‘Sleeping through the night' is actually untrue of how any of us sleep – adults, children or infants.
In fact, we all wake multiple times per night during light stages of the sleep cycle.
This might be in response to external disturbance, for example, a snoring partner, a barking dog or a noisy garbage truck, or physical disturbances such as a full bladder, thirst or hunger, over or under heating, or needing to adjust bedding for comfort.
What changes with maturity is the ability to resettle after partly or fully becoming awake. Older children, teens and adults do not need the support of a parent to deal with these sleep interruptions.
Babies, toddlers and young children do. The transition is often referred to as “self-settling/soothing” and has become the Holy Grail of modern parenting.
What Is Sleep Training?
Sleep training is a generic term used to describe any method of hastening this process. The end goal is more sleep for parents, though it is usually portrayed as more sleep for babies!
Sleep training methods generally fall into two categories. There are those which avoid reinforcement of undesirable behaviour by parental ignoring (e.g. extinction) and those which reinforce desirable behaviour (e.g. positive routines).
Isis Online presents these as:
- Extinction – unmodified (“Cry It Out“)
- Extinction – graduated (“Controlled Crying“)
- Extinction – with parental presence (Cry It Out with parent in the room/camping out)
- Positive routines, bedtime routines, and positive reinforcement
- Scheduled awakenings
- Parent education/prevention
This article will focus on the variations of extinction. You can read more about alternative gentle approaches here.
Before embarking upon extinction methods of sleep training, it's important to understand the potential long-term impacts. While there's no doubt these methods show remarkable and often immediate results in altering reliance on parental support during the night, research is now beginning to show this might not be as positive a result for infants as it is for adults.
Here are 6 things to consider:
#1: Is Your Baby Old Enough For Sleep Training?
Extinction methods have been popularised by several authors, most notably Richard Ferber, whose name has become synonymous as the Ferber Method. Babies trained using his methods are said to be “Ferberized”.
Young babies need to feed at night, and their sleep-wake patterns are still immature. For these reasons, even researchers who advocate Ferber sleep training warn that sleep training is inappropriate for babies under 6 months old.
As Richard Ferber himself acknowledges, the Ferber method doesn’t teach babies how to fall asleep on their own: children are simply denied access to their parents, and are left to cope.
#2: Mother and Baby Separation During Sleep Training
Babies are designed to sleep in close proximity to their mothers. Extensive research by Professor James McKenna’s Mother-Baby Behavioural Sleep Laboratory (Department of Anthropology, University of Notre Dame) in the US, and Professor Helen Ball’s Parent-Infant Sleep Lab (Department of Anthropology at Durham University) in the UK show this beyond doubt.
Emerging evidence is showing the potentially negative impacts of interrupting the strong connections between mother and baby, when the natural call and response pattern of night waking is broken.
In 2012, 4-10 month-old infants undergoing a hospital-based extinction program were studied. The babies ceased crying at bed-time by the third night of the program. However, their levels of the stress hormone, cortisol, remained elevated – as high as they had been on the first night of crying. While their behaviour had adapted to sleeping alone, their bodies had not, so they remained stressed. Their mothers, however, adapted quickly and had normal cortisol levels.
Further research is needed to look at the longer-term impacts.
“Before six months, you're just extinguishing,” explains Doctor Howard Chilton, a neonatologist at the Prince of Wales Private Hospital and the Royal Hospital for Women in Sydney. “Eventually, the baby just gives up.”
Extinguishment is the baby’s last survival mode: when no parent appears, despite a long period of crying, she will go quiet. Although she might seem to have settled, she isn’t. She is doing the only thing she can do to protect herself: keeping silent so predators can’t find her. She is responding as if she is abandoned. No wonder her cortisol levels remain high.
#3: Separation Anxiety
As babies get older, another factor comes into play. In the second half year (as they become mobile), they also become fearful of their mother being out of sight. Again, this makes sense from an anthropological perspective: a mobile baby without boundaries could wander and become lost. Stranger anxiety, appearing around 9-10 months, acts as an extra protection – that mobile baby is not going to stray from his mother’s view, nor happily go off with someone outside their circle of security.
Separation anxiety generally peaks at around 14 months and can continue to be an issue until 2 years or beyond. It makes sense not to contribute to the problem by using extinction methods with a child already showing signs of distress when her mother or other primary caregiver is out of sight.
#4: The Impact of Sleep Training On The Breastfeeding Relationship
A breastfed baby is particularly vulnerable to any manipulation of their natural feeding and sleeping patterns, both in the day and at night.
The finely balanced feedback loop between the baby and the breast relies on unscheduled feeds to stimulate the milk-making cells to produce enough milk to meet the baby’s needs. This process takes place around the clock, and interfering with it can dramatically reduce your supply.
Night feeds can actually increase at times, as the baby naturally compensates for reduced day feeds: during the distracted stages around four months and nine months, during breast refusal and when mama goes back to work. Read more about four month monsters and how babies change.
If your breastfeeding goals include continuing to breastfeed until 12 months or beyond, maintaining cue-based feeding at night is important to ensure your milk production continues to meet your baby’s changing needs.
There are many reasons why nighttime breastfeeding is important.
#5: Sleep Training And The Risk of SIDS
Extinction methods of sleep training rely on the baby being in a separate room to his parents.
Dr James McKenna recommends that babies share their parent’s room. Actually, he recommends babies sleep near their mother. This is because research shows SIDS risk is increased when babies sleep in another room in the first 6-12 months. That might be especially important for formula fed babies whose risk is already increased. Although SIDS occurs mostly in the the 2-4 month age group, it's important to practice safe sleeping guidelines until at least one year.
There is obviously a conflict then between safe sleep guidelines and extinction methods of sleep training.
Because there has not been any research into what happens in the baby’s brain during or as a result of sleep training, we have no way of knowing if those babies who no longer cry for their mother are sleeping normally or have an altered sleep state. There is also a lack of data about SIDS in sleep trained babies compared to those whose parents respond to their cries.
#6: Sleep Training And Your Child’s Mental Health
Parents might be surprised to read about concerns for their baby’s mental health. Aren’t they too young to need to worry about that?
The answer is no. Your baby’s emotional development is equally as important as their physical and neurological growth. Emotional development in babies is known as attachment. It refers to the strong bond formed between a baby and her primary caregiver. We promote secure attachment when we respond to signals from our baby that she needs to connect: smiling, reaching out, vocalising and crying.
Crying is nearly always the last option a baby uses to communicate – when all other methods have been unsuccessful. Just as it is a late hunger signal. Learning your baby's cues is a very helpful tool.
The Australian Association for Infant Mental Health (AAIMHI) is concerned that methods like controlled crying are not consistent with infants and toddlers needs for optimal emotional and psychological health, and may have unintended negative consequences.
The AAIMHI position paper on controlled crying clearly states:
“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 parent is absent…
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.”
Compounding on these concerns, a recent study in the US found that as many as 40% of children lack a secure attachment. It's clear that research should be undertaken to see what, if any, role the extinction methods of sleep training might have in that.
Many parents claim they turned to extinction methods of sleep training due to fears for their own mental health. While that is understandable, a positive outcome for a parent at the price of a negative one for their child needs to be weighed heavily. Instead of trying to train your baby, first troubleshoot any possible ways you can fix the real problem at home. Do you need more sleep, more support, more community around you? First seek to improve your situation, which is a win for baby and a win for the mother.
While gentle alternatives to extinction methods of sleep training may not be as heavily promoted, they are effective. These are explored in our article on gentle alternatives to sleep training.