toddler sleep

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Crying-it-out and the modified controlled crying are sadly almost mainstays of modern parenting.  So much so that people who don’t use them are often thought to be weak or asking for trouble with their children.  Some doctors even tell their new mothers that they have to use these methods if they want to “help” their child learn to sleep.  With this, many family embark on the sleep training journey that involves learning to ignore your child’s distress (and your own) during the nighttime hours.

The problem for many is that they do this and then regret it.  Sometimes they read up on it after the fact and wish they hadn’t even though they may have done it “successfully” (i.e., baby is going to sleep without crying and not signaling to mom and dad during the night).  Sometimes they see changes in their children or their relationship to their children that make them realize this was the wrong thing to do for them.  When I hear from these parents it’s often to ask one or both of these questions:

1)      Have I done long-term damage to my child?

2)      How can I “undo” what I have done and move on?

Herein I want to tackle these questions because as much as I speak out against the methods, but very briefly I will say that my response to (1) is “not necessarily” and to (2) you can’t “undo” it but you can work with it to move on and we’ll discuss how below.  Notably, this post is for people who do feel this way.  If you have done CIO or CC and feel that you have done nothing wrong, there is no reason to read this.  It’s not for you and simply because a post is not for you is no reason to send hate mail.

Have I done long-term damage to my child?

One of the things that is often spoken of with respect to crying-it-out (CIO) and controlled crying (CC) (especially when the intervals become long) is cortisol.  Although no one study has looked at the long-term effects of cortisol activation during CIO and CC, there are reasons to believe it can have an effect, especially on certain children.  (Of note, people often speak about this issue as being closed, saying there is “evidence of no harm” which isn’t true at all, but rather there is “no evidence of harm” because it hasn’t been studied.)

These reasons include research on: The cortisol levels during early sleep training (including high levels when baby isn’t crying) and the disruption of the maternal-infant synchrony that is key to successful attachment[1][2], the “stress-reactive” profile that children show when exposed to repeated stressors[3] combined with the fact that repeated stressors seem to be activated even in what might be deemed typical negative interactions in the household[4][5], infant brain development is highly sensitive to stress indicating with evidence that the brain can rewire after a single stressful exposure[6], and the biological paradox that infants between two months and a year are almost impossible to stress when they are offered comfort by individuals they are attached to[3].  As for the issue of “certain children”, we know that “high-needs” children are far more susceptible to their environment and the types of parenting they face (resulting in outcomes that are either significantly worse or better than their “low-needs” counterparts)[7], meaning they are at higher risk of experiencing distress during a CIO or CC procedure (and in turn they may be the children for whom these techniques take much longer).

These reasons, coupled with general knowledge of neurological development and how responsive caregiving plays a role[8], are most likely the reason why people fear that they have done long-term damage.  These fears are often focused exclusively on the potential for cortisol damage, and yet this is where the evidence is, as mentioned above, circumstantial.  So what if there were no long-term cortical damage for a given baby?  If baselines return to normal within a week, what’s the problem?  Well, first, we don’t know there is no long-term damage for any child, so let’s keep that in mind.  Even if there isn’t, this ignores the effect of a child experiencing trauma, the fact that we have no idea how children will interpret the actions, and the long-term implications that can come from the experience of a traumatic event for that child (for a fuller discussion of this, read this).  We often forget that to a mind that has limited capabilities, what we intend may not always be taken as such.

All this said, I still don’t believe you have done long-term damage if you work to change your relationship and behaviours.  People experience traumatic and stress-inducing events around the world all the time – children too – and many recover quite well from them.  However, we know that for some people, these traumatic events are too great and they become changed (not for the better) from them.  When it comes to CIO or CC, the issue as many of us see it is a failure to be responsive – not all the time, but at a scary time for children (i.e., night) and we don’t necessarily know ahead of time how the child will react to it or react later to it.  Furthermore, when we do this with older siblings in the house, we teach them that the cries of their sibling are to be ignored, raising questions about how they will be able to respond to other people’s distress.  Like other traumas that children endure, they can “get over it” with the right support and responsiveness.  The question now is, how?

How can I “undo” what I have done and move on?

If you read here regularly, then you know I’m a huge proponent of responsiveness in parenting, but with the knowledge that that will look different to each dyad and family.  Often families think that sleep training is what’s needed for their child and they often believe they are doing good.  (Some still think it years later and again, this post isn’t for you.)  For some families, though, they see changes in their child, or fear the changes they may see in their child due to others’ experiences or what they have read, and they want to “undo” this.  Here are some steps that can help you on this path…

1.  Resume/continue/start being responsive to your child at night as well as during the day.  Your children don’t stop needing you at night, but they will stop calling out to you if they have been taught that’s the way.  Often parents who return to co-sleeping or night nursing or simply responding find an increase in these behaviours right off the bat.  Although some people consider it a sign of “manipulation”, I see it as a means of the child to (a) test the waters to see if things have really changed, and (b) express their sense of fear and/or stress over the situation they’ve been in.  By being responsive, you’re allowing your child to express this and when they are young, this may be the only way.

More importantly, sleep problems are often signs of other problems and you should be looking into the causes instead of focusing solely on sleep (see here for more information).  A pattern or responsiveness is critical to your child developing a healthy attachment to you even though we all miss times to be responsive (trust me).  (As an aside, I’ve always wondered why no one has looked at the relationship between sleep training and problems at night.  I don’t know why we’d expect lots of daytime changes from sleep training alone.)

2.  Look for subtle changes in your child around sleep time.  For example, a child who is clingy or cries or screams when the bedtime routines starts is likely experiencing the anticipation of separation and is attempting to change that.  Even if the child quiets once in bed, that’s likely a result of conditioning in that the child has learned that no one will come at that stage.  Another, more obvious, sign is that of a child who doesn’t seek help when needed at night.  For example, a child who is sick or scared of thunder who doesn’t seek out his/her parents but may mention it the next day.  In this case, the child has hopefully wrongly internalized that your parents are not there for you at night no matter what.  (It is reasons like this why I say we never really know what children are thinking about our actions.)

If you notice these changes, you need to change the nighttime scenario at once, possibly even needing to switch to one that allows your child more access to you right off the bat (e.g., room sharing).  Regardless, you do need to both talk to your child about what happened and allow them to express and experience their own emotions surrounding it.  I’m going to talk about this briefly below, but the best explanation for creating a narrative around any traumatic event (even if we don’t think it’s traumatic to us or should be traumatic) and how to help do this with our children (even when it’s due to our own failures), I cannot recommend Parenting From the Inside Out by Dan Siegel and Mary Hartzell highly enough.  It is the most detailed account and step-by-step instruction – science included – that you need on this topic.  If you have any fear surrounding your use of sleep training, please look at this book.

3.  As touched on point 1, allow them to express their emotions surrounding sleep.  Unfortunately, the children that are often sleep trained are too young to simply voice what they feel and thus you may need to deal with increases in crying, increases in the expression of separation anxiety (i.e., the child wanting to remain close all night), and in toddlers, possible tantrums.  Let them feel this.  Don’t make them feel bad, but be with them during this time and reassure them that things have changed.

As this can be very difficult on parents – you can feel defensive or frustrated or even feel that you’ve “regressed” from sleep training, please be assured that you have actually allowed your child to open up.  You’ve created a line of communication whereby your child feels comfortable enough to express how he feels.  Please note I’m not talking about giving in to any behaviours; for example, if you have a toddler who is crying about not wanting to go to bed because he’s scared and is asking to stay up, letting him stay up isn’t the answer if he’s tired, but reassuring him that you will now be there at night for him and cuddle him to sleep is a possible answer.

4.  One of the more important things you’re going to have to do is what’s called “creating a narrative”.  This is where the advice and tips in Parenting From the Inside Out are well worth reading the entire book.  However, this is a trick that has been used in therapy for quite some time (notably in treating all kinds of anxiety disorders and acute or post-traumatic stress disorder).  In short, the gist is to create a coherent story about what happened from one’s perspective, importantly including the thoughts and feelings that were associated with it.  If you’re doing this for yourself, when you have the story about what happened and you repeat the story, you may first experience strong emotional responses to it.  The best thing you can do is to continue to repeat the story to yourself (or with someone you feel comfortable with) until you have adjusted to it.  When your mind comes to terms with what happened and how you felt during that time, you will cease to have the associated emotional responses to it.  Research on trauma has found that the link to how people think about it or learning to think differently can mitigate the stress they feel[9].

What’s harder here is how to do this with a child, especially a baby.  They don’t have the language to create a narrative of their own.  As such, we don’t know if it’s possible to deal with the trauma before the child has the cognitive capacity to understand language and follow a narrative.  However, it doesn’t mean it’s not worth a shot.  For this, it would be you creating the narrative and hoping you have it right.  You can start by, at bedtime, telling your child the story of their sleep training: When they went to sleep and cried for mom/dad to come and no one came, how they felt sad and scared, how mom/dad came back in the morning but did this again the next night, how mom/dad wanted to be there, and how mom/dad is here now, even at night (and obviously each narrative will be unique to your circumstance and what you believe your child felt).

If children are toddlers or preschoolers already, it’s never too late to talk to them about what happened.  Even if you don’t feel it had an effect on your child, the fact is you don’t know and it may not present itself until your child becomes a parent or has to deal with a crying child him/herself.  The mind has an amazing capacity to hold onto traumas, reliving them only when they are brought forth by some trigger.  If you’re doing it at this age, I would simply ask them if they remember the event (children can have incredible non-verbal memories of early times) and then help them create a narrative.  If they don’t have an explicit memory, you can help them create the narrative and note their physical reactions to what you’re talking about.  If your child shows no distress at talking about them being left to cry, you can probably feel reassured that whatever happened didn’t cause any problems you need to “undo”.  If your child looks scared again, or tenses up, or even starts to cry, you’ve probably hit the nail on something that should be processed now and using the narrative and allowing your child to express any new emotions that surface is crucial.

5.  Forgive yourself.  When parents write to me about the issue of CIO or CC, underlying their writing is the issue of self-blame and self-anger for using these methods in the first place.  Although some people would suggest simply saying, “You have nothing to forgive yourself over” I don’t believe that it’s a helpful answer at all because it’s another way to say “Ignore your own feelings”.  I don’t believe we do well ignoring our children’s feelings or our own.  If you are feeling bad, simply believing you shouldn’t feel bad only serves to ignore the guilt that we have for very good reasons – namely to help us survive and improve and learn (see here for more information).

I propose you look at it like this: We are all going to screw up in our parenting journey.  All of us.  The greatest thing we can do is learn from our mistakes and remember that what may be a mistake for us won’t be for someone else.  We have to look to why we make the mistake, work to make amends, and then move forward.  When we do this, we’ll be moving forward with more information than we had before and there’s nothing wrong with that.  Making mistakes is natural, normal, and something every parent has done or will do.   Being able to confront them and fall back on defensiveness is what we need to strive for, and if you’re at the end here, you’re already most of the way there.

[Image Credit: Unknown]

[1] Middlemiss W, Granger DA, Goldberg WA, Nathans L.  Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following extinction of infant crying responses induced during the transition to sleep.  Early Human Development 2012; 88: 227-32.

[2] Feldman R.  Parent-infant synchrony and the construction of shared timing: physiological precursors, developmental outcomes, and risk conditions.  Journal of Child Psychology and Psychiatry 2007; 49: 329-54.

[3] Gunnar MR. 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, 2006.

[4] Thapar A, Harold G, Rice F, Langley K, O’Donovan M.The contribution of gene–environment interaction to psychopathology. Development and Psychopathology 2007; 19: DOI:10.1017/S0954579407000491.

[5] Carlsson E, Frostell A, Ludvigsson J, Faresjo M. Psychological Stress in Children May Alter the Immune Response. The Journal of Immunology 2014; 192: 2071 DOI: 10.4049/jimmunol.1301713.

[8] Sunderland M.  The Science of Parenting.  New York, NY: DK Publishing, 2006.

[9] Kinderman P, Schwannauer M, Pontin E, Tai S. Psychological Processes Mediate the Impact of Familial Risk, Social Circumstances and Life Events on Mental Health. PLoS ONE 2013; 8: e76564 DOI:10.1371/journal.pone.0076564.