Now I’m going to tell you why a 58-year-old guy, whose kids are all over 20, is still wading into debates about night waking and sleep training. I’m not so much concerned about what individual parents decide they need to do to navigate sleep issues. If a family feels they need to try a Ferber-like technique, for whatever reasons they have – it’s not any of my business. Similarly, whether or not someone chooses to co-sleep, go into a different room to settle their baby back to sleep twice a night for three years, or flop on mattress beside the crib, is none of my business either.
My business is what parents are told they should do.
And my concern here is the promotion of sleep training as the only legitimate way to manage night waking and nighttime needs of babies. I don’t mind people promoting it as one way to handle night waking. But there are a few things I wish the promoters of sleep training would start admitting.
Admit it! Sleep training doesn’t always work.
Some of the studies by the very researchers who promote sleep training actually show that sleep training is not always successful. They know this but they prefer to look on the bright side because, in fairly controlled settings where parents have a lot of support and guidance, sleep training often does work, though by no means always. The thing is that most parents who try sleep training methods do it in the messy world of real life. And it doesn’t work for a lot of them. In a study that I helped design (led by Dr. Lynn Loutzenhiser of the University of Regina) 53% of the 900-odd mothers of babies 6 – 24 months old who answered our internet survey said they had tried a “controlled crying” technique at some point. Only one in six of them said it eliminated night waking completely. Another 26% said it reduced the number of awakenings significantly. That means more than half the families who tried it got little or no improvement. One third said it made no difference at all! That’s a pretty shoddy track record for a technique that is billed as “effective.” Parents seem to have figured this out, if some experts haven’t. We asked parents to agree or disagree with the statement. Controlled crying seems to work for some children but not others: 86% agreed.
Admit it! Even when it works, the results aren’t necessarily permanent.
We asked the mothers of night wakers – 43% of our sample by the way – if there was ever a time when their child slept through the night and 41% said yes. That may explain why 43% of the parents in our study (about 20% overall) said they had initiated a round of controlled crying on four or more occasions and fits with what I’ve heard anecdotally. There are all sorts of reasons why kids “forget” how to go to sleep on their own. Sometimes a little cold or teething is all it takes. I was actually able to get a Canadian sleep training proponent/ researcher to acknowledge this in a Today’s Parent article a couple of years ago. I admire that and I wish more sleep training proponents were as honest as her.
Admit it! Sleep training is stressful for babies.
Some experts like to gloss over this by reassuring parents that sleep training causes no long-term harm (and I have seen no convincing evidence that it does). Well, don’t try to tell me it ain’t stressful for the babies. Moms know it is. We asked mothers if they thought controlled crying was stressful for babies. 63% said it was. (73% said it was stressful for mothers.) Wendy Middlemiss, of the University of North Texas, did some really interesting research at a facility in New Zealand where they do an approach to sleep training that really does warrant the label cry-it-out. Basically, moms, with the help of nurses, go through their normal bedtime routine, then they put the baby in a crib and leave the room. The nurses go in occasionally to make sure the babies are OK, but the moms, who are in another room where they can hear their baby crying, can’t go in. Researchers measured the moms’ and babies’ cortisol levels on the first and third night. Cortisol is a hormone that is elevated when we are stressed. Both moms and babies had elevated cortisol on the first night. By the third night the baby’s were going to sleep with little or no crying. The moms’ cortisol levels went down. But the babies’ cortisol levels stayed up. So these kids were going to sleep but they were still displaying physiological signs of stress.
Now, that doesn’t prove in any way that these kids were “damaged.” Babies can endure some stress from time to time. Geez, they’d better be able to; stress is part of life. And one thing that is totally clear from research is that even when babies experience pretty significant stressors, they can be OK if they also get sensitive, supportive, responsive caregiving.
Back to the Middlemiss study. What I’d like to know what those babies’ cortisol levels were like on, say, day 8 or day 14, and I’d also like to know if they kept going to sleep on their own, without crying, after they went home. But this study wasn’t designed to record that info. So what does it prove? Mostly that sleep training is stressful for the baby, which we already knew. But I think this finding is another nail in coffin of so-called “self-soothing.” These babies went back to sleep in spite of stress, not because they had summoned up their little resources to calm themselves. Pretty hard to call that self-soothing.
Admit it! Some kids are going to be very, very hard to sleep train. One question we asked in our study – a question I’m pretty sure has never been asked before in any sleep study – was this: What is your child’s state upon awakening in the night? More than half of the parents – 60% – said their child was either calm or not very upset when they first woke. This is the state that some sleep experts would have you believe virtually all babies are in upon waking, But almost a third of our sample described their child as very upset, very quickly when they woke up. 14% said their child was very upset shortly after waking. And 17% said their babies appeared to be crying hard before they were even awake. How is a child in that sort of physiological state supposed to settle down with no help?
Admit it! Some parents are just not going to be willing or able to implement sleep training successfully. In our study various beliefs that mothers held predicted their success or lack of success with sleep training. Moms who agreed with the statement: “My baby will feel abandoned if I don’t respond immediately to his/her cries at night” were much less likely to report success with controlled crying. Those who agreed with “It is all right to allow my child cry at night” were more likely to succeed. No surprise. Those statements, by the way, come from something called the “Limit Setting Scale” on the Maternal Cognitions about Infant Sleep Questionnaire. It’s a recognized research tool developed by a British researcher and now used in other studies. Do you get the implication of the phrase Limit Setting? That’s right, the implication is that parents who feel they can’t let their babies cry at night don’t set “limits”, which as we know, has a negative connotation. Good parents set limits, weak parents don’t. That’s just another example of the ways in which researchers and conservative sleep experts use rhetoric to promote their views. I actually read one paper that referred to a “sleep disorder” (I’ve forgotten the name) which was defined by the presence of a parent at when the child falls asleep (which BTW, is the norm in many cultures all over the world). Where do these people get off? Honestly!
Here’s what I will admit.
Sleep training (in varying forms) has worked and been helpful for quite a few families.
I have seen no evidence that kids are damaged in the process.
I know kids who have been sleep trained, and they’re fine. And their parents are nice, warm, caring and loving.
Sleep is important, for both parents and babies.
When it comes down to it, parents have to make these tough decisions about how to deal with things like night waking, whether or not they and their children are getting enough sleep, and what to do about it. And I’d like them to be able to do make those hard decisions in an atmosphere of support, respect and non-judgment, based on their understanding of their child and his or her needs, not what some researcher believes is best for most children (and, in case you hadn’t noticed, researchers don’t all agree anyway.) Parental judgment – call it intuition, if you will, but I think it’s more than that – is an imperfect mechanism. But it’s the best one we’ve got.