A Timeline of Horrors: the history of sleep training
The 19th Century
"How is an infant to be managed that cries from temper, habit, or to be indulged?”
“It should simply be allowed to “cry it out.” This often requires an hour, and in extreme cases, two or three hours. A second struggle will seldom last more than ten or fifteen minutes, and a third will rarely be necessary.”
Dr. Luther Emmett Holt
In 1894 Dr. Luther Emmett Holt published The Care and Feeding of Children: A Catechism for the Use of Mothers and Children's Nurses. He wrote those three words: Cry. It. Out.
Holt promoted the idea of regimented and disciplined parenting. His book included a schedule of activities (such as toilet training) to be learned at specific ages, and meals to at regular hours to "prevent disease". He advised that:
““Babies under six months should never be played with: and the less of it at anytime the better for the infant. They are made nervous and irritable, sleep badly and suffer from indigestion.””
Not content with the medicalisation of childbirth, white men now turned their patriarchal gaze to the raising of those children. The Victorian era was one of regimental order: Holt was born in 1855, soon after the American Civil War and the Napoleonic Wars. The British Empire was at its peak.
As president of the American Association for the Study and Prevention of Infant Mortality (AASPIM), Holt also promoted reproduction control by society as a means of eugenics. In his 1913 presidential address he said:
““We must eliminate the unfit by birth not by death. The race is to be most effectively improved by preventing marriage and reproduction by the unfit, among whom we would class the diseased, the degenerate, the defective, and the criminal.””
This man was the father of sleep training.
He also decreed how breastfeeding should be practiced: Holt detailed,
““…in the first two days infants should only be fed four times at 6-hour intervals with one feed between 6 pm to 6 am (the period he called ‘night nursing’s’), because he claimed that little milk was secreted at this time. Thereafter, infants were to be fed 7 times per day at 3-hour intervals, with two feedings during the night, decreasing to a single nighttime feed by four months. At each of these feeds, infants were to stay at the breast for twenty minutes maximum. By 7-12 months, all night feeds should be eliminated, and infants were only to be breastfed five times per day””
Dr. Anna Fullerton wrote in her Handbook of Obstetrical Nursing for Nurses, Students, and Mothers (1891): Parents should
“not spoil the baby by picking him up every time he cries. A certain amount of crying is not harmful; it even gives him some exercise.”
“If a baby is picked up every time he cries, he will soon develop the habit of crying insistently each time he wakes until the mother does pick him up…. This is not a good habit for the baby or the mother. It interferes with the baby’s sleep and with the mother’s work or rest. It teaches the baby that crying will give him control over his parents, whereas a baby should learn that such habitual crying will only cause his parents to ignore him.”
The 20th Century
It is hard to imagine the advice could get any more inhumane but, it did.
In his book Psychological Care Of Infants And Children, published in 1928, behaviourist John Watson wrote:
“Let your behavior always be objective and kindly firm. Never hug and kiss them, never let them sit in your lap. If you must, kiss them once on the forehead when they say good night. Shake hands with them in the morning.” Give them a pat on the head if they have made an extraordinarily good job of a difficult task.”
John Watson believed that children should be treated as young adults. In his book, he warned against the inevitable dangers of a mother providing too much love and affection. Dr John Watson believed that nothing is instinctual, but that children develop through interaction with their environments, over which parents have complete control. Watson was one of the first to stand on the “new” side of the nature-nurture debate, namely the nurture side. He believed that excessive early attachments could contribute to a dependent, needy personality in adulthood, emphasizing that people do not receive excessive comfort in adulthood and therefore should not receive it in childhood.
The goal of this type of parenting is control. Submission, compliance and fear are desired. There is no nurturing. For parents raising children during World War One, The Great Depression and World War Two, you can understand the primary focus must have been keeping their children alive. Sadly, many of those babies would die in battle. It is easy to imagine the tears of mothers who wished they had held those babies more.
Dr Frederic Truby King
In New Zealand, Dr Frederic Truby King established The Plunkett Society in 1907. King's methods to teach mothers domestic hygiene and childcare were strongly promoted through his first book on mothercare, Feeding and Care of Baby, and via a network of specially trained Karitane nurses and a widely syndicated newspaper column, Our babies, written by King's wife Isabella.
The Truby King method was one of strict schedules. Babies were to be fed every four hours - no more, no less - and ideally not a all during the night. Cuddling was to be limited to ten minutes per day. Truby King believed “children should be seen, not heard” and in the first year all they need do was rest, grow and develop. When not asleep between feeds, babies should be left to play by themselves, although a 10 minute period outdoors in the pram was required, regardless of the weather.
Truby King was particularly interested in cows and their milk and developed what he referred to as a recipe for “humanising” cow’s milk for when a mother’s own milk supply fails. At the same time, he was adament that babies must be breastfed: “Breast Fed Is Best Fed” was his motto, even though his routines and schedules would have made successful breastfeeding near impossible to achieve.
The Plunkett Society in New Zealand was set up as The Society for the Promotion of the Health of Women and Children in Karitāne, near Dunedin, New Zealand. The Tweddle Hospital and first school of Mothercraft in Melbourne, Australia was based on Dr Frederic Truby King's 'Plunket system of infant care'. Tweddle began as a Victorian public hospital, established to save the lives of sick and foundling babies. In Sydney, Australia, the Royal Society for the Welfare of Mothers and Babies established the Tresillian Mothercraft Home in 1921, using the Plunkett model. However, just two years later, in 1923, they had ceased to follow Truby King’s methods. Matron Elizabeth McMillan was dismissed for continuing to use his recipe for infant formula, which he believed in "humanized" [cow’s] milk with the protein reduced to 1.4% to match breast milk, against the general paediatric consensus at the time in favour of high protein feeds. McMillan, who had trained in Dr Truby King's Plunket Mothercraft method in London, became the first director of the Karitane organisation in Sydney after parents who supported the Plunkett approach established a local branch of the society. Tresillian was established as an organisation to co-ordinate childhood and maternal services in response to statistics during World War I that showed 63,000 Australian servicemen had lost their lives fighting, whilst 70,000 children under 5 had died through poverty, lack of hygiene and disease in the same period. In Melbourne during the same period and with similar concerns about infant mortality, Baby Health Clinics were established. Dr Isabella Younger Ross developed the Infant Welfare Society in Victoria and the first baby health clinic in Richmond in 1917. That clinic would evolve to become the Queen Elizabeth Centre in 1986. Meanwhile elsewhere in Melbourne, in 1930, the Family Care Sisters (Grey Sisters) were founded to provide a personal service to mothers in their own homes. When founder Maude O’Connell asked Dr William Collins, at St Francis church, Melbourne, why this wasn’t happening; he said: “are you prepared to roll up your sleeves and help the mothers in their homes?’ “Yes”, she replied, “and I will get others to do it also.” In 2008, The Grey Sisters joined with the with Sisters of Mercy and became known as Mercy Health O’Connell Family Centre.
Today, many of these community support services which originally set out to reduce the infant mortality rates due to malnutrition, illness and poor sanitation, offer mother and baby residential units colloquially known as “sleep schools”.
Truby King was not revered by all, despite his extensive efforts to influence practices in Europe and the United States. In his work A History Of Infant Feeding (October 19, 1953) in The Archives of Disease In Childhood, Ian Gordon Wickes wrote:
“His work was marred by his gross over-emphasis by the of the dangers of overfeeding, which he described as more common and more dangerous than under- feeding in the breast-fed infant, and his influence in this direction is still plainly discernible in England and New Zealand today. It is curious that a man so interested in nature should have insisted on such a stead of rigid restriction of quantity and such a strict adherence to feeding by the clock when it is so plain for all to see that nature obeys no such man-made laws.
Most twentieth century writers have ignored Truby King though his disciples have continued to put his principles into practice and to use his products almost without alteration to this day.”
In 2007, a television documentary series aired in the UK. Bringing Up Baby featured three approaches to infant care, including the Truby King approach, used on the babies of families who volunteered to take part in the experiment. Overseen by Claire Verity, who describes herself as a “maternity nurse”, the parents followed the strict schedule provided and the babies were left to cry alone. Such was the public outrage at the methods endorsed by Verity, even Gina Ford (see below) was moved to report her to the National Society for the Prevention of Cruelty to Children (NSPCC) for what she described as “child abuse”.
The alternative methods used by other families in the program were based on the work by Dr Benjamin Spock and the 1970s Continuum Concept written by Jean Liedloff
The Baby Boom
In 1946, Dr. Benjamin Spock’s The Common Sense Book of Baby and Child Care revolutionised child care advice. Pushing back against the harsh approaches recommended by Holt and Watson, Spock gave parents permission to do what they felt was best for their child. He believed "natural loving care" would help children thrive.
Trust yourself, you know more than you think you do.
Dr Benjamin Spock
Routines are nice, but babies don’t need a strict regimen
While Spock recognised a regular daily routine was useful, he didn’t think it necessary to have strictly-adhered to feeding or sleeping schedules. His views were opposed by those who upheld the beliefs of Holt and Watson, warning that such permissive parenting would result in rebellious and self-indulgent adults. Years later, as post-war babies became young adults in the 1960s and 70s, critics cited Spock’s books as cause for the anti-Vietnam protest movement - of which Spock himself was a supporter.
The 1960s and 70s were also an era of counter-culture and the hippy movement did away with parenting books altogether, embracing many practices frowned upon by the mainstream. Breastfeeding, carrying babies in slings and family beds were associated with the long-haired waifs drifting about in communes - and considered another result of Dr Spock’s parenting advice.
I am Woman, Hear Me Roar: the 1970s
In the 1970s, the voices of women were beginning to be heard in the growing genre of books on mothering and caring for infants.
British psychologist Penelope Leach, author of Your Baby and Child: from birth to age five (1977) viewed infant care from a different perspective.
“To me, the most important thing one can give a child is genuinely unconditional love. That is what self-esteem and self-confidence are founded on. The more you push a child to do things early or to be the best at gymnastics or dancing class, you imply, ‘I love you more when you win.’ That is very damaging.”
Although originally writing in the late 70s, Leach continued to speak up for babies. Her later book The Essential First Year – What Babies Need Parents to Know (2010) affirmed her belief that leaving babies to cry could have long-term effects. In an interview with The Guardian, she said:
“The reason babies raised on strict routine regimens go to sleep, usually with less and less crying, is because they are quicker and quicker to give up. Their brain has adapted to a world where they are not responded to. That kind of early-induced anxiety may relate to anxiety right through adult life.””
Childbirth activist and mother of five, Sheila Kitzinger also spoke up for the babies in response to the rise of sleep training manuals. Kitzinger campaigned for women to have the information they need to make choices about childbirth and was a well known advocate for breastfeeding. Her work is considered influential in changing the culture in which women give birth. Writing more than 20 books across four decades, her 2005 work Understanding Your Crying Baby addressed her serious concerns about the influence of books promising to train infants to sleep without disturbing parents at night:
“At the moment we are in a very directive phase when mothers are told babies must not disrupt their lives. Their babies should not affect their careers, they should not affect their sex lives, they should not affect their social lives - it’s about ‘me time’. Babies are treated like the enemy.”
So what was happening to have these icons of British motherhood up in arms?
The Rise and Rise of the Sleep Training Industry: 1980s and 90s
The mothers of babies born in the 1980s and 90s were recieving very mixed messages: breastfeeding was no longer tightly-timed by the clock but to be offered “on demand”. Although this “demand” was expected to be within the traditional four hourly feeding schedule, there was to be some flexibiliy in expectations: feeds might be 3-4 hourly or occasionally only 2 hours might pass between feedings. Night feeds were to be endured in “the early days” but parents could look forward to longer periods of sleep as the baby grew.
Women were now more likely to have the means to meet mothers outside their family or neighbourhood circle, as drivers licenses (and second cars!) and home telephones became the norm. Community playgroups and mothers groups brought together mothers whose babies were of similar age and soon comparison turned into competition. Rather than waiting for nature to take its course, encouraging babies to sleep longer, sooner became attractive.
Unlike the generations before them who largely relied on their mothers, family and friends for advice, the educated women of the “power dressing” era looked to books and magazines for instructions to follow. And a market-driven avalanche of offerings met the demand.
The Sleep Training Methods we look at in this section fall into two categories:
Extinction – Unmodified (Cry it out)
Extinction – Graduated (Controlled crying)
In 1985, Richard Ferber (US) published Solve Your Child’s Sleep Problems. He advocated for graduated extinction, controlled crying, sometimes still referred to as Ferberizing. Ferber equated night waking with night feeding and suggested that discouraging feeding would stop babies from waking. Babies are put to bed as usual and when they wake, parents wait a prescribed period of minutes before they enter the room to reassure the crying baby before leaving again. This cycle is repeated with increasing periods of crying before soothing the baby. The process continues over several nights. As Richard Ferber himself acknowledges, the Ferber method doesn’t teach kids how to fall asleep on their own: children are simply denied access to their parents, and left to cope.
This approach is basically the same as Holt described a hundred years earlier.
In 1987, Marc Weissbluth (US) published Healthy Sleep Habits, Healthy Child which advocates for unmodified extinction, cry it out. The baby is put to bed awake, in their own room, and the door closed at 7pm. At 7am the parents return. During the night the baby is not attended unless in extreme circumstances, such as vomiting.
This approach is the most extreme interpretation of Holt’s 1894 advice.
On Becoming Baby Wise: Giving Your Infant the Gift of Nighttime Sleep written by Gary Ezzo and pediatrician Robert Bucknam (US) in 1993 brings Christianity into the mix. Introducing the concept of feed, play, sleep, the book directs parents to take charge of the baby’s feeding and sleeping schedule. The Ezzo approach is basically the same as that of Ferber, graduated extinction controlled crying. Babywise advocates a “parent-directed feeding” method (PDF), which calls for feeding on a schedule based on baby’s age beginning almost from birth.
In Australia, it was Dr Christopher Green reassuring parents they could stop their toddlers waking in the night - Green did not initially recommend his methods for babies under nine months. His popular book Toddler Taming (1984) gave parents a scale of techniques to try - including controlled crying, picking up and comforting the child before putting them back down again, increased periods of crying and …
“4 Sedation: the safety valve
When I first started using this controlled crying method, I insisted that parents engage in a fight to the death, never giving in until the child finally fell asleep. Most parents seemed to rally immense strength to see this through, but others dropped by the wayside, finding the cure harder to cope with than the disease. Consequently, over the past 2 years, I have inserted a ‘safety valve’ into the system. This is in the form of a sedative, which must only be given once 1 full hour of the treatment has elapsed. This ensures that the parents can give of their best, safe in the knowledge that, if the worst comes to the worst, help is at hand.
Although most parents actually buy the sedative to keep as a form of insurance, only about one-fifth of them ever need to uncork the bottle Most youngsters seem to get the message long before the prescribed hour has elapsed.
I suggest 1 hour as the average time a parent should stick it out before administering the knock-out drops, but for those parents who may be delicate, depressed and exhausted, a shorter waiting time is allowable. It is, after all, the powerful message given before the child falls asleep that is decisive, rather than the time itself. A child who has been awake and crying for this length of time in the middle of the night is particular y susceptible to sedation, and it usually takes just a sniff of the cork to send them reeling into the Land of Nod.”
A New Century … Enter The Baby Whisperers
It is hard to keep up with the growing industry of sleep training in the 21st century. A simple internet search brings up a startling number of books, websites, consultants and services.
Rarely are terms like “controlled crying” used by these new gurus offering to solve parents problems with infant sleep. Instead, parental withdrawal of supporting children as they fall asleep is described as “controlled comforting”, “responsive settling” and similiar language aimed to reassure parents.
However, all techniques like these are based on the premise that infants can learn to settle themselves to sleep. This implies behaviour, not development, is the reason babies seek contact with their mother at sleep times. The collective term used to describe parental modification of infant sleep is Behavioural Sleep Interventions (BSI) This is problematic: it reflects the theories of behaviourists like John Watson.
The most commonly utilised BSI (Blunden et al. 2011) are based on the psychological concept of extinction. Extinction methods are based on behaviour theory’s principle of operant conditioning (Bouton 2007) where an unwanted behaviour (disruptive sleep and night-time crying) is ‘extinguished’ by ignoring that undesirable behaviours and eliminating the ‘reward’ component (parental attention) to encourage self-settling. All of extinction interventions withdraw parental assistance either immediately and completely (“cry it out”), more gradually (“controlled crying”) or very gradually (“camping out”) at sleep onset and overnight (Meltzer et al. 2014). However, in as much as the interventions are successful, they are dependent on parents having to ignore their crying child.
Blunden, S., Osborne, J. & King, Y. Do responsive sleep interventions impact mental health in mother/infant dyads compared to extinction interventions? A pilot study. Arch Womens Ment Health 25, 621–631 (2022). https://doi.org/10.1007/s00737-022-01224-w
Gina Ford's (UK) 1999 book The Contented Little Baby Book advocates a daily routine for both the baby and the parents, with the day divided up into very precise slots. Although Ford was confronted by the methods of Truby King applied to babies in the 2007 documentary Bringing Up Baby, her own techniques echo those rigid recommendations. Like Truby King, babies are fed to a strict four-hourly schedule, put to bed with a minimum of eye contact and expected not to disturb the parents by waking in the night.
Tracy Hogg, Secrets of the Baby Whisperer: How To Calm, Connect, and Communicate With Your Baby, co-authored by journalist Melinda Blau, was published in 2001. Hogg’s approach to sleep is a variation of graduated extinction controlled crying, where the crying baby is put to bed and left, with the parent returning when the baby cries. The baby is picked up and soothed until calm, then put back into the bed. This is repeated until the baby settles to sleep. This is also known as the “Pick Up Put Down” technique. Hogg states in her book:
Most Sleep Problems Occur Because …
One of the following happens before bedtime
Baby is nursed
Baby is walked around
Baby is rocked or juggled
Baby is allowed o fall asleep on an adults chest
or
When Baby is asleep, parents rush in at the first little whimper. She might have fallen back to sleep on her own without their well-meant interference. But ten she becomes accustomed to her parent’ rescuing her.
Tizzie Hall Save our sleep: a parents' guide towards happy, sleeping babies from birth to two years (2006). Hall believes there are four main things that can affect a baby’s sleep: lack of routine, hunger, being cold and diet. She says that by simply addressing these four factors you can transform a poor sleeper into a good one. Hall is a proponent of the “dream feed” where parents introduce a feed at their own bedtime, taking care not to wake the baby while getting them to feed from breast or bottle. Hall’s routines at each stage of infancy are mapped out in great detail, including directions to express milk a set times, from specified breasts, collecting specific volumes of breastmilk. She suggests the dream feed is an ideal time for fathers to bottle feed formula or the milk expressed by the mother as directed in the daily routine.
Others in a similar vein include:
Dream Baby Guide : Sleep The Essential Guide to Sleep Management in Babies (2015) Sheyne Rowley The Australian Baby Whisperer :”Having loved, cared for and understood babies since her little sister was born when she was nine, Sheyne Rowley went on to study Early Childhood Development, and has a Diploma in Social Science”
Babybliss by Jo Ryan (AUS) (2009) a former nanny and paediatric nurse with a Masters degree in public health
The First Six Weeks (AUS) ad “After The First Six Weeks” “Midwife Cath” Cath Curtin (2018) In a 2015 article on her website, Curtin says:
“Do you want your baby to go back sleep? No time for sleep school? Here is the only way to successfully get your babies back to sleep…there are some strict rules so read on…
Yes it’s called control crying and everyone has a breakdown over it, thinking they are going to cause their child long term harm but believe me…a child waking up 3-7 times a night will do more harm to you parenting and the child than controlled crying. There have been no published studies to show any evidence that there is any physical or psychological harm to the child if controlled crying is practiced. More to the point, what is the effect on long-term sleep deprivation to the baby and parents?
So for a start, let’s call it something else…passive settling. That sounds better and we don’t feel like we are standing over our child “controlling him” while he is “crying his eyes out”.”
There are many, many more similar books available however they are churned out at such a rate it is near impossible to keep up! Each claims to be unique, written by a self-styled expert with a background in baby-sitting, nannying, midwifery or nursing. Some are written by authors without personal experience as parents. All benefit from the global market for sleep “solutions”. A marketing technique common to many of these consultants is to list celebrity parents who have endorsed their products.
Preparing this article has been stressful, returning to my collection of referenced books and once again re-reading the parent-centred advice given. Reflecting on the decades which saw my grandparents (born in the 1880s), parents (born around 1930), myself (early 1960s), my children (1980s/90s) and grandchildren (born in the 2010s) … alongside the growing industry of marketing the exact same extinction methods described by Dr Luther Emmett Holt in 1894.
Next up, much more enjoyable for me to research - approaches to parenting which support night waking through infancy.
