By Tracy G. Cassels
The recent post on the research showing a greater risk of harm than good for early sleep training (under six months of age) sparked a lot of defensiveness and anger by some people on the site and on places where the piece was shared. The most popular argument was that they had done early (presumably) sleep training and their child was fine so who was I to write up research that would suggest otherwise. Add in some bits of “Can’t we just support one another’s choices?” and the accusations that I don’t know a specific person’s situation so how can I write or say anything and you’d think I’d written that parents who sleep trained deserved to be locked up despite nothing of the sort being said.
With respect to this exact piece, I think some people just clearly either don’t want to read what’s there or didn’t as it was pretty clear this was all about the promotion of sleep training as opposed to parents who have done sleep training. However, that fact is something that is often lost in the discourse on sleep training at any age and I think it’s time we talk about it.
I can only speak for myself and my site here (but I know from many discussions with many others who write about sleep training, they feel the same as what I am about to describe). I write about sleep training and the problems with it because there are a lot of “experts” out there who don’t take one tiny glance at the research on it but tell parents they must do it. There’s also a lot of crappy research that gets picked up in the mainstream media – last year’s Price et al. article in Pediatrics which claimed to find no long-term effects of controlled crying, for example (their methodology didn’t allow them to even test this) – while others that counter sleep training are ignored. So I write. Do I have an opinion? Yes, after doing the research, I do, just as those who write other pieces have their opinion that sleep training is fine. No one writes on this completely unbiased, so let’s get that out of the way. But unlike many “experts”, I do make sure to cite my sources so people can read them themselves and form their own opinion, something I hope parents take the time to do.
However, the writing I do isn’t about parents, it’s about the promotion of sleep training. When we as a society promote something, it is done under the assumption that it will provide more benefits than harm. It also assumes we know nothing about individual circumstances, and that is why it has to be based on research. This leads to a very important fact: There may – in fact, probably will – be select individuals for whom whatever is being promoted does not help. They will have unique circumstances that dictate a different course of action is needed. BUT, and this is important, it doesn’t mean the original promotion is wrong.
When we talk about sleep training – especially early sleep training – we’re talking about people telling families to do it. And what the most recent research found was that people are being told to schedule their children, to put them down off the breast when breastfeeding, to leave them to learn to “self-settle”, all when there’s no evidence for it and never was. Worse still, they were telling families who had no sleep issues to start engaging in these practices, a type of promotion that takes things even further than providing interventions. What we now know, based on 20 years of research nicely reviewed and summarized, is that from a population or promotion point of view, early sleep training (whether intervention is needed or not) not only doesn’t work, but increases the risk of harm to infant and mother. This does not speak to any individual person’s situation or case. It speaks to how we want to promote matters of safety and well-being in our society, something we do on a regular basis over all kinds of activities.
For example, we don’t promote smoking because we know it leads to higher risks of very serious health outcomes. It doesn’t mean there aren’t individuals who smoked and never had a bad outcome. We don’t promote heavy drinking in pregnancy because we know it can lead to FASD. It doesn’t mean there aren’t individuals who drank heavily and their child did not have FASD. We promote a balanced diet in children and adults because we know it’s linked with better health outcomes, but it doesn’t mean there aren’t people who ate a balanced diet and caught any number of diseases. With early sleep training, there is no reason to promote it when we now know that it is more likely to cause harm than to help the average family. We can no longer say that anyone promoting early sleep training is looking out for the well-being of babies and families. Regardless of what has happened in individual families.
This brings us to the issue of the individual parents and there are two parts to discuss here: Supporting choices and individual circumstances. Starting with supporting choices, parents are getting very upset over people not supporting what they see as their choice. This is the whole “whatever you choose is fine” attitude that accompanies the push to end “mommy wars”. It’s something I feel great disdain for, though, not because I don’t want to support parents (I do and spend a lot of time each day answering questions from individual families and trying to help their individual circumstance), but because supporting a parent doesn’t mean agreeing with all of their choices. In fact, I firmly believe blindly telling a parent what they want to hear isn’t actually supporting them at all. And any parent who needs universal agreement is lacking in the conviction of their initial choice.
When it comes to sleep training methods like cry-it-out, I will not say it is a “good” method, but I can still call a given mother “good”. I will acknowledge that we live in a world that is not family-friendly and that sometimes families may feel they need to do that, but I view that as the lesser of two evils. Still evil, but families with little choice don’t get to always pick. And as such, I don’t harbour ill-will towards parents. Even if it wasn’t the lesser of two evils but rather because a doctor or family member said they must. People work with the information they have at a given time and you cannot judge a person for acting in accordance with the information they have. You can just hope they can learn more and make more informed decisions (whatever they are) going forward. And you still don’t have to agree with all of them. For example, I have friends that smoke and although I find the act of smoking disgusting, I don’t find my friends disgusting. The same can go for any parenting choice and any individual parent.
The second part here is about the individual circumstances families find themselves in. In our society as it is today, there are lots of reasons families find themselves pitted against their children. It’s one of the things that bothers me the most as families should be bonding and feeling supported from the start, and sadly that is a bit of a pipe dream these days. So I do understand where parents are coming from – sleep deprived, back at work early, etc. – but this has nothing to do with promotion and everything to do with building up your toolbelt and finding what works for your family while minimizing the harm done to each and every member of your family.
As I write for the site, I can only speak in generalities which means I cannot, nor should I be expected to, know your individual circumstance. That does not mean I cannot talk about the methods we promote as a society. It means I talk about the methods not the people that use them. And when people contact me for help, then we can start to look at the individual circumstances and try to find more tools for them to try out that can help their individual circumstance.
If reading that someone disagrees with some aspect of your parenting or that there’s research suggesting it does more harm than good generally bothers you or angers you, it’s not the problem of the person who is sharing that information. It’s your problem. Information should never be hidden because someone doesn’t like it. And when that information has important implications for policy and what caregivers should be promoting? Even less reason to hide it, no matter how many people may be upset by the findings. I hope those who are in the position of power to promote various techniques for infant sleep take heed of the research. Especially when there are techniques that are gentler and don’t pit mom and/or dad against their child. Those are what we should be promoting. Will these gentle methods work for everyone? Honestly, probably not, but they should remain your first line, or key players, so to speak, and then work with individual cases when those key players fail.
Parenting isn’t always easy. For that reason alone parents should be able to come to the table armed with the best information possible, including a variety of tools and the risks associated with each, and then make their decision. And that requires us to disseminate the research and make sure that when we promote techniques, we do so focusing on minimizing harm, not winning popularity contests.
[Image Credit: AC Wraith via The Express Tribune]