Controlled Crying - Miracle Cure, Tough Love or Dangerous Misunderstanding?

It is estimated that 25% of babies suffer from prolonged periods of excess crying and nearly 60% of babies still wake regularly at night at 9months of age (4) small wonder then that so many parents are crying out for help with their baby’s sleep. For most of these this help will come in the form of sleep training involving managed crying episodes. “Controlled Crying”, “Cry it Out”, “Wind Down Crying”, “Pick Up, Put Down”, “Spaced Soothing”, or whichever new term picked by the latest expert to make the whole process sound new or more gentle, these methods are a temporary fix to a problem that can cause much more harm than goood.

Leaving babies to cry for a predetermined period of time in order to teach themselves to fall asleep (or “self settle” as are the common buzz words of the moment) was introduced by Dr Emmett Holt in his 1895 book “The Care and Feeding of Children”, this idea was then popularised by Dr Richard Ferber (which gave rise to the term “Ferberisation”) in his 1985 book “Solve Your Child’s Sleep Problems”. Since then many babycare authors have picked up on the trend of leaving babies to cry for an increasing period in order to encourage them to get themselves to sleep and not wake in the night, the most famous of these being Gina Ford in “The Contented Little Baby” book.

Does controlled crying work? One cannot refute that it does, however this also depends on your definition of “work”. Does it make babies quiet throughout the night? usually, yes. Does it guarantee long term nights of sleeping through? No, in fact many sleep trained babies regress back to regular wakings around 9mths to 1yr (3) (there  is no small coincidence this coincides with seperation anxiety), Does it guarantee “contented babies”? Here many gentle parenting advocates around the world would echo a resounding NO. Another thing to consider also is WHY it works? and perhaps the most important consideration of all – What is NORMAL infant sleep?

Let’s start with an understanding of what normal baby sleep is. When a baby is in utero he borrows the circadian rhythms (natural sleep/wake cycle) of his mother as melatonin is passed to him via the placenta, after birth however, he’s on his own and it takes his wee body a while to be able to do what his mother’s did. In fact it takes him until at least 4mths to get anywhere close and even longer – until he begins school at AGE 4 to really get the same effect. That’s not all though, not only do they lack the hormonal regulators of sleep of an adult – a baby’s sleep cycle is hugely different, in fact it’s very simplistic, composed of two basic states (quiet – deep -sleep and active – alert – sleep) and is about half the length of an adult sleep state. Now this makes perfect biological sense, it keeps our tender young offspring more alert should a predator threaten their life – but what predator will come and gobble them up in their nursery I hear you ask? Nature might be clever, but not quite clever enough to evolve us that quickly, so – for now – we still possess the same innate responses that kept our hunter gatherer predecessors safe. Imagine then that a baby goes through a sleep cycle twice as quickly as an adult, that means they wake AT LEAST twice as much as us during the night, in fact they move into a light sleep state around once every 25 minutes. That means they have the likelihood of waking fully every 25minutes if something alerts them – but we must remember this is a GOOD thing, it plays a vital role in SIDs prevention, keeps them well nourished and in a good state of homeostasis.

Why then do we presume babies “should be able to sleep through by 12 weeks” (or even younger according to some experts!) – for a start that is WRONG, a baby will not “sleep through” – they WILL wake, LOTS they just may not alert us, as parents, to the fact (why cry out if nobody comes?). It is NORMAL for a baby to wake – LOTS – in the night!

Now, let’s look at why babies might cry during the night. Babies always cry for a reason, they simply do not have the required connections in their brain to manipulate us. Sometimes they cry because they are hungry, sometimes thirsty, sometimes cold, sometimes hot, sometime uncomfortable, sometimes needing a nappy change, sometimes needing human contact, sometimes scared, sometimes over stimulated…..sometimes, well who knows, because all babies are different!

Controlled Crying/CIO highlights a gross misunderstanding of a young baby’s brain and neurophysiological development. This presumes tiny babies can form habits and  think logically and rationally, the only thing is….they can’t! when a baby is born their brain is incomplete, not only is it  smaller than an adults, the vast majority of its 100 billion neurons are not yet connected into networks. Babies simply don’t think like we do – the neocortex – the home of logical thinking – does not really spring into life until 3yrs plus, before that a baby’s brain is very primal – focussed on survival and basic emotions. That said early experiences can and do  have a big impact on the wiring of an infant’s brain, a baby’s brain has twice as many synapses (connections) as the child will eventually need. If these synapses are used repeatedly they are reinforced. If they are not used repeatedly, they are eliminated – therefore we can cause permanent changes in the brain structure of our children, both good and bad. Depriving a baby of the love and contact they need in infancy alters the neuroplasticity of the brain, changing the wiring in the relationship part of the brain which affects the individual’s experience of relationships long into adulthood. Research on the impact of early attachments confirms that warm, responsive caregiving is essential to healthy brain development and ironically those babies who were allowed to be attached as a baby are the ones that can TRULY self settle as older children and adults!

So why then does controlled crying/CIO “work”. The easiest way to answer this is to imagine being upset or hurt yourself. Imagine crying, crying for comfort from a loved one and them ignoring you, albeit only for a minute or two before briefly comforting you (with limited speech and eye contact) and then leaving you again, you cry for 2 or 3 more minutes, they come in and half heartedly comfort you before leaving again, this continues for hours. Now ask yourself, would you bother to keep crying for them? or would you finally give up, shut down and push your hurtful emotions inside? The techy answer here is to discuss Martin Seligman’s Theory of Learned Helplessness. Accidentally discovered in 1965 whilst researching the relationship between fear and learning, Seligman discovered that the harnessed dogs in his experiment learned to be helpless (stand still and accept it) when Seligman rang a bell whilst shocking them. Seligman then allowed the, this time unharnessed, dog to move out of the way and rang the bell again. The dog did not move, it had learned to be helpless and did not even try to avoid the painful stimulation, it had learnt it was futile trying to get away from the shocks, just as it is futile for the baby to continue crying when nobody gives them what they really need.

Does controlled crying work? Yes, if you want your babies to learn helplessness and sit in their cot not communicating their needs, then yes indeed it will give you many nights of unbroken sleep!

The negative consequences of controlled crying are many. I shall list them all below:

• babies miss out on stimulating touch
• babies may not receive as much nutrition
• increased cortisol levels *** and neurological damage
• increased pulse, blood pressure and temperature
• vomiting
• potential SIDS risk
• learned helplessness phenomenon
• potential effects on breastfeeding
• potential effects on secure attachment

The Australian Association of Infant Mental Health (AAIMHI) states:

“Controlled crying is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences. There have been no studies, such as sleep laboratory studies, to our knowledge, that assess the physiological stress levels of infants who undergo controlled crying, or its emotional or psychological impact on the developing child.”

If you like this article you’ll find many more  suggestions and discussions on baby sleep, colic, babywearing, co-sleeping/bed-sharing and much more in my newly released BabyCalm Book – available from AMAZON IN THE UK or with worldwide free delivery from THE BOOK DEPOSITORY if you live elsewhere in the world!

I shall leave the final comment here to Dr Paul Fleiss * who sums it all up so well:

 ”The idea, often heard these days, that babies can and should learn to “self-soothe,” without any physical or emotional interaction with parents, is incorrect. The best and most effective way for a child to learn to lull himself quietly back to sleep after experiencing a night waking is for parents to have demonstrated their dependability and availability when the child was a baby. Otherwise, that emotional upset the baby suffered as a result of the traumatic event that aroused him from sleep in the first place may, be compounded by the terror and frustration of feeling abandoned and unwanted. If a baby learns that his mother will come to him whenever he awakens in distress and cries out for her, he is more likely to develop into a self-reliant and self-assured child who will have the ability to assess and manage his own night wakings without involving his parents unnecessarily. It cannot be overly stressed that depriving a baby or a child of emotional support when he needs or wants it runs the risk of creating an emotionally unstable child and eventually an emotionally unstable adult. Only good can come from cuddling your baby whenever he needs it. “

If you would like to learn about gentle alternatives to controlled crying/sleep training have a read of THIS POST.

* = Mistaken Approaches to Night Waking
Excerpt from Sweet Dreams: A pediatrician’s secrets for your child’s good night sleep, Lowell House, 22-28
By Paul M. Fleiss, M.D., M.P.H., F.A.A.P., 2000

** = when a baby continuously secretes cortisol as an infant it can have an effect on their stress response in later life (they may either over or under produce cortisol when stressed as an adult – either of these is undesirable too much cortisol can lead to anxiety and depression – too little can lead to ambivalence and emotional detachment).

References

Scher “A Longitudinal Study of Night Waking in The First Year”, 2006, Child Care, Health and Development.

by:

Sarah (Mum to Four, Parenting Author and Founder of BabyCalm Ltd)

You can read more of Sarah’s articles HERE.