If you're a parent, you've probably heard about the cry it out method to get your baby to sleep.
Well-meaning family or friends might suggest letting your baby cry himself to sleep, so he can ‘learn to be independent'.
Or perhaps they suggest ‘cry it out' because they say, ‘it works'.
However, parenting techniques like ‘cry it out', which originated in 1913 (and potentially earlier), aren't always best.
And when we know better, we do better.
What some people believe ‘works’ on babies, actually has effects that go beyond their own understanding of the infant brain.
In order to understand what cry it out really does to the infant brain, and why highly educated and trained professionals refuse to support it, I interviewed some leading experts in the baby sleep world. From paediatricians and professors to a lactation consultant, the evidence is startling and of great concern.
What Is Cry It Out?
There are two types of cry it out methods:
#1: The ‘extinction' method — which is what most people know as ‘cry it out' (CIO). Parents are instructed to leave their babies alone at bed time, completely ignoring their cries. These babies literally cry it out until they have absolutely nothing left.
#2: The ‘graduated extinction' method — which is also known as controlled crying. Some ‘Baby Whisperers’ try to soften the term, by calling it controlled comforting or sleep training. Parents are instructed to leave their babies alone at sleep time. They alternate between attending and not attending during crying spells, at increasingly longer intervals.
‘Cry It Out' – What Do Well Researched, Educated Experts Say?
Just to be clear – we’re not talking about putting your baby down for a minute because you need a sanity break. ‘Cry it out’ is a specific sleep training method of leaving babies alone in their beds, with the intent that they will fall asleep on their own.
So, why does ‘cry it out' have highly educated professionals seriously worried?
Here are the facts based on years of research, which is absolutely not the same as opinion or judgement:
#1: Dr. Margot Sunderland
What makes her so qualified? Doctor Margot Sunderland is the Director of Education and Training at The Centre for Child Mental Health in London. She is also an Honorary Visiting Fellow at London Metropolitan University, Associate Member of the Royal College of Medicine, and a Child Psychotherapist with over 30 years’ experience of working with children and families. She is also the author of over 20 books in the field of child mental health, including the best selling book, ‘What Every Parent Needs to Know‘ (new edition to be released in 2016).
Doctor Margot Sunderland says:
“I would be very surprised if any parent continued to use ‘cry it out’ if they knew the full extent of what is happening to their infant’s brain. The infant brain is so vulnerable to stress — after birth, it’s not yet finished! In the first year of life, cells are still moving to where they need to be, a process known as migration. Migration is hugely influenced by uncomforted stress.
Then in the first year of life, there are adverse stress-related changes to the gene expression of key emotion chemical systems, that are responsible for emotional well-being and the ability to be calm and handle stress well in later life.
In addition, the level of stress caused to the infant brain by prolonged uncomforted distressed crying is so toxic, it results in:
- Elevated blood pressure
- Elevated cerebral pressure
- Erratic fluctuations of heart rate, breathing, temperature
- Suppressed immune and digestive systems
- Suppressed growth hormone
- Extreme pressure on the heart, resulting in tachycardia
It can even re-establish fetal circulation, as the part of the heart known as the foramen ovale re-opens. We don’t know the long term impact of this on the health of the heart in later life. Science hasn’t got there yet, but who would risk it?
Any uncomforted infant mammal will stop crying. So it's not an achievement when you hear their crying stop. It's a process known as ‘Protest-Despair-Detachment.' A resigned, self-protective, giving up.”
#2: Professor James McKenna
What makes him so qualified? Professor James McKenna is the Endowed Chair in Anthropology and the Director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame. He is a Fellow of the American Association for the Advancement of Science, and has been a member of many medical advisory boards. In over 30 years of work dedicated to mother-baby sleep, Professor McKenna has published over 139 scientific articles in journals on co-sleeping, breastfeeding, evolutionary medicine and SIDS. He lectures not only to parents, but also to paediatric groups. He has published a book for parents, Sleeping With Your Baby.
Professor McKenna says:
“The only 30 minutes I wish I could take back in my life are the 30 or so minutes my wife and I wondered if it was really selfish of us NOT to have our son Jeffrey learn to ‘self-soothe'.
So, in trying to be a ‘good parent’, and before that same son changed my career, once I realised that separating infants for night-time sleep and denying them breast milk laid the foundation for the rise of SIDS, we, too, levied a cruel and undeserved punishment against our innocent son.
The fact that I subjected my beautiful little boy to 30 minutes of unnecessary inconsolable crying ‘for his own good' still causes me to cry! I can still feel my heart being torn out, when despite our well-intentioned cruel behavior, after opening the door to his room, all I could see in my son's eyes was his unqualified love — still in need for me, and only wanting to feel his dad's arms around him.
The fact that we let anyone convince us that it was important to teach ‘self-soothing’ still leaves me angry and resentful, of medical authorities of any kind using such estranged and adult-centric beliefs and values as weapons against trusting parents and their infants. They do not realize that the practice of ‘crying it out' is entirely a western, cultural construction, and nothing less than a form of abuse.
Such ways of thinking only illustrate all too well mistaking social ideology for science — a mistake that continues to pervade western pediatric sleep advice in general.
What remains true is that every infant and child will eventually — and without any instruction — learn how to put themselves back to sleep. There is no need whatsoever to be “taught” this behavior.
Dr. Tom Anders, who is associated with inventing the concept, is clear when asked that he never intended his work on signallers vs self-soothers to be used to argue that self-soothing is important — or a necessary prerequisite — to assure optimal sleep development. Nor to provide some social developmental skill that could not be acquired equally well by some other more humane social learning.”
#3: Dr Howard Chilton, MBBS, MRCP (UK), DCH
What makes him so qualified? Doctor Howard Chilton is a Consultant Neonatologist at the Prince of Wales Private Hospital and the Royal Hospital for Women in Sydney. He also has books published, including Baby on Board.
Dr Howard Chilton says:
“Cry it out makes absolutely no biological sense.
Like other primates, humans are a ‘continuous contact’ species, but we are even more than that — we are born the most immature of all placental mammals. The important point is that in the early months, our fetus-like babies have to embark upon massive amount of brain development. They have to lay down life-long brain connections and embed fundamental beliefs about how safe and secure their world is, how reliable their parents are, and how valued and loved they are.
This is a vital time during which they are learning from their parents (but their mother in particular) new things about the world around them and how to deal with stress. So it makes no sense at the darkest, scariest time of the day to abandon them to a regime of nocturnal neglect!
Cry it out also contradicts the very basic parental instincts of nurturing and caring for those we love the most in our lives. It truly makes no sense.”
#4: Professor Helen Ball PhD, MA, BSc.
What makes her so qualified? Professor Helen Ball is a Professor of Anthropology and Head of Department, as well as the Director of Parent-Infant Sleep Lab (established in 2000) at Durham University. She pioneered the translation of academic research on infant sleep into evidence for use by parents and healthcare staff via ISIS, the Infant Sleep Information Source website.
Professor Helen Ball says:
“From an evolutionary anthropological view point, human infant crying is an identical behaviour to the separation distress call displayed by infants among other primate species. Crying is the infant's only means of attracting their mother's (carer's) attention once separated, in order to ensure their own survival.
Responding to their infant's cry is an instinctive behaviour of human mothers. To resist the urge to approach her crying infant is emotionally and physiologically stressful for mothers. Leaving an infant to cry is therefore evolutionarily inappropriate and biologically detrimental to both mother and baby.
Sleep techniques that employ prolonged crying to ‘teach' an infant to sleep simply teach the infant that the mother will not respond as he or she expects. As a consequence, the infant cannot rely on the mother's care and for survival, and he or she must conserve energy, since the mother as a food source is now unpredictable.
The infant therefore ceases to cry when crying fails to produce a response, and presents the appearance of sleep (shuts down activity). This leads parents to think they have successfully sleep trained their baby, while the baby is responding to the possibility it has been abandoned, and attempting to conserve energy to stay alive.”
#5: Tracy Cassels PhD
What makes her so qualified? Tracy Cassels has a Masters in Clinical Psychology and a PhD in Developmental Psychology. She also has a background in research and statistics, so she well understands what research is telling us — and she even teaches it. Tracy’s academic works have been published in many peer-reviewed journals, including Psychological Assessment, PLoS One, Personality and Individual Differences, Midwifery, and more.
Tracy Cassels says:
“What all parents need to know is that ‘cry it out' and all modified forms of it are based on early behaviourist beliefs that if you stop the crying, you stop the distress. But what we now know is that this is not at all close to the truth.
Infants and children often have a behaviour-physiological mismatch. For example, a child that is upset, but is being held and comforted by an attached caregiver, may not show physiological signs of distress. Whereas a child that is silent can be experiencing huge internal distress.
This is why responsiveness is key in our parenting. Responding to our children is paramount in building a sense of security and later independence for our children. Understanding what is normal for infants and children with respect to sleep can help alleviate the pressure to use extinction sleep training to ‘solve’ our children’s ‘sleep problems'.
Parents also need to know that there are gentle methods to help guide our children’s sleep when changes are necessary, and, even more importantly, that most of the severe ‘sleep problems' that children display are actually not sleep-related at all, but reflect feeding or underlying health problems.
When we ignore these facts, we are unable to truly help our children — and hopefully that is the actual goal of all parents.”
#6: Dr Frans Plooij Ph.D
What makes him so qualified? Doctor Frans Plooij, Ph.D, is the president of the International Research-institute on Infant Studies (IRIS) at Arnhem (the Netherlands).
Dr. Plooij has served as Vice President for Information of the International Society for Human Ethology, Vice President of the Institut European pour le Développement de tout les Enfants (IEDPE). He is on the editorial board of the journal Ethology and Sociobiology, and is a member of the panel of assessors of the Journal of Clinical Child Psychology and Psychiatry.
He is a member of several international, scientific societies for child development and behavioural biology, and of the New York Academy of Sciences. In addition to many scientific publications, Dr. Plooij has written several best-selling books on parenting, including The Wonder Weeks, which is based on 35 years of research and has been published in twelve languages.
Doctor Plooij has posted a YouTube clip telling parents to never let a baby cry it out:
Cry It Out Also Affects Breastfeeding
Not only can cry it out or other sleep training methods have an impact on a baby’s brain, but on the whole breastfeeding relationship too.
Renee Kam is BellyBelly’s IBCLC (International Board Certified Lactation Consultant, which is the gold standard in lactation training). She explained to me what happens to breastfeeding when we sleep train our babies.
“Night waking can be an exhausting and stressful time for parents. Feeling like they are doing something ‘wrong' can make these feelings worse. Unfortunately, our society contributes to parents feeling this way, due to setting up unrealistic expectations of what babies of certain ages should and shouldn't be doing.
Parents deserve evidence-based and realistic information about their baby's sleep. Hopefully then more parents will be able to feel more relaxed about their baby's sleep, and trust that their baby will wake less or sleep through the night in their own time.
All of this is important, since getting babies to sleep for longer before they are ready to (e.g. with cry it out) can be damaging for a mother's breastmilk supply. This is because breastmilk production works on a supply equals need basis. So if a baby's needs are ignored by them being left to cry it out, then a mother's milk supply can suffer.
So, the less we feed our babies, the less milk our body thinks we need to make. This creates a ‘low supply’ belief, which is simply a symptom of not feeding baby frequently enough to keep up supply”.
What About Controlled Crying? Is It Better Than Cry It Out?
While controlled crying isn’t as intensive as ‘cry it out', it certainly has its fair share of problems too.
“Too often you’ll hear parents say that they would never do ‘cry it out', but will happily engage in modified versions such as controlled crying,” says Tracy Cassels.
“They honestly believe these methods are ‘different' and ‘better', and will not cause as much distress to their children. The problem is that the evidence we have would suggest they are wrong. Modified versions of ‘cry it out' may sound nicer, but in reality, they are the exact same principles at work, only possibly more frustrating for the infant or child.”
Tracy continues, “A parent who checks on their child every 3, 5, 10, then 20 minutes isn’t actually responding to the child, but rather providing a glimmer of hope to the child that their cries are being heard and the warm arms of a parent will soon be available. This hope is short-lived, of course, as parents shush their children, possibly pat their back, then walk out the door again. Some parents may even pick up their child for a moment, only to put them back down and start the process over again. There is no comfort, only loneliness, fear, sadness, and repeated feelings of abandonment.”
Professor Helen Ball agrees. “It's not part of a baby's evolved biology or behavioural repertoire to be sleep trained anyway, therefore it's completely normal for a baby to resist such a process — however gradually it's done. The fact that it's possible to sleep train babies doesn't mean it is an appropriate thing to do. We have no idea of the consequences.”
Speaking about her interviews with parents about their sleep training preferences, Helen says, “Some parents are very clear that their baby must fit into their life, and this involves sleep training. Others are very clear babies’ needs come first and they as parents must adapt to cope. Those who struggle are those who are unprepared to do what ‘society' thinks they should do, yet also haven't contemplated how to adapt (or aren't able to adapt for some reason). This group really struggles with the trade offs between parent needs and infant needs, and controlled crying appeals as a half-way house for them. They assume/hope/believe it won't have any (serious) consequences for their baby.”
The Australian Association of Infant Mental Health doesn’t support cry it out or sleep training for babies either.
What can you do instead of ‘cry it out'? Read though BellyBelly’s baby sleep articles to become more informed about your options, to build up your baby sleep toolbox, and to understand baby sleep much better. Remember, all babies will eventually sleep through in their own time, so with a little love and guidance from you, sleep needn't be traumatic for mother or baby. I also highly recommend reading one of the above experts’ evidence-based books, and choosing from among BellyBelly's recommended baby sleep books.
At the end of the day, you need to make the best decision for you and your family.
But before you consider cry it out ask yourself this: in a society already brimming with anxiety, depression, low self esteem, co-dependency, narcissism and other mental disorders, do you think it's acceptable to continue this widespread experiment on infant mental health? When we don't respond to our babies, what sort of future are we paving the way for?
Note: If you feel that you are not coping, please contact a post-natal support organisation such as PANDA (in Australia) to connect with someone who can provide emotional support.