Controlled Crying / Controlled Comforting / Sleep Training
CONTROLLED CRYING: AAIMHI POSITION PAPER
Introduction
The Australian Association for Infant Mental Health aims (in part):
* To improve professional and public recognition that infancy is a critical period in psycho-social development, and
* To work for the improvement of the mental health and development of all infants and families.
Definition
Controlled crying (also known as controlled comforting and sleep training) is a technique which is widely used as a way of managing 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 intention of controlled crying is to let babies put themselves to sleep and to stop them from crying or calling out during the night.
AAIMHI is concerned that the widely practiced technique of ‘controlled crying’ is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences.
Background to AAIMHI’s concerns
* This statement is premised on an understanding of crying to mean crying that indicates distress, either psychological or physical, rather than the "fussing" that many babies do in settling or adjusting to different circumstances.
* Babies have to adapt to a totally new world and even small changes can be stressful for them. Leaving babies to cry without comfort, even for short periods of time, can be very distressing to the infants.
* Crying is a signal of distress or discomfort from an infant or young child. Although controlled crying can stop children from crying, it may teach children not to seek or expect support when distressed.
* Infants from about six months of age suffer from differing degrees of anxiety when separated from their carers. This continues until they can learn that their carers will return when they leave, and that they are safe. This learning may take up to three years.
* Almost all children grow out of the need to wake at night and be reassured by three or four years of age, many much earlier than this.
* Infants are more likely to develop secure attachments when their distress is responded to promptly, consistently and appropriately. Secure attachments in infancy are the foundation for good adult mental health.
* Infants whose parents respond and attend to their crying promptly, learn to settle more quickly in the long run, as they become secure in the knowledge that their needs for emotional comfort will be met.
* The demands of Western lifestyle and some "expert" advice has led to an expectation that all infants and young children should sleep through the night from the early months or even weeks. In fact infants have the potential to arouse more often in the night than older children or adults because their sleep cycles are much shorter. These short sleep cycles allow infants to experience more REM sleep, which is considered to be important for their brain development.
* Many parents become distressed and exhausted when their infants and young children cry at night, in part because of the physical strain of getting up and going to their babies to re-settle them, and sometimes in part because of the unrealistic expectation that babies "should" sleep through the night.
* Many infants and parents sleep best when they sleep together. There is no developmental reason why infants should sleep separately from their parents, and in most of the world infants do sleep with their parents or other family members, either in the same bed, or in a cot next to the parents' bed. Co-sleeping with infants should never occur when a parent is affected by drugs or alcohol, or where the bedding is overly soft. [All parents whether co-sleeping or not should check current information regarding safe sleeping for infants to avoid risk of SIDS eg http://www.sidsaustralia.org.au/
* Many parents find controlled crying helpful and this is one of the reasons for its popularity. For other parents it does not work, or causes so much distress for the parent and the infant that it is discontinued.
* There have been no studies, to our knowledge, such as sleep laboratory studies, which assess the physiological stress levels of infants who undergo controlled crying, or its emotional or psychological impact on the developing child
Australian Association for Infant Mental Health - Controlled Crying Principles
* It is normal and healthy for infants and young children not to sleep through the night and to need attention from parents. This should not be labelled a disorder except where it is clearly outside the usual patterns.
* Parents should be reassured that attending to their infant's needs/crying will not cause a lasting "habit".
* Waking in older infants and young children may be due to separation anxiety, and in these cases sleeping with or next to a parent is a valid option. This often enables all to get a good night's sleep.
* Any methods to assist parents to get a good night’s sleep should not compromise the infant's developmental and emotional needs.
* If "controlled crying" is to be used it would be most appropriate after the child has an understanding of the meaning of the parent's words, to know that the parent will be coming back and to be able to feel safe without the parent's presence. Developmentally this takes about three years. This varies between children and observing children and responding to their cues is the best way to assess when a child feels safe sleeping alone.
* A full professional assessment of the child’s health, and child and family relationships should be undertaken before initiating a controlled crying program. This should include an assessment of whether in fact the infant’s crying is outside normal levels. All efforts should be made to link parents with community supports to minimise the isolation and frustration felt by many parents when caring for a young child. Other strategies, apart from controlled crying, should always be discussed with parents as preferable options.
* If an infant or child has already experienced separation from a parent due to sickness, parent absence or adoption, or if he or she becomes very distressed the method should not be used. This is because children who have already experienced traumatic separation are more vulnerable to negative effects from the kind of stress caused by controlled crying.
* Where parental stress due to infant crying may lead to risk of abuse it is essential that parents are linked with social supports and therapeutic intervention.
* Parents should be told that the method has not been assessed in terms of stress on the infant or the impact on the infant's emotional development.
* Where it is used recommendations should be for exercising caution and playing safe.
For example:
* Paying attention to level of distress rather than number of minutes baby has to be left to cry
* Not continuing with any technique if it does not feel right.
References
The references below are not specifically to studies on the impact of controlled crying on infants because there are no records of such studies. They are general background information related to sleep and to understanding children and stress.
1. Bell, S. M. & Ainsworth, M.D. (1972). Infant crying and maternal responsiveness. Child Development, 43, 1171-1190
2. Blurton Jones, N. (1972). Comparative aspects of mother-child contact in Blurton Jones, N. (ed) Ethological Studies of Child Behaviour. Cambridge: Cambridge University Press.
3. Bowlby, J. (1973). Attachment and loss:2. Separation. Harmondswroth, Middlesex: Penguin.
4. Dolby, R. (1996) Overview of Attachment Theory and Consequences for Emotional Development in Seminar 15. Attachment: Children’s Emotional Development and the Link with Care and Protection Issues. Sydney: Child Protection Council.
5. Hope, M.J. (1986) Selected Paper No. 43 Understanding Cyring in Infancy. Kensington, NSW: Foundation for Child & Youth Studies.
6. Keller, H. et al (1996). Psychobiological aspects of infant crying. Early Development and Parenting, 5(1).
7. Lamport Commons, M. & Miller, P.M. Emotional learning in infants: A cross-cultural examination http://www.naturalchild.com/research...g_infants.html -
8. Leach, P. (1994) Children First: What we must do, and are not doing – for our children today. London: Penguin.
9. McKenna, J and L Gartner (2000) Sleep Location and Suffocation: How Good Is The Evidence.? Pediatrics vol. 105 (4) 917-919
10. McKenna, James J (2000) Cultural Influences on Infant Sleep (abbreviated chapter) Zero To Three Vol 20, No 3, 9-18.
11. Odent, M. (1986) Primal health: A blueprint for our survival. London: Century Hutchinson.
12. Perry, B. D., Memories of Fear:How the Brain Stores and Retrieves Physiologic States, Feelings, Behaviors and Thoughts from Traumatic Events http://www.childtrauma.org/CTAMATERIALS/Memories.ASP
13. Perry, B.D. & Pollard, R. (1998) Homeostasis, stress, trauma, and adaptation: a neurodevelopmental view of childhood trauma. Child and Adolescent Psychiatric Clinics of North America, 7; 1: 33-51.
14. Trevathan, W. and McKenna, J. (1994) Evolutionary environments of human birth and infancy: Insights to apply to contemporary life in Children’s Environments, 11 (2), 88-104.
Suggestions for alternatives to controlled crying
McKay, Pinky - "Parenting by Heart" and "100 Ways to Calm the Crying" or http://www.pinky-mychild.com
Dr William Sears http://www.askdrsears.com . He also has a number of helpful books, including "The Fussy Baby" , “The Baby Book†and “Nighttime Parentingâ€.
Fleiss, P. M. ,Hodges, F.M. Phil. D, 2000, Sweet Dreams: A Pediatrician's Secrets for Your Child's Good Night's Sleep, Los Angeles: Lowell House,
Gordon, Jay and Goodavage, Maria "Good Nights" NY St Martin's Griffin, 2002
Hope, M. (1996) For Crying Out Loud!: Understanding and Helping Crying Babies Randwick: Sydney Children’s Hospital
The ‘Natural Child’ website has a wide range of articles for parents. http://www.naturalchild.com
Pantley, Elizabeth "The No-Cry Sleep Solution" NY Contemporary Books, 2002
Tracey, Norma et al Sleep for baby and family PIFA 2002, 02 82301646
Australian Association for Infant Mental Health
November 2002
Another useful sleeping link is Dr. James McKenna's Sleep Lab website HERE.
