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Controlled crying; is it safe?

Α young child’s night sleep: how safe is controlled crying?

“Let her cry”.. How right is it for our baby?

Controlled crying (also known as sleep training) is a technique that is widely used as a way of managing infants and young children who do not settle alone or who wake at night. Controlled crying involves leaving the infant to cry for increasingly longer periods of time before providing comfort. The goal of controlled crying is to let babies put themselves to sleep and to stop them from crying or calling out, with the aim of making you go to them during the night.

The concern here is that the widely spread and recommended technique even by health professionals is not consistent with what infants need for their optimal emotional and psychological health, and may have negative – though unintended from the side of the parents – consequences.

Let’s see the scientific data.

Babies have to adapt to a totally new world and even small changes can be stressful for them. Leaving babies to cry without response and comfort, even for short periods of time, can be very distressing and painful for them.

Crying is designed by nature as a signal of distress by the infant in order to get response. Although the technique of controlled crying can stop children from crying, it may teach children not to seek or expect support when distressed.

Infants from about six months of age suffer from differing degrees of anxiety when separated from their parents – a “side effect” of the realization of object permanence. This anxiety continues until they can learn that their parents will return when they leave, and that they are safe no matter what is happening. This learning process is a stage that may take up to three years.

Almost all children grow out of the need to wake at night and be reassured by three or four years of age, many much earlier than this. The arbitrary persistence of an adult for premature maturity of the child in this sector often results in sleeping problems and problems of emotional nature, which last over time.

Infants are more likely to develop secure attachments when their distress is responded to promptly, consistently and accurately. Secure attachments in infancy are the foundation for all the relationships of the young person in the future, and for good adult mental health.

Infants, whose parents respond and attend to their crying promptly, learn to settle more quickly in the long run as they become secure in the knowledge that their needs for emotional comfort will be met.

 

Biological programming and REM sleep

The demands of Western lifestyles and some “expert” advice has led to an expectation that all infants and young children should sleep through the night from the early months or even weeks. In fact infants are biologically programmed to arouse more often in the night than older children or adults because their sleep cycles are much shorter. Our babies sleep deeply for a short period of time, then experience enough REM sleep (sleep with rapid eye movement, connected with dreams), and wake up after 1-2 hours, in order to return then to a similar short sleep cycle. These short sleep cycles allow infants to experience more rapid eye movement (REM) sleep during the day, which is considered to be important for their rapid brain development.

Many parents feel exhausted when their young children cry at night, in part because of the physical strain of getting up and going to their babies to re-settle them, but sometimes in part because of the unrealistic social expectation that babies “should” sleep alone throughout the night. Many parents find controlled crying helpful. For other parents it does not work, or causes so much distress for the parent and the infant that it is discontinued.

 

Sleep, night stress, and separation anxiety

Unfortunately there have been no studies that assess the psychological stress levels of infants who undergo controlled crying, or its long term emotional or psychological impact on the developing child.

Thus, science today says that it is normal and healthy for infants and young children not to sleep through the night without interruption and to need the attention and the presence of their parents during the night. This should not be labeled a disorder, a disease, or a problem, exept where it is clearly outside the usual patterns.

Parents should be reassured that their attending to their infant’s needs and crying will not cause a lasting “habit”, as it is supported by widely spread claims without any scientific basis.

Waking in young children may be due to separation anxiety, and in these cases parents should be informed that it is “ok” to sleep with or next to the child, observing certain precaution measures. This often enables all to get a good night’s sleep.

Any methods used to assist parents to get a good night’s sleep should not compromise the infant’s developmental and emotional needs.

If controlled crying is to be used, it would be most appropriate after the child has an understanding of the meaning of the parent’s words, to know that the parent will be coming back and to be able to feel safe without the parent’s presence. Developmentally this takes about three years. Of course this varies between children, so observing children and responding to their cues is the best way to assess when a child feels safe sleeping alone. The mother should avoid comparing her child with other children, and focus on her own child’s developmental maturity, which can vary.

 

Training of parents.

Full professional assessment (e.g. by a paediatrician) of the child’s health, and child/family relationships should be undertaken before initiating a controlled crying program. This should include assessing whether in fact the infant’s crying is outside normal levels. All efforts should be made to link parents with community supports to minimize isolation and frustration felt by many parents when caring for a young child. Other strategies, apart from controlled crying, should always be discussed with parents as preferable options.

If an infant or child has already experienced separation from a parent due to sickness, parental absence or adoption, or if he or she becomes very distressed during controlled crying, the method should not used. This is because children who have experienced traumatic separation are more vulnerable to negative effects from the kind of stress caused by controlled crying.

Where parental stress due to infant crying may lead to risk of abuse, it is essential that parents be linked with social supports and therapeutic intervention.

Parents should be told that the controlled crying method has not been assessed in terms of stress on the infant or the impact on the infant’s emotional development.

Where it is used, recommendations should be for exercising caution and playing safe. In particular, parents should pay attention to the level of distress rather than the time period – number of minutes – the baby has to be left to cry. In addition, parents should discontinue this technique at any time if it does not “feel” right.

 

Source: Australian Association for Infant Mental Health. Position Paper 1: Controlled Crying. Revised ed, March 2004.

 

Bibliography

Bowlby J (1973). Attachment and loss: 2. Separation. Harmondswroth, Middlesex: Penguin.

McKenna J (2000). Cultural influences on infant sleep. Zero to Three 20, 9-18.

Perry BD et al. Homeostasis, stress, trauma, and adaptation: a neurodevelopmental view of childhood trauma. Child and Adolescent Psychiatric Clinics of North America 7, 33-51: 1998.

 

Stelios Papaventsis Paediatrician MRCPCH DCH IBCLC 2010

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