Why do Some Still Think Cry it Out is Okay?
It is almost implicitly understood that no parent should willfully damage their child. In contrast, it is also understood that a parent is to do what they see fit when it comes to the way they choose to raise their child. After having my first child, I soon accepted that being tired had become a part of my personality. I told myself I didn’t have my son to sleep better at night. When you become a parent, it is assumed that you will make sacrifices and change your life in dramatic ways in order to adapt to your child’s ever-changing needs. The way you go about your daily life changes, every aspect. From the ways, you plan social engagements and vacations, to the ways you eat and sleep. During the first 8 months of his life, my son woke up anywhere from 2 to 4 times a night, for up to an hour. Babies wake as part of the development of natural sleep cycles. Unlike adults, infants start to sleep in the REM state and then after about half an hour to 45 minutes they transition to a lighter sleep cycle (Linda Folden Palmer). During these transitions, most infants will wake as their breathing patterns, brain wave patterns, and subconscious state changes. It is natural, and healthy for an infant to wake frequently throughout the night as part of their development (Glenn) (Linda Folden Palmer). Infants with active waking reflexes are also suggested to have a lowered risk of Sudden Infant Death Syndrome, or SIDS (Mayo Clinic).
As I said, when you become a parent you are expected to make changes in your life in order to accommodate the needs of your child. This change is expected immediately, from the moment the mother gives birth. Mothers are typically expected to make the greater sacrifices. Mothers are encouraged, often bullied by peers and even medical professionals, into breastfeeding their child. Breastfeeding alone can take over a mother’s entire day. Mothers are encouraged to breastfeed their children on demand, which can be every 30 minutes, it can be every 2 hours, or it can be a continuous feeding for hours at a time, day or night. Additionally, newborns are not capable of maintaining their own circadian rhythm until their bodies begin to produce melatonin around 6 weeks, so often times parents of newborns struggle with day and night reversal (Dr. Frans X Plooij). When the infant reaches four months old, the first of many sleep regressions occur. Sleep regressions are the points in a child’s development where their sleep patterns change and usually results in more frequent waking at night, and trouble falling asleep. Respectively, these regressions happen every 2 to 4 months until the child reaches biological maturity. It should be apparent that sleep is one commodity parents will oftentimes find themselves in short supply of.
There are hundreds of books boasting to help parents “get their child to sleep longer and easier”. A majority of these books advocate for some form of a gradual extinction method for promoting sleep. The most common forms of gradual extinction are Cry it Out or CIO, and “Ferber Method”. For variety’s sake, I will use these terms synonymously, as they each involve allowing your child to cry for timed intervals up to at least 10 minutes at a time with little to no parental contact. The Ferber method is the process of putting your child down into their crib drowsy but awake and then leaving the room. You are to then allow the child to cry in graduating 1-minute intervals while alone, for up to 10 minutes. At the end of each timed session of crying the parent is to re-enter the room, soothe until the baby is no longer crying, and then leave the room again. CIO is different in that you simply allow the child to cry for the full 10 minutes, some older books will suggest leaving them even longer, before reentering the room to soothe the child. Historically, graduated extinction methods have been documented as the accepted manner in which parents “teach” their children to sleep, and one way to prevent the infant from “manipulating” the parent. Most graduated extinction advocates recommend parents wait until the child is 6 months of age, but many parents are encouraged by peers and pediatricians to do it as early as 6 weeks. Another anecdotal argument commonly used to back the use of CIO is “my mother did it to me and I turned out just fine.” Anxiety disorders affect 40 million American adults each year and 16.1 million American adults suffer from major depressive disorder (AADA). Overall mental health is on the decline (AADA). It is more likely that someone does not “turn out just fine” than otherwise.
Gradual extinction methods usually coincide with the old-fashioned belief that children should be seen not heard. This doctrine can be found throughout history, but graduating extinction originates sometime after the Industrial Revolution, in the 18th century (Aletha Solter). Notably, CIO and other graduating extinction methods have only been used in English speaking, industrialized countries (Aletha Solter). This implies a that parents in an English speaking industrialized country are subject to a set of unique societal core values, resulting in a misconception of what a healthy maternal and paternal relationship should entail. Americans, I’ve observed, value hard work and work ethic. Americans seem to place little value on rest and prioritize productivity. This ultimately results in most American’s sacrificing sleep or rest in order to remain productive for longer periods of time.
There is little to no evidence to suggest that parents need to teach their children how to sleep, or that infants are capable of “manipulation”. In fact, studies show that children are incapable of understanding the concept of “cause and effect”, the fundamental understanding required for manipulation, until approximately 18 months (Dr. Frans X Plooij). For the first year of life, the primary way infants communicate their needs and wants to their parents is through crying. Crying is not inherently a negative experience for the infant, it is simply a form of communication that ultimately enhances the maternal bond between the mother and child when the mother responds. It evolves into something negative when the communication attempt is ignored or goes unanswered, which has tangible short and long-term ramifications. These negative effects are not exclusively suffered by the child, parents can also be affected in adverse ways as well. Allowing your baby to cry while willfully ignoring their needs, to put it plainly, hurts.
“I’m around 1 ½ years old. Recently separated from my mother, my grandmother cares for me. I see myself standing in my crib at my grandparents’ home. It’s dark. I am crying and crying. I don’t know what I did that was so wrong. I’m confused, utterly distraught. So, I climb out of my crib and walk through the house. I find my grandmother in the kitchen cleaning. I cling to her leg crying, begging. I want to be picked up. “I am a good girl!” I tell her.
Years later my grandmother confirms the story. She said it broke her heart to ignore my cries. She was pressured to make me cry myself to sleep by her husband, my grandfather, and by her son, my biological father.
She tells me she is sorry. -- Victoria Fedden, author of “Amateur Night at the Bubblegum Kittikat”
A mother responds to their baby’s cry both emotionally and physically, and to deny succor to the child, to refuse release of the mother’s natural reaction, can cause palpable distress to the mother particularly on an emotional level. As Victoria Fedden illustrates, even grandmothers can be affected (Glenn). Most mothers who have used a graduating extinction method reflect on how hard it was for them, the parent, to go through afterward, and describe “crying on the other side of the door” right along with their infants. “Biology links mothers to children, and when that relationship is in sync, cortisol levels (associated with stress), as well as oxytocin levels (associated with bonding), rise or fall together. CIO breaks this bond.” suggests Amy Wright Glenn in her article “Screaming to sleep, Part Two: The moral imperative to end 'cry it out’”.
There is a lot of recent evidence to support that graduated extinction methods have the potential to leave lasting negative impacts on children that have undergone this form of “sleep training”. In the peer-reviewed study, “How the Timing and Quality of Early Experiences Influence the Development of Brain Architecture" it was concluded that “early life events can exert a powerful influence on both the pattern of the brain architecture and behavioral development” (Sharon E. Fox 28). The study focuses on negative experiences during sensitive times of development and how they can alter the way in which genes are expressed, thus changing the brain’s architecture at certain times in an infant’s development. Children that have been neglected or abused express lower cognitive function, behavioral and emotional dysfunction, and even have irregular brain structure. This phenomenon is not limited to abuse victims, however. For example, otherwise normally developing children that are hospitalized for long periods of time at an early age can also display similar signs of abnormal brain structuring during development (Sharon E. Fox 34). Oftentimes the damage is masked by higher functions well into adult life, so often remains unnoticed, or untreated until brain development is complete (Sharon E. Fox). Depressive disorders, learning disabilities, ADHD, bipolar disorder, autism, and countless other disorders are linked to malformation of certain areas of the brain during development (Melilllo) (Sharon E. Fox 29-30).
Dr. Frans X. Plooij explores the sensitive times in a child’s development in his multiple award-winning, and top selling book “The Wonder Weeks” (Dr. Frans X Plooij). I was given three copies of this book during my baby shower. Clearly, it has become a staple of modern parenting. The book’s purpose is to help parents understand and stimulate the healthy development of their infants through the first year and a half of their lives by walking them through the first 10 “leaps” of development (Dr. Frans X Plooij). This gives new parents a form of “guidebook” for what to expect in the first year and a half of their child’s life. Numerous times in his book, Dr. Plooij advises parents to not let their child cry. He encourages parents to support and guide their babies through the influx of new, and often overwhelming information they are receiving as their brain develops and learns new concepts and skills. Additionally, the Mayo Clinic recommends parents remain sleeping in the same room as the child for 6 months to a year to reduce the risk of SIDS (Mayo Clinic) while CIO requires separate sleeping quarters.
Despite solid evidence that it can be harmful to the child, the recommendations of a wildly popular author among parents, their mother’s natural instincts, and the inferred increase in the risk of SIDS, babies are largely still being left to cry it out at night. Why do parents continue to resist change and continue to sleep train their children using this archaic method? It works. Gradual extinction methods do generally result in babies sleeping longer and, in turn, allow for more parental sleep (Michael Gradisar). Promoters of CIO like to use mantras such as “happy mama, happy baby”, “rest makes you a better mother”, or “be strong, they need to learn you’re in charge” to support mother’s in the process of sleep training their child using CIO methodology. These are deceptive rationalizations, typically offered as a means to continue the maltreatment of a child. CIO is one of the top topics debated in the social phenomenon dubbed “the mommy wars” (Gerritson). Parents that choose not to do any form of sleep training are berated by other parents, even their own partners. They are often criticized as promoting bad lifelong behaviors such as manipulation, dependence. and spoiling their child despite evidence that suggests otherwise.
"Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial“ was a study published in Pediatrics, American Academy of Pediatrics’ journal in 2016, that supported the claim that CIO was not damaging to infants or the maternal bond in the long term (Michael Gradisar). Pediatricians like Dr. Claire McCarthy, quickly posted their own articles, citing this study as proof that CIO was not damaging (Claire McCarthy). In McCarthy’s article, she even uses this study to validate her own parenting choices. This study, in particular, is the most common citation used by supporters of gradual extinction as it is also the most recent study on the subject. The study is arguably proponent of fallacy, from its misleading title to its methodology and process. Firstly, the study was conducted on children who already had a history of sleep issues from the parent’s perspective. The study included three groups, a “control” group, a group that used the Ferber method, and a group that used a non-gradual extinction process called bedtime fading. The information analyzed was provided by the parents therefore clouded by their perspective. The study only extended to a year, not truly allowing for a “long-term” conclusion. It also rated the success of the sleep training based on the mother’s sleep and her perspective of the maternal bond. The study’s conclusion was that bedtime fading, not graduating extinction, provided the best sleep with the least amount of damage. It is one of the few studies used to support CIO, and like the majority of CIO advocation, it is done through opinion, theory, and sensationalizing of surveys.
As previously mentioned, the sustained use of CIO, the Ferber Method, and other gradual extinction implies there is an underlying reason. Why do parents and professionals struggle to accept that they are potentially harming their children through these practices? The answer boils down to the idea that it is normal to do so. Socially normative behavior is defined as “group-level beliefs and expectations about how members of the group behave or should behave” by the CDC (Beverly L. Fortson 20). In other words, parents are still using CIO because their parents did it to them, as their parents did to them, and so on. This rationale is also seen in what CDC refers to as the abuse cycle, or the continuation of abuse through generations as the abused become the abusers. Abused children are more likely to abuse their own children later in life (Beverly L. Fortson 8).
Not too long ago a similar debate was centered on the socially acceptable way parents were to discipline their children. It is strange to think that 25 years ago a parent could spank their child in public while receiving nods of approval from other adults in the area. Now, the reaction would be vastly different as the social norm has changed. Organizations like the CDC advocated for this change through propaganda, education, and lobbying for changes in legislation and law (Beverly L. Fortson). They continue to do so today. In their recent technical package released to health and public workers, the CDC states that one way to stop the abuse cycle is through changing of the social norms that influence it (Beverly L. Fortson 18). The norm that they are specifically focusing on is the idea that “it’s none of my business”. In other words, the tendency we have to turn away when we see someone speaking to their child, or treating their child in a way we disagree with. Instead of hiding behind the phrase “mother knows best”, we need to embrace the idea that there may be a better way, welcoming questions about our choices, and treat them as the opportunities they are. This is not to say that we should raise our children as everyone else sees fit, but we do need to treat all advice with an amount of skepticism, especially if the reasoning behind that advice goes against your instincts.
Another norm that is seemingly ignored by the CDC is the expectation that parents, should remain as productive, outside of their family life, after a child is born as they were prior to having children. This directly conflicts with the goal of raising children in a healthy environment in many ways. You are expected to make sacrifices to ensure the child’s wellbeing. Sleep, however, is less likely to be sacrificed due to this expectation. Changing the way we think about our purpose when we start a family, and how others perceive our purpose from then on, is also essential in halting the progression of CIO through time.
As with all things, there is no dichotomous divide between the maltreatment of a child and the raising of a child in a healthy environment. Children are raised within a situational gradient of imperfections, hopefully, resulting in the best possible outcome we can provide as parents. We need to break away from the traditions of the past and be unafraid to discuss what we may be doing wrong. It need not be a “war” as it is depicted by media. We need to break the idea that parents’ choices are none of your business. It is your business, as it truly does “take a village”. Parents need to look at the evidence and think critically before implementing recommendations of their elders, peers, and even medical professionals. Cry it out hurts children almost identically to the ways other children who are neglected are affected (Aletha Solter) (Beverly L. Fortson) (Glenn) (Susan Rick) (Sharon E. Fox). There’s a plethora of evidence to support that claim, and little to refute its validity. The standard by which we judge whether or not a parent is neglecting their child, and if we should intervene, needs to be raised. We need to stop biting our tongues, out of fear of rebuke or out of apathy, and share that information with anyone who mentions they are planning to sleep train their child.
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Aletha Solter, Ph.D. Crying for Comfort: Distressed Babies Need to be Held. February 2004. Article. 29 November 2017. <http://www.awareparenting.com/comfort.htm>.
Beverly L. Fortson, Ph.D., Joanne Klevens, MD, Ph.D., MPH, Melissa T. Merrick, Ph.D., Leah K. Gilbert, MD, MSPH, Sandra P. Alexander, MEd. "Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities." 2016. cdc.gov. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. PDF. 10 11 2017. <https://www.cdc.gov/violenceprevention/pdf/CAN-Prevention-Technical-Package.pdf>.
Child Abuse and Neglect Prevention. 17 April 2017. National Center for Injury Prevention and Control, Division of Violence Prevention. Website. 10 November 2017. <https://www.cdc.gov/violenceprevention/childabuseandneglect/index.html>.
Claire McCarthy, M.D. New study says that it’s okay to let babies cry at night. 31 May 2016. Article. 9 November 2017. <https://www.health.harvard.edu/blog/new-study-says-okay-let-babies-cry-night-201605319774>.
Dr. Frans X Plooij, Hetty Van de Rijt. The Wonder Weeks: How to Stimulate Your Baby's Mental Development and Help Him Turn His 10 Predictable, Great, Fussy Phases Into Magical Leaps Forward. Kiddy World Publishing, 2013, 1992. Book.
Gerritson, Meg. 11 Topics Guaranteed To Ignite Mommy Wars. n.d. Blog. 12 November 2017. <http://www.scarymommy.com/topics-guaranteed-to-ignite-mommy-wars/>.
Glenn, Amy Wright. Screaming to sleep, Part Two: The moral imperative to end 'cry it out'. 2 February 2015. News Article. 29 November 2017. <http://www.phillyvoice.com/screaming-sleep-moral-imperative-end-cry-it-out/>.
Linda Folden Palmer, D.C. Stress in Infancy. 15 March 2004. Book Excerpt. 2 November 2017. <http://www.naturalchild.org/guest/linda_folden_palmer2.html>.
Mayo Clinic, staff. Sudden infant death syndrome (SIDS). 12 July 2017. Web. 29 November 2017. <https://www.mayoclinic.org/diseases-conditions/sudden-infant-death-syndrome/symptoms-causes/syc-20352800>.
Melillo, Dr. Robert. "Reducing Your Risk Factors." Autism, The Scientific Truth About Preventing, Diagnosing, and Treating Autism Spectrum Disorders- and What Parents Can Do Now. New York: Penguin Group, 2012. 217-264. Book .
Michael Gradisar, Kate Jackson, Nicola J. Spurrier, Joyce Gibson, Justine Whitham, Anne Sved Williams, Robyn Dolby, David J. Kennaway. "Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial." 24 May 2016. Pediatrics.org. American Academy of Pediatrics. PDF. 10 11 2017. <http://pediatrics.aappublications.org/content/pediatrics/early/2016/05/21/peds.2015-1486.full.pdf>.
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Sharon E. Fox, Pat Levitt, Charles A. Nelson III. "How the Timing and Quality of Early Experiences Influence the Development of Brain Architecture." Child Development 81.1 (2010): 28-40. Journal Article.
Susan Rick, DNS, APRN-CNS and Dianna H. Douglas, DNS, APRN-CNS. "Neurobiological Effects of Childhood Abuse." Journal of Psychosocial Nursing & Mental Health Services 45.4 (2007): 47-57.
