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 ). 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). When infants are distressed for prolonged periods, they release cortisol into their system which has an effect on their neurological development. Specifically, one study found that at around the 20-minute mark of crying alone, infants’ cortisol levels spike, indicative of a stress response (note that other researchers seem to be able to achieve a spike for distress earlier when there is pain, but it’s unclear if psychological distress elicits such a quick response as well). If this occurs too frequently (the definition of which is still unknown, except in extreme circumstances), 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.
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 by a responsive caregiver. 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 they trust 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. In fact, the cry is assumed to be more of a signalling cry than one that mirrors the internal state of distress for securely attached infants so long as the caregiver is trusted and responds to the child’s 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, 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.
 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.
 http://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93adrenal_axis (Accessed October 10, 2011)
 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.
 Uvnas-Moberg K. The Oxytocin Factor: Tapping the Hormone of Calm, Love, and Healing (2003). Da Capo Press: Cambridge, MA.