Cry-it-out, Ferber, and balancing risk
Look at most attachment parenting resources, breastfeeding-friendly forums, or crunchy mom refuges, and you’ll likely see people decrying “Cry-it-out” sleep training (“CIO”) for babies. While deliberately letting baby cry in distress is not a great approach to parenting when all things are equal, there are a couple problems with the knee-jerk hate this idea inspires.
First of all, when someone says, “CIO is terrible for babies,” what do they mean by CIO? My sense is they’re picturing parents dumping their infant in his crib, shutting the door as they leave, and gritting their teeth as he cries for hours until falling asleep due to exhaustion. And while many people associate Dr. Richard Ferber with CIO, this isn’t at all what he advocates. I think a lot of concerned moms wind up demonizing Ferber when they should be reserving their strongest disapproval for Marc Weissbluth, who’s much closer to the “dump and ignore” method of sleep training. But even he doesn’t just say you should drop your kid and run – his suggestions incorporate everything from what to do when your baby wakes up in the morning to understanding normal sleep patterns and using them to establish routines supportive of good sleep.
Secondly, there’s not really much evidence that letting older babies cry as they adjust to falling asleep unaided causes lasting harm. It’s important to note that young infants need to wake during the night to drink milk. There is no consensus on when a baby can go the whole night without caloric input, but estimates range from 4-9 months. In older babies, there is speculation that sleep training involving crying may introduce some risk because the baby is experiencing stress, including elevated cortisol levels, during the crying. However, for babies whose cries are generally soothed, and whose physical and emotional needs are met on a regular basis, there’s just no evidence that a few days or weeks of nighttime sleep training causes any harm.
It is true that experts like William Sears and James McKenna have written about sleep training in very critical terms, indicating that it has been shown to cause lasting harm. However, their philosophical zeal seems to have colored their reading of the literature, as the studies they cite either involve children suffering severe abuse or neglect, or don’t actually support the arguments they’re cited to bolster.
For instance, in Sleeping with your Baby, McKenna states on page 38:
Some studies have suggested that elevated levels of cortisol in infancy can cause physical changes in the brain, prompting a greater vulnerability to social attachment disorders. At the very least, the energy lost in crying could be better put into growth or maintenance.
McKenna cites J Pediatr. 1988 Mar;112(3):457-61. “Effects of crying on cerebral blood volume and cytochrome aa3.” Brazy JE., which concludes “Thus crying alters cerebral blood volume in all neonates in a pattern consistent with cyclic obstruction to cerebral venous return; it decreases cerebral oxygenation in infants with respiratory problems.” No mention of cortisol, changes to brain structure, or social attachment disorders. (It’s also worth noting that the study involves only newborns, who should never be sleep trained anyway, and that the scary-sounding “cyclic obstruction” is a result of the Valsalva maneuver, which infants regularly perform when coughing or pooping as well as crying.)
Now, it’s perfectly valid to decide against sleep training that allows extended crying, just in case that stress could cause long-term problems. But you can’t honestly lambaste a parent who chooses sleep training with the threat that they’re causing permanent damage to their babies. There’s no foundation for that claim.
The other problem with blanket rejection of sleep training is that it doesn’t account for balancing of risks. My personal story is a good example. (Yes, I used sleep training, in case you hadn’t guessed!) When Claire was almost 6 months old, her sleep periods started to become shorter and shorter. Overnight, she was sleeping for mere 90 minute intervals, requiring our help to get back to sleep with each waking. As you can imagine, this sleep deprivation had extreme effects on my husband and me. I remember being totally unable to form a coherent sentence and convey what I was trying to say. My husband has always been regarded as a wizard at work, but suddenly he was screwing up even relatively simple tasks, and his bosses were taking notice. In addition, to attend to our responsibilities, both of us needed to drive, which is very dangerous when one is suffering sleep deprivation. Bed sharing was not an option for us due to several different issues. We decided that any risk to our baby from crying for 10 minutes at a time was less than the risk of having an unemployed father or getting in a wreck.
I’m not saying that I love the idea of letting babies cry, even for a few minutes at a time. But in our circumstances, it was the best solution to a bad situation. Note also that we did our own version of Ferber’s plan. Not only did I pat or talk to Claire between crying periods, I picked her up, nursed her, rocked her – did anything to soothe and calm her, just being careful not to put her to sleep. I also didn’t let her cry for longer than 10 minutes, because that was the limit of my personal comfort zone with letting my baby cry.
And that’s something I want to emphasize: I think philosophical beliefs are a fine basis for deciding against CIO. If you just think it’s wrong or can’t bear to leave your baby to cry, more power to you. Just as there’s no real evidence that sleep training causes permanent harm, there’s no real evidence that soothing your baby to sleep or bed sharing (safely!) cause any harm. If CIO doesn’t feel right to you, you shouldn’t do it. If you try it and it doesn’t seem to be working for your individual baby, you should feel comfortable stopping. For me, it’s not something I would choose as a first response, but only became a viable choice when our situation became extreme. Other parents will have different parameters. Thankfully, almost all our babies will do just fine.
(This post was written before I learned of a new anti-CIO article by Darcia Narvaez, Ph.D. Her article is far worse than the articles that I criticize here: hysterical, judgmental, and lacking in the research department. I will follow up this post with a critique of the full article.)