To say that the subject of infant sleep is a controversial one among parents is an understatement. In fact, calling for the abolishment of all government seems less controversial.
Every parent wants to believe they are doing the right thing for their child. Conventional wisdom calls for letting an infant "cry it out". Cry it out specifically refers to any method of putting a baby to sleep that involves lying baby down awake and alone, without sleep aids (blanket, pacifier, stuffed animal, or mom and dad), at a scheduled bed time, and when baby begins to cry he/she is to be left crying in timed increments until finally baby gives up and goes to sleep. This method also emphasizes parent directed feeding which involves parental initiation and control of feedings and the importance of the schedule.
Books dedicated to the cry it out method are numerous. The method of using controlled crying is so ingrained in our cultural understanding of how to get one's baby to sleep that any other approach is met with suspicion, eye rolls, accusations of spoiling, even disdain.
When you're sleep deprived, the thought of getting that baby to sleep through the night becomes something of an obsession. I certainly have felt this way. As a mother of five children, I have had my share of sleep deprivation.
The birth of our first child was a particularly harrowing experience. After a reluctant induction and being coached by an ignorant doctor to push for four hours on my back, I was in no shape for caring for a newborn. Nursing got off to rather rocky start.
Once home our main goal was to just get her to eat, never mind a schedule. Once she was eating and having enough wet and soiled diapers I began to turn my attention to the various books I'd read as preparation for parenthood. A well-meaning friend gave us the book On Becoming Babywise prior to the birth and I'd read it along with several other books to help prepare me for life with a baby.
Babywise principles and promised results sounded great. We would have our baby sleeping through the night by 6 or 8 weeks old. All feedings would be scheduled. The baby would be put to bed and "taught" to sooth herself by being left to cry. Life would be calm, predictable, our baby would be content, and we would not be over-tired zombies.
I began to implement the basic feeding schedule recommended by Babywise, every 2.5 to 3.5 hours making sure she got a full feeding. The book emphasized that "snacking at the breast" should not be allowed.
As the first two weeks wore on I noticed that our daughter seemed to need to nurse more frequently than the Babywise recommended feeding schedule. I was exhausted, still recovering from the difficult birth, and very sleep deprived, since she did not seem to be able to stay asleep for very long. We tried laying her down and letting her cry, but something inside of me did not feel right about it. Many times, I would get her to sleep in my arms, attempt to lay her down in her crib, only to have her wake right back up as soon as her body touched the mattress. Babywise recommended letting her cry, otherwise she would be trained to manipulate me into picking her up during her scheduled sleep-times. I could not bring myself to let our baby cry. She seemed to need to be close to me, and I her. What was right: the book or my instincts?
Desperate, I searched through my other parenting books for advice. I came across a rather thick book given to me by another friend. I hadn't opened it yet, but The Baby Book by Dr. Sears would become my "baby bible" for the next few months. The Dr. Sears approach was opposite to Babywise. Where Babywise suggested manipulation by the baby, Dr. Sears pointed out appropriate dependency. Babywise demanded schedule, Dr. Sears, feeding when the baby was hungry. Both books acknowledged the exhaustion that round the clock parenting brings, but Babywise emphasized parental control of baby's sleep through purposefully letting baby cry to sleep. Dr. Sears encouraged us to help baby learn to sleep through the night by cuddling, sleeping with us, or nursing to sleep. Gradually I found myself reaching for Dr. Sears more and more frequently.
Dr. Sears is one of the leading proponents of Attachment Parenting, which is based on Attachment Theory.
One thing all of the books on cry it out do not emphasize, or even acknowledge in some cases, is basic attachment theory. I should have remembered this from my training as a therapist, but somehow I forgot. Attachment theory is simply this: all infants become attached to the person with whom they interact most often, which is usually the mother, and second the father. This sounds fine and good; however, there's a catch. This attachment takes three different forms depending upon the responsiveness of the attachment figures (ie. mom and/or dad). A secure attachment is formed when mom and dad are responsive to baby and meet baby's needs consistently. Baby develops trust.
An avoidant attachment is formed when mom and dad are unresponsive to baby's needs. Baby becomes distrustful, loses hope. These babies develop failure to thrive. Most parents do not fall into this category.
An anxious-ambivalent attachment is formed when baby's needs are met inconsistently. For instance, sometimes mom and dad respond to baby's cries and sometimes the cries are ignored. Sometimes baby's diaper gets changed, and sometimes not. Sometimes baby is fed when hungry, and sometimes not.
The cry it out method's most basic premise promotes a pattern that will lead to an anxious-ambivalent attachment by the infant. Why is this bad? An infant who develops an anxious-ambivalent attachment does not trust that his needs will be met consistently. This baby can develop Shutdown Syndrome as a direct result of parenting that is inconsistently responsive.
Dr. Sears writes:
"Babies who are “trained” not to express their needs may appear to be docile, compliant, or “good” babies. Yet these babies could be depressed babies who are shutting down the expression of their needs, and they may become children who don’t ever speak up to get their needs met and eventually become the highest-need adults."
I recall being asked by numerous people from varying backgrounds and ages when I first became a mother, "Is she a good baby?" At first I just laughed at the question and answered "Oh, yes!" After the 9th or 10th time my answers were less nice. Once I answered half laughing, "Oh no! She's evil. Very evil in fact." The look of shock at my response compelled me to give an explanation for my outburst. I asked, "What can you mean by asking if my baby is good?" The answer to that question varied depending upon the person being asked. By good, people were asking, does she cry? Does she sleep well? But, the real question, the one it all boiled down to was this: Does she need me too much? For our culture, anytime a child does not sleep through the night by 6 or 8 weeks, needs to feed at inconvenient times, and generally wants to be held a lot is NOT a "good" baby. This kind of baby is spoiled. Not only is this not true, it is also an unrealistic view of babies. By training our babies to be "good" babies we are systematically emotionally shutting our infants down which is a problem since developing a secure attachment with ones primary caregiver is crucial for all future emotional development and independence.
Recently, researchers at the Harvard Medical School's Department of Psychiatry studied long-term effects of the cry it out method. One of the researchers, Michael L. Commons reports these findings:
“Parents should recognize that having their babies cry unnecessarily harms the baby permanently,” Commons said. “It changes the nervous system so they’re overly sensitive to future trauma.”
Also, "Research has shown that infants who are routinely separated from parents in a stressful way have abnormally high levels of the stress hormone cortisol, as well as lower growth hormone levels. These imbalances inhibit the development of nerve tissue in the brain, suppress growth, and depress the immune system."
Letting babies cry it out harms them permanently.
A second major problem with Babywise is the scheduling of breastfeeding.
I can never understand how the cry it out camp gets away with recommendations of scheduled feedings for breastfeeding mothers. The biggest problem with scheduled breastfeeding is the subsequent issues with supply and demand. A mother's milk supply is directly regulated by baby's demand for milk. Scheduled feedings disturb this delicate balance and do not take into account differences among breastfeeding women and babies.
Dr. Matthew Aney highlights this problem:
"According to one report, differences of up to 300 percent in the maximum milk storage capacity of women’s breasts mean that, although women have the capability of producing the same amount of milk over a 24-hour period for their infants, some will have to breastfeed far more frequently than others to maintain that supply. Babies must feed when they need to, with intervals and duration determined according to a variety of factors in temperament, environment, and physiological make-up. Averages may fit into a bell-shaped curve, but some babies will require shorter intervals. (Daly S., Hartmann P. “Infant demand and milk supply, Part 2. The short-term control of milk synthesis in lactating women.” Journal of Human Lactation; 11; (1):27-37).
By feeding on a schedule mothers risk again a diagnosis of failure to thrive: baby does not get enough milk, moms milk supply drops, baby stops gaining weight. Sadly I have seen this situation occur more than once. Most mothers catch the fact that their baby is hungry before failure to thrive is diagnosed. They supplement with formula and eventually give up on breastfeeding altogether. They don't make the connection between the schedule and their lowered milk supply. These mothers blame their body, "I just couldn't make enough milk." I hear this statement nearly every time I go out and interact with other mothers.
The effect on the mother of the interrupted breastfeeding relationship that often accompanies cry it out is depression. Gordon Gallup and associates found a higher incidence of depression in mothers who bottle fed when compared with mother's who breastfed. This makes sense when you consider the hormones released in the mother each time she brings baby to breast, hormones that promote bonding and feelings of love for her baby. In the absence of the release of these hormones via breastfeeding, the mother may experience depression.
For those of you who chose to use the cry it out method the findings presented in this article may be disturbing for you. You are not alone. An entire website devoted to helping mother's cope with their decision is available at cryitoutrecovery.org.
For a full list of articles addressing medical concerns related to cry it out see Dr. Aney's list here.
Our journey away from this dysfunctional model of parenting was swift I am happy to say. By the time our first child was 6 months of age we were fully on board with attachment parenting and the happier for it. Responsive parenting has yielded such wonderful bonds with each of our children. As a culture we need to reject the cry it out method. It is not an emotionally healthy way to raise children. There are gentler, more responsive ways to get your baby to sleep and eat that allow for individual differences in temperament and level of neediness.
"Remember, you are not managing an inconvenience; you are raising a human being." ~ Kittie Franz