Sleep

Put Cry-It-Out to Bed

CIO

Sleep Training: Sleep is not learned.

There are a lot of sleep trainers out there who will begin by espousing the importance of sleep for your baby’s health and then explain that it is your responsibility to teach (force) them to sleep. Sleep is not a learned behavior. A learned behavior is something we are not born knowing how to do. Babies know how to sleep just fine. Sleeping like an adult is learned—over the course of an entire childhood as the needs of your baby’s brain and body mature.

Babies are capable of and content with doing the things evolution programmed them to do: the things that are in the best interest of their health. Your baby will happily sleep on your chest where he is being protected, soothed by your heart rate, having his temperature regulated, reminded to breath from the sensations of your breathing, bonding through skin-to-skin contact, and positioned with his upper body slightly elevated to ease digestion. He will wake every couple hours to boost oxygenation and blood flow from the increased heart rate and take in the breastmilk calories needed for healthy growth and optimal development.

Oh yes, your baby can sleep just fine. Babies sleep when they are tired. They can’t tell time and they selfishly know nothing of your schedule or needs. Try to look at it from your baby’s perspective. Maybe you need to “learn” to accommodate his sleep schedule so that instead of being up all night (crying alone in a crib), your baby can get some sleep (in close proximity to you). If you flip the scenario on its head, it is the exact same situation! Of course, you both need to come together and compromise some to your mutual benefit so you can both get some sleep. Utilize a sleep arrangement that meets both your needs. You need sleep too in order to give your baby the best care you can. But your sleep agenda is not inherently more valid than your baby’s. Come to the table with an understanding of and respect for the fact that your baby sleeps just fine, and you are asking him to change to meet your needs just as much as your baby is asking you to change to meet his.

“Genetics were seemingly responsible for the sleep habits of 47% of 6 month-old babies, 58% of 30 month-old babies and 54% of 48 month-old tots. … The study also tells us that methods such as cry-it-out may never work for some babies because they’re simply made to awaken during the night, no matter what, and deserve comfort when they do wake. In other words, ignoring a baby who is genetically designed to awaken frequently, won’t help change your baby’s habits.” [Reference]

Research: Legit science, yo.

There was a study (which proved to be a cornerstone of infant sleep research) that proved that sleep training extinguishes the communication but not the physiological distress. Even after the communication is extinguished (the baby stops crying), the stress response (elevated cortisol level) is still present! Think about that and really let it sink in. This means that Baby is not “learning to self-soothe.” Baby is learning not to bother asking her mother for help when she is in distress because her mother does not care for her. Baby is not suddenly no longer in distress—Baby has just lost trust in her parent. [Reference]

This is sometimes referred to as the “defeat response” by neurobiologists. When humans feel threatened, a spike of cortisol facilitates “fight or flight.” Since infants can’t fight or flee, they cry out for help. When that distress call is ignored, the trauma elicits the defeat response. “Babies eventually abandon their crying as the nervous system shuts down the emotional pain and the striving to reach out.” [Reference]

Another disturbing facet of this study taught us that through CIO, mother and baby stress levels become dissociated. Normally, when Baby is distressed, Mom is distressed, and as she tends to Baby, both stress levels are lowered. It is maternal nature at its finest. But after CIO, mothers no longer experience stress along with their babies, so Mom is not as drawn to care for Baby and thereby lower Baby’s stress level. Once the communication (cry) stopped, the mother’s stress went away, while the baby remained in a silent physiological panic.

This prolonged flooding of the infant’s brain with the stress hormone cortisol has a plethora of scientifically documented consequences on brain development and the nervous system. It results in a child either under- or over- producing cortisol when under stress. “Too much cortisol is linked to depression and fearfulness; too little to emotional detachment and aggression.” [Reference]

“Pain responses are activated when babies are physically separated from their caregivers. This leads to the ‘underdevelopment’ of receptors for serotonin, oxytocin and endogenous opioids – chemicals essential for our experience of happiness. In particular, the neural pathways formed by oxytocin released in our infancy remain with us and continue to impact our adult physiology. When these pathways are compromised it makes forming healthy, future attachment relationships challenging at best.” [Reference]

One study looking at anxiety in rats found that low maternal nurturance during infancy failed to activate the gene that builds the neural pathway for managing anxiety. These rats remained anxious when faced with new situations for their entire lives. Our mammal brains work in the same, having a sensitive period of brain develop that requires a high level of nurturance to develop to it’s healthiest, happiest potential. [Reference]

Remember: one of the main reasons babies wake during the night is to breastfeed. So what happens when you abandon infants’ nighttime feeding needs? They literally starve. The AAP even went so far as to issue an official warning against Babywise, the most popular baby training method: “…On Becoming Babywise, has raised concern among pediatricians because it outlines an infant feeding program that has been associated with failure to thrive (FTT), poor milk supply failure, and involuntary early weaning. A Forsyth Medical Hospital Review Committee, in Winston-Salem N.C., has listed 11 areas in which the program is inadequately supported by conventional medical practice. The Child Abuse Prevention Council of Orange County, Calif., stated its concern after physicians called them with reports of dehydration, slow growth and development, and FTT associated with the program”. [Reference]

That “involuntary early weaning” is a common result of sleep training. You may have had a successful nursing relationship, but once the trauma of sleep training sets in, your baby enacts what is sometimes referred to as a “nursing strike”—refusing to breastfeed altogether. If you find yourself in this position, I recommend the immediate help of a lactation consultant and, obviously, to immediately cease and desist your sleep training efforts.

Even Dr. Ferber himself, who admitted to having little knowledge of infant psychology yet pioneered the CIO approach and whose name is synonymous with CIO in verb form (“Did you Ferberize your baby?”), has since had a change of heart and mind. “The doctor says he’d just as soon it went to sleep.” [Reference]

Anecdotal Evidence: “But my friend’s baby sleeps through the night and she says her baby is Einstein reincarnate and they are closer than PB&J.”

The research is clear and importantly teaches us to be very respectful of our infants’ nighttime needs. Yet some parents are confused about the issue of leaving a baby to cry alone at night as a means of training the baby to sleep independently (CIO or Controlled Crying, or any other sleep training method that involves not responding to Baby’s cues of distress) by what’s called anecdotal evidence: “I did CIO with my kids when they were babies and they are very well-rounded children who still love me.”

First, it is valuable to understand that a parent who made a certain parenting choice is drawn to seeing only what validates that choice. For example: “Baby stopped crying after I left him alone screaming for three nights. This fostered independence, so I made the right choice.” Of course, that is not what happened at all, but we assign meaning to experiences that bring us the most peace. Parents who used CIO will see one example of their child being connected to them (“He didn’t want to leave me yesterday,” or “He wanted to cuddle this morning.”) and attribute it to having a very close maternal bond. Of course, “close” is relative. Does he hate you? Of course not—you’re his mother. All primate offspring have a powerful and innate connection to their mothers. Does he fully trust the security of your love? I don’t know.

Second, it’s all relative. Think about those kids on the playground whose parents say, “We swat our kids and they are fine,” as their children run around physically bullying other children. If your threshold for “fine” is “not an ax murderer,” then sure, you are coming out ahead. Your standards and goals for your child’s well-being are very different from the next person’s. So when parents say they used CIO and their kids are awesome, that doesn’t mean they are awesome objectively, it means those parents see their children as awesome.

Third, some children are incredibly resilient. Some are much less so. Some babies could survive CIO fine. Many could not. Just as some kids can walk away from serious abuse to live successful lives while many, many more do not. The problem is, you just don’t know until the damage is done. It is particularly worrisome when you think about the fact that children with a high level of need (a high potential for anxiety when older) are the very group most likely to be sleep trained.

Fourth, not everyone is clear on the difference between a baby crying-in-arms versus crying-it-out. My babies sometimes cried while I held, loved, and cared for them. That does not elicit the same stress response as CIO. It is okay for a baby to communicate his feelings with you through a cry. When the message is, “I am here for you; tell me all about it,” the bond is enhanced.

Fifth, I want to add that while CIO is never in the best interest of a baby directly, there are rare circumstances in which a parent is in a position where CIO is necessary to ensure the overall safety or indirect best interest of the child. If a frustrated parent is about to shake her baby, I would prefer she place the colicky baby in a crib and walk away for a break. So while making it clear that CIO is never in the direct best interest of a baby, I wouldn’t want to ban that option from existence altogether. I just advise parents that if they choose to use CIO, it needs to be because the benefit to their baby, whatever the reason, will be worth the negative effects.

Nights with a baby will entail less sleep than your pre-baby nights. They just will. As mentioned earlier, parenting is a 24-hour job—you don’t get nights off. Your baby’s needs don’t set with the sun. When you chose to have a baby you signed a cosmic contract to nurture this human being, a soul on loan from the universe. You cannot “grow them up” before they are physiologically capable or psychologically ready. You don’t need to teach your baby to do something infants are born doing. You just need to tap into the frequency of your little one and respect who he is and where he is right now. Achieving nighttime harmony is not a gold standard destination but a journey of living in a harmonious balance of meeting your baby’s nighttime needs while getting the rest you need to lovingly parent your child. So hide the clocks, resist any temptation to seize control, and allow your mindset to shift. You can paint a beautiful and restful night with your baby. Once the sun sets on this season of infancy, you will transition into more sleep independence in stride with more independence overall.

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