Infants and Sleep: Is It Okay to Let Him Cry?

August 3, 2009  |    research, Social and Emotional   | Keywords: Sleep

Author: Danielle Z. Kassow, Ph.D.

Walk into any major bookstore in America, stop by any newsstand, turn on the television, talk to other parents and grandparents- it seems everywhere you turn there is parenting advice on how to raise children, how to make your baby the smartest, happiest, and on and on.

While much of the information that is directed to parents comes from the early childhood research and medical communities, some of it also comes from “pop culture” and is not necessarily based on science. All of this can make a parent’s job harder- you want to do your best as a parent, but how do you decide what is best for your baby and you?

Infant sleep and crying is one of parents’ biggest concerns and many parenting books offer advice on how to respond to this issue. “Cry it Out” (CIO) is one sleep method that stirs much discussion and debate amongst new parents, pediatricians, and the research community. CIO teaches parents to respond less or stop responding all together to a waking, crying baby at night thereby, teaching the baby to stay asleep. But is it safe?

In A Parenting Myth: Can I Spoil my Baby? the importance of responding to an infant’s cries is explained. Consistent, warm and nurturing parental responses to an infant in the first year of life help infants develop a secure and loving bond with parents. These loving responses are critical to the young child’s emotional health, brain development and long term life outcomes, including success in school and life. The first months of an infant’s life can be exhausting for parents. Along with the joy of a new family member you may also be overwhelmed, stressed, and sleep-deprived. Sometimes you need to take a break from a crying infant and it is important to listen to your internal signals that tell you so. After you take a deep breath, remember that infants are too young to manage their own emotions and crying is her way of telling you that she needs something. This fact stirs concern and questions about using CIO: Are there harmful effects on children? And, are young children’s needs being met if parents use this method?

In March 2007 I attended the Biennial Conference of the Society for Research and Child Development, where many of the leading child development experts in the world come to present their research findings. It was just my luck that a colleague of mine, Macall Gordon, who is an expert on CIO, was there hosting a panel of scientists on this very topic! I had the chance to sit down and talk to her about whether CIO is safe and effective. Below is a brief summary of our talk. Here you can listen to the entirety of our talk.

Macall Gordon on “crying it out”:

Danielle: What exactly is “crying it out” and how did this method come about?
Macall: The idea is that if a baby is waking up at night, the parent’s response to the baby then encourages the baby to continue waking up. If parents stop responding a little or completely, the baby will learn that they will not get anything from waking and crying and they will then go back to sleep. This method has its roots in the 1920’s. John Watson’s Behaviorist theories said that any learned behavior can be unlearned if the reinforcement (in this case, parental response) is withdrawn. Back then, the idea was that you should put baby in the bed, close the door, and not go back in for any reason at all. Very quickly that child would learn that crying was not going to work and they would go back to sleep. This idea is still in play today in varying ways.

Danielle: Is there scientific evidence that supports the use of this method?
Macall: All the parenting advice that I have seen reports that research supports this method. But when I started looking at this research, I found that very few of these studies were actually conducted on infants. Only about half of them included infants under one year of age. Only two studies included infants under 6 months and no studies have been conducted on infants under 4 months. The studies that included infants also included a large number of much older children. In almost every case, the study reported results for the whole group and not by age. For instance, there was a study that included children between the ages of 9 and 60 months. The study concluded that 75% of this group resolved their night waking issues, but they didn’t say how many of the infants, how many of the toddlers, how many of the preschoolers, how many of the school age kids—they just reported results for the group as a whole. As a result, we really don’t know how the babies did.

Danielle: Is this sleep method effective and is it safe?
Macall: The main question that has been asked by researchers is, ‘If we use CIO with infants, do they go to sleep?’ Well, yes they do. But there needs to be a new kind of research that asks questions beyond ‘does it work?’ We need to look at how infants are doing (emotionally and physically) and whether there are repercussions of CIO that we haven’t looked at. When I started looking for research that supported the notion that “you will not psychologically damage your infant from letting them cry,” I only found five studies that looked at whether there were any psychological effects. Out of those five studies only three included infants. Further, none of these studies actually measured psychological effects. I also looked for research that supports the idea that ‘crying is not physiologically harmful for the baby.’ I’ve searched and asked major experts in the field. Apparently, there is no research on the physiological effects of crying. No one has done that work.

Danielle: What drew you to researching this method?
Macall: It actually came from having a very sleepless infant myself. My first baby was very colicky and did not sleep. I was bombarded with sleep information on CIO in books and magazines. There was even a television sitcom with a whole episode on the parents letting the baby cry. CIO seemed to be everywhere. At the same time, I noticed that there was information that said how important it was to respond to your baby and how bad stress was for them. To me, these two things just did not make sense. At the time, I thought, ‘if it’s really as safe as they say, there must be a lot of research to back it up.’ There must be research that proves that it doesn’t do anything harmful to the baby. So I started looking and asking questions. At first, when I couldn’t find anything, I thought that I must not be looking in the right place. Interestingly, the more I looked, the more I realized that these questions may have been asked by other parents, but they certainly hadn’t been asked by people in the child development or developmental psychology fields.

What I hope to encourage through this work is the notion that sleep problems should be a flag for further evaluation—similar to how they’re beginning to handle mothers who come to the pediatrician with symptoms of depression. Sleep problems can be indicative of a whole lot of things going on with the baby, the parents, or the family like health issues, difficulty with self-regulation, temperament, food allergies, family stress. There are all kinds of reasons why a baby might wake up. For a pediatrician to say, ‘just let the baby cry’ is a band-aid solution. Any other factors that are affecting sleep are still in play with that family. Families end up not well served by that information. This is especially true for parents with intense or sensitive infants. For them, CIO might be really problematic. Intense babies start to cry and they don’t (or can’t) stop. These are the babies that you hear are crying for three hours before they fall asleep exhausted and the parent feels awful. CIO may not work right away, it may not work at all. Then the parents end up feeling badly about themselves and possibly their baby. These parents need different information and a different kind of approach.

Danielle: When infants have sleep problems, this may be partly due to biological and physiological issues: The infant’s body is just not ready to do what adults want, which is to stay asleep.
Macall: That’s absolutely right. I think that another piece to look at is whether our cultural requirements for babies are outstripping what babies can really do. One book says babies should be able to sleep 12 hours solid by 12 weeks. We have to ask ‘should we be striving for that?’ Certainly it would be convenient, certainly it would be great, but is that really what happens with babies? It used to be, back in our parents’ day, you expected babies to be wakeful. You expected to be sleep deprived for a certain amount of time and that babies would sleep sooner or later. And while that was really difficult, it was accepted as normal. Now we expect that infants should sleep a lot as soon as possible. It’s somewhat culturally bound to the United States and some Western European nations. We place a high premium on independence and sleep. There are other countries that just don’t worry that much about it. I wish that it were better communicated to parents what to expect at what ages. Right now it’s a little bit all over the map and I don’t think it’s clear at all for parents.

Danielle: What advice do you have for parents about CIO?
Macall: If you feel like you don’t want to do it, there are other methods you can use and you will not be ruining your baby, you will not be damaging your baby by not using CIO. The second thing I would say is try other things first and seek out the best information you can. Follow your instinct and there are other methods that don’t involve crying that appear to work really well.

Conclusion: While CIO may be one sleep method, there is very little research to support its use and science does not yet know how safe this method is or what its long term effects are. Science does tell us, though, about the importance of being responsive to a crying infant. Parents have a natural inner drive to respond to a crying infant. Follow what is in your heart and what you feel is right for you and your baby. When you look for parenting advice always be a critical consumer of the information you see or hear. Ask a lot of questions when visiting your child’s health care provider, when attending parenting groups, and when searching for information on the internet. Ask and search for the answer to this question: “Has science researched and supported this method?” Whatever sleep method you choose, make sure that it is safe and that you feel comfortable with it.

To find out more about Macall Gordon’s Infant Sleep Study visit: www.infantsleep.org

Acknowledgement:
Many thanks to Macall Gordon for granting this interview and sharing her expertise. Macall is a Mother of two children and a graduate student at Antioch University in Seattle, Washington.