Monday
Aug112008
Cry it out (CIO): Is it harmful or helpful?
Monday, August 11, 2008
About a month ago, I wrote a post outlining the scientific and emotional reasons why we have chosen not to use the Cry It Out (CIO) method with our children. In brief, the ten reasons are:
Several people have commented on that post, both in the comments to that post and in other places, questioning the rationale that was posted. The greatest area of critique appears to be that a lot of the research presented looks more broadly at children whose parents are not responsive to their cries and doesn't specifically look at situations where parents are loving and responsive all day long, but just let their children cry to sleep "for a few nights". They insist that there are children that are left to cry it out that are perfectly happy and healthy despite going through the sleep training.
Fair enough.
This is acknowledged in at least one of the articles that I linked to (Pinky McKay - The Con of Controlled Crying):
But...
There are things that cannot feasibly or ethically be researched
Imagine a poster in your pediatrician's office that says something like this:
Would you sign your child up? Of course not. First of all, most responsive parents would not be willing to let their child cry. Second of all, I'd be willing to bet that even those responsive parents that do resort to CIO would not be willing to have a researcher dictate specific terms to them. And without this, it would be hard to get valid scientific results. I'm also pretty sure that a study like this would not make it as far as the poster stage. It wouldn't make it past the ethics board that all medical research proposals need to go through, so I don't think we need to worry about coming across this poster.
The issue of alcohol during pregnancy is one that is similar to the issue of crying it out. We know from data that has been collected that some women that drink alcohol during pregnancy end up having babies with Fetal Alcohol Syndrome. Other women that drink alcohol during pregnancy have babies that are perfectly healthy. It would appear, from anecdotal evidence, that some women are heavy drinkers during pregnancy and have healthy babies. Others are only light drinkers and end up with babies with fetal alcohol syndrome. Ideally, we would do more research to understand better why alcohol impacts some babies and not others and to figure out how much alcohol under what circumstances is okay. However, it is not advisable or ethical to tell certain women to drink while pregnant in order to study this issue further. As a result, health organizations advise women to abstain from drinking while they are pregnant.
We don't know which babies will turn out okay and which ones won't
Some babies of mothers that drink during pregnancy turn out okay. Others get fetal alcohol syndrome. Some kids that are bullied at school brush it off, others suffer from depression, get bad marks, commit suicide or murder. Some children that are victims of sexual abuse are able to get over it and move on, for others their lives are ruined. Some children who are left to cry it out will turn out okay and others will suffer intellectually, emotionally and socially.
The human brain is a sensitive organ and we do not know why it is so resilient in some people and so sensitive in others. We do know that the brain is particularly sensitive during the first few years, so it makes sense that someone with a sensitive brain is going to be even more sensitive as an infant and even more susceptible to potential damage.
Because we don't know which babies have resilient brains and which ones have sensitive brains, we cannot assume that any one baby will be okay as a result of crying it out, just because others have been okay.
We don't know how much is too much
Some of the so-called sleep experts and sleep trainers will put limits on how long to listen to your baby crying before you offer reassurance. But how did they come to their conclusion that 5 minutes, 15 minutes, 30 minutes, 60 minutes, or whatever is a reasonable amount of time to leave a crying child before checking in? There are no scientific studies that say that a certain amount of crying is okay and your baby still knows that you are there and that you care and that you will meet his needs but that after "X" minutes it is no longer okay anymore. We don't know what the snapping point will be for any particular child. So for an "expert" to tell you that a certain number of minutes is okay, is ridiculous.
We need to question what we define as success
Parents generally define success as uninterrupted sleep. Sleep trainers will measure success "by the reluctance of the child to call out for his parents, even if he still wakes up, needs help, or is traumatized by fear" (Paul Fleiss - Mistaken Approaches to Night Waking).
Personally, I reject any parenting tactic that has, at its core, a goal of teaching children not to connect with their parents when they need them. Some people will say that if you are otherwise always responsive to your kids, but just do CIO, then they will still know that they can come to you. But will they really? Will they always know that it is okay? Perhaps a thought will linger on their brains that it is best not to disturb their parents at night. And then when they have been drinking at a party and can either call their parents to pick them up or accept a ride home with someone that has been drinking, they figure their parents will only be upset at being disturbed. Maybe not all children that are left to CIO will make that choice. Perhaps enough reminders from their parents that it is okay to call will sink in.
However, I'd rather just get the right head start and teach my children from the start that they can reach out to me whenever they need me. If that message sinks in, that is what I define as success.
It is your choice, you need to feel comfortable with it
My original post was written to explain my reasons for not using the cry it out method. I put it out there for the benefit of parents who are being told that their baby must sleep through the night and that they must use sleep training, cry it out, controlled crying, or whatever you want to call it to achieve that. I wanted to provide a balance to that voice that is strong and give another perspective to those parents that might benefit from it.
While I do believe in the reasons that I posted, that only really matters for my children. You need to believe in the reasons that you are doing things the way that you do them with your children. If you feel confident that the "lack of evidence" that CIO is harmful means that it is harmless, that is your choice. And I hope that you are right. But I'm not taking the chance.
- CIO can cause harmful changes to babies' brains
- CIO can result in decreased intellectual, emotional and social development
- CIO can result in a detached baby
- CIO is harmful to the parent-child relationship
- CIO can make children insecure
- CIO often doesn't work at all
- Even if CIO does "work", parents often have to do it over and over again
- CIO is disrespectful of my child's needs
- Deep sleep from CIO is often a result of trauma
- Our world needs more love
Several people have commented on that post, both in the comments to that post and in other places, questioning the rationale that was posted. The greatest area of critique appears to be that a lot of the research presented looks more broadly at children whose parents are not responsive to their cries and doesn't specifically look at situations where parents are loving and responsive all day long, but just let their children cry to sleep "for a few nights". They insist that there are children that are left to cry it out that are perfectly happy and healthy despite going through the sleep training.
Fair enough.
This is acknowledged in at least one of the articles that I linked to (Pinky McKay - The Con of Controlled Crying):
Although many baby sleep trainers claim there is no evidence of harm from practices such as controlled crying, it is worth noting that there is a vast difference between "no evidence of harm" and "evidence of no harm". In fact, a growing number of health professionals are now claiming that training infants to sleep too deeply, too soon, is not in babies' best psychological or physiological interests. A policy statement on controlled crying issued by the Australian Association of Infant Mental Health (AAIMHI) advises, "Controlled crying is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences." According to AAIMHI, "There have been no studies, such as sleep laboratory studies, to our knowledge, that assess the physiological stress levels of infants who undergo controlled crying, or its emotional or psychological impact on the developing child."
But...
There are things that cannot feasibly or ethically be researched
Imagine a poster in your pediatrician's office that says something like this:
Dr. Sleep of the Infant Sleep Laboratory at the University of Good Night is seeking parents of babies that do not sleep through the night to participate in a study. We are looking for parents that are committed to being responsive parents and meeting their child's needs. Some participants in this study will be required to respond to their babies needs at night. This will be the control group. Other participants will be required to let their baby cry to sleep following specific instructions on how long to let the baby cry and under what circumstances it is okay to check on the baby. We will then monitor your child's physical and emotional health and development at certain intervals during childhood and early adulthood to determine the effects of letting your child cry to sleep.
Would you sign your child up? Of course not. First of all, most responsive parents would not be willing to let their child cry. Second of all, I'd be willing to bet that even those responsive parents that do resort to CIO would not be willing to have a researcher dictate specific terms to them. And without this, it would be hard to get valid scientific results. I'm also pretty sure that a study like this would not make it as far as the poster stage. It wouldn't make it past the ethics board that all medical research proposals need to go through, so I don't think we need to worry about coming across this poster.
The issue of alcohol during pregnancy is one that is similar to the issue of crying it out. We know from data that has been collected that some women that drink alcohol during pregnancy end up having babies with Fetal Alcohol Syndrome. Other women that drink alcohol during pregnancy have babies that are perfectly healthy. It would appear, from anecdotal evidence, that some women are heavy drinkers during pregnancy and have healthy babies. Others are only light drinkers and end up with babies with fetal alcohol syndrome. Ideally, we would do more research to understand better why alcohol impacts some babies and not others and to figure out how much alcohol under what circumstances is okay. However, it is not advisable or ethical to tell certain women to drink while pregnant in order to study this issue further. As a result, health organizations advise women to abstain from drinking while they are pregnant.
We don't know which babies will turn out okay and which ones won't
Some babies of mothers that drink during pregnancy turn out okay. Others get fetal alcohol syndrome. Some kids that are bullied at school brush it off, others suffer from depression, get bad marks, commit suicide or murder. Some children that are victims of sexual abuse are able to get over it and move on, for others their lives are ruined. Some children who are left to cry it out will turn out okay and others will suffer intellectually, emotionally and socially.
The human brain is a sensitive organ and we do not know why it is so resilient in some people and so sensitive in others. We do know that the brain is particularly sensitive during the first few years, so it makes sense that someone with a sensitive brain is going to be even more sensitive as an infant and even more susceptible to potential damage.
Because we don't know which babies have resilient brains and which ones have sensitive brains, we cannot assume that any one baby will be okay as a result of crying it out, just because others have been okay.
We don't know how much is too much
Some of the so-called sleep experts and sleep trainers will put limits on how long to listen to your baby crying before you offer reassurance. But how did they come to their conclusion that 5 minutes, 15 minutes, 30 minutes, 60 minutes, or whatever is a reasonable amount of time to leave a crying child before checking in? There are no scientific studies that say that a certain amount of crying is okay and your baby still knows that you are there and that you care and that you will meet his needs but that after "X" minutes it is no longer okay anymore. We don't know what the snapping point will be for any particular child. So for an "expert" to tell you that a certain number of minutes is okay, is ridiculous.
We need to question what we define as success
Parents generally define success as uninterrupted sleep. Sleep trainers will measure success "by the reluctance of the child to call out for his parents, even if he still wakes up, needs help, or is traumatized by fear" (Paul Fleiss - Mistaken Approaches to Night Waking).
Personally, I reject any parenting tactic that has, at its core, a goal of teaching children not to connect with their parents when they need them. Some people will say that if you are otherwise always responsive to your kids, but just do CIO, then they will still know that they can come to you. But will they really? Will they always know that it is okay? Perhaps a thought will linger on their brains that it is best not to disturb their parents at night. And then when they have been drinking at a party and can either call their parents to pick them up or accept a ride home with someone that has been drinking, they figure their parents will only be upset at being disturbed. Maybe not all children that are left to CIO will make that choice. Perhaps enough reminders from their parents that it is okay to call will sink in.
However, I'd rather just get the right head start and teach my children from the start that they can reach out to me whenever they need me. If that message sinks in, that is what I define as success.
It is your choice, you need to feel comfortable with it
My original post was written to explain my reasons for not using the cry it out method. I put it out there for the benefit of parents who are being told that their baby must sleep through the night and that they must use sleep training, cry it out, controlled crying, or whatever you want to call it to achieve that. I wanted to provide a balance to that voice that is strong and give another perspective to those parents that might benefit from it.
While I do believe in the reasons that I posted, that only really matters for my children. You need to believe in the reasons that you are doing things the way that you do them with your children. If you feel confident that the "lack of evidence" that CIO is harmful means that it is harmless, that is your choice. And I hope that you are right. But I'm not taking the chance.
Reader Comments (52)
Came across this post while researching CIO after yet another night (my son is 4.5 months) of multiple wakings. After tears of my own, serious thoughts of regretting having a child and a bad cold that is getting worse...and seeing my child's dark circles from not sleeping well...and back and neck pain from co-sleeping (definitely NOT the magic cure)...and of course overwhelming anxiety preventing me from sleeping between his nursing sessions...well...I am thinking that who was I to think that I would be a good mother? Gosh, it looks like good mothers never get sick, upset, anxious, depressed, and maybe just a little worried about whether they might get in a car accident the next day from cumulative sleep deprivation. Congratulations on being superior human beings. The rest of us are just trying to survive...and if that means CIO as a last resort, so be it.
......They require more patience than a few nights of CIO, but it is possible. Again, gently and slowly is key for me ........
Spoken like someone that runs away from anything difficult enough to not have any concept of dealing with difficult things.
You ACTUALLY think it's easier to sit there and listen to your child protest, cry and tantrum when you know picking them up will result in peace and quiet? As someone who has applied ( and still applies) different philosophies to parent two very different kids, I can tell you have no idea what you are talking about.
It's 1000 times easier to simply respond to your child on every whimper than it is to CIO. It requires more fortitude than I can begin to explain to a person that can't fathom teaching their child anything difficult at the risk of their child crying.... You know, cause if they get upset enough they will suffer brain damage.
You make a lot of assumptions....your whole blog is one assumption laden OPINION piece presented as fact. Blogs like these are what turn people away from ideas that are actually beneficial ( breast feeding, baby wearing etc) because the people that present them seem to think of themselves as superior and assume they care more about their kids than others do about theirs and everybody else makes selfish decisions........cause nobody else's way could possibly be right, necessary, or work. How off putting.
Btw co sleeping is a risk factor for SIDS...and that is a proven scientific fact. While you are pushing concepts that have to scientific evidence if harm you are actually promoting one is proven to be a high risk for harm. I just love that selective reasoning.