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The Con of Controlled Crying
by Pinky McKay
When controlled crying ("graduated extinction") was first advocated around twenty years ago, it was recommended for infants over six months old, not newborns. While there are still professionals who feel comfortable with variations of controlled crying for older babies, many of these people would see any such methods as inappropriate for younger babies. However, popular advice by various authors and even some baby sleep centers now commonly includes leaving babies as young as a couple of weeks old to cry in order to teach them to sleep, much like advice offered in the 1850s. Sometimes modern sleep-training methods are couched in euphemistic labels like "controlled comforting" or even "controlled soothing" and within each definition there can be different recommendations about how long to leave babies to cry and how often or how long to "comfort". Others simply advise leaving the baby to cry until he falls asleep.
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." Controlled crying is not consistent with what infants need.
Despite the popularity of controlled crying, it is not an evidence-based practice. Professor James McKenna, director of the Mother–Baby Behavioral Sleep Laboratory at the University of Notre Dame and acclaimed SIDS expert, described controlled crying as "social ideology masquerading as science". What this means is that despite a plethora of opinions on how long you should leave your baby to cry in order to train her to sleep, nobody has studied exactly how long it is safe to leave a baby to cry, if at all. Babies who are forced to sleep alone (or cry, because many do not sleep) for hours may miss out on both adequate nutrition and sensory stimulation such as touch, which is as important as food for infant development. Leaving a baby to "cry it out" in order to enforce a strict routine when the baby may, in fact, be hungry, is similar to expecting an adult to adopt a strenuous exercise program accompanied by a reduced food intake. The result of expending energy through crying while being deprived of food is likely to be weight loss and failure to thrive. Pediatrician William Sears has claimed that "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."

Often the predisposing conditions for depression in infants are beyond our control, such as trauma due to early hospitalization and medical treatments. However, if we consider the baby's perspective, it is easy to understand how extremely rigid regimes can also be associated with infant depression and why it isn't worth risking, especially if your child has already experienced early separation. You too would withdraw and become sad if the people you loved avoided eye contact, as some sleep training techniques advise, and repeatedly ignored your cries.

Crying infants experience an increase in heart rate, body temperature and blood pressure. Leaving a baby to cry evokes physiological responses that increase stress hormones. Crying infants experience an increase in heart rate, body temperature and blood pressure. These reactions are likely to result in overheating and, along with vomiting due to extreme distress, could pose a potential risk of SIDS in vulnerable infants. There may also be longer-term emotional effects. There is compelling evidence that increased levels of stress hormones may cause permanent changes in the stress responses of the infant's developing brain. These changes then affect memory, attention, and emotion, and can trigger an elevated response to stress throughout life, including a predisposition to later anxiety and depressive disorders. English psychotherapist, Sue Gerhardt, author of Why Love Matters: How Affection Shapes a Baby's Brain, explains that when a baby is upset, the hypothalamus produces cortisol. In normal amounts cortisol is fine, but if a baby is exposed for too long or too often to stressful situations (such as being left to cry) its brain becomes flooded with cortisol and it will then either over- or under-produce cortisol whenever the child is exposed to stress. Too much cortisol is linked to depression and fearfulness; too little to emotional detachment and aggression.
One of the arguments for using controlled crying is that it "works", but perhaps the definition of success needs to be examined more closely. A recent Australian baby magazine survey revealed that although 57 per cent of mothers who responded to the survey had tried controlled crying, 27 per cent reported no success, 27 per cent found it worked for one or two nights, and only 8 per cent found that controlled crying worked for longer than a week. To me, this suggests that even if harsher regimes work initially, babies are likely to start waking again as they reach new developmental stages or conversely, they may become more settled and sleep (without any intervention) as they reach appropriate developmental levels.

I am so glad that I didn't cave and do controlled crying. My baby is now fifteen months old and even my husband has thanked me for standing my ground on this one. Learning to listen to what is in my heart when it comes to parenting has been the greatest gift. I know myself better now and I think it has helped me in every area of my life. Just knowing that my instinctive responses are the right ones give me so much confidence as a mother.  - Michelle

Controlled crying and other similar regimes may indeed work to produce a self-soothing, solitary sleeping infant. However, the trade-off could be an anxious, clingy or hyper-vigilant child or even worse, a child whose trust is broken. Unfortunately, we can't measure attributes such as trust and empathy which are the basic skills for forming all relationships. We can't, for instance, give a child a trust quotient like we can give him an intelligence quotient. One of the saddest emails I have received was from a mother who did controlled crying with her one-year-old toddler.

After a week of controlled crying he slept, but he stopped talking (he was saying single words). For the past year, he has refused all physical contact from me. If he hurts himself, he goes to his older brother (a preschooler) for comfort. I feel devastated that I have betrayed my child.  - Sonia

It is the very principle that makes controlled crying "work" that is of greatest concern: when controlled crying "succeeds" in teaching a baby to fall asleep alone, it is due to a process that neurobiologist Bruce Perry calls the "defeat response". Normally, when humans feel threatened, our bodies flood with stress hormones and we go into "fight" or "flight". However, babies can't fight and they can't flee, so they communicate their distress by crying. When infant cries are ignored, this trauma elicits a "freeze" or "defeat" response. Babies eventually abandon their crying as the nervous system shuts down the emotional pain and the striving to reach out. Whether sleep "success" is due to behavioral principles (that is, a lack of "rewards" when baby wakes) or whether the baby is overwhelmed by a stress reaction, the saddest risk of all is that as he tries to communicate in the only way available to him, the baby who is left to cry in order to teach him to sleep will learn a much crueler lesson – that he cannot make a difference, so what is the point of reaching out. This is learned helplessness.

Secure attachments in infancy are the foundation for good adult mental health.
Neuroscientists and clinicians have documented that loving interactions that are sensitive to a child's needs influence the way the brain grows and can increase the number of connections between nerve cells. The Australian Association of Infant Mental Health advises: "Infants are more likely to form secure attachments when their distress is responded to promptly, consistently and appropriately. Secure attachments in infancy are the foundation for good adult mental health." So, when you adopt the perspective that your baby's night howls are the expression of a need, and she is not trying to "manipulate" you, and you respond appropriately (this will vary depending on your baby's age and needs), you are not only making her smarter, but you will be hardwiring her brain for future mental health.
 
Excerpted with permission of the author from Sleeping Like a Baby.

Pinky McKay is the mother of five, an International Board Certified Lactation Consultant (IBCLC) and a Certified Infant Massage Instructor based in Melbourne, Australia. In addition to Sleeping Like a Baby, she is the author of Parenting By Heart, 100 Ways to Calm the Crying, and How do we Tell the Kids?. For more information, visit the author's website at Pinky My Child.

 
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