What is Cry-It-Out (CIO)?
“If your baby is sick, then this is about as tough as controlled crying gets and you will have to be strong-minded not to scoop him into your arms to comfort him. But do try to resist as you’ll only prolong the process and his misery. Try to be efficient and calm as you change the sheet… Don’t speak to your baby, and be as quick as you can so that you don’t get his hopes up allowing him to think that he’s going to be cuddled and fed.”
-- Dr. Caroline Fertleman and Simone Cave, “Your Baby Week by Week: The ultimate guide to caring for you new baby”
We, as a culture, do very little to support new parents. Gross misconceptions about what constitutes normal sleep patterns in infancy and early childhood abound, even in professional circles.
We, as a culture, do very little to support new parents. Gross misconceptions about what constitutes normal sleep patterns in infancy and early childhood abound, even in professional circles. We have no federal maternity (let alone paternity) leave and our entire adult population is overworked and sleep deprived. Is it any wonder that the “sleep training” of babies/toddlers has become such a popular phenomenon? Akin to debates about circumcision, corporal punishment, and vaccination, the question of whether or not it is right to let a child Cry-It-Out (CIO) deeply divides American parents.
CIO, also known as “controlled crying,” is an “extinction method” of ending – “extinguishing” -- the cuing for attention, help, nourishment, hydration, support, and loving, physical comfort that is programmed into the biology of young mammals. While popularized by Dr. Richard Ferber in his 1985 book, “Solve Your Child’s Sleep Problem,” advocates of CIO date back to pre-Ferber days. In his 1946 classic entitled “Baby and Child Care,” Dr. Benjamin Spock advised parents to "say good night affectionately but firmly, walk out of the room, and don't go back."
This “don’t go back” approach perfectly describes CIO in its “unmodified” or “total extinction” form. Some pediatricians who subscribe to this method of CIO advise parents to shut the door to their baby or toddler’s room and not open it again for a full twelve-hour period. The only caveat to this involves assuming nighttime parenting duties if the child is physically ill. Yet, throwing up due to the stress of nocturnal abandonment doesn’t constitute a sign of physical illness and parents are advised by proponents of “total extinction” CIO to clean up the vomit promptly without touching the child or displaying emotion.
In its “modified extinction” form, CIO advocates argue that parents should leave a baby or toddler alone to cry to sleep. But this stressful experience is best practiced when punctuated with intermittent, and increasingly less frequent, check-ins from the caregiver. The intention of such visits is to persuade the little one verbally, or with minimal physical touch, that their nighttime expression of distress, thirst, and/or panic will not lead to the comfort being sought.
In both methods of CIO described above, babies and/or toddlers are repeatedly left alone to fall into cycles of sleep. Over time, they learn not to signal to their caregivers as the bonds of attachment fray. Proponents of CIO mistakenly refer to the resulting detached state as one in which the child has learned to “self-soothe.” This is patently false.
Recent research conducted at the University of North Texas clearly reveals that the cortisol levels of babies left alone to CIO remain at unnaturally high levels even days after they learn to stop crying/cuing for help. However, the cortisol levels of mothers -- which register as abnormally high when their babies cry -- return to normal levels in the silence. At this point, mothers and babies are no longer biologically in sync. The mothers assume all is well; they interpret their babies’ silence as proof that their little ones have learned to self-soothe. Yet, physiologically babies can’t self-soothe. Rather, CIO teaches them to panic silently and detach from those whom nature intends for them to trust.
Sarah Ockwell-Smith, a psychotherapist, doula, and UK-based author of the soon-to-be published book, “The Gentle Sleep Book: A Guide for Calm Babies, Toddlers and Pre-Schoolers” argues that the erroneous pursuit of a baby that self-soothes profoundly misleads parents. She writes: “You are categorically not leaving your baby to ‘soothe,’ you are leaving him to cry, even if it is only for periods of two minutes at a time… Is it possible to train a baby or a toddler to not call out for their parents when they are in need? Yes, it is, but this is categorically not indicative of an infant who is happy, calm and soothed.”
“Three Schools of Thought”
A human infant is born with a brain that is only 25% developed. Babies’ brains grow rapidly in the first two years of life -- up to 70% of their adult size. Hundreds of trillions of neural connections are established and billions of nerve cells develop. It’s a majestic biological orchestration requiring a great deal of REM sleep. Babies spend most of their nighttime hours in REM sleep (much more than adults) and this contributes to their frequent night waking and notorious patterns of light sleep. While frustrating for parents, these patterns are actually healthy for babies. During REM sleep, key proteins central to the construction of nerve cells are manufactured and blood flow in the brain doubles. Consider that premature babies spend 90% of their sleep time in REM.
Given our sleep-deprived, over-worked culture that embraces a hyper-independent vision of success, the question of how best to respond to the normal sleeping patterns of babies and toddlers is a loaded one. In her popular “Aha Parenting” blog, New York-based child psychologist Dr. Laura Markham, author of “Peaceful Parent, Happy Kids: How to Stop Yelling and Start Connecting,” explains there are “basically three schools of thought” with regard to the matter.
The first approach consists of “the family bed.” Here, the primary caregiver (usually a breastfeeding mother) chooses to sleep nearby her baby or toddler -- either in the same bed or in the same room. Mother and child sleep close enough to each other so that nighttime cues and signals can be responded to quickly and comfortably. Not needing to walk down a hallway after checking a bleary-looking monitor at 3am, a co-sleeping mother simply brings a night waking baby or toddler to her breast wherein they both can fall back to sleep with ease. Advocates of this approach, argue that co-sleeping, when practiced safely, is the most natural and instinctive way all breastfeeding mammals sleep. After all, consider that we are the only social mammal which can be persuaded to purposefully separate our young from their mothers during nighttime hours.
In the second approach, one finds proponents of gentle sleep training techniques such as those advocated by Markham herself as well as by Elizabeth Pantley in her popular book “The No Cry Sleep Solution.” In this school of thought, young children are not left to cry alone. However, they are taught, when developmentally appropriate, to learn to sleep, or fall back to sleep, without the constant reassurance that they naturally crave. This may involve crying. Should parents walk away when crying occurs? “Never, in my view, if you want an emotionally healthy child,” answers Markham. She continues: “Crying is fine, as long as you’re there.” It’s important to note that these gentle techniques are not taught to babies. After all, it is natural and appropriate for babies to breastfeed to sleep. “Nursing to sleep is no more a ‘bad habit’ than peeing in a diaper,” Markham writes. As children grow, they leave behind diapers as well as breastfeeding in an organic and supported way.
Eighty-five percent of the neural pathways relating to how we respond and interpret the world are formed in the earliest years of our development. Sensitive caregiving, particularly in the first three years, correlates with professional and social success/happiness in later life.
Finally, standing in stark contrast to co-sleeping and gentle sleep training advocates, one finds proponents of CIO. Like Keith and Janet in the opening story, parents practicing CIO choose to let their children cry alone into an exhausted sleep, over and over, until the little ones learn that protesting their situation is futile. Advocates of CIO may argue that Keith and Janet’s story is too extreme. “I’d never let my son cry until he vomits,” they may say. Or, they may openly admit that such a sign of distress is par for the course. Consider this recent post on a parenting FB group:
I just saw a post on another web site from a mom doing controlled crying. The poor bub has vomited from distress and is sweating to the point he needs his clothes changed - out of distress also. The other moms are commenting - be strong, stand your ground and my LO [little one] vomited too, and it gets easier... So heart breaking.
How parents and caregivers choose between these three schools of thought matters. While we may not consciously remember how we were treated in our earliest years, the first three years of human life are vital to the development of our implicit memory serving as the foundation for how we feel about relationships, trust, and love. In fact, eighty-five percent of the neural pathways relating to how we respond and interpret the world are formed in the earliest years of our development. Sensitive caregiving, particularly in the first three years, correlates with professional and social success/happiness in later life. Yes, how babies and toddlers are treated matters -- a great deal.