Posted tagged ‘Ferber’

Will cry-it-out hurt your baby?

May 16, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

Jess, like many parents, has been hearing conflicting information about what crying can do to your baby. She wrote: “So, my husband and I accidentally let our kiddo (5.5 months) cry it out. So of course, I’m spending all sorts of time on Google finding out that I’ve caused long-term damage to my son and he’ll be more likely to get ADHD and be dumber now that I’ve let him cry. I know the studies on cortisol show that some longer-term stress may be evident (at least for a few days), but are there any other real, scientific studies that show long-term damage due to cry it out? I’m pretty sure the other studies cited in the article above are irrelevant to this–am I right? I know you’ve written about cry it out before, but with all the hype, can you clarify?”

A friend of mine is working on a project called “Guilt Free Childbirth”, meant to dispel the guilt and hand-wringing that so many families seem to experience during and after childbirth. What if I need a c-section? What if I can’t do it “naturally”? What if I can’t “bond” instantly with my baby?

This cry-it-out worry—I think I could make an entirely new blog, “Guilt Free Parenting,” just to try to dispel this nonsense. Parents are so saturated with messages telling you that everything—I mean everything—we do is wrong, it’s a wonder we don’t all just curl up in a ball in the closet sucking our thumbs.

Wait, thumbsucking. That’s bad, too.

Anyway: the sky isn’t falling. We are not raising warped, worthless, sick, incompetent kids. There are always things parents could do better (including me!), but that doesn’t mean that if we don’t do everything “right”, our kids will suffer.

Back to cry-it-out: babies don’t always learn to sleep straight through the night on their own, and there are several competing “methods” to help nudge them towards independence. Some parents are very eager to help train, others take a more “easy-going” approach. How you tackle this depends on how parents feel about the importance of a good night’s sleep, and also on the temperament of the baby. I am not going to declare that any one method is perfect for everyone.

But if sleeping through the night is a priority, I have offered up one simple solution that works well for many families. Yes, there is crying. No, I don’t think there is any good evidence that shows any lasting ill effects from letting your baby cry some. There are certainly lots of web sites, pro and con, and lots of people with strong opinions—sometimes they’ll even comment in ALL CAPS for emphasis. But you are not damaging your child by letting tears fall without instant intervention.

Babies have been crying for many, many years. It is how they get our attention. If crying were so damaging, well, I don’t think any of us would have survived.

Jess included an example of reporting that stressed the damage done by cry-it-out sleep training, a list of 10 reasons it’s bad for babies. Most of the reasons were undocumented opinions from the author, who has clearly made up her mind on this issue. The references that were included are rife with methodologic issues—especially retrospective bias (of course parents with children who are thought of as problematic are going to report more sleep issues, in retrospect, when asked), or skim though the complex issue of cause-and-effect. That is, did the excessive crying cause the later problems, or are children who are temperamentally difficult more likely to resist sleep and more likely to later experience emotional problems? One thing may not cause the other, even if they are correlated.

Studies of levels of the cortisol rely on that hormone as a biomarker of stress, and cortisol does indeed increase with stress in humans and other animals. But is that bad? Didn’t human babies always have stress in their lives? Some studies point out that cortisol can change the way brains develop, or can perhaps contribute to the pruning of interconnections between neurons- but that is a normal process that occurs in the development of the human brain. Interfering with this process by avoiding undue “stress” may actually be harmful in the long run.

Or maybe not. I am not saying that babies need to cry to be healthy. Certainly I spent a lot of time holding and reassuring my babies (and even babies in my practice!) But these studies that some claim show cry-it-out = bad for babies, it’s a stretch. And it is not something that parents ought to be worrying about.

Though there aren’t a lot of great, long-term, clinical studies of the consequences of these different sleep approaches, one published last year was reassuring—a method that allowed more crying didn’t lead to scary consequences later.

Also: there are consequences to poor sleep, both for babies and for parents. Underslept babies are fussy and unhappy. Underslept parents are irritable and miserable, and may be more likely to get in car accidents, get divorced, or smack their child. It’s not unreasonable for parents to want to take an active role in pushing towards a good night’s sleep.

A great website with far more detail and insight into baby sleep issues is at www.troublesometots.com—including a detailed guide to one common-sense way to help babies learn to sleep better. Yes, there may be some crying. It’s OK.

Cry-it-out sleep solutions: Harms versus benefits

September 17, 2012

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.