To Sleep Train Or Not To Sleep Train?
“They have to learn how to pacify themselves when they wake up during the night. But if you rock your baby to sleep, if you feed your baby to sleep, if you otherwise help them to go to sleep, they’re never going to learn to fall back to sleep again without the props.”[1]
“Prevention will be better than cure, can you put something over her hands like a pair of socks?” [advice given to a mum whose baby ripped half her face off during prolonged crying while sleep training] [2]
“When your baby stirs at night, don’t immediately assume hunger. Even with newborns, I can help you develop healthy sleep habits.”
“We really believe that after four months, children are ready to be successful at sleeping through the night.”[3]
“As far as check and console or cry it out ala “extinction,” I think it’s a lot easier to say “Just let him cry” than to actually see it through, especially as a new parent.”[4]
Above are examples of the kind of advice that parents of young infants receive from “sleep trainers”. Sleep training is a growing business, usually run by self-proclaimed sleep experts, that promises sleep deprived parents to get their fussy offsprings to sleep through the night. To achieve this result, the methodology employed is usually loosely related to the one described in M.D. Richard Ferber’s best selling book: “Solve Your Child’s Sleep Problem”, in which he advocates to let babies “cry it out”.
Sleep-training, a short-lived success at a huge cost
While letting a baby cry until she gives up goes against the conventional wisdom that cries are the expression of needs that should be addressed, and certainly goes against the maternal instinct of comforting distressed infants, sleep trainers would usually couch their approach in euphemistic labels like self-soothing or controlled comforting.
During a sleep training session, parents are told not to make eye contact or pick up the baby when she cries but only offer verbal reassurance and minimal body-contact by patting the child. The original Ferber method recommends to go in and out of the room every few minutes and to prolong the waiting time gradually to check on the baby, but some sleep trainers simply ask parents to let the baby cry until she falls asleep. If the baby were to vomit due to excessive crying, parents would be instructed to clean her up (preferably without picking her up), leave her in the crib, and continue with the training. While Dr Ferber advises in his book to use this technique on babies older than 5 month old, it is not uncommon for sleep trainers to intervene on infants as young as a few days old.
The sleep training approach is often successful in getting babies to sleep through the night, usually by the third or forth night, although in some cases, with resistant or stubborn babies, sleep training can last up to three weeks before the results are achieved. Prominent public figures such as Gina Ford (author of “the contented little baby”) and Tracy Hogg (the “baby whisperer”) have risen to fame by publicly preaching and advocating sleep training for young babies.
But a body of research and numerous anecdotal evidence seem to indicate that the perceived success can be short-lived and come at a huge cost.
Studies have shown that, shortly after the objective of getting the baby to sleep through the night is achieved, sleep regression often occurs as a result of a phenomenon called “extinction burst”, leading to outbursts of crying accompanied with frequent night-wakings due to the suppression of earlier cries. New developmental milestones such as crawling or teething also frequently lead to sleep regression.
High level of infant distress
Research conducted by Wendy Middlemiss from the University of North Texas[5] have also shown that prolonged maternal non-responsiveness is associated with continued high level of infant stress, which is problematic as their physiological stress responses are developing in that first year. Chronic stress can cause infants to develop an overactive stress response system, which can result in later difficulties regulating social and behaviour responses, such as attention disorders, anti-social behaviour and possibly even obesity. The study found that during sleep training, babies may no longer cry at night even when they are distressed, which results in a disconnect between the baby and its mother. As Dr Sears, a renowned pediatrician, says, “babies who are ‘trained’ not to express their needs may appear to be docile, compliant or “good” babies. Yet, these babies could be depressed babies who are shutting down the expression of their needs.”
Earlier research, conducted by Michael Commons and Patrice Miller, researchers at the Harvard Medical School’s Department of Psychiatry, showed that not responding quickly to a baby’s cries can lead to incidents of post-traumatic stress and panic disorders when the child reach adulthood. Commons said “Parents should recognize that having their babies cry unnecessarily harms the baby permanently, it changes the nervous system so they’re overly sensitive to future trauma.”[6]
Some specialists have already started to turn their backs on sleep training. Dr Gabor Mate in an article published in the Canadian newspaper The Globe and Mail “Why I no longer believe babies should cry themselves to sleep”[7] declared, “As a family physician, I used to advocate the Ferber technique and, as a parent, practised it myself. Since then, I have come to believe that the method is harmful to infant development and to a child’s long-term emotional health. (…) Even if infants cannot recall what they “learned” in the first year of life, they serve as a template of how we perceive the world and how we react to later occurrences. These emotional memories may last a lifetime.” Even Dr Ferber himself, in the new edition of his book, felt the need to add in the preface the following warning: “simply leaving a child in a crib to cry for long periods alone until he falls sleep, no matter how long it takes, is not an approach I approve of.”
Harmful to infant development and long-term emotional health
The detrimental effects of sleep training on children demonstrated in the scientific research discussed above have been experienced first hand by many distressed parents seeking for help:
“After a week of controlled crying he slept, but he stopped talking (he was saying single words). For the past year, he has refused all physical contact from me. If he hurts himself, he goes to his older brother (a preschooler) for comfort. I feel devastated that I have betrayed my child.”
“I went up to 5 hours one night going in every 5 then 10 then 15 min and she just would not rest, she vomited several times her nose was bleeding she rubbed her eyes but would not got to sleep. It just didn’t feel right to let my baby cry for that long with that much intensity.”
“Fast forward 2.5 years and (…) I have an extremely insecure, jealous, aggressive toddler who suffers the most horrendous separation anxiety and who will not sleep.”
“Last night, I think I made a bad call and invited a bunch of people over. This obviously had an affect in her and she cried for 52 mins. I felt so bad. I struggled with the idea of letting her cry it out in the first place, and now I’m just feeling so unsure. But my biggest hang up has been her mood in the past few days! Co-incidence? She’s been much crabbier than usual! She is 6 months old in a few days. She has become very needy and seems sad and short tempered. It breaks my heart. Have I traumatized my poor baby?”
The scientific research conducted on sleep training seems to be confirmed by countless anecdotal evidences. The opposition to sleep training is increasing and getting more vocal, as illustrated by the Australian Association for Infant Mental Health which recommends, in a positioning paper, to not practice sleep training: “controlled crying is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences.”[8] Professor James McKenna, Director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame even goes as far as qualifying sleep training as a “Social Ideology Masquerading As Science”.[9]
The best interest of a baby is often not the most convenient to the parents. It is natural for infants to cry at night, and it is in the maternal instinct to respond sensitively to their needs, even if that means many sleepless nights and a constant state of fatigue. No caring parent would risk the health of a child by seeking advices from unqualified medical practitioners. Parents should therefore be wary of blindly following the guidance of sleep trainers with no credentials that could put the mental well being of their children at risk.
[1] Nicola Mitchell Cheeky Chops Consulting. Lullaby and Goodnight http://www.winnipegfreepress.com/arts-and-life/life/lullaby-and-good-night-199987191.html?device=mobile
[2] Facebook page of Dawn Whittaker, founder of Cheekychops https://www.facebook.com/pages/Cheeky-Chops-Dawnn-Whittaker-Baby-Contentment-and-Sleep-Consultant/175799800446?ref=ts&fref=ts
[3] Family uses sleep consultants to turn fussy toddler to bed http://abcnews.go.com/US/family-turns-sleep-consultants-fussy-toddler-bed/story?id=18840912#.UVZlxRm9Ziw
[4] Baby Sleep Site http://www.babysleepsite.com/tag/ferber-method/
[5] http://research.unt.edu/news/unt-researcher-finds-infant-stress-levels-remain-high-during-sleep-training
[6] Children need touch and attention. Harvard Researchers say. http://www.news.harvard.edu/gazette/1998/04.09/ChildrenNeedTou.html
[7] Why I no longer believe babies should cry themselves to sleep http://www.theglobeandmail.com/life/parenting/why-i-no-longer-believe-babies-should-cry-themselves-to-sleep/article622978/
[8] Australian Association of Infant Mental Health positioning statement on controlled crying http://www.aaimhi.org/inewsfiles/controlled_crying.pdf
[9] http://www3.nd.edu/~jmckenn1/lab/director.html
Thank you for this article, specially for referencing and acknowledging the sources. It just helps me confirm that responding to my child’s needs is the natural thing to do.
Thank you so much for publishing this post. My heart weeps for those children who have fallen victim to sleep training. I chose to cosleep with both of my children. My 4 year old boy now sleeps in his room with his daddy. I sleep in the master bedroom with our 4 month old daughter. Everyone in our house gets 8-9 hours of sleep every single night. I firmly believe that because our children are not in a state of alarm when they are most vulnerable is why they are able to sleep so well. Our 4 year old son is the most enthusiastic, securely-attached, and loving preschooler I know, and I’d like to think that part of that is attributed to our choice to cosleep. When he was an infant, I would get 10-11 hours of sleep every night. (It was not straight through, however, I would wake up to nurse him 3 or 4 times, but fell asleep with ease after each nursing.) The only reason I don’t get that much sleep with my daughter is because our son comes in to snuggle each morning 😉
How lovely that you are giving your little ones this great start to life!
Thank you so much for this, and for the citations. It reinforces what I have always felt.
Hello, I love your article! Could you tell me where you found the picture at the top please? (I saw it on pinterest long ago and have looked for it ever since). If it is a stock photo I would very much like to buy it and use it in an article I am doing on why NOT to sleep train babies. Thanks lots and bless you for what you are doing. Babies need their mothers from birth on and the “myth” that babies can “self-soothe” is just that — a myth. A baby who has been sleep trained may appear to be sleeping peacefully, but have dangerously high levels of stress hormones. On the other hand sleeping close to mother grows babies’ brains!
I sleep-trained my daughter through controlled crying at 9 months, which seemed to work – she was an excellent sleeper, but battled to get herself to sleep and I honestly started to feel as though she was staying up ‘for’ me when i was in the room. two nights of hell, and it was done. (And she is very well-adjusted now – she’s 6). I subsequently read a very good book called ‘Babies in mind’, which was an insight into the minds of children under a year and it made a very good case for not doing any behaviour modification during the first year – because if babies cry and you don’t come, they don’t learn to be ‘good’, they just learn that the person they need most is not there for them. So if i had it to do over i would have waited. With my second child, i did wait until she was older, but the controlled crying resulted in vomiting, which was awful – and I felt instinctively that it wasn’t going to work. The clinic advised me to sit with her, then over time, sit closer and closer to the door until eventually she could go to sleep on her own. It took 3 weeks, but it was smooth, she was calm and we were successful – she could get herself off to sleep without my physical presence. So, i think, there is a middle ground – waiting until they are older and then helping them to get to sleep themselves. and it doesn’t have to be traumatic.
I sleep trained my son when he was several months old. Honestly, I believe that for me and for him that was the single best decision that I made as a parent during his first year of life. I was slipping into depression after several months of constant interrupted sleep and my son was tired, cranky, and always sick. He was literally unhealthy from the effects of not being able to sleep soundly. We tried everything: co-sleeping, “gentle” techniques. I was also a doctoral student in development at this time (I now have my doctorate), and I started to turn my “researcher’s eye” on the sleep training literature. After about a week looking at the actual research (and consulting pediatrician friends and scientists), I became so angry that this type of ill-informed fear-mongering is preventing parents from using one set of tools to help their families be happier and healthier. Most of the supposed “research” cited by Sears and others have absolutely no bearing to an evidence-based discussion of sleep training of babies living with caring, loving parents. Most of the research is conducted with abused, neglected children, or with children who have other special needs or issues. I’ve written about my family’s journey with my son’s early issues extensively on my blog, as well as with other evidence-based writers and scientists on other websites. Children have different temperaments and different needs, and we do women and families a great disservice by telling them that they just have to grin and bear the effects of months of sleep deprivation, depression, and subsequent bad parenting because no one is getting any sleep. Let’s stop the judgment of other families’ choices, which are usually made with the help of their doctors and their own perspective on the research evidence. Telling women that they’re “harming” or “abusing” their babies by teaching them to sleep independently is just as toxic as other battle cries in the ongoing “mommy wars.” http://www.schoolofsmock.com/2013/07/01/sleepless-in-boston-and-buffalo-colic-co-sleeping-and-me/
I usually do not publish comments like this one, but I have chosen to make an exception and address some of your points as they are quite representative of the criticisms I have received from sleep trainers and their advocates.
No, this article is not fear-mongering. All the arguments in this article are supported by scientific research from the most reputable universities such as Harvard, University of Notre Dame, or statements made by recognized doctors or professional organizations such as Gabor Mate or the Australian Association of Infant Mental Health. You may choose to ignore the findings of these scientific research, but you are in no position to qualify their work as “ill-informed fear-mongering”.
The anecdotes I posted are from real people experiencing the negative results sleep training can have on children. In their case, sleep training has done the opposite of making their families “happier and healthier”. At no point in the article have I made a judgment on families that have done sleep training. The main criticism of this article is towards sleep trainers’ claim that sleep training is totally harmless even though research prove the opposite. After all, sleep training is an unregulated business and sleep trainers have no incentive to be factual if that hurts the bottom line. Of course every child is different and none of them would react the same way to sleep training. Some may totally be fine after being sleep trained, but some may be badly affected emotionally, and that may stay with them for the rest of their lives. The problem is that it is impossible to know what effects sleep training will have on a child until he or she has gone through the process. If you knew that a certain type of food had 50% (or even 10%) chance of doing irreversible damage to your child, would you take that risk?
I keep hearing from parents that have done sleep training that their children are totally fine, happy, balanced and thriving. Maybe it’s true for most of them. But I experienced first hand with a friend of mine whose sleep trained child is the most aggressive, insecure, and temperamental I have ever seen, despite the mum’s claim that the son is the “happiest child ever”. It takes courage and humility for a parent to admit that he or she has made a big mistake. Most parents would simply close their eyes and keep believing they have done the right thing.
I obviously didn’t sleep train my child, and I didn’t even know sleep training existed when he was an infant. He was a colic baby, crying constantly when awake. It was not uncommon for my husband and I to walk him to sleep for two hours in the middle of the night. It was tough, really tough, and we didn’t have any help from relatives or family. Sleep deprivation took a toll on us. But we knew deep inside that this hard moment would eventually pass and life would get easier, and it did. I decided to write this article in reaction to some advices that were given by somebody I knew to some random parents of infants on a Facebook group. She didn’t introduce herself as a sleep trainer, but I later found out that she was one. I was in real shock when reading the advices she was giving without having ever met these people. According to her, it was normal to let a child cry alone for 1 hour straight, it was normal for the child to vomit due to excessive crying, etc. To me, it sounded more like child abuse than anything else. I started to do my own research and warn parents about sleep training. It didn’t take long before I got kicked out of her group, which prompted me to write this article.
Before answering your comment, I quickly browsed through your blog and saw this:
I really feel sorry that you had to go through that experience. I’m pretty sure deep inside, you are still wondering whether your did the right thing. Only time will tell. I will just finish this long answer with a comment left by a mum on one of my Facebook groups: