Here it is the big term: Sleep Training…(insert dramatic music here).
Why is sleep training so controversial these days?
Sleep learning is probably a better word for it.
The internet and misguided opinions have taken this term which actually encompasses a number of different techniques that help babies learn to sleep and made it to mean one thing..cry it out.
This automatically makes parents cringe at the thought of leaving their sweet baby in a room, closing the door and letting them cry all night long by themselves. Completely understandable! and yes no parent likes to hear their baby cry.
But this is not what sleep training means AT ALL! This is severely misguided. It gives parents the impression that there is only one way to help your baby and your family get better sleep.
Let me just tell you that there are MANY ways that parents can choose to help baby sleep and it’s not as limited as one method that to be honest, is rarely used.
As a sleep consultant, I work with parents of ALL parenting styles and I used over 10 different sleep training techniques, ranging from VERY gentle- where parental presence and soothing play a huge role, to methods where you are present and responsive while gradually working on learning new ways to sleep to methods that allow crying with parental checks to buffer any stress. No matter what method of sleep training you choose, they all end in the same goal, independent sleep or re-directing the association. They all work and although the path is difference the results are the same. NONE are harmful and none will “damage” your child or rupture attachment.
If you are working on re-directing behaviour in any way, I’m sorry but that’s sleep training. Call it what you prefer but it’s the same thing with the same goals.
What you choose depends on your child’s temperament, your level of comfort and YOUR family. No one can choose a sleep training method for you (although after a complete assessment, I can offer some suggestions).
About Crying
No matter how you approach sleep, you can’t always eliminate crying altogether, nor should you. A baby’s cry is their way of communicating with us that they aren’t happy about something or that they want something that they don’t have. They might be frustrated but it’s unrealistic for us to think that our babies will be content 100% of the time.
We can limit crying but we can’t stop it, being allowed to express emotion is a part of creating healthy responses to difficult or stressful situations. What makes the difference and where this whole debate is misconstrued is the role of parents in responding (not reacting) to their babies cries in a supportive way.
Please note: whatever approach you choose should be developmentally appropriate for your baby's age. Newborns vary greatly from 5-12 month old and toddlers. So ask me what is age appropriate for your baby. Age makes a huge difference.
The bottom line
All research to this point on sleep training states that it is NOT harmful and that in fact, it’s actually beneficial for both babies and the health and wellbeing of families. A well rested child, will cry less in the long run, be less fussy and irritable. Let’s be real, sleep deprivation is no fun for you but can you imagine how miserable it makes your baby?!?
The proof is in the studies, these are peer reviewed scientific studies. NOT a blog of someone’s opinion and a mishmash of studies pieced together to prove a bias but actual scientific, peer reviewed studies.
The American academy of Pediatrics, the leading authority on information related to baby health states that:
behavioral intervention, (A.K.A Sleep training) “provide(s) significant sleep benefits above control, yet convey(s) no adverse stress responses or long-term effects on parent-child attachment or child emotions and behavior.” Let me tell you these guys would never say something like this so bluntly if they weren’t 1000% sure.
There are many more of these studies which I will include below, not to mention the number of studies on the importance of sleep and the detrimental and even lethal effects of chronic sleep deprivation. Also included below.
“He also discusses various forms of CIO such as cry it out in arms (done with dad) and how to change a baby’s sleep associations over time. Dr Sears, James Mckenna and Elizabeth Pantley, all agree that children and families need sleep, it’s not a want or a luxury it’s a biological necessity, they all agree that if your situation is no longer working for your family you need to change it.”
Key point: IF IT WORKS FOR YOU, KEEP DOING YOU!! Absolutely no judgement there, but if it doesn’t change it.
Sleep deprivation is no joke, it’s dangerous and sleep is a need just as important as feeding, cuddles and diaper changes. So no matter your level of comfort, what you choose for YOUR family and YOUR parenting philosophy there is an approach for you. I guarantee it doesn’t have to be cry it out.
Talk to me and I can guide you on what sleep training method might be best for you. There are so many factors to consider and that’s where I can offer expertise. Making an informed choice that suits your family and baby is the key to success. I can help. It can be fast, you can be comfortable and you can be 100% sure that it will work and you can begin to enjoy life again.
Evidence:
Journal of Abnormal and Social Psychology (1959) : "No unfortunate side - or after affects of this treatment we’re observed. At three and three-quarters year of age, the child appears to be a friendly, expressive, outgoing child."
Journal of Developmental and Behavioural Pediatrics (1991) : "Extinction is an effective, reasonably rapid, and durable treatment for infant sleep disturbance [three citations]…mothers became less anxious as the study proceeded… [the data show that extinction] is consistent with previous reports on improvements in parental self-esteem, depression, marital satisfaction, and sense of control following extinction-based treatments of sleep disturbances [cites two additional supporting studies]. Some have argued, sometimes forcefully, against the use of extinction procedures with infants, on the grounds that such procedures will damage the infant-caregiver (mother) bond and impair the infants sense of security. A measure of infant security was explicitly included in this study to test this hypothesis, and again, the results are clear. Infant security improved significantly over the course of the study…we can reject the hypothesis that exposure to extinction…will impair security."
Journal of Pediatric Psychology (1992): "Measured and compared the behaviour characteristics and security scores of infants (6-24 months) treated with extinction for sleep disturbance.. There was no evidence of detrimental effects on the treated infants whose security, emotionality/tension, and likeability scores improved."
Journal of the American Academy of child and adolescent psychiatry (1994): Sleep training improved daytime mother and infant interactions.
Journal of Paediatrics and Child Health (1998): "Cold turkey extinctions [and other methods improved] problematic childhood sleep behavior [and] is associated with significant improvement in maternal mood. It is likely significant numbers of mothers diagnosed as having postnatal depression are suffering the effect of chronic sleep deprivation'
Journal of Abnormal Child Psychology (1999): "Both [extinction and graduated extinction] treatments improved bedtime and nighttime sleep problems and only positive side effects were associated with both treatments. Graduated extinction was easier to implement."
Gunnar, M.R. and B. Donzella. Social regulation of the cortisol levels in early human development. Psychoneuroendocrinology. 27(1-2): p. 199-220. 2002.
Jansen, J., R. Beijers, M. Riksen-Walraven, and C. de Weerth. Cortisol reactivity in young infants. Psychoneuroendocrinology. 35(3): p. 329-38. 2010
Middlemiss, W., D.A. Granger, W.A. Goldberg, and L. Nathans. Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Early Hum Dev. 88(4): p. 227-32. 2012.
A CIO study which showed no increase in cortisol between the pre-bed time sample and the CIO sample.
Ahnert, L., M.R. Gunnar, M.E. Lamb, and M. Barthel. Transition to child care: associations with infant-mother attachment, infant negative emotion, and cortisol elevations. Child Dev. 75(3): p. 639-50. 2004.
Karraker, K.H. and M. Young. Night Waking in 6-Month-Old Infants and Maternal Depressive Symptoms. J Appl Dev Psychol. 28(5-6): p. 493-498. 2007.
Despite these widespread claims of negative outcomes for babies who are sleep trained, there is no real evidence to back it up. As some researchershave pointed out, the only evidence that crying can be detrimental to infant development comes from studies on long term abuse and neglect; none of these studies look at the effect of brief periods of crying in an otherwise loving family. Sleep training generally doesn’t involve sustained crying for long periods of time—only brief and controlled periods of crying that usually doesn’t last more than a few days.
One recent study looked at children who had been sleep trained as babies five years later to see if there was anything different about these now 6-year-olds when compared to 6-year-olds that weren’t sleep trained as infants. The study found that there were absolutely no differences between these kids: Sleep trained kids were no more likely to have emotional problems, sleep problems, or attachment issues than kids that weren’t sleep trained as babies. In fact, there was nothing positive or negative about sleep training in the long-term, and kids were all sleeping well at age six whether they were sleep trained or not. This study suggests that there aren’t any negative long-term effects of sleep training, and that there aren’t any positive ones either. That means whether you choose to sleep train or not, your baby will probably be fine and eventually sleep through the night.
Despite there being no evidence of negative consequences of sleep training, there’s a lot of evidence that there are serious long-term negative consequences of sleep deprivation, including depression, inattentiveness, and marital problems.
Price, A.M.,M Wake, et al (2012) “Five-Year Follow-up of Harms and Benefits of Behavioural Infant Sleep Intervention: Randomized Trial” Pediatrics. Published online September 10, 2012.
Hiscock, H. J. K. Bayer, et al (2008) “Long-term mother and child mental health effects of a population-based infant sleep intervention: Cluster-randomized, controlled trail” Pediatrics 122 (3) e621-627.
Hiscock, H, J. K. Bayer, et al (2007). “importing infant sleep and maternal mental health: a cluster randomized trial” Arch Dis Child 92 (11): 952-958.
http://scienceofmom.com/2012/03/30/helping-babies-cope-with-stress-and-learn-to-sleep/
The following references all show the benefits of great sleep!
1Tarullo, A.R., P.D. Balsam, and W.P. Fifer. Sleep and Infant Learning. Infant Child Dev. 20(1): p. 35-46. 2011.
Scher, A. Infant sleep at 10 months of age as a window to cognitive development. Early Hum Dev. 81(3): p. 289-92. 2005.
Gomez, R.L., R.R. Bootzin, and L. Nadel. Naps promote abstraction in language- learning infants. Psychol Sci. 17(8): p. 670-4. 2006.
Hupbach, A., R.L. Gomez, R.R. Bootzin, and L. Nadel. Nap-dependent learning in infants. Dev Sci. 12(6): p. 1007-12. 2009.
Ross, C.N. and K.H. Karraker. Effects of fatigue on infant emotional reactivity and regulation. Infant Mental Health Journal. 20(4): p. 410-428. 1999.
Mindell, J.A., B. Kuhn, D.S. Lewin, L.J. Meltzer, and A. Sadeh. Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep. 29(10): p. 1263-76. 2006.
Tikotzky, L., D.E.M. G, J. Har-Toov, S. Dollberg, Y. Bar-Haim, and A. Sadeh. Sleep and physical growth in infants during the first 6 months. J Sleep Res. 19(1 Pt 1): p. 103-10. 2010.
Taveras, E.M., S.L. Rifas-Shiman, E. Oken, E.P. Gunderson, and M.W. Gillman. Short sleep duration in infancy and risk of childhood overweight. Arch Pediatr Adolesc Med. 162(4): p. 305-11. 2008.
Wake, M., E. Morton-Allen, Z. Poulakis, H. Hiscock, S. Gallagher, and F. Oberklaid. Prevalence, stability, and outcomes of cry-fuss and sleep problems in the first 2 years of life: prospective community-based study. Pediatrics. 117(3): p. 836-42. 2006.
Martin, J., H. Hiscock, P. Hardy, B. Davey, and M. Wake. Adverse associations of infant and child sleep problems and parent health: an Australian population study. Pediatrics. 119(5): p. 947-55. 2007.
Bayer, J.K., H. Hiscock, A. Hampton, and M. Wake. Sleep problems in young infants and maternal mental and physical health. J Paediatr Child Health. 43(1-2): p. 66-73. 2007.
Hiscock, H., J. Bayer, L. Gold, A. Hampton, O.C. Ukoumunne, and M. Wake. Improving infant sleep and maternal mental health: a cluster randomised trial. Arch Dis Child. 92(11): p. 952-8. 2007.
Hiscock, H. and M. Wake. Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. BMJ. 324(7345): p. 1062-5. 2002.
Martins, C. and E.A. Gaffan. Effects of early maternal depression on patterns of infant-mother attachment: a meta-analytic investigation. J Child Psychol Psychiatry. 41(6): p. 737-46. 2000.
Murray, L. and P. Cooper. Effects of postnatal depression on infant development. Arch Dis Child. 77(2): p. 99-101. 1997.
Essex, M.J., M.H. Klein, E. Cho, and N.H. Kalin. Maternal stress beginning in infancy may sensitize children to later stress exposure: effects on cortisol and behavior. Biol Psychiatry. 52(8): p. 776-84. 2002.
Murray, L., A. Arteche, P. Fearon, S. Halligan, I. Goodyer, and P. Cooper. Maternal postnatal depression and the development of depression in offspring up to 16 years of age. J Am Acad Child Adolesc Psychiatry. 50(5): p. 460-70. 2011.
Connor, J., R. Norton, S. Ameratunga, E. Robinson, I. Civil, R. Dunn, J. Bailey, and R. Jackson. Driver sleepiness and risk of serious injury to car occupants: population based case control study. BMJ. 324(7346): p. 1125. 2002.
Study often used against sleep training
[1] Middlemiss W, Granger DA, Goldberg WA, Nathans L. Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Early Human Development 2012; 88: 227-32.
This study was done on 25 infants and mothers. In a hospital setting. https://expectingscience.com/2016/04/21/the-middlemiss-study-tells-us-nothing-about-sleep-training-cry-it-out-or-infant-stress/
