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It is OK to let your baby cry for a while

Robin Wulffson MD's picture
crying baby, parental exhaustion, sleep program, Ferberizing, camping out

A crying baby produces a knee-jerk reaction to most individuals within earshot. One’s first reaction is to rush to the child and offer comfort. This often results in parental exhaustion. However, a new study reports that allowing babies to cry for short periods of time while teaching them to sleep by themselves does not cause long-term psychological problems or damage the parent-child relationship. Researcher in Australia and the United Kingdom published their findings online on September 10 in the journal Pediatrics

The researchers noted that randomized clinical trials have reported the short- to medium-term effectiveness of behavioral infant sleep interventions. However, concerns persist that they may harm children’s emotional development and subsequent mental health. Therefore, the researchers conducted a study to determine long-term harms and/or benefits of an infant behavioral sleep program at age six years on: (1) child; (2) child-parent; and (3) maternal outcomes.

The study, which followed children until they were six years old, will likely add fuel to an ongoing emotional debate whether or not exhausted parents should “sleep train” their babies. The study group comprised 326 Australian children with parent-reported sleep problems at age seven months; they were selected from a population sample of 692 infants recruited from well-child centers. Allocation was concealed and researchers (but not parents) were blinded to which group they were allocated to. Behavioral techniques were delivered over one to three individual nurse consultations at infant age eight to ten months. The main outcomes measured were: (1) child mental health, sleep, psychosocial functioning, stress regulation; (2) child-parent relationship; and (3) maternal mental health and parenting styles.

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The behavioral techniques used in the study did not include the most controversial method, known as extinction, or “cry it out,” in which parents put the baby to bed, close the door and do not open it until morning, no matter how long and vociferously the baby sobs. The researchers noted that cry it out is very distressing to parents; however, it is difficult to accomplish and they do not recommend it. Instead, the study used two somewhat gentler approaches. In “controlled comforting,” parents return to the room of a crying baby at regular intervals to offer some limited soothing. It is the technique known colloquially as “Ferberizing,” after Richard Ferber, the doctor who popularized it. The method generally takes a few days to work; hpwever,some babies can need several “booster” rounds in later months. An alternative technique known as “camping out” was also employed. With this technique, parents start by sitting in a chair next to the baby’s bed and slowly—over a period several weeks—move the chair until they are out of the room and the baby is falling asleep alone. The researchers note that both techniques still usually involve some, and sometimes a great deal of, crying.

When the children were six years old, the investigators administered various tests to assess emotional health, behavior, sleep issues and the quality of the parent-child relationship. The mothers were also screened for depression and anxiety. The study took into account factors such as socioeconomic status and child temperament. Two saliva samples were taken to test the children’s levels of cortisol, a stress hormone. Abnormal cortisol patterns can indicate that there was early exposure to high levels of stress.

A significant percentage (30%) of the participants did not complete the study. significant chunk of participants. The investigators found almost no difference on any of the measures between the children who had the sleep training as infants and those who did not. They concluded that behavioral sleep techniques have no marked long-lasting effects (positive or negative). They noted that parents and healthcare professionals can confidently use these techniques to reduce the short- to medium-term burden of infant sleep problems and maternal depression. Interestingly, 16.5% of children in the control group scored as having emotional or behavioral problems, compared with 12.3% in the intervention group.

Reference: Pediatrics