Critics of Cry-It-Out Fundamentally Misunderstand How Stress Affects the Brain

Because whether or not to sleep train can be such a fraught decision for new parents, I wanted to share my sleep training story, and to explain why, given everything we know about stress, the argument that sleep training causes long-term harm doesn’t hold water.

Sleep Training My Son

When my son was 4.5 months old, I decided to sleep train him. Even by baby standards, my son was not much of a sleeper. He’d snooze for at most 4 or 5 hours, and then wake up every hour like clockwork, wanting to nurse but not wanting milk, popping on and off my breast and screaming in frustration.

I had gone back to work a month earlier, so napping to catch up on sleep was out of the question. Worse, I was commuting an hour to the office each way.

By then, I had reached the end of my sleep deprivation rope. I was so tired I could barely string two thoughts together. I had to coach myself through even mundane tasks like checking out at the grocery store. Say hello to the cashier. Take out your credit card. Pick up the grocery bags. Leave.

I was terrified every time I got into my car to head to work that I would nod off at the wheel and kill someone, quite possibly myself. I joked with coworkers that driver’s licenses should be temporarily suspended for new parents, but the situation really wasn’t funny.

So there I was the first night of sleep training, dripping sweat as I listened to my son’s cries. Minutes ticked by, each seeming longer than the last. I pondered whether the Ferber method included soothing every five minutes just so that you would realize only five minutes had passed.

But I was determined to stick this out, to get it done. Doing it halfway was worse than not doing it at all, I reminded myself over and over. If I were to give in, I could teach my son that crying for 30 minutes was what it took to get mommy to pick him up.

That night, he woke two more times, but never again cried more than 15 minutes. The next night, he cried for 10 minutes at bedtime, conked out, and slept until morning. That morning we greeted each other with a smile, and for the first time since his birth, I really felt like smiling at his freshly woken little face.

Although by all appearances, sleep training went well for us, some critics of cry-it-out methods would contend that I was an inadequate parent who had permanently harmed my son by leaving him alone to cry.

The Cry-It-Out Controversy

“An emotionally available parent would probably not let their baby cry it out,” claims Dr. Teti, a researcher at Penn State.

Dr. Narvaez writes in Psychology Today:

“Letting babies get distressed is a practice that can damage children and their relational capacities in many ways for the long term. We know now that leaving babies to cry is a good way to make a less intelligent, less healthy but more anxious, uncooperative and alienated persons.”

When someone tells you that you have permanently damaged your child, it’s hard to shake off, no matter how much happier you and your baby seem once you start getting some solid rest.

Thankfully, as someone who has studied the effects of chronic stress in animals and in people, I knew that claims like Dr. Narvaez’s are not supported by data and instead rest on a fundamental misreading of stress research.

Studies on Cry-It-Out

Studies involving cry-it-out methods find no ill long-term effects for babies, and big benefits for parents. In one study, rates of depression in mothers dropped from 70% to 10% after sleep training.

Critics of cry-it-out methods argue that these studies are flawed–they don’t have the right measures of harm, they fail to determine whether the parents actually used cry-it-out methods to sleep train their babies, and they rely on parents’ reports instead of observation.

Admittedly, some of these criticisms of sleep training research are fair. Sleep training research is hard to do, especially since researchers can’t exactly force parents to sleep train little Johnny, or prevent parents from doing so.

That said, there’s no evidence in humans–none–to support the view that sleep training is harmful. If there were, we’d have heard about it.

So what the critics of cry-it-out argue, really, boils down to this: They know that sleep training is harmful, because they know stress is harmful to babies.

The problem with that argument? All stress is not created equal. We were designed to handle short-term stress. Where we humans, and other animals, run into trouble is when stress becomes chronic.

Short-Term Versus Chronic Stress

In terms of their effects, the difference between short-term and chronic stress is one not of degree, but of kind. Short-term stress enhances memory; chronic stress impairs it. Short-term stress boosts the immune system; chronic stress weakens it.

(Seeing short-term and chronic stress as fundamentally different is not just my own heterodox personal take. This is the view of people who study stress for a living, including the renowned stress neuroscientist and primatologist Robert Sapolsky, professor of Neurology at Stanford University, who writes extensively about this key distinction in his excellent book, Why Zebras Don’t Get Ulcers. The American Academy of Pediatrics emphasizes this distinction in its statement on early life stress. And the Harvard statement on child development, cited by Dr. Narvaez herself in her Psychology Today piece, makes a point of distinguishing between short-term and long-term stress.)

The Effects of Stress in Early Life

Short-term stress mobilizes us for action–the classic fight-or-flight response. Adrenaline and cortisol pump through our veins; our bodies brim with energy; and mentally we become hyper-focused.

But these short-term adaptations are harmful when switched on for too long, especially when we are young. Scores of animal and human studies show that early life stress, such as severe early social deprivation, leads to long-term changes in the brain, cognitive and social problems, and heightened susceptibility to anxiety, depression, and drug abuse in adulthood. Chronic stress is toxic.

But from this can we conclude that all early stress, even short-term stress, is harmful?

No. Absolutely not. In studies of short-term stress early in life, occurring within the larger context of a close caregiver-infant relationship, none of these ill effects are observed.

In fact, young monkeys exposed to early short bouts of stress, such as brief periods of separation from their mothers, become more resilient to future stresses. They are less anxious and have less extreme physiological reactions to stress later in life. This phenomenon is so consistent that researchers have labelled it stress inoculation.

My Take

So where does that leave us? A little stress, even in infancy, is fine, if not beneficial, but too much for too long is very, very bad.

Do we know exactly where sleep training fits in this spectrum? Just how much stress does a baby experience during cry-it-out?

The short answer is that we don’t know for certain. Everything we do know, however, suggests that this amount of stress, in the context of a warm, loving family, is just fine.

To see why, let’s return for a second to the American Academy of Pediatrics statement on early life stress, which provides examples of the types of stress children can withstand, provided they occur within a broader context of loving, supportive relationships. These include “the death of a family member, a serious illness or injury, a contentious divorce, a natural disaster, or an act of terrorism”. By comparison, sleep training seems pretty mild.

But I would go further. I believe that sleep training is not only not harmful, it is beneficial. Successful sleep training can decrease depression and chronic stress in the parents, and this benefits parents and their babies. Unlike sleep training, having a depressed mother during early childhood has been shown, repeatedly, to be linked with worse long-term outcomes for children.

Which brings me to what I find most troubling about the claims of sleep training opponents: Their zero-sum take on parenting. Worrying about your own sleep needs is selfish, they not so subtly imply. Any time you fail to put your baby’s needs before your own, you are potentially doing him harm.

What a narrow, cramped view of parenthood.

No one would ever dispute that parenthood entails enormous sacrifices, especially when your children are young and their need for you feels so endless and all-consuming.

But I think that because parenthood, and motherhood in particular, is so often judged in terms of self-sacrifice, we tend to forget that a primary job for parents is to be strategic.

As parents, we must weigh short-term costs against long-term harms, because our children cannot. We have to consider the risk of a few nights of stress and unmet needs against the risk of a car accident or job loss, and against the serious physical and emotional toll of chronic sleep deprivation on the entire family.

We can forget, too, that the parent-child relationship is one not only of sacrifice but also of profound mutual benefit. You being a whole, fulfilled individual with a solid relationship with your partner, meaningful social ties, and a sense of purpose enriches your world and your child’s world. You being a well-rested, healthy, and happy parent is good for you and good for your child.

References

Ashokan A, Sivasubramanian M, Mitra R. Seeding Stress Resilience through Inoculation. Neural Plasticity. 2016;2016:4928081. doi:10.1155/2016/4928081.

Center on the Developing Child (2010). The Foundations of Lifelong Health Are Built in Early Childhood. Retrieved from www.developingchild.harvard.edu.

Crofton EJ, Zhang Y, Green TA. Inoculation Stress Hypothesis of Environmental Enrichment. Neuroscience and biobehavioral reviews. 2015;0:19-31. doi:10.1016/j.neubiorev.2014.11.017.

Darcia Narvaez. Dangers of “Cry-It-Out”: Damaging children and their relationships for the longterm. Psychology Today. 2011.

Fenoglio KA, Brunson KL, Baram TZ. Hippocampal neuroplasticity induced by early-life stress: Functional and molecular aspects. Frontiers in neuroendocrinology. 2006;27(2):180-192. doi:10.1016/j.yfrne.2006.02.001.

Gunnar M. Reactivity of the Hypothalamic-Pituitary-Adrenocortical System to Stressors in Normal Infants and Children. Pediatrics. September 2, 1992;90(3):491.

Hsiao YM, Tsai TC, Lin YT, Chen CC, Huang CC, Hsu KS. Early life stress dampens stress responsiveness in adolescence: Evaluation of neuroendocrine reactivity and coping behavior.Psychoneuroendocrinology. 2016 May;67:86-99.

Lyons DM, Parker KJ, Schatzberg AF. Animal Models of Early Life Stress: Implications for Understanding Resilience. Developmental psychobiology. 2010;52(5):402-410. doi:10.1002/dev.20429.

Mindell JA, Kuhn B, Lewin DS, Meltzer LJ, Sadeh A; American Academy of Sleep Medicine. Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep. 2006 Oct;29(10):1263-76.

Parker KJ, Buckmaster CL, Sundlass K, Schatzberg AF, Lyons DM. Maternal mediation, stress inoculation, and the development of neuroendocrine stress resistance in primates.Proceedings of the National Academy of Sciences of the United States of America. 2006;103(8):3000-3005. doi:10.1073/pnas.0506571103.

Sánchez MM, Ladd CO, Plotsky PM. Early adverse experience as a developmental risk factor for later psychopathology: evidence from rodent and primate models. Dev Psychopathol. 2001 Summer;13(3):419-49.

Sanchez MM, McCormack KM, Howell BR. Social Buffering of Stress Responses in Nonhuman Primates: Maternal Regulation of the Development of Emotional Regulatory Brain Circuits. Social neuroscience. 2015;10(5):512-526. doi:10.1080/17470919.2015.1087426.

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Author: Amy Kiefer

I am a research scientist and mother of three munchkins. I live in the Bay Area and when I am not child wrangling and catching up on lost sleep, I love digging into the research on all things fertility, pregnancy, and breastfeeding related.

55 thoughts on “Critics of Cry-It-Out Fundamentally Misunderstand How Stress Affects the Brain”

  1. Hi!

    I absolutely love your site and what it’s all about.

    This is my first time receiving your email notification…and as a marketing professional, I have to ask why you post the full article in the email? You should only post the first paragraph and then ask us to continue to your site. It will help with SEO if you get more clicks to your site. Just wanted to let you know if you didn’t already 🙂

    Thanks again for such great content!

    On Tue, Apr 12, 2016 at 12:22 PM, Expecting Science wrote:

    > Amy Kiefer posted: “Because whether or not to sleep train can be such a > fraught decision for new parents, I wanted to share my sleep training > story, and to explain why, given everything we know about stress, > the arguments of those opposed to sleep training don’t hold water. ” >

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    1. Thanks for the suggestion! Marketing and thinking about SEO are definitely not my strong points–so if you notice anything else, please let me know what I am screwing up 🙂

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  2. I really feel for your situation as I’ve recently experienced the same except I have been able to postpone going back to work. From my understanding critics of sleep training methods involving infant distress do argue that these methods can indeed cause chronic stress as the baby has learnt not to signal when struggling during the night. Parents are led to believe by misleading reporting and health professionals that because a baby no longer cries, that they are no longer in distress.

    Liked by 1 person

    1. I have seen that argument made. It is my understanding that it is based on a single study of 25 infants that failed to include a control group.

      Melinda Wenner Moyer has an excellent piece on sleep training. She describes the multiple problems with that study. And problems aside, its findings do not support the conclusion that sleep trained babies continue to experience distress. Here’s Moyer on the topic:

      “There is, however, one study cited multiple times in Clinical Lactation that specifically assesses the effects of crying-it-out on infant cortisol levels. In this 2012 study, University of North Texas educational psychologist Wendy Middlemiss and her colleagues tracked the behavior and cortisol levels of 25 infants, ages 4 to 10 months, as they went through a five-day sleep training program à la crying-it-out in a sleep lab in New Zealand. The researchers measured the blood cortisol levels of the infants and their mothers before and after the babies were put to sleep on the first and the third nights. On the first night, the babies cried, but their cortisol levels did not go up upon being left to cry themselves to sleep. On the third night, none of the babies cried much at all, and their cortisol levels stayed constant. In other words, the sleep training worked.

      What Middlemiss considers a cause for concern is that the babies’ cortisol levels never dropped during the course of the study (the mothers’ cortisol levels did, on the third night). “What’s dangerous about the situation,” Middlemiss explained to me, “is that the mother has no idea—because the behavioral indication [i.e. the crying] is absent—that the infant had remained stressed.” But how do we know the infants were stressed to begin with if their cortisol levels never rose? Middlemiss says that the babies in her study must have been stressed as soon as they arrived at the sleep lab—it’s a foreign environment—so it didn’t matter that the training itself didn’t incite a further increase. But there were no comparison groups included in the study to validate such a conclusion—no infants lounging around at home with much lower cortisol levels—so it’s unfair to assume that the sleep-trained infants were stressed. (Middlemiss told me that she once took cortisol measurements of babies while they were at home, and that their cortisol levels were lower than the babies tested in the sleep lab, but she didn’t include this information in her study.) Even if the babies at the sleep lab were highly stressed, the obvious take-home is that parents shouldn’t bring their babies to sleep labs—not that they shouldn’t cry it out”

      http://www.slate.com/articles/double_x/the_kids/2013/07/clinical_lactation_jumps_on_the_dr_sears_bandwagon_to_say_sleep_training.html

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      1. Have you read the research published by Middlemiss? I understood Middlemiss’ study to be an investigation on the variation of cortisol levels between mother – baby dyads prior to and following sleep training. On day three of the sleep training, the mothers’ cortisol levels dropped as their baby cried significantly less compared to days one and two. However, the babies cortisol levels did not drop regardless of the fact that they were crying less. It’s disappointing a respected journalist such as Moyner can misrepresent the objectives and outcomes of Middlemiss’ research.

        Liked by 1 person

      2. I don’t think Moyner misrepresented Middlemiss’s findings. I think what Moyner is saying–and I agree with her–is that it’s very hard to know what exactly is happening in Middlemiss’s study, given the way it was designed and what she found. You cannot tell whether the babies were stressed by cry-it-out or the hospital setting, and she did not find an increase in cortisol with CIO, just no decrease after 3 nights. You cannot conclude some tragic decoupling of parent and baby distress from this study. The results don’t support that conclusion. They don’t really tell you much of anything.

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      3. I’m not sure, given that a decoupling of distress did occur, that this is enough to evidence cry it out doesn’t harm babies. The main take away from this study is that babies’ cortisol levels should have dropped in line with their mothers on the third night. Ultimately there will never be a study directly proving or disproving the dangers of cry it out as its very nature contradicts research ethics.

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      4. Thank you for your detailed criticism of Middlemiss’s study raising several important issues. However, as you also admit in this article that research on CIO is also flawed, I’m interested in how you deduce that CIO is safe. Surely you should be calling for better research instead?

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      5. Certainly more and better research would help clarify matters. Until then, I think it’s fair to say everything we know about sleep, stress, and development suggests that CIO will not cause lasting harm. If a new study comes out on the topic that supports this view or refutes it, I will be sure to cover it.

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      6. I just started to look at that article as well. But initial thoughts are cortisol levels are circadian. They drop to nearly undectable levels during the night, peak at waking then slowly drop the rest of the day. So 1. it appeared they used a within subjects design, they wouldn’t need a control group. The group is the control group by making the change on one night and comparing it to a baseline. and 2. we would expect cortisol levels to naturally drop through the night, quickly. If they even stayed even that would actually be elevated beyond the norm.
        Even in a new environment the babies should adjust quickly.

        But none of that matters
        Because the whole point of the paper was asynchrony. That the babies behavioral cues (crying) are important for the mother to get in sync with the baby, as shown by cortisol levels. As a matter of fact if the baby was freaked out by the new environment, that proves the papers point (but not those who cite the paper) that there was a greater asynchrony between moms cortisol and babies. In short, it doesnt matter why the babies cortisol levels were high, new environment or sleep training, they were high and therefore should have elicited a behavioral response, crying. But they didnt.
        I dont think this paper provides any evidence against cry it out. This paper says when a mom and baby spend 5 days in a sleep training program, their cortisol levels get out of synchrony due to the babies crying cessation..thats it. Crying increases cortisol for baby (or stress increases both) which evelates moms levels.

        For this to be against the cry it out method (which I dont use, we used partial by checking every 15 min on our first 3 children to great success) one would have to accept the basic assumption that asynchrony causes long term neg effects. And I dont see that supported in this articles review. So this paper was done fine for what it wanted to measure- a between subjects design with a control group would have worked as well. But I do not believe it shows what people want it to.

        PhD behavioral neuroscience.

        Liked by 1 person

  3. The other aspect of this that I’ve always wondered about: what is the effect of long-term sleep deprivation on the child? Surely long-term sleep deprivation is a form of chronic stress?

    I once came across a study (and sorry, I don’t have the citation) which found that with even an hour’s less sleep, cortisol levels would spike in the evening, when the person would normally go to bed. That’s one hour. What is the effect of days, weeks, months, even years, of inadequate sleep on the child? And surely that is far worse than a few days of short-term stress?

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    1. Absolutely–I did not have the space to get into that research in this post, because I really wanted to focus on stress research, but Alice Callahan has an excellent summary at her blog Science of Mom on how sleep deprivation is also bad for babies and children: https://scienceofmom.com/2012/02/13/why-sleep-matters-to-babies-and-parents/

      Her series of posts on sleep training are the best in-depth discussion of the topic I’ve seen.

      Liked by 1 person

    2. Are you saying that all (most? some?) children that haven’t been sleep trained are chronically sleep-deprived? What brought you to that conclusion?
      Our current cultural norm of 8-hour solid block of sleep (or 12 hours – 7pm-7am – the golden standard for sleep trained babies) is by no means a biological nor a historical norm for humans in general.
      It is not just the obvious and overt stress that the baby (and the mother) experiences from mother’s unresponsiveness during sleep training but the potential long-term effects of tampering with these biologically and evolutionarily normal patterns of sleep, breastfeeding and parental soothing that prevented me from ever considering sleep training as something to be implemented.

      Liked by 1 person

      1. I think that in cases where babies have not learned to soothe themselves back to sleep, but instead require lengthy parental intervention every time they come out of a sleep cycle, sleep training can mean more uninterrupted sleep. That certainly was the case in our household–my son was a much happier better rested little boy once he could fall back asleep on his own.

        Liked by 1 person

    3. The objective of sleep training a baby is to stop them crying at night time and not to deal with the underlying cause of why they are in distress. There is no evidence to support that sleep trained babies actually sleep more.

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      1. Are you kidding? My 10 month old had bags under his eyes for months on end from all of his night wakings and inability to connect sleep cycles. Co-sleeping didn’t even help him get a full nights rest! He was constantly waking and needing to be helped back to sleep. A week after sleep training his dark circles and bags are gone from his sweet little face and he is SO much happier. The poor boy was chronically overtired for moths. I will never regret giving him the space to learn how to sleep.
        My sleep trained baby ABSOLUTELY sleeps more.

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  4. Let me start by saying I really enjoyed reading your post! I personally hate “studies” that really are just strong opinions of what affects people mentally. I had a very unstructured childhood, filled with everything in the book that can “damage” a child. But I turned out happy and healthy with a family of my own. Now as a new mother I’ve read every blog and book on how to do anything and everything. It seems to just all be opinions on how to not screw up your kid. If letting your baby cry it out (to a certain extent) works for you and you don’t notice negative outcomes then great for you! Being a happy healthy mother to a new baby is the most important thing you can do for the little one (in my opinion). So do what works for you! Thanks again for the post.

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  5. I think this is a sad attempt to make yourself feel better for putting your baby through this. As a parent, you should respond to your baby. If your baby is crying out to you, do what your biology is telling you to do, and respond. I don’t understand CIO at all. I think it’s extremely harmful. You are just saying that a little bit of stress is fine. But who are you (or anyone) to say where that line lies. To me, letting your babe cry for hours in a day is chronic and extreme stress. Letting them cry for 2 minutes because you are tying putting on your three-year olds shoes to get everyone out the door; that, my dear, is short-term stress.

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    1. Totally agree. Leaving your child to cry goes against your instinct as a mum for a reason. If humans were still living in a primative way, you would never leave your child to cry as it would attract predators! It’s just not natural. Research has found it hugely increases cortisol levels in the brain for a significant time after the child has been left which can cause mental health problems later in life. My child is an awful sleeper and I work, but he will always have me there when he cries.

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  6. I truly hope the next time you are crying your husband or friends doesn’t ignore just because they want sleep. Ultimately the issue here is you had to return to work, had you not I am sure you would never have put your 4.5 mth old through this. The reason babies stop crying is because they give up. If you were to do that during the day it would be classed a neglect.
    I find astonishing that anyone can justify CIO.

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    1. I’m a SAHM and I sleep trained my daughter we she was around 6 months old. It has nothing to do with working or not working outside the home. Sleep deprivation isn’t good for anyone.

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  7. I thought your article was fantastic. I have seen the difference between moms who sleep-trained and moms who didn’t, whether or not they worked or stayed home, and the evidence in favor of it is extremely strong. I sleep trained my little boy, without ever leaving him to cry for longer than 5 mins before soothing him, and he has slept through the night the majority of the past two years. The idea that they would sleep through distress, or be in distress and be awake and yet not cry, is absolutely ridiculous. Anytime my LO hit a growth spurt, he would begin waking up at night again until I started producing more milk, and/or supplemented with more food. As soon as he was satisfied, he returned to sleeping through the night. When he hit any milestone, or was sick or cold, he would wake up and let me know he needed me by crying. He doesn’t sleep through distress and never has. I find it ridiculous that people put their own health and safety last. I believe some of the people who have commented would rather you have gotten into a car accident on your way to work then let your child CIO for short periods of time to learn to sleep. Anyone who does it right knows that you don’t let the infant cry for hours on end! Sleep training works even if you return to soothe and touch the baby every five minutes. If someone doesn’t want to sleep train, all I do is feel sorry for them and the fact that they will be sleep deprived for the next 2 to 10 years depending on how many kids they have. I don’t berate and belittle them and tell them how messed up their children will be because they don’t know how to get themselves back to sleep. I don’t write list of all the bad things that happen physically and mentally when a person is chronically sleep deprived and wave it in their faces.To each his own, but the mom judgment needs to stop.

    Liked by 1 person

    1. I think expert opinion is exactly that, opinion. It is considered the lowest form of evidence, ranked far below randomized trials and observational studies, which in this case all suggest that cry-it-out is not harmful.

      Liked by 1 person

  8. Frankly your whole article is opinion. Your evidence is based on 9 journals which you have used to argue your case but do not fundamentally speak about cry it out. One of your journals is from a study on rats! 9 Journals does not an expert make or a well researched piece for that matter. The 6 professionals in the article linked above have come to the view of the detrimental disadvantages of CIO through their own thorough academic research, their own journal publications and their positions – doctors, professors etc. If you actually read the link properly you will see the wealth of knowledge all of their backgrounds hold. I’m sorry but I’ll take their expert opinion any day which is based on actual knowledge rather than an opinion piece by someone who went to University and now thinks they can debunk the damages of CIO by using only 9 journals. It’s scary when people like you do things like this and put it out on the internet. In this case may common sense prevail for those who are reading it.

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    1. I debated for a long time whether to reply to this comment, or to even post it. But I wanted to make this forum an open one, to all points of view, and I think this comment raises a really important larger question, of how to evaluate information on the internet.

      Several things: Whenever I investigate a topic, whether for this blog, another forum, or just for my personal use, I tried to read a diverse set of opinions on the topic, and look closely at the sources each side cites. Are they major medical establishment positions? Are they literature reviews or single studies? Or are they based on personal knowledge, emotions, or anecdotes?

      I also try very hard both to be impartial and to admit my perspective outright where I think it matters. At the same, I realize that no one is perfectly objective, especially not when it comes to parenting.

      On many occasions, though, I have come to a topic thinking one thing and come around to thinking the opposite. I thought folic acid supplements were less important in early pregnancy than they are. I breastfed both my children for over a year, and was disappointed to find that the research supporting long-term benefits was so poor. If I found credible evidence that sleep training was harmful, in any way, I would say so.

      All that said, I appreciate you taking the time to read my article and comment on it. We all have to make our own individual decisions when it comes to our children. And what is overwhelming clear to me is that people on both sides of this debate care deeply about doing what is right for their children.

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  9. What I don’t understand is how a child in distress (short or long term) is learning how to connect sleep cycles. I only started looking into it and I’m tremendously confused by all the information. I don’t like the thought of crying it out at all but I am tired after 10 months. So just thinking about it as a possibility. My child goes to bed fine (well, mostly) but after a short period of initial sleep she comes every 1-2 hours. Three times in a good night, hourly in a bad night, which predominate since month 4. But just technically-how is cio helping my child to find back to sleep at 2/3/4 o’clock in the morning? It is a contradiction per se to me. How to distinguish genuine hunger from habitual/comfort feed? (We breastfeed.) How to tell my child that even after 2am the cot is still fine and there’s no need to prefer co-sleeping? What message do I give to my child by letting her cry? What about the amount of time they need to calm down after they nearly vomited due to crying? When their little lungs are shaking in spasm after they stopped crying? And how is this helping her sleep? I simply don’t understand the correlation. How is the difficulty of connecting biological sleep cycles eliminated by crying? Please enlighten me. Btw, she naps during daytime twice, 30 mins on the dot. When in the cot. Longer in the pram sometimes, or when I’m with her in bed. Can set the watch to it. Not enough for all the sleep specialists out there. But that’s how it is. No chance to put her down on her own unless she’s very, very tired. Then not so much of a problem.
    Any advice/explanation very much appreciated.

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    1. i highly recommend the gentle sleep guide, it explains about sleep, our expectations and the so called sleep charts where actually made up!! after having my second son it saved my sanity. My eldest slept well for 7 wks. My youngest wakes 1-3 times at 27mths. But there is no way I’d leave him to cio. It’s tempting when I’ve not had a full nights sleep for so long, but the fact that I want him to know I’m always there regardless and that it would break my heart to hear him scream out for me, I know it is totally the wrong thing to do.
      Also it’s not recommended to miss night feeds for babies under 12mths as breast milk is their main source of nutrition regardless of the time. All the best it will get easier

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      1. Hi Ena, I’ve read The no-cry sleep solution (E. Pantley) about three times now and I still don’t understand what to do apart from feeding and picking them up when they get unsettled. I have no idea how this should help them to sleep longer either. Maybe I’m too tired, haha. About the night feeds-yes, I’m aware that they shouldn’t skip any feeds. But this as well is a very contradictory topic. The other camp says they don’t need so many feeds at this age anymore. That’s why I’m so reluctant to start sleep training.

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    2. Hi Romina, great questions. Babies and adults wake up slightly between sleep cycles. Most often, we simply fall back to sleep and do not even remember waking up. But because very young babies must learn to how to fall asleep, they often form sleep associations with however they are put to sleep or put back to sleep. Then, when they often wake up in the middle of the night and are unable to fall back asleep on their own, they want parental intervention, usually bouncing, rocking, nursing, or swinging.

      The goal of sleep training is to break these associations, so that babies stop relying on them and learn to fall asleep on their own. For some babies, this can be as simple as learning how to put their binkie back in their mouth. For others, they are very reliant on their sleep association and need to learn that they can go to sleep without it. That can be frustrating for babies–they want something and are tired, and they have to learn to do without it.

      But most babies will, after a couple of nights of consistent sleep training, do learn how to fall back asleep on their own. When they are distressed, because of a toothache or an upset tummy, they will still cry for you, and then you get them, soothe them, etc. The key is keeping them falling asleep on their own, and letting them practice that skill as much as possible.

      The second time around, knowing the importance of falling asleep without assistance, I was very careful to put my daughter down drowsy but awake as often as possible from about 4 weeks on, picking her up and soothing her if she fussed, and then putting her back down while still awake. She did not cry; she was not distressed. I would often sing or talk her to sleep, but I tried very hard to let her drift off on her own as often as possible. She slept better earlier than my son, partly, I believe, as a result of practicing this skill from an early age.

      I wish more pediatricians told parents about the importance of teaching your baby to fall asleep on their own early, unless you intend to co-sleep. Babies start forming sleep associations as early as 4-6 weeks, and then by 4 or 5 months, they can be hard to break. Most night nurses, doulas, and others with significant newborn experience tell new moms about the importance of drowsy-but-awake.

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      1. Hi Amy, Thanks for your reply. More questions – can you still speak of “bad” sleep associations when the baby might need a feed before bed but always finishes herself at some point, throwing her head back and coming off the breast, is capable of going off to sleep just by munching on her muslin, often just with dad present? The problem we’re having is that she doesn’t stay asleep for long, and her night wakings in combination with wanting a feed and also ending up in our bed at some point at night are what’s taking its toll after 10 months. Even if her feeds might only last 5 minutes, and she comes off herself, it still can happen about 5 times at night. When she’s feeling under the weather even more. We had nights where she’d come every hour.So is the need to feed itself the “bad” association? There is the “camp” (or school of thoughts if you want) out there that says that night feeds are still important for babies under 12 months and shouldn’t be skipped. And I kind of agree with that. But I also don’t think that she’s hungry or thirsty or whatever EVERY HOUR. But, and here’s the question, sorry, – How do I distinguish between a genuine hunger waking and a god knows why she’s up again-waking? Where and when do I refuse the breast? What do I do instead? She doesn’t take bottles so a water bottle is not really an option. We could try the sippy cup but she’s no great fan of that either. We haven’t tried yet. And I also don’t know how to make her stay in her cot all night. I mean, of course I could shove her in another room, refuse any night feed apart from one maybe and just sit it out. But I’m simply not sure about how this would help her in connecting her biological sleep cycles and fall back to sleep on her own without feeling abandoned and left alone all of a sudden. How do I stop her from feeding so much, waking so much, needing our bed after she was fine in her cot without messing too much with Biology and Psychology? And the state they get in when they have cried for 5 or 10 minutes! It takes another hour just to calm them down! I can’t see how that helps. Again, please enlighten me. I’m willing to listen and learn. Thank you so much in advance for your time and effort.

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      2. Hi Romina, I would agree. Your daughter does not need to feed every hour at 10 months. She can go at least 8 hours without a feed at that age, and probably longer. When I sleep trained my children, they just transitioned to monster feeds in the morning. Their weight gain did not slow down. They were happy and alert. If she is getting up every hour, no one, not you and not her, is getting enough sleep.

        It sounds to me like you have some real fears about sleep training, though. And so it may not be the right approach for you, at least not yet. I would try to research some more gradual, and thus slower, approaches to weaning her off night feeds. Have your husband start putting her to bed and soothe her back to sleep, so she learns she can’t get milk. That should at least transition her hunger signals to daytime feeds, and should reduce the number of times she wakes up. If someone gave you your favorite dessert every time you woke up in the middle of the night, you might keep waking up and asking for it too.

        I would also try to get her to fall asleep on her own, and to fall back asleep on her own, as much as possible. Try to put her down when she is almost but not quite asleep, pick her up if she cries, but then put her back down while still awake.

        If you do ultimately decide to sleep train, I would just like to say, there’s no evidence that it’s harmful, and lots of evidence that it’s not.

        She clearly has a mother who loves her, a lot. And she is going to be just fine.

        Let me know how it goes.

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  10. Hi Romina,
    I tried to read the no cry sleep solution but found it of little use. Where as the The gentle Sleep Book, was both informative and reassuring. I felt the choices I made where the right ones. A lot of western parenting is based on what the Victorians did, ie cry it out and limited feeds, which we are now beginning to understand the effects its having. For me, once I accepted my sons sleep patterns and read the book life became a lot easier. The la leche league are great source of trusted information regarding Breastfeeding, i would trust them over any HCP every day. Our babies are small for such a short amount time. I know how hard sleep deprivation can be but personally for me I think CIO would be so much harder short and long term.

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    1. Oh great! I thought it’s only me who doesn’t get anything from it. I see if I can borrow the Gentle Sleep book from somewhere. That’s great, thanks so much for your advice. My guts would rather go with the gentle method.
      Regardless, I hope someone from the other camp can explain to me anyway what it is they are doing abd how it supposedly works.

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  11. All these comments about cio by people who know NOTHING about cio is so frustrating to read. Those who use it understand that we begin to understand whether out babies are possibly having a nightmare, feeling sick or whatever. They communicate their needs by their cry and we read and respond accordingly. We don’t just ignore regardless of how they sound. Maybe because you just go in at every noise, you haven’t learned to evaluate that? Also yes, I truly do believe that babies whose parents are constantly encouraging them awake by coming in every single time are sleep deprived. From a mom of 2 well adjusted and incredibly well rested boys

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    1. That’s not completely accurate. Those that are using CIO are actually ignoring their child’s cry, regardless of how they sound. I have many moms on a parent group I am on that use CIO. They quote recommendations from the Happy Sleep Habits Happy Child book that promotes CIO and leaving your child to cry “for up to an hour.” Moms are talking about how their child was so distressed they were throwing up, but they continued to ignore them in order to “teach them self-soothing.”

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      1. Actually, since I used a form of CIO for my children, what I said is exactly true. It’s not black and white. There are a great many ways of using CIO, the most extreme are what you have mentioned, bit there are many modified versions that don’t have children anywhere near the point of vomiting. We listen to what they want. When I determined it was a ‘I want to party at 3am, I didn’t go in’. The longest it would go would be 5-15 minutes. You assume that it is one way but it’s not. It has many many forms.

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    2. I’m a critic of what is often called “crying it out,” but what you are describing sounds ideal: listening and responding accordingly! (I’m not sure if this has come up already, but not every medical cause of sleep problems can be ruled out at a young age. Fortunately, listening can make it possible to care for needs that haven’t been identified yet!)

      I don’t see anything wrong with letting an unhappy baby express unhappiness through crying. Letting the crying run its course actually seems really healthy.

      But it’s distressing when a baby seems to be desperately asking for help and not getting any. There are well-meaning parents who don’t distinguish when babies are crying (as an expression of sadness, frustration, feeling tired) and when babies are panicking. The result is that babies are left screaming and hyperventilating and shaking with visible fear (not pitching a fit, but scared and losing it). And it lasts much longer than 5 or 10 minutes, because the babies get so worked up. I guess we could say this isn’t “crying” so this isn’t “crying-it-out,” but eventually–even if it takes an hour or hours–it does produce exhaustion. So maybe I’m really a critic of “letting scared infants wear themselves out panicking until they’re too exhausted to continue.” But people do call this “crying-it-out.”

      That’s where I’m coming from as a critic of the idea of “letting them cry it out.” What you describe sounds like a decent way to treat another person and also thoughtful, attentive, and attuned to individual difference. What I’m used to is a one-size-fits-all mandate to ignore noise that happens after bedtime, *especially* if the noise starts to sound frantic or lasts a long time.

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    1. I find it interesting that the author did not reply to this comment, because I think it the article posted addresses all of her counterpoints in a very systematic, researched, and cited way. I’d really like to hear her response to it.

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  12. STTN is a developmental milestone – like walking, talking etc. If you would not force your child to walk before they are ready (there are sadly parents who try by using awful props like walkers which are a hindrance to long term development) then why try and do it with sleep? Trying to use adult sleep habits and imposing them on babies is incredibly unfair – and yes, it is selfish and purely for the benefit of the parents. If you’re not prepared to deal with the lack of sleep – maybe rethink the whole idea of having children

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  13. There is a book called The Anthropology of Childhood: Cherubs, Chattel, Changelings, that among other very interesting topics, talks about how different indigenous cultures approach infant sleep. There are cultures where babies are constantly catered to, and there are cultures where babies are essentially ignored for the first three years of life (other than being fed). Each culture ‘grows’ children into adults that fit in with that culture. I find it important to understand that there are many ways for us to teach our kids how to be functional adults in our culture and that training starts when they are infants.

    Thanks for the interesting article. I’ve been enjoying getting a more science-based look at all these controversial issues. It’s not easy to realize that sometimes science does not support our beliefs, but it’s so imporant to be open minded.

    Liked by 1 person

  14. I didn’t sleep train my first child and became so chronically sleep deprived and depressed I could hardly function.
    I now have a second child (5 years later) and I decided to sleep train. I have 2 totally different children. The latter being so much more relaxed and happy and the other very wired and sensitive.
    A mum has to do what they can to be rested and happy for her children and if that means sleep training then so be it.
    Great article. I’m so sick of being made to feel inadequate and guilty for trying to get my baby to sleep.

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  15. I’m a fan of RIE, Dance with me in the Heart by Pennie Brownlee, and Janet Lansbury’s blog. I believe all three vouch for letting children learn how to settle themselves to sleep in a gentle version of CIO. That’s not “leave your child to cry every night for hours” but a belief they can and will learn it and deserve the chance. I thoroughly recommend hearing more about it from the authors themselves, as it gave me the confidence I needed.

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