You can read this article in Hebrew here, thanks to Idan Melamed!
You can read this article in Romanian here, thanks to Andrea Boabes!
You can read this article in French here, thanks to Pascal!
A new review paper out in the Journal of Developmental and Behavioural Pediatrics
Just a reminder, in case people didn’t know, many doctors, sleep experts, sleep trainers, and clinics start to promote sleep training at month 3 or 4. Some parents start even earlier. And when those of us speak out against it’s promotion, arguing infants are in a sensitive period at that point (the fourth trimester so to speak) or have naturally developing circadian rhythms we don’t want to mess with, or that this type of training can harm breastfeeding success, we’re told it’s up to us to prove the risk of harm if we don’t want it *promoted*. Well… here is that proof. (Remember we’re talking about promoting something here, not speaking to parents who used methods without knowing anything or who were told by doctors, sleep experts, etc. to use these methods early. We have to differentiate between speaking to parents who are trying anything that will work and the people who should know what to promote and what not to promote.)
One of the most disturbing revelations is that articles promoting sleep training in the early months don’t actually have scientific backing for it. What many of them found was simply that sleep consolidates rapidly during the first four months postpartum and that because it does this, it is assumed to be evidence that sleep training will prevent later problems in sleep-wake cycles for infants. But when they actually looked at outcomes for infant and mother (as this is who has primarily done the sleep training in the research they found), they find the following:
- Sleep training in the first 12 weeks does result in longer sleep durations but does not reduce infant crying, which is the main concern for parents seeking sleep training.
- Increased night wakings in breastfed babies was not associated with any long-term sleep or behavioural problems despite many suggesting long-term problems associated with infant night wakings.
- Infants who show night wakings or other sleep disturbances at six months (without intervention) have completely normal mental health in young adulthood, meaning those who suggest a link to later problems don’t have a leg to stand on.
- For those who worry about moms with depression, sleep training prior to six months was not found to decrease maternal depression at all. And in fact, mom’s sleep problems do not correlate with infant sleep but rather are due to the depression, not the infant.
- In fact, it was maternal depression that predicted longer infant awakenings at night (though not frequency), not the other way around.
- Mothers who breastfeed wake more to feed babies but report better sleep quality and lower rates of postpartum depression.
- The few studies that reported a decrease in maternal depression due to interventions were incredibly complex interventions with many elements (including support for mother) and the lowered depression cannot be said to be due to sleep training.
- Decoupling feeding from sleep in infants younger than six months was associated with increased breastfeeding failure.
- Rigid, scheduled sleep and care in the early months is associated with three times the risk of behavioural problems at six months and twice the amount of crying as infants with cue-based care.
- Placing an infant in a dark room during the day under the guise of them needing sleep or crying from being “overstimulated” or “overtired” actually inhibits the consolidation of night sleep (meaning more night wakings) and increases the risk for SIDS. It also reduces the ability of mom to develop a good daytime biorhythm with the baby which reduces maternal mental health.
- The focus of sleep interventions – namely the amount the baby has slept, how long between sleeps, number of wakings, etc. – actually increases parental anxiety. It can also result in worse sleep for baby.
Perhaps most interesting of all, though not an outcome, most families don’t report any issues with infant sleep in the first six months. Most people are being told to use behavioural techniques as preventative measures for later problems. Only there’s no evidence that this works and as we’ve just read, actually can pose more problems for the family both in the short- and medium-term. And none of these studies even looked at any longer-term social or emotional issues that can arise from sleep training so young, thus the question of what the risk of long-term harm is still remains.
What to do? As the authors here suggest, treatments need to be holistic. In the minds of these authors and researchers, early treatment of any problem should avoid sleep training and all behavioural techniques in favour of education about cue-based care, parent-child synchrony, healthy daytime biorhythms, and addressing parental anxiety about sleep and normal crying. Further, feeding difficulties should be examined as one of the potential causes of unsettled infant behaviour, thus parents should be given all the assistance they need to address any feeding issues.
Isn’t it sad that we needed 20 years of studies to prove the risk of harm? Couldn’t we have not promoted this and saved these families the anxiety, stress, and problems that came with promotion of something that hadn’t been proved to do no harm despite countering all biological norms?
So… sleep trainers, baby “experts”, doctors, and anyone else promoting sleep training in young infants: What are you going to do now?
Update: Here is a video with the authors of the review talking about the research and sleep in the first six months! (Thank you to Natalie for this.)
Click here for a follow-up opinion piece.
[Image Credit: Unknown]
[1] Douglas PS, Hill PS. Behavioral sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic review. J Dev Behav Pediatr 2013; 34: 497-507.
Great article!
We provide postnatal care to new families and always have to explain to parents sleep training in the early months is not beneficial.
thank you Liza
AMEN AND HALLELUJAH!!!! I hear those angels singing too!
Great blog post, seriously. And I’m also very grateful for the research.
So I have to wonder, did this get posted to some Babywise forum with a cry for help to support leaving your baby to cry? Because I can’t imagine this many people who follow Babywise would also read this blog.
It makes me sad so many people deny themselves the connectedness and joy that comes from tending your child when they cry, and the freedom from guilt that comes from doing the research and following your instincts.
So agree with everything you say. I wonder if this research will be read by enough people to cause changes. I always breast fed and followed my natural instincts so baby never cried. Needed cuddles, feeding, settling, and lots of love and attention, but all this was done before the baby had to cry aloud to receive it. I can’t understand why any mother thinks it is OK to let their baby cry. Harder for bottle feeding mothers even if some babies sleep longer when bottle fed than breast fed, but I still can’t understand why mothers will let their babies cry.
I hate this tone, I had a cry colicky baby ( my secound ) and I didn’t ‘let’ him cry, he just cried, for about 20 hours of the day for a few day there. We EBF on demand, I was happy to co-sleep, wore him, etc etc he still cried…
Thats so different though, you were still there for your baby. The basis of most sleep training is leaving them alone to cry.
Crying while being supported (while obviously not ideal but has to happen in some cases) doesnt have the same negative effects.
The tone is like this because those of us who have been saying this for years have been shot down repeatedly, told to get proof etc. we are frustrated and feel like its about bloody time we got this evidence. Let alone the retaliations of “your baby is going to be clingy” “you will have an unhealthy relationship” that i hear on a daily basis.
We were right, i think its ok to be on our high horse (so to speak) about this. Its no like they havent acted all high and mighty by promoting sleep training as if its the only way to go.
I don’t think it actually talks about the harm CIO does, or have I missed this?
I am interested to see what other factors the physicians above looked at while compiling the information. For example, are the children from all socioeconomic groups included in this study, or is that information left out? And what about foods used (EBF, BF, Supplementation, FF, Cow-based FF, Goat milk based FF, etc.) And those children who were studied, did any of them have medical issues before, during or after the articles were written?
I feel like, while I only zipped through your recommended article (after reading your blog post), a lot was left out, and I believe it’s important to understand all factors to determine if sleep training was truly “the” issue.
I also have not once met a family who schedules base their schedule on the clock. That isn’t what scheduling your baby is about, and honestly the family that watches the clock and not the baby (while scheduling) has no idea what they are doing.
Schedules for babies are exactly like a curriculum for subject areas for learning–constantly in motion, changing with the child and is very flexible. For example, we schedule our baby who is currently 7 months old and base the times on when she gives hunger cues, active cues and sleep cues. I know that she loves her nights and sleeps 12 hours. I also know that she is hungry about every 4 hours, with the exception of growth spurts, when she becomes hungry around 3.5 hours. If I try to feed her “off schedule” she doesn’t take a full feeding, and often refuses it. Which leaves her snacking through the rest of the day.
So I am quite surprised to see you writing about schedules that are based solely on the clock, because I honestly have never heard of that before, while I researched all about scheduling. Is that really what you see schedules as? Or just how a friend of yours does it?
I love it, it helps plan our days, and after teaching for 10 years, I’ve seen countless children who have followed a schedule/routine for years since they were babies, who are quite well-organized, intelligent, creative thinkers and exceptional children overall. And I’ve seen too many of them to think it’s just a coincidence.
As for feedings, I nursed my LO until she was 6 months, and it was amazing. I stopped when we decided to try for another baby using IVF (no Infertility program will accept breast feeding mothers because it does release hormones that make it difficult to get pregnant.) It was very sad, but in the long run we feel that a sibling outweighed the perks of BF at that point. However, we were going strong right up until that appointment when I found we had to stop. So I don’t see as how scheduling can or would ever contribute to loss in milk:
For example, we use Babywise, which explicitly states to feed your baby when she is hungry, regardless of where in the schedule the hunger cues fall. I make note of it, so as to determine what’s going on–is the quality of milk suffering, is it a growth spurt, is it an oncoming illness, perhaps we need to work on the latching again…etc.
I don’t understand the “placing in a dark room” statement—naps are important, and a dark room helps to calm everyone down (me included) and only helps in sleeping….so where’s the problem? Her naps in a darkened room certainly don’t detract from her nighttime sleep–never have. She has slept solidly 8 hours in a stretch consistently from when she was around 10 weeks old. Then I put in an earlier bedtime with consistent routine and she, herself with no help from me, stretched her nights to a good 12 hours.
So I must be missing something?
Overall, I guess this article is good for those who apparently set rigid schedules, but most people know that a schedule serves the baby and the family, not the clock.
Recommended readings are set by a plugin, not me 🙂
However, many books recommend set times – this isn’t new.
As for Babywise, I recommend you read a bit more on it. The program is spoken out against by many groups as it’s been linked with “failure to thrive” in infants.
(Sorry – having to run out the door so can’t write more.)
As I am not the author, I don’t know the intent but I expect when she wrote about scheduling she was referring to a parent imposed schedule rather than a child centric schedule. For example the doctor says feed every 3 hours so rather than learning you babies unique schedule and conforming you impose your own. All babies will have their own schedule and rhythm much like all adults do.
I understood the placing in a dark room part to be similar in nature. The parent wants the child to nap at a set time rather than when the child would be ready to nap. So you place child in a dark room hoping to force them into a nap. She was not saying don’t let your child nap in a dark room. That would be silly since that is where babies nap best.
Maybe that perspective helps?
Yes on the schedule, but no for the dark room: You actually don’t want your baby in a truly dark room. First, it usually means you’re away from them and that increases SIDS. Second, too dark and they don’t learn the night/day distinction. A dim room with some light coming through is far better for napping during the day.
How is a dark room increasing SIDS?
I am a parenting Educator and i strive to be very clear about sleep and SIDS.
I find it irresponsible to say what causes SIDS directly, when it isn’t totally known. However many people lump SIDS in with risky sleep choices. Bed-Sharing and Co-sleeping are also set up to be risky and parents are very scared.
It seems to be due to the same issues of a child being in a separate room at night from a parent – it doubles the risk of SIDS. And no one is saying what *causes* SIDS, but rather what *increases the risk*. Bedsharing (which is only one form of co-sleeping, room-sharing is the other and there are no known risks with that) can be very risky if done unsafely but can be done safely to eliminate the risk relative to room-sharing.
I loved what you wrote, Kristen!
Just to comment that many parents have the Priority to raise :
glad, happy, flexible, relaxed, connected, warm, self-loving children above the objective of raising kids who are”well-organized, intelligent, creative thinkers “.
Many “good kids” (“well-behaved” are not happy).
So when we want to AVOID instilling in our kids anxiousness, sense of loneliness, sense that they have to earn our love, that they have to “behave” , or comply or be convenient to the life of the adult, or to be “good” or valuable, Then, with that mindset, we try to AVOID any kind of “training” that the child does not ask for explicitly (when he/she can) or that is not related to protect their body, mind of emotions.
In short, when emotional intelligence is priority over “academic intelligence or other types”, then we focus on how our children FEEL, not only how they behave.
I totally agree. I had two babies, never had a problem with feeding or sleeping. They both napped in a quiet, dark room in there cribs, I just laid them down when they were fed and tire, no point trying to nap a tired baby.. It was easy to see the cues and they slept and fed on their own schedule which was regular, I didn’t have to ‘make the schedule’. What I see with parents now is they read way too much about baby care, keep it simple. Parents are napping the baby on their chests, they grow to expect this and do not want to sleep in their own crib, who would? I also notice babies are being napped in swings and other new baby furniture in full light and active room, now how does this promote a deep sleep without interruptions? Keep it simple, babies are not that complicated.
Sorry, I meant no point trying to nap a baby that isn’t tired.
Kristin, what a well written and concise reply you made. I completely agree with you.
Both our boys have had daily schedules (we call them routines because they are not based on the clock but on the routines that baby starts to fall into. Those routines adapt and change as the baby grows and develops).
I really hate these articles that try to push these ideas that you must co sleep, you must breastfeed until four years old, Don’t sleep train, Don’t ween, Don’t do anything that could possibly assist in making that first year easier on your tired, worried self as you adapt to motherhood because that would be selfish. There’s enough guilt going around for new mothers. When will we start supporting each other rather than criticizing each other every step of the way. That’s all this article does. I ask you to show me a method that promotes sleep habits for babies that works with the society we currently live in. You know, the society that has to sleep at night and work during the day. Not some myth of a society where new mothers can sleep whenever their baby sleeps to catch up on rest and family members live down the street and swoop in to do the laundry, make the meals, and clean the house. That may happen with your first child during your maternity leave (only the sleeping part, no one cleaned my house) but by the time baby # 2 comes, you won’t have that luxury. And in this society, you’re expected to be super mom and do it on your own. We don’t have the support, we don’t have a village to raise our children. It is what it is and we, as mothers, are just trying to find the best way to mother in the society and culture that we live in now. At least try to be helpful about it.
JEM, I agree our society is completely antithetical to healthy families. However, I like to work towards changing that and providing parents with gentle resources to guide sleep when necessary. To me, accepting a shitty situation and not working to change it helps no one.
Agree with this statement! Raised 3 boys, and did modified training with first and third, but not till 7months and 18 months Breastfed till 3 years with third, and 2.25 years with first. Did not co-sleep Did not know the babies should sleep in the same room in the 80s. However Peds. teach sleeping in same room now for the first 5 months-lowers SIDS! Kaiser is very good with this, and exposing problems with BabyWise
Jem I must have missed the part about one must co-sleep & breast feeding until they are 4!!! You certainly don’t have agree with the article & if your parenting style works for you and your family more power to you. But I think a lot of people would appreciate it, I know I do. I think people need to take it for what it is. Oh and I had no one to clean my house either 🙂
I too had no to clean! Lower your standards, your kids are more important!
Actually, Babywise is wonderful for our baby. We started with it on day 1, never had to do any “Cry it Out” because the whole book focuses on learning your child’s sleep cycles and responding appropriately. She’s now 7 months old and thriving amazingly well–she’s meeting milestones 2-3 months ahead of schedule (according to our Pediatrician) and while I’ve researched Babywise extensively, I can’t find anything negative about the philosophy–assuming people read the book and follow it the way it’s meant to be.
The failure to thrive simply means parents went against the Babywise philosophy and watched the clock, not the baby. That’s the complete opposite of the method, and definitely would cause issues.
Babywise simply allows parents to understand how to work an easy and gentle routine for their child–and as we all know, children thrive on routines that fit them.
And I’ve read many, many parenting books about scheduling–but like the Healthy Habits book by Weissbluth, who does not give set times, only approximations, with age appropriate ranges. Baby Whisperer gives approximations and suggestions, Babywise also gives approximations.
So I don’t know to which books you refer, but the popular ones do not state strict timelines for sleeping babies.
That all being said, back to the CIO method and sleep training–hundreds of thousands of us (I”m 30) were raised that way, from day 1 often, and I have yet to see an article that cites a study showing adults having lasting effects of crying. I’m perfectly normal, happy, healthy and close relationship with my family, and I never had behavioral issues. Still don’t. So, I am sure there is more that plays into the CIO method results listed above than what’s being presented.
I am completely with you on this one Kirsten,
Every point you have made makes complete sense. as long as you are listening to your baby, following their cues i don’t think there is anything wrong with having a little more predictability, and a little more sleep!
Hannah x
It may be wonderful for you baby, but I was pointing out that there are those who study this and speak very strongly against it. Here is the statement from the American Academy of Pediatrics:
http://aapnews.aappublications.org/content/14/4/21.abstract
As for CIO, many people feel the rising rates of mental disorders and childhood disorders are a reflection of the type of parenting we had. There are no studies looking at long-term effects which is a real pity and why I was pleased to see this summary for early sleep training. Though not long-term, it does show that there are harms to the practices immediately and in the moderate-term.
Also, the idea of age-appropriate “ranges” was discussed in this article as there really is almost no such thing. Variability between and within infants (day to day) is so large that unless your child is getting 4-5 hours of sleep per day, there’s not this algorithm to follow.
I will agree with you 110% on routines fit to the child though. Absolutely – it’s one of the gentlest methods to help guide sleep and lots of other factors.
The rising rate of mental disorders is clearly a result of our ever expanding diagnostic criteria.
I’m not sure I would agree when it comes to childhood disorders or anxiety/depression. The criteria have not changed dramatically. Perhaps more are actually seeking treatment, but many feel even that doesn’t explain the massive rise.
The rise of childhood disorders and anxiety (in America) is more likely contributed to [American] adults'(parents and teachers mainly) inability to handle their hyperactive nature. It can also be contributed professional and graduates needed to find a way to stay relevant and keep a paycheck.
I say American because there are really no other countries that have such a rise. Many of them have different ways of raising their children. They keep strict schedules (how ever you want to define it) as early as 4 months old. They also do not coddle as much.
In America people tend to treat children like they should always remain innocent forever. The term let kids be kids is abused. Many other countries, that report no such rise in childhood disorders (such as France), believe that children are going to grow up one day to be adults and insist on preparing them instead of spoiling them.
In America we are more worried about keeping children happy and from crying, this adds to there inability to handle reality (or as Americans say: childhood mental disorders) and is also why we have higher numbers in childhood obesity.
But you’re incorrect, the study doesn’t show anything, because the studies they completed were invalid–that’s my main point!
A research article and research study has to incorporate control groups that are void of any environmental influences outside of the topic of the study. This article you reference does not ensure a sterile control group, nor does it allow for any reasonable amounts of test subjects.
So how can you “jump on the bandwagon” when it doesn’t actually prove anything?
That’s my concern over your so-called justification to not incorporating CIO.
(And the AAP link is complete nonsense–Babywise follows AAP’s guidelines, sooo….I can’t argue with a statement that makes no sense.)
Many of the studies do include control groups – that’s what randomized control trials are. Of course you can NEVER study anything parenting related if you expect to have no environmental influences, and randomized control trials need not because the random nature serves as the check.
As for Babywise, I’m just bringing a statement to your attention.
Hi Kristen,
I valued reading your perspective even though I don’t agree.
Babywise quotes selected AAP statements that back the “parent directed feeding plan”. However, the AAP released a statement regarding Babywise as it was found that the core message of Babywise was leading to several cases of failure to thrive by parents who followed it avidly.
Over the years Ezzo and Buchnam have added certain statements throughout the book that sound like they promote flexibility and watching the child, but the overall message is one of restricted feedings. I know this because I have read it five times.
If you understand how breastfeeding works you would understand why this can have a real effect on milk supply in many mothers. I won’t go into the science and I know that BW states stats of 70% success (but they have never provided any evidence of this, and given the readership and view that BW and breastfeeding are “God’s Way” I would expect a higher success rate, such as the 96% the World Health Organisation say is achievable if children are fed in demand, night and day).
More traditional methods of parenting do require more work and sacrifice and this is hard in a culture without a strong support network. On the other hand, I’m glad I have a washing machine and don’t have to grind grains for food with rocks by hand like the women of old did!
Parenting certainly stretches us!
Regards, Gem
Omg
That was rubbish in my opinion
Doesn’t really say anything
As mum of 2 who now 7&5 I did comfort crying
And bloody well would have lost plot without it
And both kids breastfed and I found I had crappy sleep
Because my first born wouldn’t sleep and my depression was worse
Because she wouldn’t sleep
Anyway I don’t care what this research says which is nothing
As doesn’t state lots of information
Like how many mothers
How kids turned out later
Etc etc
I glad I did what I did and would do again if had to but I had tubes tied
This doesn’t help mothers who really struggling
Mums feel bad enough without this
http://www.slate.com/articles/double_x/the_kids/2013/07/clinical_lactation_jumps_on_the_dr_sears_bandwagon_to_say_sleep_training.html
I think thinking about these things critically, instead of just looking to prove your own point is what is needed her.
I wouldn’t say that article looks at things critically. However, not sure what to say except the post shares the main findings from the research. Take from it what you will.
Thankyou
now that is more of a research than the above one….it has more facts and figures…..it wasnt bias……
HOWEVER….YOU CAN NOWDAYS FIND FINDING FOR AND AGAINST ANYTHING….so i dont care….it is what works for the parents and the child….you dont know everyperson story or baby story…..
In my case i TRIED EVERY BLOODY THING and nothing worked except this…..so i would LOVE to know what you other parents would have done in my situation…please enlighten me……..i had no family help or anyone to take my baby from me to get a break so please tell me …..
Where did I or the original article speak to parents at their wits’ end? This is about PROMOTING sleep training when science tells us it’s a bad idea for children under 6 months of age. When you promote something, you aren’t looking at every person or every baby either and that’s very important to remember so one must be aware of the research for generalities and when it raises risks and harms to the families, it’s not a good thing to promote.
However, for people looking for gentle alternatives, I recommend BabyCalm classes or book, Pinky McKay seminars or books (Sleeping Like a Baby being one) or Elizabeth Pantley’s the No-Cry Sleep Solution.
Oh my goodness! Your writing style is absolutely painful. I couldn’t even read past the second paragraph. I’m sure what you had to say was interesting, but sadly for me, I’ll never learn that wisdom. Please hire an editor.
Hannes, thank you! Yes, it was a very difficult read. It was also extremely disappointing that she only sited on author/article, and then ran with the entire post based on the findings of two doctors who co-authored the book. If she was going to post a blog about such a controversial subject, then she should have done her research and cited several books. At the very least, four or five different articles would at least make it appear she did research on it, instead of just finding one article that matched her viewpoint and assumed it meant she was validated.
She writes as though it’s fact, when in reality it’s just another opinion piece. Which is probably why she couldn’t cite anything else.
Kristen, the article cited is a systematic review (not a book) which is an up-to-date summary of all available evidence following strict research criteria so that it is designed to be objective, unbiased & one of the highest forms of evidence. Any results from a systematic review are not the authors opinions but a summary of the results currently available in the literature. It’s worth reading the original article to see how they came to these conclusions and to keep in mind the target group of the review (infants under 6 months & their mothers).
Wow! you people need to stop hating, if you don’t like her blog then go somewhere else! so what if you don’t agree we could debate anything. Tracy keep doing your thing, I enjoyed your read and didn’t not see anything wrong with it. just know there are many that appreciate it! as for you other women come on grow up, do you really have to criticize her on her writing and knowledge?!? that is just ridiculous. go to another website. there are many studies you could go look at on both sides.
I say follow your instincts on being a mom, if it feels wrong than it probably is. as for me, my instincts told me not CIO and follow gentle parenting, not force something on my child when they need some comfort. and ya it is hard, really hard but that is why the reward is so big, many of us don’t have help either.
I just have no idea why most of these responders even bothered to read this post. You clearly are convinced that your methods are the best and no amount of critical research will persuade you otherwise. This blog is for people who want actual evidence for their parenting methods. I understand that is not for everyone, but don’t criticise the poster for bringing some new information to light for those of us who do.
I loved this article and am constantly on this blog to read everything especially in relation to CIO.
Among my friends’ baby sleep training habits, one mum has since the early weeks shut the door on her son at 7pm not to be seen until her return at 7am (including one time where their son was sick and vomited all over the room), another recently did CIO on her 12 week old in a pram in the middle of a birthday party (not in another quiet room, right smack in the middle of all the noise and celebrations… what better way to learn how to “self-soothe”, right?), still another puts her son down wide awake and lets him scream himself to sleep, another once glibly mentioned to me that her son had cried for 1.5 hours and should be just about done by now… and the reason all of these mums do these things is that it’s shoved down our throats that not only is it ok, it’s what’s best for baby. They’re not bad mums but they’re seriously misinformed by the people who are held up as authorities in the matter. What else would make a mother harden herself against her own baby’s cries except the idea that they’re doing them some sort of favor?
I could go on with the examples, but aside from the fact that I should probably make new friends, my point is that blogs like this kinda keep me sane by giving me the support and confidence I need to know that my choice NOT to do any of the above is right.
Kirsten, I appreciate that following Babywise has worked for you. But whilst recent editions of Babywise may have changed thanks, no doubt, to the AAP article mentioned above, previous editions of the Babywise philosophy went against much of the current medical advice. Example: “Some researchers suggest that putting a baby on his or her back for sleep, rather than on the baby’s tummy, will reduce the chance of crib death. That research is not conclusive, and the method of gathering supportive data is questionable.” And “A mother who takes her baby to her breast 12, 15, or 20 times a day will not produce any more milk than the mom who takes her baby to breast six to seven times a day.” I would think twice about the underlying philosophy of the author regardless of the many about-faces he may have done in his later editions.
Tracy, coming from someone who read 54 books in the last year, I find your writing style very clear, interesting and easy to read.
Thank you 🙂
Here here mamaduck. Those stories of mothers leaving their babies to cry make me so sad and sick to my stomach. A friend of mine told me a similar story where basically she says goodnight at 6.30pm not to return until 7 am despite cries from her boy. This was advised by the way by the sleep doctor they saw and he’s advising parents to “train” their babies this way every day!!! I could never practice any of these horrible techniques but sometimes you feel like everyone around you is sleep training and you are the only one who isn’t and so maybe you are the one doing something wrong! Then you have your reality check.
Great blog… This systematic review has been long awaited! Much neuroscience and physiological research has pointed to the concerns about leaving babies to cry alone. Sleep training is becoming more and more of a concern for those who work with infant mental health. I agree that tired moms need support, but this systematic review along with work by Dr Nils Bergman and other neonatologists are showing how the effect of sustained cortisol and abandonment is effecting brain wiring and baseline cortisol levels in infants.
Guilt has no place – do what’s right for your family! Bit don’t expect other parents to be shielded from research, conversation and other information simply because it goes against what you chose. Children do not NEED schedules or training. They will learn to sleep all by themselves, when supported to on cue. Parents do did brilliant ways of sustaining their own mental health when they let go of the expectations created for them and simply surrender to this human being who needs them often. And if you don’t want to? Then you get to choose what’s right for your child, EVEN if its possibly not the healthiest choice, developmentally or psychologically. But withholding the research from there because t might make you feel guilty is awfully selfish. Own your choices, and let others make theirs.
This review isn’t addressing finding a routine – it’s starting to study and describe the more abusive methods of controlled crying and CIO vs the true effects on families’ quality of life. It’s simply stating that overall, outcomes aren’t as dramatic as those who promote sleep training believe they are. I’ve worked with many families who were just fine, happy and not concerned about sleep until their doctor/friend/sleep training book convinced them that their child was experiencing a “sleep deficit” or that their child would never “learn to sleep and self-soothe” without training. This is the issue – when professionals and practitioners convince mothers and fathers of a problem when there isn’t one. When left to it, all children will reach sleep maturity. Some make a lot of money saying otherwise, but its just not true. I believe the burden of proof lies with those advocating sleep training to prove it is safe, not the other way around. Culture does often get in the way of parents being able to support their children through normal sleep development – but that is entirely another issue. In the US, mothers get 6 weeks of maternity leave and this atrocious reality leads to desperate needs to change normal biology. Yes, it’s unfair. But as a professional with an investment in infant mental health and wellness, I cannot ethically take he side of culture when the infant is potentially put at risk.
As for baby wise – the original books are awful, and led to failure to thrive. It did command 4 hour minimums, it recommended slapping babies hands, and was incredibly rigid. When reverend ezzo faced backlash from the AAP, who made a statement against the book, they rewrote it completely. Read its religious counterpart “growing kids gods way”. It’s eye opening, to understand where this reverend gets his baby scheduling from, and how he misuses the bible to control babies. He’s a nut job – but at least he rewrote the book and babies aren’t at suck risk any longer.
Please excuse the few typos! I’m mobile.
As a mom of 5 with twin girls last, I tried to schedule my firstborn. But after reading “The Continuum Concept” by Jean Leidloff, and listening to my instincts, I stopped. Listening to my baby cry was murderous and seemed very unnatural. Every one of them were nursed and very close by most of their first year. I’m happy to report all five have reached young adulthood well adjusted and successful. 🙂
Excellent – thank you!!
Congratulations for listening to your heart!!
Thanks for contributing to peace in the world by raising your kid with love.
WHAT?!
That article makes no sense. I am lost… so to schedule or not to schedule. How ridiculous…. My 6mth old is THRIVING on a schedule.
Babies cry, get over it. Thats what they do…
I used Babywise and found its entire approach realistic and practical. It was a tool that I could use. At the end of the day Im his mum and I know what he needs… Sure we work it out together but when nap time comes he goes down for a nap. Its as simple as that.
Yes babies do cry, but does that mean they shouldn’t be responded to? Adults cry too – should we ignore them? Plus, remember this isn’t about what works for an individual family but about the PROMOTION of a technique that science has found to be more problematic than helpful.
No… I agree, its not about ignoring them however its vitally important to know the difference of when your baby is crying because he/she is ready for a nap/sleep and when there is a actual problem such as illness. Techniques such as Babywise allows you as the parent to determine what is ‘normal’ crying and ‘abnormal’ crying. So… if there is an actual issue you can treat the problem almost immediately with appropriate action rather guessing and losing confidence in yourself and thus results in a distressed baby.
I will say many babies don’t cry before needing to sleep. Often crying is a last-ditch communication or signal of something wrong. Very rarely do children get so overstimulated they cry, but even then, being there for them is still important, in my opinion. I also will never advocate for Babywise given it’s link with failure to thrive. No matter how many individual people feel it worked for them. Again, it’s about promotion of techniques and I can’t promote one that has a higher risk of leading to serious problems in babies.
However, learning babies’ cries is important. I just think every cry signals something, we just may not know what it is at a given time.
Please explain how Babywise promotes Failure to Thrive?
I just got to read all of Ashley’s comments and apparently they completely rewrote it. I shared the AAP statement which led to the rewriting so that’s good to know. Haven’t read the new one so cannot comment. Hoping you have a new version 🙂
Great Article,
I have started studying a Bachelor in Early Childhood Education and some of the things we have had to read about the effects Cortisol has on the human body and psychological development is incredible!. It is nice to finally see something that undoes some of the misconceptions out there.
I loathe CIO solutions and regimented sleep training, the stress it caused in my house when the first baby (surprise surprise) wasn’t responding … the BEST thing those ever did for use was start the fireplace that following Winter!
following baby, I ditched everything! responded to her crying, BF her to sleep, co slept (still but she is only 22 months) and realizing that it won’t last forever …… BEST for us.
At the end of the day …… whatever floats your boat no need for other people to attack the blogger because it challenges YOUR methods.
I have done it both ways now and if there was ever another …… I KNOW which way I’d do it again!
Hi
Thanks for your post. I can see that you have reviewed the article thoroughly however I also note you have a particular view point on behavioural sleep training. I am unable to access the full article and I was wondering if you could be more specific about your summary points?
How did they researchers determine that darkened room day time sleeps increase SIDS? What is the mechanism? Also what do they define as “behavioural problems” at 6 months of age. Unfortunately I can’t access the full article but I see from the abstract they point out that there are problems with behavioural sleep interventions as a “population strategy”. Does this mean they view it differently when it is done based on parental choice? Also did they group all of the methods together as being harmful – or were they more specific about influences of each.
Thanks
Nat I tried to be as clear as possible (e.g., increased SIDS is linked with placing baby in a dark room by himself, with the by himself being the key there, but the totally dark being key to the failure to consolidate night sleep). I don’t know what was defined as behavioural problems – I’d have to look at the original articles for that. And yes, population strategy is what I was referring to as what is *promoted* to parents because you will not know individual situations. I personally don’t believe CIO should ever be a go-to and that we need to work on promoting other methods, but also creating systems that don’t pit parents against their kids. However, yes, there will be individual cases where perhaps CIO is necessary given a stage that the family has hit, though I don’t know what that would look like personally. But I’m open to that suggestion. Does that make sense??
The issues I raise here against the article is that it is written in a manner suggesting the CIO as unsafe as an absolute fact. When it comes to most things you can’t make sweeping generalizations because it just doesn’t work. That’s what I take offense to. She didnt just present information, or cite sources that contain clear and concise study results. She wrote this as a statement that pretty much alludes to her beliefs that CIO is wrong and abusive toward babies.
Some babies do well with the AP style, others need structure, and others need something in between. But never should someone write an accusatory post that is meant to attack another parenting style, especially when it can’t be backed up by proven medical science, using only another opinion article as “proof.”
That’s what I find inappropriate. That’s what I dislike.
Oh, and I make my statements based on years of study of children from all parenting styles, accumulating data, creating and using assessment, evaluation and anaylsis on said data in order to complete my Ph. D in primary and secondary education with a focus on music and emotions. So studying how children are raised plays a huge role in my work, and I can’t fathom how someone can assume the two doctors cited above completed a scientific study that accurately assesses children. They missed several steps, therefore their study is tainted.
But Kristin, the whole article is based on the population level – what we *promote* to parents. So I’m very confused about the concern for individual parents.
couldnt have said it better myself…
I think what we all need to work on is accepting that every family is going to have different things that work for them, and it isn’t for anybody else on the outside to judge. If one mom wants to breastfeed her baby until the little one falls asleep- that is her decision. If another mom finds that terribly tiresome and prefers to let her baby CIO, it shouldn’t be a problem to anybody else. If it works for the family- it works for the family. We moms need to start supporting each other and stop being so judgmental…and then wondering why bullying has become a huge issue amongst our children’s generation…talk about something that will CERTAINLY lead to mental problems, much more so than a baby falling asleep with a bottle (or boob) in mouth, or being left to cry for 10 minutes at a time.
But what behaviours lead to bullying? We should be looking early in development to see what leads there… what are we doing as parents that has led to these behaviours in our kids? It may have nothing to do with CIO, but this whole idea of “anything goes” doesn’t hold water to me because the way we parent influences the type of child our kid will become and we know the importance of early years. For example, a child who does not have parents who are responsive to their distress will be of a higher risk of not developing appropriate empathy which is key to later bullying. So it’s interconnected and looking at bullying just when it happens is looking for a band-aid, not a fix or a preventative measure.
Our kids learn from and follow in our behavior. If they see their mom out there judging all the decisions of other moms and constantly and telling, or “promoting” what the “right” way to do everything is, they will in turn learn to judge other kids. If they see us modeling acceptance and being open minded to the conditions of other families, they will learn to do the same. Don’t get me wrong- I am not condoning ignoring or neglecting our babies, but the discussion is taken to the extreme when we start to pick apart which sleep methods each parent is using and which ones are the “right” ones. All babies are different, and as moms we know our babies. Some can candle CIO and others need more soothing methods…but what makes it anybody’s job to judge which method is better?
A better approach might be to offer suggestions on what to do if CIO or sleep training is not working for a family, and help them to find a solution that works for them, not preach what is the ultimate “right” method for all families.
If they see us approaching individual moms, yes, but when we speak about what methods should be promoted for parents to have as go-to methods, we’re talking about something different. As for “handling” CIO, yes some can, but why would we promote a method based on a) pitting moms and babies against each other and b) on a population level is more likely to cause harm to the family? That’s pretty clear in terms of promotion as to what is “better”.
I would prefer to see CIO be seen as a last resort instead of promoting it still then offering help after they run into difficulties which are more likely.
CIO method is not the only form of act of love, discipline, care, aka MOTHERING that the child will receive. It is only a form of sleep training so that the child has the ability to feel safe and secure within him/herself. Learning to sleep is a life skill.
CIO does not ‘undo’ all the love, attention and care that you show during the day (and nights).
The CIO method works especially well when you have combined proper feedings and appropriate play times followed by appropriate assessment of the child before putting them down for a nap. Ie: dirty nappy, too hot, too cold etc… Its not like a mother doesnt do all these things and then puts the baby down and lets it cry it out for an hour. Once proper ‘assessment’ of sleep cues and proper feedings have been dealt with than the CIO method has a purpose.
As for the bullying … I think you need to tread VERY carefully as to what you are suggesting here. Factual evidence would need to be supported with what you are suggesting.
It does not undo it, but based on support for domain theory, all the love and attention and care shown during the day doesn’t make up for being left at night.
As for bullying, yes, I firmly believe parenting has a role. What the specifics are, I was clear, we don’t know. I know that there’s a very well-established link between responsiveness to distress and the development of empathy. So it would not be shocking if children who were not responded to regularly showed later bullying as we know they already show low empathy behaviours.
It would also not be shocking if children who grow up in a home of parents casting judgments on others, rather than demonstrating tolerance, would grow up to do the same.
Tracy – how many children do you have?
Two. My stepson (who I’ve parented since he was 3) and my 3-year-old daughter. I’ve been working with and/or studying children since I was 11.
Also you’re misconstruing judgments of techniques as judgments of people. I have friends that smoke. I find it a vile, disgusting habit. And I love my friends and don’t find them as people to be vile or disgusting. I hope to teach my children the difference between our thoughts on an act and our thoughts on a person.
Now that the healthy debate has turned from different sleep training techniques to bullying, I am no longer going to be apart of this.
shame.
It is different to judge a mother from judging a methodology or a philosophy.
When we say “sleep training a baby is dangerous”, is like saying “letting a2 y.ol. playing with a knife is dangerous”.
We don’t say mothers that sleep train are bad persons.
We dont say mothers that let a 2yo play with knife are stupid (maybe there is a reason to it in some cases)
We can teach our kids to have critical thinking, evaluating the thoughts and ideas of others without being aggresive or judging the Persons who expose those ideas.
We can say , I do not agree with your idea, this is how new knowledge is born, but I respect you and wish you well.
There’s seems to be a lot of animosity in the comments, when there really shouldn’t be. I haven’t read any other entries by Tracy, so I don’t have a basis of comparison, but just based on this entry alone, here’s my take-away:
1. Tracy’s primary concern is that people are taking the advice to use sleep training as “expert” that everyone should use (e.g. it’s becoming standard practice) based on her feelings of flimsy evidence. Her article sounded more concerned than accusatory to me (well, perhaps more accusatory to doctors and other professionals).
2. Tracy’s intent seems to be more to get people to think about all options and consider whether there is real backing to various parenting styles before fully subscribing to them, rather than to just provide a blasting one-sided opinion. I think the heat in her writing in the article is more based from her frustrations with trendy parenting styles that have little scientific backing.
Tracy, if I’m way off base here, I apologize. I just think that while your writing is passionate, the responses some of these these people have given seem a bit too hostile to me.
To add my opinions on the subject itself:
All parenting is much like any other lifestyle choice, particularly when it comes to health. There isn’t any one overarching technique that is 100% proven for every parent with every child in every situation. CIO and regulating sleep patterns may work for some, and high attentiveness and liberal sleep patterns may work better for others. Parents need to first try to “feel” their baby’s habits and response requests before subscribing to any style, whether old and proven or new and popular. My daughter gets cranky when she needs something, whether it’s a new diaper, a bottle, or a nap. She does have slightly different cries between each one. Sometimes she stirs in her sleep and fusses for a minute. I’ll stop and listen to see if she continues or if it’s just a short fuss. Sometimes she’s just stirring and she falls back asleep, and sometimes she stirred and realized she was hungry or needed a diaper change. But you know what? No doctor told me this. Sure, I’ve read articles and such providing different viewpoints, but no doctor had to sit down with my specific situation to tell me which technique to use.
Trendy parenting IS risky, because there is usually much less study done on it than the old tried-and-true techniques. As such, it should be used with care and after great consideration. If your trusted doctor gives you a regimen that seems a little different than you’re used to, ask him or her a million questions about it. Heck, go ask another doctor or two. That’s not insulting to the doctor, that’s getting a rounded view of the situation and, in my opinion, smart parenting.
I don’t think Tracy was saying her researched method is the only good method, I think she was just saying that new styles need more consideration before promoting it as “standard practice” over styles uses for centuries.
THANK YOU 🙂 Yes, exactly. Promotion of a technique and use are different and need to be treated differently. One is based on science and the least harm/most benefit principle, the other is based on what works for a given family. I still don’t like CIO or CC because there are gentle methods and would prefer to see people try those first, but I can also dislike a method without feeling anything negative for a family who had to use it (especially when we live in a very non-family-supportive society).
As a postpartum nurse and a lactation counselor, I say thank you! It makes me crazy that the first thing new parents ask is,” When is this baby going to sleep through the night.” There is too much emphasis on getting your child to sleep being the measuring stick of good parenting. All children are different and I am not opposed to cry it out or other such methods, just their use too early on. Our promotion of unrealistic expectations of the early postpartum period and of the uninterrupted sleeping of newborns and infants causes parents often to ignore their own care giving instincts, and instead rely on the not researched opinions of so called experts.
And as for the above comments about milk supply. Sleep training most certainly can effect supply in patients who start “sleep training” too early or are too rigid in the number of feedings/ timing of feedings. As for Babywise, the original edition totally goes against current research on successful breastfeeding. So Tracy thank you for posting your thoughts and I look forward to reading the study.
Agree to disagree none if you are going to change the belief of the other party…as for CIO or sleep traing or attachment parenting vs whatever other crap you read in a book and decide to follow let me say this
Whatever works for you and your family is the best for you!! The Smith family might be on with sleep training cause lil Joey is adaptable whereas the Jobes family might do CIO cause lil Annie is easy going self soothing from birth and the Doe family cosleeps cause mom and baby thrive together where as my family goes with the flow sometimes I cosleep sometimes I put her down a lil fussy and sometimes I just go for a walk the point is
There is NO ONE RIGHT way it’s like feeding a baby it all is what is best for your family cause breast is not best if mom and baby are miserable – even if breastmilk is a better food its not best if the delivery system isn’t working for a family so in some cars formula with a bottle is best just like sleep is whatever works for you and your family
My last thoughts before I go nap…I do not recommend letting a baby or any child cry for more than 5 minutes before being comforted whether that comfort is a hug, a boob/bottle, or a pat and kind words is up to you but e tended crying can harm the vocal cords and cause sore throats which lead to even more upset baby so please use common sense also routines based on babies cues or patterns are possible even early on BUT keep in mind their patterns change often so you have to be adaptable and not rigid and never use a clock to tell you baby is hungry trust me the baby will let you know and no one knows better than baby!!
I feel like if there was an article written FOR the cry it out method, there would be people jumping down the throats of those who wrote and those who do it. That little study doesnt represent anything to me. To me it pushes co-sleeping, not to ween at 1 which a lot of mothers do, & no sleep training until 3 or 4.
My 18 month old sleeps through the night and has been since he was 6 months. If your 3 or 4 year old is getting up in the middle of the night to breastfeed I see something seriously wrong. Your child is school age at that point (pre-k). I’m sorry but I wouldnt want to be that parent walking into school like, hey…my 4 year old needs to breastfeed now. Just my opinion. If you do it, hey whatever I’m not judging you. I just wouldnt wanna do it.
On top of that, have they studied working women, women who’s husbands are gone a lot, women who have more than one child in diapers, etc.
Just because you do one thing and another mother does another, why is it a big deal? Who cares! Stop putting each other down and support each other. Stop pushing ideas on each other. It just makes people hate you.
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The conclusion of this article clearly states: “The belief that behavioral intervention for sleep in the first 6 months of life improves outcomes for mothers and babies is historically constructed, overlooks feeding problems, and biases interpretation of data.” which means that the studies themselves are problematic and cannot be used to support interventions with infants under 6 months of age, not that sleep training or crying before sleep is harmful. Like another mother said before: this type of post doesn’t help mothers or babies but just promotes more angst and fuels the mommy-wars.
Not quite, but I see why people feel this way. The studies can be well done, but the *interpretation* of the results can be taken in the context of assuming behavioural interventions are good. Often you can see many studies in which the authors’ conclusions don’t match what the data says. Overlooking feeding problems is an issue that will hopefully be resolved. FYI, this is also the conclusion of the abstract – a very brief piece of the article.
Here is the conclusion from the article (prior to their discussion of their own technique):
“Contemporary mothers have complex identities and responsibilities and are vulnerable to high levels of fatigue in the first months post-birth, made worse if the new baby has cry-fuss or sleep problems. Parents with unsettled babies in the first weeks and months of life demonstrate an urgent desire for health professional support. Behavioral intervention for infant sleep, as both a population strategy of prevention and clinical intervention, is a dominant health professional response. But our analysis demonstrates that despite substantial investment in implementation and evaluation of behavioral interventions for infant sleep in recent years, behavioral interventions in the first 6 months do not decrease infant crying, prevent sleep and behavioral problems in later childhood, or protect against postnatal depression. In addition, behavioral sleep interventions risk unintended outcomes, including increased incidence of problem crying, premature cessation of breastfeeding, worsened maternal anxiety, and, if the infant is required to sleep either day or night in a room separate from the caregiver, an increased risk of Sudden Infant Death Syndrome.”
However, I’m quite unclear as to how this perpetuates “mommy wars” – this is exactly the type of comment I was referring to in my mommy wars piece, oddly enough. I never said the research said it was harmful (though I find some of their findings incredibly suggestive of harm – behavioural problems, greater crying, SIDS increase, breastfeeding failure, parental anxiety), I shared what the research said. The backstory was my view. And the crux of the piece is about promotion of a technique, not about any individual family.
I think my previous comment was not unpacked enough. Here’s my thoughts: these studies do not specify what it means to “sleep train” or what the ubiquitous “cry it out” means precisely, and because of that there really can be no over arching scientific or evidence based research that can be causal over correlation. I am a licensed social worker who has worked with dozens of families in a variety of roles and have read a lot of research on childrearing practices. In these types of papers (called literature reviews) authors are simply reading other peoples research and drawing their own conclusions based on what they find. This does not mean that the data of the original papers is scientifically sound, nor does it mean it is necessarily faulty. It is just not clearly defined enough, in my professional and personal opinion for you to make the assertions you have made in your blog post.
Now, I am a supporter of breastfeeding awareness (and do not subscribe to “it’s a lifestyle choice”), a promoter of rooming in or co-sleeping and baby wearing. But I also follow the guiding principle that if a parent is not happy with the family dynamic then something must change. A tired parent is not going to be able to be their best self for their children. And it is possible to help children fall asleep on their own in their own beds without damaging their developing brains and bodies. Again, the sociological and neurological research that is most current suggests (because there is no 100% truth in science, ever) that sleep is vital to development and also that severe neglect can also damage brain development. Parents who guide their children to sleep gently, without rocking, nursing, walking etc them to sleep are not neglecting their children. I believe that the tone of your piece implies that they are.
Emily….what you have written actually makes alot of sense to me. Thank you.
Thank you Steph.
Emily, I must be clear that I take issue with sleep training that is not gentle. I am quite clear on this site that if something doesn’t work for the family, that something needs to be done, but I prefer seeing us *promote* gentler methods. The sleep training that was assessed in this review is not about the gentle methods for these young babies. And is often being promoted when there is no problem for families.
As for the review, they used strict guidelines for which papers were included based on the science of the original. A lit review may just cover everything, a systematic review has to cover it in a scientific method looking at quality of study and only including those that meet strict criteria. That’s why there are differing names in the title (just as the meta-analysis has to include new analyses combining the data). They can all be well done or not, and the criteria this this systematic review used is well-known and robust. Furthermore, they were very clear in what the sleep training included and those papers that were not clear, were not included in the review.
In my professional opinion (as someone who used to do qualitative analyses of research), your concerns are not founded for this review. I actually would go a step further and say I struggle with their inclusion of some of the papers that they did but in a way that would make the results more strongly suggest sleep training as detrimental, so I leave that out as it would more of a conservative bias.
I totally see your point.
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Sleep is such a sensitive topic. As I read thus article and the comments left here, I feel annoyed. As I new mom, I feel like I am constantly being judged about how I am raising my child. Everyone feels they need to give their opinion on what I am doing wrong. I think we just need to accept that everyone has different parenting styles, and we are all trying our best. Whether you are sleep training, not sleep training, breast feeding, formula feeding, etc., just do what you feel is right, and learn from your mistakes. We need to start supporting eachother rather than critisizing.
I’m sorry, but your comment about leaving a baby
To nap in a dark room by themselves resulting in increasing the risk of SIDS does not have any evidence to back it up…also your comment about napping a baby in a darkened room during the day, disrupting their night sleep also does not make any sense or have any evidence to back it up.
Many babies are too stimulated to nap without
darkening the room. Darkening the room serves as a powerful sleep cue to babies.
Please don’t act as if the things you are writing are research based when it is obvious that you are offering your personal biased opinion.
Liz – there’s a wealth of research on that topic. I recommend you read the review that this piece was based on as it covered the research for 20 years. You can ignore it if you like, but the SIDS-sleeping alone link is *very well* established.
The link between SIDS and sharing breathing space with another person, is ALSO very well established. It is recommended that children who bed share, have their own “bed” on or attached to the parents’.
Another thing very very very well evidenced, is that a well rested child will sleep better and therefore daytime sleep does NOT affect night time sleep (unless the child is preschool aged or older and sleeping too close to bedtime). Sleep begets sleep. A child who is well rested throughout the day, is PROVEN to have an easier time falling asleep at night and having more restful sleep, than a child who has not had adequate, uninterrupted sleeps through the day.
That is not personal opinion; it is fact based.
Jessica,
It actually isn’t. What is established is that UNSAFE bedsharing is linked to increase in SIDS. However, when one does so safely, there is no increase. Of course side-along beds are wonderful for families where that works, but one can bedshare safely, based on research.
And yes, good sleep is important, but sleep training does not = good sleep, especially in early months when it risks ruining the breastfeeding relationship.
Tracy
Also, if a baby naps well during the day, a baby will sleep better at night. Sleep begets sleep.
I am neither pro CIO, or pro AP. I am just a new mom
Like Nichle who is trying the best I can to take good care of my baby.
I came across your blog hoping that it would promote
Unbiased, research based posts to help me decide
On whether or not to sleep train. While at first your posts tugged on my heart strings, as I began to read
Further, I realized that your posts are thinly veiled as “research” but are really just your personal opinions.
Your blog would be a lot more powerful and convincing if you used less judgement and used an unbiased point of view.
Tracy,
I just want you to know that I am grateful for this blog and for this post. After reading babywise, the most recent version which does promote listening to baby’s cues, I found that baby had no interest in a “full feeding” or waiting 3 hours to eat. She has fed every 2 to 2.5 hours since she was born so while I tried to follow the schedule suggestions, she wasn’t having it. When she was hungry, she let me know! So I fed her immediately
Also, SO MANY PEOPLE HAVE MENTIONED CIO TO ME, but it makes me SICK to think of her, all alone in a room, crying for me and me not responding. So I am very grateful for Dr Sears, and all of the blogs like yours that make me feel comfortable in the fact that I do not have to let her cry it out. As you can see from the comments, people get very aggressive in asserting their ideas about CIO & Babywise, so when it wasn’t working for me (babywise, not CIO bc I was NEVER trying that, EVER), I felt a little like I was doing something wrong. I just needed some extra support from a community that said its ok to feed your baby on cue, to co-sleep, and to follow your naturals instincts bc those were mine.
I respect that others have to find what works for them, but as someone who naturally felt led to not follow schedules, it helps to have a supportive community.
Thank you so much.
p.s. My daughter wakes once in the night, usually around 2 am (we both got to bed around 9) and she then sleeps again until 6 am. I am not tired in the least and she usually goes right back to sleep after I feed her (which only takes about 10 min – another thing babywise was wrong about for her bc she doesn’t feed both sides, nor does she take 20-45 minutes per feeding – I have a oversupply & shes a very efficient sucker!).
I start work on Monday, but luckily, because I have worked very hard in my career an been successful, I have a nanny coming and I get to work from home so I can continue to ebf and feed on cue.
Hi, thank you, thank you thank you thank you.
although it is not surprising to me personally at all.
I’m mom to two girls 13 and 8 months. I don’t have a degree or research documents or anything I just have personal experience that i wish to share. I used CIO and controlled crying with my eldest. Shameful yes. Honestly, I came to that place in my parenting journey from a place of hurt and anger and fear, and an unrealistic expectation of normal baby behaviors. I had post traumatic stress from her premature birth, my point is I suffered and made her suffer for 13 years, until I got pregnant and have birth to my second daughter. OMG the heavens just opened and an angel arrived. Seriously, in love. And the point of my story, we breast feed on demand, Baby wear, bed share. (Things I wanted to do with my first but parenting from a place of pain etc) I can never fathom using those techniques on my baby girl, I can’t believe I ever did it with my first. I always defended my position because how I was parenting felt wrong and to protect my self from the judgments and critics I had to be defensive. And we all know the best form of defense is offense.
Enlightening much new mammas? Don’t let anyone bully you into doing anything that feels wrong, and CIO and cc certainly don’t ever feel good.
I also personally believe that raising children is everyone’s business as we are raising the next generation of humans and hopefully they will be happier more enlightened than ourselves. That won’t happen when these barbaric practices are promoted for the simple reason of making money. I also can’t fathom having a child and feeling this love and then deciding to use a technique such as CIO or cc. It has only ever come from a place of hurt and anger, my question is do all the parents who use CIO or cc come from that same place?
Oh I have always seen my use of CIO and cc as shameful and horrible and nothing to be talked about in polite company because I couldn’t be a real mother who nurtures her child and is warm and loving. I never felt like I knew what to do. It also desensitizes you to your child’s entire life not just in the baby days but their whole lives.
I will always speak out against the use of CIO and cc as a technique for raising children, they are coping mechanisms for those times when you might otherwise do harm, nothing more.
I just want to point out that it would be very misleading to group ALL sleep training into one category, or to call all tactics that parents use to set up healthy sleep habits and schedules for their child “sleep training”. By 6 months, habits (like being rocked to sleep every single time) can be so ingrained that breaking them is darn near impossible (who has two hours to hold a 2.5 year old while they sleep daily?) and very very difficult on the parent who must do so. We can avoid unhealthy sleep habits from birth, without calling it “sleep training” by being “sleep educated” and therefore avoid the trauma associated in trying to break a rock-to-sleep habit (for example) at 1.5 years old. Not all things that sleep consultants work with families on, are the standard “sleep training” CIO or extinction methods. Many work with families to help their babies GENTLY learn to sleep independently as they grow, without trauma, and without scarring. It’s common knowledge to be careful and mindful that we do no judge parents for their choices since every baby, culture and family is very different, but it deserved to be said that we should also be careful not to judge sleep professionals without FULLY knowing what it is they do and how they help families. I have a two year old who has slept 12 hours a night since he was 7 months old and has never ever cried himself to sleep or been denied ANY of my nurturing and attention. I worked with him, with the help of a sleep consultant, using a plan that fit the needs of our family. There is NO WAY I could have been the attentive, rested, happy mother that I have been, without getting some rest. Simply put, my family very likely would have fallen apart because the level of anxiety, exhaustion, and depression was overwhelming. Mamas need to take care of themselves too, and this can be done without sacrificing our children’s happiness and health. I certainly wouldn’t have been in this place in my life, had I sacrificed mine. There can be a beautiful balance but it is a learned skill, just as unhealthy habits are. Not all sleep training is about traumatizing babies.
I think the idea that “if you rock to sleep at 6 months, you’ll always have to do it” is part of the problem. I held my babies while they napped in the early month bc that’s what they needed then. Eventually I could nurse and put them down. Eventually I could just pat their backs and eventually I could just say goodnight and walk out. No sleep training was needed and nursing them at 6 months or a year didn’t mean they couldn’t “break the habit”. When a baby outgrows a need they don’t need to be trained. I think the post mentions that parents worry about their 3 year old needing the same things their infant needs if they don’t intervene. That has not been my experience at all. I have 4 children.
Exactly! Needs vary – heck, what I needed as an adult 4 years ago is different than what I need now. I don’t know why people seem to struggle so much with that concept!
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Thank you for the wonderful article. As a Child Sleep Consultant and Gentle Sleep Coach I have to say I agree whole-heartedly. I have worked with almost 4000 children up to age 6 years and have over 10,000 hours of in-home experience both as a PP Doula and a Sleep Coach. I also work with adults as an insomnia coach and have not seen a sleep issue that could not be resolved at an older age.
I wish there was not so much misinformation out there for parents. I also wish that sleep consultants did not mess with babies under 6 months at a minimum. Unfortunately a lot of parents are getting to the end of their rope when their babies are at a younger age. This is partly due to this misinformation and societal expectations.
I spend a lot of time speaking with with parents of infants (at no charge). I listen to concerns, share realistic expectations, encourage nursing/feeding and comforting to sleep, share that if they are not happy long-term with sleep associations – they can fix them later and I never tell a family with a baby that they HAVE a sleep problem – this is not for me to judge. I encourage families to do what works and if it no longer works for them, I can help them with some gentle, supportive sleep coaching strategies.
Some of my colleagues and I are so concerned about this situation that we are continually trying to share gentle baby solutions with responsible information about sleep, crying, soothing and feeding for parents with babies.
Most parent I speak with, when they hear that their child is normal and that they are not creating short or long-term sleep problems are relieved and better able to enjoy their baby.
The title of this blog sets up bias against sleep training from the outset, which is not helpful. The actual title of the article by Douglas and Hill is ‘Behavioral Sleep Interventions in the First Six Months of Life Do not Improve Outcomes for Mothers or Infants: A Systematic Review. The fact that sleep training does improve outcomes is a long way from proving harm.’
This has become like a new religion for some people, pushing their perspective as if its a black and white thing. How about we support each other in doing what feels right to us, instead of heaping guilt on people during one of the most challenging periods in life!
That should read “The fact that sleep training does NOT improve outcomes is a long way from proving harm.”
Alice,
If you look at the side effects, I think there is a *risk* of harm which is what the title says – not that it proves harm as a 100% outcome.
As for the support each other, I will choose to support the child. And as such, I will not speak in favour of sleep training when there are gentle alternatives.
Tracy
“And as such, I will not speak in favour of sleep training when there are gentle alternatives.”
Tracy, how can you be certain that sleep training is NOT a gentle alternative. Again, are you familiar with all sleep coaches, consultants and ‘sleep training’ methods?
Many sleep professionals do INDEED support the CHILD gently, and thinking/penning any certainty in the other direction, is a falsity.
It’s stereotypical and judgmental, and speaking of *risk*…when you claim with such sureness, that sleep training and gentle cannot be synonymous, you could be talking a mother who desperately needs help, out of trusting a pediatric, loving, successful, sleep professional. THAT puts babies at risk too. And it equates to fear mongering.
If you read here regularly, you will see that I refer to ‘sleep guidance’ when it respects the child. Sleep training refers to the methods spoken of in this review (for prior to six months, including refusing to feed to sleep) and forms of CIO and CC. Any method that limits feeding is not gentle. Any method that leaves a child to cry is not gentle. They are antithetical as they do not respect what the child is attempting to communicate. Furthermore, for the first six months, extreme sleep problems are almost invariable feeding problems, which means when people focus on sleep, they are actually focusing on the wrong problem. That doesn’t help anyone, least of all baby.
When we start talking about sleep anything in the first six months, as evidenced by this review, you’re entering the territory of unintended negative consequences, and frankly biological oddities. Infants are not supposed to sleep through, they are supposed to fall asleep at the breast (it’s that whole tryptophan thing), and programs that suggest otherwise to parents are harmful, no matter how many times they use the word “gentle” in describing them. Now, there are parents who deal with abnormal infant sleep, but again, they are *almost always* looking at a second problem, even if not aware of it. Frankly, sleep consultants have a business here because we have such ridiculous expectations for infant sleep. If we didn’t, parents with sleep problems would be looking to lactation consultants (and possibly some doctors) for the real reasons behind problematic infant sleep.
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This particular article that you are referring to is not a STUDY! You basically went through a database of studies using specific search terms that were convenient to their narrow minded conclusions. This is not a controlled study and it’s just an opinion based on the findings that they wanted to find.
You clearly have no idea what a systematic review is. This is NOT how they did it. Reviews are considered BETTER than studies because they combine multiple studies from different areas to allow for a better summary and understanding of the research as a whole. And they have to be done in a very systematic way, guidelines that were adhered to herein. If you’re involved in research you know that reviews are a gold standard that stand above any one study. As such, this is far more powerful than if it were a study.
Leaving you poor baby to cry/scream itself to sleep IS wrong. If you have no time or patience to help your baby to sleep then I feels so so sorry for them. So what if the article is written poorly, I am guessing you got the point. If you are pro CIO then go find another support group. Thanks for the article, I already knew it in my heart anyways.
Thank you, Thank you, Thank you!
I think sleep training is cruel! of course it harms your baby. I recently read http://www.alternative-mama.com/8-reasons-to-avoid-sleep-training-your-baby/ and it really hits the nail on the head.
If you’re going to ‘sleep train’ don’t do CIO, there are gentle ways of doing it!
I was going to write an entire post on all the discrepancies in this article. I understand that the author has a strong foundation to make certain scientific interpretations of what she uses as a basis to support her opinion in this blog/posting, but some of the conclusions/assertions that she drives are ridiculous, and as opinionated as some of the replies above.I am surprised she has the credentials she does have, but so be it.
All that got through to me after reading her article, is that she seems to be extremely biased. So let her assume that what she advocates may do no harm to who ever she advises this to, and let the rest of us that choose other methods to improve the quality of sleep for our child and ourselves do what we do best; make advised, careful, loving decisions for our children, no matter what the next parent is doing.
I cant continue without making statements that are obvious to any mother that wants to improve the quality of sleep for her infant. Just because some of us choose to sleep train, does not mean we are less caring of our child, or we are cruel, or we like to hear them cry, or we want to damage them in the future, we just learn their cues and communication in a different, efficient, effective way/ And figure out how to resolve the crying before it starts, so that our infants/children can have better , longer sleep and alert, interactive days.
It is interesting that you are suggesting anyone says parents who sleep train are cruel or anything when no words were ever uttered suggesting that. And this article was simply a summary of a large research review in a peer-reviewed journal. If you have problems with this then you should have problems with the research, not me.
I don’t get the whole sleep training term, i live in Romania and my 1 yo son has made right from the beginning his own schedule. My wife would breast feed him every 2 hours or so the first 3 month, even during night, all of it at his request, nothing forced or induced in any way. I was a bit concerned about her sleeping habit being destroyed by the baby’s new sleeping schedule but she got really nicely used to the new lifestyle if i may call it like that. Now our son is 1 yo and my wife still does breastfeeding whenever he feels like it, mainly 2 times a day, once in the early morning, once before he goes to bed, he sleeps with us both in the same bed since he was born, we never had any problems at all. he’s the happiest kid, eats really well, is well proportioned, a blast seeing him grow. He didn’t cry in excess, he isn’t moody, he understands everything and communicates with us in his own way and looks really happy when we get what he wants, just a normal kid.
Why the big fuzz about training them to do this and the other thing, i’ll never understand. It’s so easy to let them make the few decisions right from the birth on. We just have to trust them, they’re fully functioning people, only with big barriers in communication, locomotive skills and coordination, that’s why they need us.
Anyway i’m just happy to have the most beautiful, understanding and open minded person to raise him with.
My sons both don’t bed or room share, my husband smokes so instead I place them in the lounge ( it’s nice and warm with the fire going ) and leave the door open so I can easily hear things.
Now I must ask, because we don’t bed share as infants – toddlers often seem to end up in our bed, or us in theirs – am I somehow being ‘less’ of a mother.
I also tend of had my babies on some kind of a routine, in the I try and get them to sleep in a bassinet, but often this doenst happen so onto the boob and onto the couch we go, but soon enough it does happen. My first son was one of those babies that self settled from day one, if he cried before sleep I KNEW he needed cuddles… My secound son however cried for most of the day. I would try feeding to sleep but due to my oversupply he ended up gagging for a whole feed, so what worked was either rocking his bassinet, or patting his tummy – he didn’t like being rocked in my arms so much…
Basically, as my sons have done what most AP parents go against – slept independent from a young age are they somehow damaged? I like to think I am a responsive parent we breastfeed until they want to wean, we don’t smack etc, and when they want to come in our bed or need me in their bed I do it.
This may seem silly but I have just discovered AP and some of the forums etc can be quite shocking – I feel like I have harmed my sons who both slept through by week 10 ( with no prompting from me )
I also got told by my lactation consultant to try and wait longer than an hour between feeds due to my oversupply – by six weeks things were much better.
Some children are very “chill” and that’s wonderful. The one who cried a lot likely had another issue that was leading to the crying (that much crying is indicative of other problems). But no, you can still be AP 🙂 You may be interested in this piece: https://gku.flm.mybluehost.me/evolutionaryparenting.com/attachment-versus-attachment-parenting/
Hi I’m just a bit confused with this. My son is 3 months old and is bottle fed, and I’ve recently found he falls asleep a lot easier if I lay him in his cot and let him cry. He hasn’t liked the dummy too much so putting him to sleep in my arms was a struggle and took at least 7-10 minutes. Then one day I just decided to let him lay him in his cot and he fell asleep on his own in under a minute. Been doing this for 2 weeks now and not once has he cried for longer than a minute. And now he is sleeping through the night, he might wake up ans let out a cry but then settles himself. So is this bad?
If he’s crying for less than a minute, I would say not at all!
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Hi Tracy.
I am a fellow developmental psychology PhD student, and I have to say that I find your misuse of research findings very unethical. The statements you make are extremely biased and involve a LOT of extrapolation, and I have even seen you assert causality from correlational findings. I’m not sure if you’re not reading properly or if this is deliberate, but given the inflammatory nature of your blog, I would assume the latter. I’m going to come back to this and post a better summary of the findings, and in the meantime, suggest that you read the Nimh review of sleep training studies, which found no harm, and some benefits for sleep training.
We’ve discussed this on FB but it seems your issue is with the original review (the things you are angry at me for not addressing were things the review stated and I summarized) and the problem of causality from correlation is a mistake on your part, not mine. I never claimed or suggested causality but rather used the terminology from the statistical techniques employed and used “association” to be clear that we were speaking of correlations.
Which NIMH review do you refer me to? (I ask because I’ve covered the one in Sleep and Sleep Medicine Reviews, so assume it’s not those, but when I search NIMH for “sleep training”, nothing comes up so clearly I’m missing something and would love to read any new research!)
I had a long post written and I deleted it because I just don’t care to explain. It’s my opinion and I’m allowed to say it because I have that freedom. CIO in most situations is child neglect and cruel. NOT ALL SITUATIONS, but most I’ve witnessed, it’s just lazy or impatient parenting.
Could you kindly direct me to the full study? I am sorry if I missed the link somewhere in your article but I would like to read the citations, limitations and methods.
Thank yOU!
The reference is at the end 🙂
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[…] Alaptarea este o relatie la care participa copilul dar si mama. Ca mame avem obiective diferite in relatia de alaptare, iar acest lucru nu trebuie judecat. Exista modalitati de a pune limite in mod bland si cu respect in relatia de alaptare a copilului mai mare. Exista tehnici blande de intarcarepe timpul noptii. Nu stiu in acest moment daca voi apela la ele, dar daca o voi face voi tine cont si de ceea ce am scris mai sus, legat de nevoia de hrana si de confort a copilului si ma voi asigura ca si copilul intelege ceea ce i se intampla. E important din punctul meu de vedere ca un copil sa inteleaga ce i se intampla atunci cand mama decide sa puna limite in relatia de alaptare. In absenta acestei intelegeri din partea copilului, relatia de alaptare nu mai este reciproca, iar tehnicile de sleep training (indiferent ca vorbim de CIO sau de metode mai blande) sunt periculoase si nu au efectul scontat. […]
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[…] life. However, there is no evidence to support that the timing is right. According to an article on Evolutionary Parenting, there is 20 years of research to support sleep training beginning at six […]
So I tried what Doreen suggested and after 4 nights my baby boy is able to fall asleep on his own, he sleeps all night long and I am in my heaven. Thank you
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