Cry-it-out sleep solutions: Harms versus benefits

The Pediatric Insider

© 2012 Roy Benaroch, MD

There seem to be two views percolating about the best way to get a baby to sleep through the night. As is typical of opinions these days, both sides paint the other as extreme by exaggeration:

In this corner! The Cry-It-Out Mama! She puts her child down, and she never goes back! Junior cries his little heart out while she sips martinis and laughs!

 And in the opposite corner! Ms. Crunchy Berries wouldn’t dream of letting a single tear touch her precious’ pillow!

In truth, rare is it that a parent is going to completely ignore—indefinitely—crying. And even the moms who favor an attachment-oriented parenting style are going to put up with tears once a while. Most parents aren’t looking for an all-or-nothing approach. What they do want, though, is a way to help their babies learn to sleep through the night in a way that’s safe and effective.

Which brings us to a recent study from Australia, with the wordy title: “Five-year Follow-up of Harms and Benefits of Behavioral Infant Sleep Interventions: Randomized Trial.” It’s been widely and incorrectly reported that this study supports letting babies cry themselves to sleep, which is a typical media oversimplification of a complex issue. Still, what it does show is reassuring.

The study looked at outcomes 5 years after two original studies looking at the same groups of kids. Initially, 328 families of children who were reported as having sleep problems at 7 months of age were randomized into two groups to look at two different ways of helping children sleep independently. About half of the families received special sessions with trained nurses specifically to discuss sleeping skills. They were taught specifically about two behavioral techniques, and were encouraged to choose one of these methods (or combine the two):

Camping out (also called “adult fading”): This entails staying with a baby as he falls asleep, then later sneaking out. Over time, parents gradually get further away from the baby at bedtime.

Controlled comforting (also called “Ferberizing” or “Gradual Extinction”): Parents leave their baby alone at bedtime, and visit for comforting at fixed intervals if crying continues. The time until the next visit is gradually increased.

So, within the study group, presumably some of the parents camped out, and some Ferberized. Neither group was encouraged to use the “cold turkey” method, which is what I think of as “crying it out.”

The control group wasn’t specifically assigned to any sleep teaching. These families were assumed to continue doing whatever they had been doing—which wasn’t explored or recorded. Parents in the control group could ask for sleep advice (and presumably some of them did), but they weren’t given sleep advice if they didn’t ask.

Previous publications by the same researchers looked at the outcomes of these same children at 12 and 24 months, finding encouraging trends: parents given either kind of sleep advice were more likely to have children with successful sleep habits, and less likely to have depression. The purpose of this new publication was to re-examine the two groups of children five years later, specifically to see if there was any evidence of harm to the children or their parents.

At age six, 225 of the original 326 children participated. They underwent a series of validated screens for a series of emotional and behavior problems, sleep issues, psychosocial quality of life, stress, child-parent relationships, parenting styles, and maternal depression, anxiety, and stress—really, quite a slew of tests. They also had most of the families collect saliva to test for cortisol, a marker of stress. In every measure, children from the control and study groups were the same—there was no objective evidence of any difference, positive or negative, in the physical or emotional health of any of the children or parents.

So: specific counseling about behavioral techniques to help 7 month old babies learn to sleep on their own has benefits. Whether geared towards “camping out” or “Ferberizing”, babies whose parents had counseling have a better chance of helping their children learn to sleep than parents who muddle through on their own. At the same time, parents can be reassured that both of these sleep training styles don’t seem to cause any harm to the child or family 1, 2, and 5 years later.

A good night’s sleep is a blessing for babies and parents alike. Many babies learn to do this quite well, on their own, without much parental coaching or encouragement. Many parents find their own sleep solutions, and if whatever-you’re-doing is working for you, that’s great. What this study adds is reassurance that at least two commonly taught behavioral sleep-teaching styles are safe and effective. If your baby isn’t sleeping well, one of them might just work for you.

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5 Comments on “Cry-it-out sleep solutions: Harms versus benefits”

  1. Jenni Says:

    and here’s another take on the same article…

    Like

  2. Awesomemom Says:

    I think that educating parents about options is an awesome idea. I ended up having to do a bit of sleep training with my youngest. She would wake up in the middle of the night and not be hungry but ready to have some play time. I started just going into her room, rocking her a bit or patting her on the back and then leaving her in her crib. Eventually she got the idea that night time was for sleeping not playing. I am a much better parent when I get a full night of uninterrupted sleep.

    Like

  3. estherar Says:

    I don’t think you quite understand what you’ve gotten into here.

    The anti cry-it-out crowd considers any method that involves crying (and especially those which involve leaving your baby on its own for any amount of time, such as Ferber recommends) as cruel as cold-turkey methods, and as likely to kill a baby’s brain with cortisol. They’re assisted by such junk science as the “Harvard Study” (which isn’t a study but an opinion piece with little behind it), Dr. Sears’ webpage about how “Science Says: Excessive Crying Could Be Harmful” (whose references don’t deal with sleep training at all, and some are badly misrepresented by Sears to suit his agenda) and most recently, the Middlemiss study , reported in the most misleading way in the general press, which purports to show that babies subjected to cry-it-out methods show elevated cortisol levels even when they stop crying (except the follow-up period was very small, and the babies’ cortisol didn’t actually rise with the crying, but was already high before the initiation of sleep-training methods).

    So just because the techniques used weren’t ‘crying-it-out’ according to your definition, doesn’t mean they aren’t considered so on the Mommyboardz. It’s important IMO to emphasize that so far, no ‘crying-it-out’ technique has been shown to cause damage to any child.

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  4. Johan Says:

    Thanks for the info

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