Controlled Crying – What Parents Need To Know

Controlled Crying - What Parents Need To Know

Controlled Crying

Controlled crying has become pervasive in households around the world, despite research-backed warnings from health professionals and organisations worldwide.

While recent research has tried to reassure parents that controlled crying is actually okay, the research – despite being peer reviewed – was very flawed.

Not only did the study contain only 43 families (meaning each group had around 15 babies), but the babies didn’t have their cortisol (stress) levels tested at the time of controlled crying. Find out more about the research and it’s flaws here.

In the meantime, many baby sleep “whisperers” write books or publish advice based on the controlled crying method, or an adaptation of it.

Ironically, they have been recycling the same bad advice from 1913. Most of the time, these “baby whisperers” have little or no formal training in lactation, infant psychology or infant mental health.

They are often ex-nannies or from other professions which simply do not have the depth of knowledge required to be able to give healthy, safe advice at a crucial time in infant development. One ‘baby whisperer’ even defies the recommendations of Australian Safety Standards, Kidsafe, SIDS and countless educated baby sleep researchers and experts.

How On Earth Can They Get Away With Bad Advice?

Even a local doctor does not have formal breastfeeding training (unless they have undertaken further education), so they are not the best point of contact for breastfeeding help. A trained lactation consultant is – ideally an IBCLC.

Selling sleep is a very lucrative business, which traps vulnerable and sleep deprived parents. Baby sleep tamers make a fortune from their methods, and they tend to have an army of uber loyal followers. They sing the baby whisperer’s praises on parenting boards and social pages everywhere, immediately ready to defend should others question these methods.

But little known to parents is that fact that these methods don’t actually “work” like they think it has. Instead, the baby has been trained in learned helplessness. They have learned not to bother calling for help with their discomfort, because no-one will come or comfort them anyway.

This is far from “working”. It’s potentially creating a lifetime pattern, let alone resulting in distressed little brains being flooded with cortisol, the stress hormone. Until a baby is around six months old, they are not even developed enough to understand the concept of being separate from their mother. To be away from her is a dire emergency and very distressing, because their life and their safety depends on their mother.

Educated professionals well know this (read what they think, here). Baby whisperers just don’t care. Because without people buying their books and funding their lifestyle, they have nothing. What will they do for work if everyone stopped buying their best selling books? Not being qualified in anything, it’s easier to defend what’s made you money in the first place than find yourself a new career. And sadly, many of them deliriously think they truly have the answer.

Two things have actually been proven to reduce infant crying, and you can read about them here.

You can also read our tips on separation anxiety in babies.

The Australian Association for Infant Mental Health (AAIMH) is one peak body that has been advocating for an end to this practice for many years. It’s important that parents and health professionals read and understand the AAIMH’s position statement (immediately below) on controlled crying. This is an organisation that has set out to educate about best infant mental health practices. Mental health is just as important as physical health.

AAIMH Position Paper On Controlled Crying:

What Is Controlled Crying?

Crying is a signal of distress or discomfort (either psychological or physical), from an infant or young child to let the caregiver know that they need help. From an evolutionary perspective, crying promotes proximity to the primary caregiver, in the interest of survival and the development of social bonds (Bowlby, 1958)

Sleep problems occur when an infant’s sleep behaviour is disturbing to their parents. Sleep problems may have a number of causes or associations including:
  • Infant temperament
  • Parental expectations related to lack of knowledge about infant crying and sleep patterns
  • Family stresses and relationship difficulties
  • Parental health issues, including depression
  • Lifestyle that focuses on infants sleeping in separate beds and/or room from parents
  • Underlying developmental problems (rare)

Controlled crying (also known as controlled comforting and sleep training) is a technique that is widely used as a way of managing parents’ perceptions of sleep problems in infants and young children who do not settle alone or who wake at night.

Controlled crying involves leaving the infant to cry for increasingly longer periods of time before providing comfort. The period of time rather than the infant’s distress level is used to determine when to attend to the infant or toddler. The aim of controlled crying is to teach babies to settle themselves to sleep and to stop them from crying or calling out during the night.

The Background to the AAIMHI’s Concerns On Controlled Crying

AAIMHI is concerned that the widely practiced technique of controlled crying is not consistent with infants’ and toddlers’ needs for optimal emotional and psychological health and may have unintended negative consequences.

Attachment is the bond between parent (caregiver) and infant within which the infant feels secure to explore and learn and return to the care giver for comfort. Attachment behaviours are those that children use to maintain closeness and include smiling, reaching out, crawling after the caregiver, vocalising and crying.

Caregivers promote secure attachment by responding to infants’ attachment behaviours. Caregivers who are sensitive to infants’ needs and signals, affectionate, enjoy their children and are available and able to comfort their children, promote secure attachment and infant well being.

This kind of caregiving is important for children to make the most of all areas of their lives (Hertzman, 2000). In the first few months of life babies need to have a parent or familiar adult nearby or available most of the time. In the early months of life unexplained and sometimes difficult to soothe crying exists across all cultures and may be seen to be a part of normal development.

While this can be distressing for parents, they should be advised that this natural increase in crying peaks at around 6 to 8 weeks and generally settles by 3 to 4 months (Barr, 1998). Responsive parenting as well as holding and soothing of the infant during this sometimes difficult time will help the infant develop a sense of security and is the beginnings of secure attachment.

Although it is rare for this kind of crying to have a serious cause it is always important for parents who are worried about crying to have a health check for their baby. Infants experience differing degrees of anxiety when separated from their parents. From early on, infants may express acute distress in the absence of a parent or when a parent leaves the room.

Going to bed is a time of separation. When infants or toddlers cry upon separation it is a signal that they may be struggling with this process and need reassurance. An increase in separation anxiety often coincides with the infant’s increasing mobility and may be linked to the infant’s recognition that things and people exist when they are out of sight and that he or she can initiate movement away from the parent. Infants whose parents respond promptly and emphatically to their crying learn to settle as they become secure in the knowledge that their needs for emotional comfort will be met (Bell & Ainsworth, 1972).

This anxiety continues until the infant has a core understanding of the concept that his or her parents will return and he or she is safe. Almost all children grow out of the need to wake at night and signal parents for reassurance by three or four years of age and many much earlier.

The demands of modern life and some currently available parenting advice have led to an expectation that all infants and toddlers should sleep through the night from the early months or even weeks. The fact is that infants normally have short sleep cycles which can cause them to arouse more often in the night than older children or adults. These short sleep cycles allow infants to experience more rapid eye movement (REM) sleep, which is considered to be important for their brain development (NCSDR).

There are various times in a child’s development (illness, absence, major changes) when children need more assistance to settle than at other times. Family events that are distressing for the infant or toddler may lead to a need for more reassurance than in non-stressful times (Slalavitz & Perry, 2010). To deny reassurance during these times would be distressing and may have a negative psychological impact. Research has shown that too much stress is harmful to infants (Perry & Pollard, 1998) but it is unclear how much is too much.

There have been recent studies (Middlemiss et al., 2011; Price et al., 2012) on the effect of controlled crying on infants, which have shown varying results. One study has attempted to address the long-term impact of controlled crying but the methodology does not justify the conclusion that there are no harmful impacts on infants (Sleep training not harmful? Methodological concerns question conclusion, 2013). No studies on controlled crying that we have reviewed stand up to rigorous scrutiny.

A recent study (Middlemiss et al., 2011) of infants and mothers admitted to a parenting centre found that when babies between the ages of 4 to 10 months were subjected to a sleep training program that was based on controlled crying, the crying decreased over three days.

Initially when infants expressed distress in response to the sleep transition, mother and infant cortisol responses were elevated synchronously. On the third day of the program, however, results showed that the babies became quieter, no longer expressing distress during the sleep transition but their cortisol levels remained elevated. Without the infants’ distress cue, mothers’ cortisol levels decreased. While the babies no longer exhibited crying behaviours, elevated stress hormones indicated that they remained psychologically distressed. (It should be noted that this research was conducted at a parenting centre and not in the natural surrounds of the home).

AAIMHI is concerned that although controlled crying may stop infants and toddlers from crying it may also have the effect of teaching children not to seek or expect support despite remaining internally distressed.

Many infants and parents sleep best when they sleep together, either co-sleeping on separate sleep surfaces (a cot near the bed) or bed sharing – sleeping in the same bed. There is no developmental reason why infants should sleep separately from their parents (McKenna & McDada, 2005). There are certain conditions however when sharing a sleep surface with an infant must be avoided, where:

  • The infant shares the sleep surface with a smoker
  • There is adult clothing, bedding, doonas or pillows that may cover the infant
  • The infant can be trapped between the wall and bed, can fall out of bed or could be rolled on
  • The parent is under the influence of alcohol or drugs that cause sedation or is overly tired
  • Infants are sharing beds with other children or pets
  • The infant is placed to sleep (either alone or with parents) on a sofa, beanbag, waterbed or sagging mattress

Parents should check current information about safe sleeping; see Sids and Kids for more information. It is important to note that there are no long term health or developmental problems caused by babies waking at night (St James-Roberts, 2008).

Australian Association for Infant Mental Health – Controlled Crying Principles

It is normal and healthy for infants and young children to wake through the night and to need attention from parents. This need not be labelled a disorder. There are no long term health or developmental problems caused by babies waking at night. Responding to an infant’s needs/crying will not cause a lasting ‘habit’ but it will contribute to the infant’s sense of security.

There is a wide variation in how quickly infants and toddlers ‘sleep through the night’. Early and realistic information about what to expect and ways to settle infants may help parents understand their infant’s state of mind and appropriately engage with their infant’s sleeping patterns. When concerns are raised by parents about sleeping difficulties, a full professional assessment of the child’s health, and child and family relationships should be undertaken.

This should include:

  • an assessment of whether in fact the infant’s crying is outside normal levels
  • an understanding of experiences of isolation and frustration felt by many parents of infants and young children
  • an assessment of any other family difficulties (including post-natal depression) that may impact on parents’ ability to respond to a crying child

This assessment may then lead to appropriate referral allowing parents to access social supports and possible therapeutic intervention. Any methods used to assist parents to get a good night’s sleep should not compromise the infant’s developmental and emotional needs. Controlled crying is not appropriate for use before the baby has a real understanding of the meaning of the parent’s words; the infant or toddler needs to know that the parent will return and needs to feel safe when the parents are absent.

Most children by the age of about three have a good sense of self, are able to be more-or-less self sufficient with an abating separation anxiety so they may understand and cope with being left alone at bedtime for short periods, knowing that parents will return as required.

Observing infants and toddlers and responding to their cues is the best way to assess when they feel safe to sleep alone. Waking in older infants and toddlers may be due to separation anxiety. In situations where an infant or toddler has already experienced separation from a parent (e.g. due to sickness, hospitalisation, parental absence, out of home care or following adoption) he or she may easily become very distressed at sleep time, that is, at times of perceived separation. These infants and toddlers are more vulnerable to the stress caused by controlled crying. Sleeping with or in the same room as a parent is a valid option, enabling all to get a good night’s sleep.

The controlled crying method has not been rigorously assessed in terms of the impact on the infant’s emotional development. Other strategies, apart from controlled crying, should always be discussed with parents as preferable options.

The AAIMH’s Controlled Crying References

For a full references list for this position statement, please see here.

Baby Sleep Books That BellyBelly Recommends

Take a look at our article on the best baby sleep books to help you find gentle methods that work and are better for your baby.

 

 

CONTRIBUTOR

Kelly Winder is the creator of BellyBelly.com.au, a doula, writer and mother to three awesome children. Currently, she's travelling the world for 12 months with her partner and children, and hopes to inspire more families to do the same. Visit aroundtheworldpluskids.com.au for more information.


9 comments

  1. Thabk you for this amazing blog (if that’s what you call it?) I have ALWAYS disagreed with the whole controlled crying methods and find it dispicable. Little did I know scientists did too!!!!! The works needs to change how we raise our babies and go back to what Mother nature intended.

  2. Your whole premise of this article is that controlled crying can POTENTALLY lead to a lifetime feeling of helplessness and an inability to know to call out for help when that baby is older. Are there any studies that actually prove this? Also, are there any studies that show that this learnt ‘helplessness’ in babies can’t be overcome with normal socialization and brain development as the baby progresses into a toddler and beyond? If I acknowledge that with brain injuries can learn to walk again, I think this is a good chance this could be the case. Also, when you say ‘a percieved sleep problem’ does that mean the author does belive ‘sleep problems’ exist in babies or does that mean that there is a measurement and a criterion where an unsettled baby becomes a baby with a sleep issue? And if so, what is that definition? Also, if controlled crying has been proven to help some babies learn to sleep, how do we balance the risk of potentially (guys always look at how many people participate in a study) giving them a ‘life long inability to ask for help’ vs disadvantages in brain development from a not getting the proven minimal required amount of sleep in a 24 hour period? Vs the impact of no sleep on the mental health on its mother? This article is slanted and gives no acknowledgment that some babies might only sleep for a total of 5 hours in a 24 hour period and might do this for months despite the best efforts of the parents, numerous tests etc etc. Not all parents who use controlled crying are doing it so they can have 12 hours sleep, they are using it so their baby can sleep for more than 45 minutes in a 3 hour cycle and so they can survive. Please keep these instances in mind before we all get on the beat – people- down parade. Mothers who cradle their babies and attend to them always are no better or worse than those who think they are doing the best for their child by using a method they think is going to help.

    1. As per the article states, this is mostly the position statement from the AAIMH. It also says for full references to click the link at the end of the article (goes to the original document).

    2. What the article does point out, & is definitive, is the levels of cortisol in the mothers & babies when they were measured at the center.

    3. I totally agree with you Mikhaela! I will stick my hand up and say controlled cryingn worked for my daughter. Who is now 8 years old and the happiest, loveliest and most confident child around!

      1. Some mothers like Gemma are deluded I’ve seen the children of those that have done controlled crying and a lot of them suffer from mental issues especially in their teens.

  3. Controlled crying is cruel and ridiculous! I don’t even want to imagine how those infants feel!Some mothers are lazy and cruel! A child/ren needs or wants must be responded to immediately and a mother should try her very best to meet her child’s needs immediately!

  4. Just for those who have been to uni and appreciate peer reviewed research, the latest comprehensive study shows no lasting emotional issues. Babies learn to self settle and have better quality sleep, leading to better mood and function for learning… So in a way, this articles’ advice may lead to dumb kids… But that’s my own hypothesis and it’s not proven… In reality it probably makes no difference.

    http://mobile.abc.net.au/news/2016-05-25/controlled-crying-babies-not-harmful-flinders-uni-study-finds/7443878

    The notion that all subsequent teenage angst can be blamed on this behaviour is laughable and has no scientific evidence.
    Don’t listen to self styled mummy experts. Peer reviewed or it doesn’t count.

    1. Actually, that very small study is hideously flawed – they didn’t even test the cortisol levels of babies at the time of controlled crying, amongst other things. We wrote about all the flaws here:

      http://www.bellybelly.com.au/baby-sleep/controlled-crying-study-are-babies-really-okay/

      The author of the above article is VERY experienced and qualified in baby issues, having worked for over 20 years for the Australian Breastfeeding Association, teaching twin breastfeeding classes and so much more. Her knowledge is exemplary and she is VERY qualified in writing this article.

      For parents, it’s a really good idea to read the research paper rather than journalists articles (they don’t understand the research nor are experts on the topic, and jump to erroneous conclusions). Even then, it can be hard to interpret results unless you have some knowledge in research, as it can be confusing.

      Scientists are experts in science, but they aren’t experts in breastfeeding or early parenting, like our writer. And I think an important part of science is observation too, not just relying on a study of a handful of subjects.

      BellyBelly’s writers include research in the articles they write, peer reviewed where possible.

      But even then, peer reviewed research has it’s flaws.

      Scientific peer reviews are a ‘sacred cow’ ready to be slaughtered, says former editor of BMJ.

      “Richard Smith, who edited the British Medical Journal for more than a decade, said there was no evidence that peer review was a good method of detecting errors and claimed that “most of what is published in journals is just plain wrong or nonsense”.”

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