (bath, mini massage and then me nursing her to bed until she fell asleep). We co-sleep. Over the past few days though, she has started this kicking and thrashing some of activity where she pulls herself off the breast, rolls around a bit, then comes back to the breast. She never used to do this and it’s getting a little tiring! It is taking her longer to fall asleep and it’s definitely exhausting for me. Tonight, she started doing it again and I sat up, got out of bed and sat on a nearby chair and watched her. I have never left her before like this, only getting out of bed when she was asleep. She never cried but did the thrashing thing again for about 15 min until she finally settled on her stomach. Of course. I moved her to her back and then she thrashed a bit more and then settled again on her stomach. I moved her again and she stayed. It’s as if she is trying to get comfortable! Any thoughts or ideas for me? I know I can’t quite reason that it is bedtime with her at this point but is there something else that I can do instead? She clearly is needing something and I have no idea what it is!
Thanks for your thoughts.
Best,
Elizabeth
Tracy
Hi Elizabeth,
A few thoughts:
1) Is she teething? She’s right at that age and lots of behaviours change when teething begins. Infants get more irritated and can act out from pain more than anything.
2) My daughter started rolling to her stomach for sleep around the same age. It may be that it’s more comfortable for her. Unfortunately we know that back is best, but if she can roll from stomach to back easily, you may want to leave her for a bit then move her once she’s in a deeper sleep (say 10 minutes). As long as you’re awake watching her then move her, that could help. But if the back is uncomfortable for her, let her fall asleep on her stomach, then move her.
3) I know you want a routine that works, but you have to expect that your daughter’s routine will change regularly for quite some time, including what time she’s tired at (those I know that stick to a strict bedtime *tend* to have periods where they can sit for up to 2 hours trying to get their babe to bed). I think you’ll find another routine that works and in a few months, that too will change. The reason is that she’s constantly developing – what works at 2 months shouldn’t work at 6 or 9 because her cognitive development and mental and emotional needs are changing as well. It seems like you may need to simply follow her lead for a bit and see if it gives you more insight into what she needs. If you’re forcing your own needs, then you’ll miss out on what she’s trying to tell you.
Just keep in mind that she’s 5 months and her body and mind are changing in ways we can’t fathom. She won’t always do what works for you and your hubby and you may need to adapt to that in order to keep you all sane
Good luck!
Tracy
Elizabeth
Hi Tracy,
Thanks so much for taking the time to write back. Yes, Elisabeth is teething so it sounds like some of her behavior makes sense. I’m so glad! I definitely didn’t make this connection.
And-argh! I am really anti-routine with her so I hate that I came off that way in my comment.
Yes, I’d love her to keep what she was doing but more so I feel badly because she is so clearly tired and yet not willing to go to bed. Bedtime has been so loose that I thought I was doing a good thing by her. We really do (and are open to) whatever works for her. Definitely no forcing of our needs on her. She rules the roost for the most part!
Any reading recommendations on any of this so I can do to make it easier for her? I really haven;t had much luck in any of the baby books that I was given or have been referred to.
Thanks so much Tracy. I just love this site!
Best,
Elizabeth
Tracy
Sorry for the delay in responding. I do imagine teething is part of it – it throws so much off for so many babies each time they go through it
Something most parents are unaware of!
I don’t actually know any books – it’s a bit of a problem. I’m not sure what’s in all of the Dr. Sears books but they might be useful – perhaps the more generic ones or the sleep ones (I have them linked in the Books area under Resources). Unfortunately though, I think most of the books don’t really address this for people – sadly
Good luck!!
Tracy
Cherie
To respond to Elizabeth-my 7 1/2 month old daughter does the same thing but she seems to need it and she sleeps well so it doesnt bother me.
Elizabeth
Ah, interesting Cherie that your 7 month old does the same. But what did you mean by “need it”? Whats the “it”?
The flipping to the stomach? I wasn’t sure! Thanks.
Cherie
Yeah, I meant that maybe she has to release her last bit of energy or just get comfortable by flipping and rolling. I put a pillow in the middle of the bed to keep her from going to the other side so my hubby has room to sleep, and she will nurse, flip over away from me to the pillow, then come back and nurse, roll over and repeat and finally just sleep. Im just happy that she’ll finally fall asleep turned away from me so I can stretch out a bit.
Cherie
Of course, once she falls asleep I move the pillow (no SIDS).
Elizabeth
Ah, got it! Thanks Cherie.