To Sleep Train Or Not To Sleep Train?

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“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.