Alright folks. It’s time to unleash the Cry-it-Out debate!
I am guessing that by now you have at least heard about sleep training.
Maybe you’ve come across the term while Googling some sleep tips after a particularly difficult night. Or, maybe a well-meaning friend or family member is nagging at you to get on with it already.
A little disclaimer for anyone who has used or tried sleep training in the past. I get it! I really do. The sleep world is so H-A-R-D! This is not meant to make you feel bad, or regretful, or doubt your parenting skills in any way. In fact, I think the fact that you are reading this makes you just the savvy parent that is going to raise a wonderful kiddo!
For those who are new to this. There are a number of names, brands and variations of sleep training. Including: cry-it-out, CIO, extinction, graduated retreat, timed checks, ferberizing and more…
They are all similar in that they involve leaving a baby or child to sleep independently, typically in a crib, in a separate bedroom from their parents with minimal, timed, or no response from the parents during the night – even if the child is crying.
In essence sleep training is when you set a limit on what you will (or won’t) do for your child. The caveat here is that this limit is decided by the parent (or sleep coach) WITHOUT factoring in the child’s actual and very real NEEDS for responsive, close, loving, connection and comfort.
Sleep training involves doing the bare minimum (or nothing!) to support your child to fall asleep. The argument that sleep trainers love to use, is that you are training your child to become self soothers who can then put themselves to sleep independently. Usually, there is a push for them to sleep in their own room. (I’ll admit this does sound lovely!)
However, these methods came about decades ago, based on behavioural philosophies. Historically, they had been recommended by some big names in the literature. Advocates of sleep training promise a quick and effective solution to your sleep problems.
Opponents (including myself) are not quite convinced.
Let’s just say for a minute that it does work, personally, I still want to know…at what cost.
What are the side effects?
Is there any potential for harm?
This is the very root of informed consent. Knowing all the risks, and all the benefits.
The truth is we really don’t know!
So, today, I am going to talk a bit more about what we DO know, and what we have yet to learn about sleep training.
1) Crap Research
The first problem is that we do not have enough quality research. Sure, there have been studies looking at sleep training. The problem is that this research has been highly flawed. It’s true that there is no such thing as perfect research, but the best studies looking at sleep training have serious challenges, like: high dropout rates, small sample sizes, and poor comparison groups. One study looking at the relationship between sleep training and stress even tested the wrong type of cortisol (apparently there are two different types, who knew!?).
2) It Doesn’t Always Work, and Is Not a Long Term Solution
Advocates of sleep training commonly cite these flawed studies when convincing parents that sleep training is the best option. What doesn’t quite make sense to me is how they drew this conclusion though. Some of the studies show no benefit, and of the ones that do, show a modest benefit (as in a mere 20 mins in 24 hours!). To make matters worse, any benefit gained tended to be lost following any change in development or circumstance (i.e. nap transition, teething) requiring the sleep training process to be repeated multiple times. Talk about stressful!
3) It Stresses Kids Out
The part that sticks with me the most is the results of one particular study that showed heightened cortisol levels in babies – even after the babies stopped crying! This research tells us that when sleep training, the babies remain stressed and anxious even if they are quiet and seemingly calm.
So as it turns out, this self soothing or self settling thing that often is the key selling point for parents when deciding whether to sleep train their child is actually a myth. The more appropriate term for this would be self regulation. Which does not even start to be developmentally possible until the age of 4, and continues on developing until the mid to late TWENTIES!
You could add this all together to say that sleep training is essentially training your child to stop signaling (i.e. crying) for their parents. So instead they lay alone and stressed until they fall asleep out of exhaustion, and/or maxed out sleep pressure.
It’s a pretty bold statement, that hits home a little too hard for some (including me!)
4) Too Much Stress is Bad
Research tells us two things about our parental response. 1) That children who have been parented with a nurturing, responsive approach tend to develop more gluticorisoid receptors (which is a good thing). This helps them to respond better to stress and to get over things more quickly – even into adulthood! 2) That children who have been parented by non-responsive parents tend to have fewer gluticortisoid receptors which can lead to a heightened stress response and a slower recovery from stress – again into adulthood. Scary right? Problem is…
5) We Don’t Know Where to Draw the Line
How much is too much? The fact is we just don’t know. There are some who equate sleep training with child neglect (a form of child abuse) which has the potential to cause physiological (i.e. biological), psychiatric, and psychological harm. Personally I think that this is a bit of a stretch to equate sleep training with the type of long term, devastating neglect seen by social workers. However, the fact remains that all babies, toddlers and children are individual. They have their own unique set of protective factors, genetic predispositions, and vulnerabilities. I do not doubt for one minute that some little ones are harmed more than others. It’s just not worth the risk!
6) It Can Make Sleep Worse
It is not uncommon for parents to report a worsening of sleep following sleep training. This is in part because we have broken our child’s trust. Children thrive on consistency. It helps them to feel SAFE. When we don’t respond to them in the way that they expect and require, they can become anxious or develop separation difficulties. Parents often notice that their kids become more clingy in the days and weeks following sleep training. This is likely related to our innate need to repair any rupture in attachment. Which makes sense, babies especially are 100% reliant on their parents. They NEED that relationship to work.
Here’s another sciencey tidbit about attachment and sleep. Research tells us that kids with a secure attachment tend to sleep better. This includes having less difficulty falling asleep, staying asleep, AND their sleep tends to be of better quality overall. These benefits last into adulthood!
So by attending to your child responsively, and developing that secure attachment you are increasing your chances at having a good sleeper for life!
7) It’s not Biologically Normal
This might surprise you, but contrary to societal expectation, babies (and even toddlers and preschoolers!) are NOT actually meant to sleep through the night. Nope afraid not! They are biologically hardwired to sleep the way they do. This is, in short, shallow sleep cycles. Part of this is to ensure they get adequate milk. But, we also now know that this is protective against SIDS. Their circadian rhythm is actually quite a bit different than adults, so we probably shouldn’t be expecting them to sleep like adults. Hmm.
8) It Makes Sleep a Scapegoat
Sleep is not always the problem. There are SO many reasons why kids wake at night. Think feeding issues, torticollis, reflux, sleep apnea, teething, gas pains, environmental stressors, hunger, discomfort, itchiness, etc etc etc. The list goes on. Focusing entirely on correcting sleep without looking to the why ignores the cause. The problem is, that if the cause is not actually a sleep issue, the solution will not work! (they don’t tell you this in the sleep training books do they!?) Think about it though, if your little one is in pain, or has sleep apnea for example how is this going to help them sleep better?
This is why I am a big fan of holistic sleep support. The goal is to find the cause, and work on a solution….and let me tell you, it’s rarely just about sleep!
9) Parents Hate Doing It
Parents don’t tend to want to do CIO. And, why would they? There are alllll of the negatives discussed above PLUS it’s incredibly stressful and exhausting. As parents, and especially Mothers…we are biologically hardwired to react when our babies cry! This is adaptive genetics at its finest and it’s basically so we don’t end up abandoning our child and leaving them to the wolves in the wild whenever we need a break. Thus, it is incredibly hard to listen to a child cry while doing nothing.
No parent really wants this. They just want to to know that their child is normal, that they are doing the right thing as parents AND of course they want to feel more rested
And if all of that is not enough, here is my last point. I should have probably mentioned it first, because it’s an important one that I don’t think many parents realise.
But…
10) You can help your child sleep better WITHOUT sleep training!
And that my friends is what I have based my business on. All of the ways to help families get rest that are in tune with normal, biological sleep requirements, attachment theory, positive parenting practices, maternal mental health and and family wellness.
Not only is it possible, but most parents prefer this to sleep training.
Better sleep, better everything!
~ Maisie
PS – If you are tired and want to give my Ultimate Guide to Bedtime Routines a try CLICK HERE!
Selected References:
Gradisar, M., Jackson, K., Spurrier, N. J., Gibson, J., Whitham, J., Williams, A. S., … & Kennaway, D. J. (2016). Behavioral interventions for infant sleep problems: a randomized controlled trial. Pediatrics, 137(6), e20151486.
Hiscock, H., Bayer, J. K., Hampton, A., Ukoumunne, O. C., & Wake, M. (2008). Long-term mother and child mental health effects of a population-based infant sleep intervention: cluster-randomized, controlled trial. Pediatrics, 122(3), e621-e627.
The Holistic Sleep Coaching Program https://www.holisticsleepcoaching.com/
Hookway, L (2019). The cry it out debate. https://feedsleepbond.com/the-cry-it-out-debate/
Middlemiss, W., Granger, D. A., Goldberg, W. A., & Nathans, L. (2012). Asynchrony of mother–infant hypothalamic–pituitary–adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Early human development, 88(4), 227-232.
Price, A. M., Wake, M., Ukoumunne, O. C., & Hiscock, H. (2012). Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial. Pediatrics, 130(4), 643-651.
Simons, S. S., Cillessen, A. H., & de Weerth, C. (2017). Associations between circadian and stress response cortisol in children. Stress, 20(1), 69-75.