Tuesday
Sep182012
The Infant Sleep and Cry It Out Study That Proved...Nothing
Tuesday, September 18, 2012 
A couple of weeks ago a new study was published in and promoted by the American Academy of Pediatrics journal Pediatrics. The study called Five Year Follow-up of Harms and Benefits of Behavioural Infant Sleep Intervention: Randomized Trial is being promoted as proof that the graduated cry it out method (i.e. where you let the baby cry and go back in and comfort them and then let them cry some more and repeat until they fall asleep) causes no harm and is perfectly safe to use.
In fact, their conclusion, based on a follow-up with the families of six-year olds who had been recruited into the study as infants reads as follows:
Behavioral sleep techniques have no marked long-lasting effects (positive or negative). Parents and health professionals can confidently use these techniques to reduce the short- to medium-term burden of infant sleep problems and maternal depression.
Initially I was interested in reading the study to see how they defined and measured positive and negative effects. In the end, I decided that didn't matter at all because the methodology for randomization and intervention was so ridiculous that it rendered the study completely useless.
Do What You Want vs. Do What You Want
The parents and infants who participated in the trial were recruited from well-child centres in Australia when the child was 7 months old. If the parent reported sleep problems, they were eligible for the study (if there were no sleep problems, they were not eligible, which could bring up a whole other set of questions around how our society influences what we consider to be a sleep problem).
The well-child centres where parents were recruited were assigned as intervention or control groups. Here is what happened:
- Intervention Centres: In the centres where interventions were administered, the nurse who meets with parents at their well-baby check ups was trained to "deliver a brief, standardized behavioural sleep intervention at the routine 8 month well-child check." The standardized intervention included describing two possible interventions -- controlled comforting or camping out (the former involves the parents leaving the room and coming back at specified intervals and the the latter involves sitting in the room with the child, gradually moving your chair further and further from their bed). Parents were then free to implement one of those interventions, try both of them, or ignore them altogether and do something completely different.
- Control Centres: In the centres that were designated as control groups, parents attended the 8 month well-child check as planned and met with a nurse (as they would have if there had been no study). If the parents asked for sleep advice, the nurse could give them sleep advice, just as she would have if there had been no study. Parents were then free to implement something the nurse told them or to ignore the advice altogether and do something completely different.
So, the only difference between the intervention group and the control group is that the nurses that in the intervention group were given formal training on sleep interventions. From what I can the parents were never asked which sleep interventions they used (if any).
So all of the results of the study with regards to positive or negative impacts on the child, child-parent relationship, or the mother are based on whether they received a "brief, standardized" lecture when their child was eight months old. What other sleep advice the parents received from friends, family, books, other health professionals or random people on the Internet wasn't considered. Which techniques parents actually selected and used wasn't considered (from what I can tell) or at least wasn't used in the reporting on results, which only looked at whether parents received that standardized lecture or not.
So really, the conclusion of the study should be:
Giving a behavioral sleep technique lecture at 8 months has no marked long-lasting effects (positive or negative). Parents and health professionals can confidently use these techniques to reduce the short- to medium-term burden of infant sleep problems and maternal depression.
With all the different places that parents get sleep advice, basing any conclusions on one short lecture is ridiculous, especially when there was no follow-up to determine which approach parents actually used.
But of course most journalists reporting on this study either didn't bother to read it or didn't consider what it really meant when they simply extrapolated from the summary and declared that "cry it out is perfectly safe".
My Other Beef -- The "M" Word
There are other things I could analyze with regards to how positive and negative impacts were measured, but given what I explained in the previous section that isn't really worth getting into. I do, however, want to express my disappointment that this study, like so many others, focused on THE MOTHER exclusively. The study, like so many others, looks at maternal outcomes, maternal depression, maternal mental health and parenting style and so on. All this does is further reinforce the idea that the mother is responsible for infant sleep.
What about shared parental responsibility?
Often when I hear about moms who are completely stressed out over their infant's sleep, it is because they are getting up multiple times per night with the baby while their husband sleeps or both parents are getting up at the same time to care for the baby together. It doesn't seem to matter whether the mom works or not, it just seems to be assumed that regardless of what she has on her plate during the day, she is responsible for getting the baby to sleep and taking care of any night wakings. The father, on the other hand, needs his sleep obviously.
When babies are going through particularly difficult sleep periods and waking frequently, I would recommend that parents in two parent households split the nighttime duties. Have one parent be "on call" for night wakings from 8pm to 2am and the other one from 2am to 8am. This helps ensure that both parents get at least some quality sleep and that no one is so tired that they cannot function the next day. (Edited to add: I don't recommend this as a permanent solution for an exclusively breastfed baby with normal nightwaking/feeding patterns. I was recommending it as a way for parents of babies over 6 months of age to survive through a period where their baby is waking up every hour or so and the mom is so desperate for sleep that she feels she has no option other than to use cry it out.)
Let's take some of this off the back of the mother and find a way for parents to share responsibility for their children, both in the home and in research studies.
Need a Sleep Intervention?
Whether it is a specific sleep intervention that makes a difference (or doesn't) isn't really clear in this case. But in the event that any sleep intervention is beneficial to parents and children, here is my recommended list of gentle baby and toddler sleep tips for those who feel their child's sleep needs to be addressed.
Image credit: tamakisono on flickr
Reader Comments (88)
Good article about a dud study. Thanks so much! You are absolutely right in that most journalist simply pass on information without having read it (a study) thoroughly.
That said, I never used the CIO method. My husband and I never "co-parented" in the way that most of you are describing it. No baby baths, no diaper changing or waking up at night for him - but it's how our little family works. :) Thankfully, that just means that he was very supportive of whatever methods I wanted to use (breastfeeding, co-sleeping, attachment parenting, etc.)
I don't happen to have the reference, but I think that the "brain damage" claims come from studies done in animals.
Well then you're better than me. I just cannot. I just wouldn't sleep at all in that circumstance. Even now, she's 2.5 and if I put ear plugs in when it's not my night to deal with the middle of the night pees, I fret all night that she's going to cry and I'm not going to hear her.
For me, the bottom line is, I love her, I care for her, and I want her to be happy, but I also need for me to be happy to accomplish that. 7 months and we made no sleep progress. I was willing and did/have given a lot to my child, unconditionally. I am not trying to fit her into my life, but to make a life with her. Now she bed time stalls all the live long day. After the 9th time I've gone in there to fix the blanket on her toes or hand her the stuffy or whatever, she has to just stay in her room and realize it's time for sleep. It's 10:30pm, it's way too late for her to be awake, she has school in the morning, and bedtime is bed time. Sometimes she protests, so should I give into her all night for the rest of her life so no tears are shed? I suppose.
I just think it's complete insanity when people tell other parents who are struggling that letting a baby cry is causing brain damage or whatever. This creates anxious, stressed out parents who perform non-stop circus acts to keep a child from crying at all costs. I tend to her every need, and yet she still sometimes cries. In fact, I was given a video at the hospital which spoke to this exact thing, and how babies just, cry sometimes.
Would I allow an infant to scream for hours with no consoling? Of course not. Will I let my spirited then 7 months now 2.5 year old cry when protesting bedtime? Yup. Kids cry. I do not care how much love and attachment parenting and gentle techniques are used, it's going to happen.
There are an army of parents out there looking to villainize crying or parenting techniques, and I always find the irony in these "gentle" people calling parents cruel or whatever...like, they only have to be kind to their own kids, and not to other people.
And I'd like to add that her bedtime routine is well over an hour still. We bath her together (when we're both home), we have family couch cuddles, we go upstairs where I say goodnight, and she reads 3-5 books with daddy, cuddles in her bed with and then kisses and good nights. We started it at 7 weeks (ok there used to be 2 books), and we still do it at 30 months.
We set the stage for her to learn to sleep on her own. I tried to sit by her bed while she settled, which made her completely frantic trying to get to me. There was no putting her down half asleep or even full asleep. Leaving her to her own devices at 7 mos. it was short protesting, then sleeping. And she now talks at a 4 year old level so, I'm not thinking she got brain damage when she was crying sometimes. Never when she was sick, or teething, or when something was clearly up. Just when she was exercising her will to not go to bed.
I'm a bit confused. So the CIO thing worked and she's a great sleeper, or she protests now, stays up too late, takes forever to fall asleep, cries at bedtime?
See, I guess it depends on the definition one uses for sleep "crisis"... My 1st woke up at least 4 times a night to nurse until he turned 3... and my 2nd did the same until he was 2.5... and I never considered this a sleep crisis. Nor did I assume they had sleep problems.
They both started STTN on their own, at their own time when they were ready to do so...
Was I tired? Hell yea! For some of those years I was working full time, while still waking to nurse at night. But, I never considered it to be a crisis... BTW - this is NOT an attack on anyone. I get that everyone's tolerance level is different + some kids are harder than others (especially if colicky)... But, sometimes it also depends on our perception and the pressure we get from all over.
Night waking is harder on us if we perceive it to be a problem vs. if we perceive it as developmentally normal. In addition, if all we ever hear from peers, family, physicians is "What do you mean he's still waking up at night??? You must teach him how to sleep or else he'll be (insert whatever silly anecdote here) until he's in University", then it's no wonder so many feel they have kids with sleep issues.
"Brain damage" is a loaded term and isn't one that I would use to describe the possible effects of cry it out on a baby's brain. When people talk about the effects it can have on the brain, they are not talking about things like speech delays. They would look at or talk about ability to manage stress, incidence of depression, aggression, impulse control, that type of thing.
fascinating comment, thanks Sarah.
I think Babe_Chilla meant the protesting and crying was during the sleep training period they started when she was 7 months old.
Just by way of support for Babe_Chilla and Meghan and any others reading who have used sleep training.
I have two daughters, now 3 and 5. The eldest was a poor sleeper and various methods we used to help her settle didn't work, we were given a lot of bad advice. Neither was she amenable to being fed or rocked to sleep. Such methods never worked for more than a few days and then we had to try a new one! By 7 months we had had enough and started a sleep training method which involved crying. It was not prolonged crying though. What we learned was that until she was able to settle herself for the beginning of the night sleep she would not sleep through. We then used various methods to ensure she kept sleeping, both at night and for day sleeps (eg appropriate nightwear, room heating, day sleep times etc). Her sleeping improved out of sight and she is now a delightful, capable child. She still sleep less than most children her age but mostly does it in one stretch!
When the second child came along we decided to sleep train from birth. Starting early meant there was almost no distressing crying at all during the early months and we all enjoyed life a lot more. This child also needs less sleep than most and the sleep training helped me learn her needs (eg at 20 months the reason she yelled at 7pm bedtime was because she had had a day sleep. We slowly eliminated the day sleep and she began to snuggle in to bed happily at and sleep for 12 hours). She is your usual mercurial demanding 3 year old but we have a strong loving bond.
By the way, I BF the first to 14 months and the second to 36 months and we practise gentle parenting techniques (no time out etc). It's been a good mix for us.
I think my daughter had pretty normal sleep patterns as an infant, but I was the one who was tired all of the time. My husband slept in the guest room for months after she was born and I was the one getting up all night long. He had to go to work the next day and I did not so I took it all on myself. That was a mistake! One I won't make again. My daughter is about 27 months now and she just started sleeping through the night. We were having trouble with her waking up at about 3am every night and wanting to play for a few hours. Then she would fall asleep again. I was putting her to bed between 730pm and 8pm. The pediatrician suggested moving her bed time to a later time. Once we did that she started sleeping through the night. I am getting more sleep and much happier. I tried letting my daughter cry it out twice out of desperation and exhaustion, but I couldn't stand it. I think most people probably just do what ever works for them. It's not easy when you are sleep deprived to think through all of the options. You just try things hoping for a solution.
Thanks for breaking the study down the way you did.
Can you point me to all the "well designed" studies that show that CIO is harmful in the slightest. I take huge issue with the characterization of sleep training as harmful. We did full extinction cry it out and it changed our baby. She was sleeping for 2 hours at a time, napping for 20 minutes 3x a day at 6.5 months and was miserable. I had to get up and nurse her down and then bounce her on a yoga ball for about 20 minutes each time. After 5 days of sleep training, she went from sleeping about 9 hours in 24 hours to over 12 in 24 hours. She brightened up and was more cheerful and responsive.
She's 2.5 now, bounds to bed with a smile on her face and is an intensely wonderful child. Do what you want, but don't guilt trip mothers who are not harming their children in the slightest by sleep training. We put the needs of our FAMILY before the needs of any one individual. Our children are better off for it.
Good for you for doing what was best for your family. I'm so sick of the condescending characterizations of sleep training as abhorrent. I also follow my kids lead and approach parenting in a gentle manner, as well as practising extended breastfeeding, but sleep is vitally important to infant development and once past the newborn stage, we put the needs of the family first.
You're exactly right. How on earth are animal studies more relevant than studies on actual human children and families?
You seem to have picked apart this peer reviewed study and then reference things that either aren't peer reviewed studies at all, are studies on animals or are simply opinions expressed by other people. Here are two other studies that found improvements in demeanour in kids who were sleep trained:
http://www.ncbi.nlm.nih.gov/pubmed/1527680?dopt=Abstract
http://www.ncbi.nlm.nih.gov/pubmed/14989452?dopt=Abstract
[...] in the study. If you want details here are two examples by two top Canadian parenting bloggers PhD in Parenting and Evolutionary [...]
Well, she's 2.5 so she sometimes goes to bed late and sometimes she protests. I mean, that to me is perfectly normal. Last night she got up to pee 3 times, and one time I had to go in and "put her blankets on her toes" because toddlers are weird. To me bed stalling is something completely on it's own, outside of sleep training or whatever.
She CAN get herself to sleep, and does it quite frequently and most often, She CHOOSES not to sometimes. When she was a baby, she just wouldn't. I don't know WHY she wouldn't as she didn't communicate very clearly then (obviously) but daddy patting her bum or rocking her for 2-3 hours a night for her to just wake up again an hour later, was no longer acceptable to me.
I have read in-depth the studies (I have university access to the full papers) that Dr Sears presents. I'll give a quick summary here:
"These imbalances inhibit the development of nerve tissue in the brain, suppress growth, and depress the immune system. " - First and second study cited are both studies on rat pups and the withholding of maternal affection. This tells us nothing about either humans or sleep training. The third study cited deals with infants dealing with "maternal loss" (death) in non-human primates. Again. This study says nothing on cry it out and isn't even a human study. The fourth study is about children in child care and their cortisol levels and concluded that mothers should have several days of adaptation to child care to reduce stress. Again, nothing about sleep training, and nothing about cry it out.
"Researchers at Yale University and Harvard Medical School found that intense stress early in life can alter the brain’s neurotransmitter systems and cause structural and functional changes in regions of the brain similar to those seen in adults with depression." -Here Sears cites a study that deals with child abuse and maltreatment. This also has nothing to do with sleep training and cry it out.
"Researchers have found babies whose cries are usually ignored will not develop healthy intellectual and social skills. " - Sears sites a case study of 6 infants with attachment disorders. Again, this is not a study on cry it out or sleep training, but a case study of 6 emotionally disturbed infants.
Are you starting to see a pattern? The studies that Sears sites, are either not about sleep training, focus on maternal non-attention in prolonged extreme cases (such as that of severe child abuse, Romanian orphans etc) are just opinions or are simply animal studies that have no business being used to describe the condition of an infant who is being sleep trained.
I bed shared with my children as young infants, co-slept as they emerged from their infancies and into babyhood, nursed them into toddlerhood and with my second, responded to her needs by sleep training her using extinction cry it out when her sleep was so horrible it was disturbing our whole family. If you can find me one peer reviewed longitudinal study that proves that I harmed my wonderful child I will eat my words. As far as I can see, such a study does not exist. (though I do know of several that support the hypothesis that sleep training helps the whole family including the infant)
Some babies DO just have to cry, some have greater needs, heightened sensitivity, are more vocal, and require less sleep. But I believe that crying babies shouldn't ever have to be left to cry alone. Crying in the comforting arms of a parent is not crying it out. It's saying, I'm here for you, I don't understand what's wrong or what you're trying to tell me, but it's okay, I accept it, and we'll work through it together.
It's never the wrong choice to be empathetic to a person who has something to express - even when that expression is hard to tolerate.
The Australian Association for Infant Mental Health (AAIMHI) does not recommend CIO. For those commenters wanting to see studies proving CIO is harmful to a baby's brain development, there are none so far as I (and AAIMHI) can tell. However, they have reached this conclusion based on a number of principles - here is the position paper if any one is interested http://www.aaimhi.org/inewsfiles/controlled_crying.pdf
I think the problem with studies such as these which prove nothing, as Annie pointed out, is that it misleads parents into thinking they have even given the all-clear to use CIO and that it has been definitively proven to cause no harm, which is not the case.
Each parent has to come to their own conclusions based on the available evidence and their gut feelings. That's all any of us can do. It's good to have a forum to discuss it without feeling judged but to gain insight from perspectives that may differ from your own. Every one will have their own individual story, for my money, I like to look at the bigger picture to see whether a particular practice is advisable in general, and then go ahead and use or not use it for my family if I deem it necessary. there is an optimal way to do everything, and all of us fall short of that optimal way sometimes. We each have to conduct our own costs vs benefit analysis.
I also wrote an article about it for a local parenting magazine and republished it on my blog if any one is interested http://www.thesarahkatemonologues.blogspot.ca/2012/02/controlled-crying-great-debate.html
Yeah, stalling is quite different, I sometimes stall when I really should be going to bed!
Mentioning the differences in sub-cultures and what they name their children is now racism? Ridiculous. I don't accept that as a legitimate claim of racism. There is obviously a difference in popular African-American names and Caucasian names, any recent US census will show you that. It's not racism, it's demographics. Racism would be having a problem with these differences instead of accepting them and celebrating them.
Regardless of the quality of design for this study (I agree, its is fundamentally flawed), I did personally take some solace in the conclusion that sleep interventions have no harmful results, and if my potential maybe second baby has sleep issues like my first, you can believe that I'll be doing some sort of sleep intervention. Because the results of having a tired, stressed out mother are far more harmful than a short period of stress while learning to sleep.
My kid woke hourly. At least. For the first year of her life. She had colic. She napped in short snatches of 10-20 min, but ever more than 3x day. My husband worked long hours, so I didn't want to ask him to take over night time duty (not because I was buying into gender stereotypes, but because I was being considerate of the fact that he needed rest for his high-stress job.)
I was desperate for rest. I suffered anxiety and depression. I tired everything, short of cry it out. I hired a sleep consultant, even.
Now, two and a half years later, my child STILL sleeps poorly. Short naps, frequent wake-ups, and I attribute this to the fact that I was overly responsive to her at night when she was an infant. The moment she peeped, I'd go to her, and help her settle. I did this because the AP literature had me so scared that failing to respond IMMEDIATELY to any need would inevitably lead to attachment disorder.
Anyway, I think that there needs to be a bit of balance between the child's needs and the parent's needs. I don't think that in all cases (for example mine) a pure AP approach to sleep is best, nor do I advocate sleep training for all kids. Some kids and some families will benefit from it, at least in my opinion. And next time around, I won't worry so much if I decide to give it a try.
Each family needs to make their own decisions. We found ways to balance the child's needs and parent's needs by sharing the parenting, rather than opting for sleep training.
I don't understand how anyone could take solace in the conclusion of this study after reading about the flaws. We really don't know anything more or anything less about sleep training as a result of this study. There are plenty of other more persuasive arguments in favour of sleep training than this study (although none persuasive enough to sway me).
Actually the sample size isn't too small at all. (326 was the sample I believe out of a population of 692). To calculate the required sample the you need you need to figure out an acceptable margin of error, the confidence you require in your results, and an estimate of the standard deviation of the population. This is all pretty basic statistics. Sample size is usually determined by n = [Zα/2(σ)/E]² Where Zα/2 comes from a standard normal table and is a function of your required confidence. σ is your best estimate of the standard deviation of the population and E is your acceptable margin of error. They probably could have halved the sample size and still had statistically significant results.
Actually the brain damage claims come from studies of infants with attachment disorder - the research started with Romanian orphanage children... Basically, children whose needs are chronically unmet do suffer brain damage - their brain stem shrinks and they wind up lacking in the areas of the brain responsible for normal emotional development. In extreme cases, this results in psychopathy. The thing is, not all children need extreme situations to suffer attachment disorder... and some infants in very extreme situations come out unscathed. My thoughts on CIO style parenting is that if this is an anomoly in your parenting style - mainly you are attentive parents who go through a period of CIO, that is one thing, however, what about the families in which CIO isn't just used for sleep? Where it permeates the teaching of manners, respect, getting and giving of attention and affection.... getting and receiving the basics of food, etc... Honestly, I have seen cry it out training for the purpose of getting a child to learn to crawl... as an overall philosophy it is VERY disturbing...
I love your comment on the M word and shared nighttime parenting. My dh and I did this when one of our twins decided that 30 minutes in a 24 hour stretch was enough for him - I took the day shift and dh took the night shift...
That said - it is SO interesting to see the different assumptions in the singleton/multiple scenarios. The VAST majority of twin parents have some sort of shared night time parenting going on - even if it is that dad wakes up for the 4am feed, then goes to work short 2 hours of sleep. The "parenting in the trenches" mentality of unusual situations seems to garner a lot more willingness on the part of the mother to share parenting (I say that because it does seem that mom really does function as gatekeeper, and only when she is utterly burnt out do options like involving dad come into play - not in all families, of course, but in many...) And, I think society feeds this expectation that mom does it all. I love, love, love seeing more encouragement to share parenting. But, I thought I would mention the distinct parenting culture of twin/higher order multiple parenting... which, while far from perfect, does tend to involve dad A LOT more...
My husband and I did the shift idea, even when our daughter was young and nursing a lot. Basically, we'd split the night into two halves. The on duty parent slept with the baby and the other slept in the other room. When she woke up on his shift and wasn't easily comforted, he'd bring her to me, wait until she was done nursing (while I was still pretty much sleeping) then take her back to bed with him. It was a life saver! We only had to do this for a few nights in a row, and then we would both feel a lot better.
Thank you so much for this study. It puts alot of things into perspective.
With our first, My hubby was able to settle him better than I could. I found it so frustrating. He was such a bad sleeper and I didn't handle the sleep deprivation at all well. I was expressing from about 4 weeks and became a very good dairy cow and my dear hubby would get up and do the 3am feed. When we moved from aussie back to nz it was realyl hard to get our boy to settle at all and we did use the cry it out technique. He was sleeping through for 6months excluding when he had a cold or was teething.
Now, at 4 years old he sleeps through, has never gotten out of bed and if he cries (mostly if he has the flu) Hubby gets up to him.
Our girl, I was mum on duty until very recently. She refused a bottle of EBM very early on and therefore I was the only option which was perfectly fine. So hubby got up to our boy as normal and I got up to our girl. Now I am pregnant and our DD has weaned and happily takes a bottle. Hubby gets up to feed her on weekends in the wee hours of the morning and I do the weeks. She slept through from 5 weeks old untill about 3 months when she started teething which disrupted her sleeping patterns so I used the book "save our sleep" by Tizzy Hall and that made an amazing difference. Most nights she sleeps through and This really is amazing. She is 9 months old and has such a great sleep pattern. She goes down at 7pm and might wake at 4 or 5am for a feed then back to bed until 7.15am.
Your interpretation is very interesting, and there is another blog that interprets it differently http://scienceofmom.com/2012/09/13/the-last-word-on-sleep-training/ and I suggest that parents have a look at this one too. If you take all of the groups articles published relating to this cohort of people, then perhaps the outcomes start to make more sense.
Ultimately, it highlights that all things are open to interpretation. My particular viewpoint, is that there is some noteworthy reassurance from (all) of the studies but it detracts from their validity when one cannot assess each study on its own, and can only interpret them as a pool. Evidence Based Medicine has a lot to learn, and a long way to go.
Snap, we live in NZ and used Tizzie Hall too. It was pretty fantastic. All the best with no 3.
It doesn't seem like you actually read the study. The study you cited was only a 6-year follow-up to another study whose outcome measures included (but were not limited to): maternal report of infant sleep; an established indicator of frequent and prolonged night wakings; maternal sleep quality and quantity; maternal rating of infant temperament; confidence in their nurse’s health advice; satisfaction with and usefulness of the sleep information in treating their infant’s sleep problem; how often they used the strategies; and degree of support they received from their partner when using the sleep strategies. To quote the study, "All mothers were asked if they had received help other than that given in the study and, if so, from where (eg, stay at a parenting centre). In the 12-month questionnaire, intervention mothers also rated specific advice/strategies given by their nurse as “helpful” or “unhelpful”."
By all standards for quality social science research, these guys more than met the bar. You might disagree with what they concluded. but that doesn't mean their methods were less-than-sound. Very few of the scales used in this follow-up study were developed specifically for this study. Most were developed and validated in other contexts. So really, I'd be interested to hear your beef with those. This intervention reduced infant sleep problems and maternal depression. With the only difference between the groups being the training from the nurse, it's entirely acceptable to infer a causal relationship. The other outcome measures give a more nuanced and qualitative description of why that causal relationship was observed. To then return to the same participants and measure emotional and mental health outcomes six years out is important, and this study adds something of substance to the conversation.
I say all of this as a mother who doesn't believe in CIO. And, more importantly, as a social science researcher who read the study.
I did read the whole study (the one just released), but did not read the original study (or possibly I did years ago when it was released). If the original study collected information on the actual sleep tactics used and there was a substantive difference between the intervention group and the control group, I think that would have been an important thing to mention in the follow-on study. I'm not entirely sure from your comment, however, whether they did collect that or report on it specifically.
@babe_chilla: I had the exact same experience with BOTH of my babies. Neither of my babies did any better co-sleeping, in fact my eldest hated co-sleeping. (He rarely nursed to sleep either. When he was a baby, I was so worried because all the books said, Oh you know he's full when he falls asleep - and he never fell asleep!) Both kids tend to overstimulated by touch,though my second baby is cuddlier/less sensitive. But it's like when they are lying next to me, they think - Oh fun, party time! Anyway, co-sleeping was a bust for us, and my second used to wake up every 45 min-1 1/2 hr for six months. We did the same kind of system that you did - I hesitate always to call it CIO because people think we locked him in a room to cry until he vomited, when the reality was he cried for ten minutes and slept through the night. Both of them did, actually. There are different kinds of babies, with different needs, and different personalities. There are different kinds of crying too - there's a difference between fussy-crying and distressed crying. Some babies are what is called tension releasers, which means they release tension through crying (grown ups too) whereas others cannot tolerate that and crying makes them more agitated. I think as parents our primary duty is to work *with* our child to see what his/her needs really are, not just our idea of his/her needs. I thought my baby would want to co sleep and be cuddled all the time. That was not the case at all. I follow *his* cues, and they led me somewhere different than where I thought (ie, leaving him in the crib while he fussed it out.)
Have you read this one that came out in April? http://www.ncbi.nlm.nih.gov/pubmed/21945361
It isn't about long-term effects, but I found it really interesting. A tidbit: "Overall, outward displays of internal stress were extinguished by sleep training. However, given the continued presence of distress as evidenced by their physiological response, infants were not learning how to internally manage their experiences of stress and discomfort."
Hi friends, its wonderful piece of writing on the topic of educationand completely
defined, keep it up all the time.
The other thing that is blatantly missing from this study is any discussion of sleep training PRIOR to seven months old. Arguably, those who want to try it earlier (say before six months) might be more concerned about adverse effects than those who try it later. It doesn't seem to me to be a stretch to suggest that many of those parents who didn't identify their children as having sleep problems at their seven-month check-up might very well have done some kind of sleep training at five or six, or even three or four months.
You have reviewed the 5 year follow-on to this study, rather than the original publication (and primary outcomes). The original article provides more intervention details as well as compliance data, which likely will address many of the concerns you cite. The original article can be found here http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2083609/