Things to Consider Before Sleep Training
Sleep training encompasses various methods aimed at helping infants and young children learn to self-settle during sleep disturbances. The ultimate goal of sleep training is to promote longer stretches of uninterrupted sleep for both children and parents. These methods typically fall into two main categories: those that discourage undesirable behavior through parental non-intervention (such as extinction techniques) and those that encourage positive sleep behaviors (like establishing bedtime routines).
Specific variations of extinction methods include unmodified extinction (commonly known as "cry it out"), graduated extinction (also called controlled crying), and extinction with parental presence (involving a parent staying in the room). Other techniques like positive routines, scheduled awakenings, and parent education also play a role in sleep training practices. By helping children develop the ability to resettle during night waking, sleep training seeks to create healthier sleep habits for the entire family.
Before embarking upon Extinction methods of sleep training, it is important to understand the potential long-term impacts. While there is no doubt these methods show remarkable and often immediate results in altering reliance on parental support during the night, research is now beginning to show this might not be as positive a result for infants as it is for adults.
Extinction methods, like the Ferber Method popularized by Richard Ferber, involve training babies to sleep independently. However, it is widely recognized that this approach is not suitable for infants under 6 months of age due to their immature sleep-wake patterns and need for nighttime feeding. Even Ferber himself acknowledges that his method does not actually teach children how to fall asleep on their own, as it primarily involves denying access to parents and leaving children to self-soothe.
Babies are designed to sleep close to their mothers, as research from Professor James J. McKenna's Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame and Professor Helen Ball's Parent-Infant Sleep Lab at Durham University has shown. The separation between mother and baby during sleep can have negative impacts, disrupting the natural bond and leading to elevated stress levels in infants. Studies have found that infants in hospital-based extinction programs displayed high levels of the stress hormone cortisol, even after adapting to sleeping alone. This response, known as extinguishment, is a survival mechanism where the baby goes quiet after prolonged crying in the absence of parental response. This behavior is a signal of feeling abandoned and can contribute to ongoing stress. More research is needed to understand the long-term effects of this separation on babies.
Separation Anxiety
In babies older than six months, separation anxiety can arise as they become more mobile and fear being away from their mother. This fear, rooted in anthropological reasons, serves as a protective mechanism to prevent a wandering baby from getting lost. Stranger anxiety, which typically appears around 9-10 months, further ensures that the baby stays within the caregiver's sight. Separation anxiety peaks around 14 months and may persist until two years or beyond. To avoid exacerbating the issue, refrain from using Extinction Methods with a child experiencing distress when separated from their primary caregiver.
Breastfeeding
Breastfed babies rely on unscheduled feeds to stimulate milk production to meet their needs. Night feeds and maintaining cue-based feeding are crucial for sustaining milk supply, especially if aiming to breastfeed beyond 12 months. Interfering with this natural process can reduce milk production and disrupt the feedback loop between the baby and the breast.
SIDS
Dr. James McKenna recommends that babies sleep near their mother, as research suggests an increased risk of SIDS when babies sleep in a separate room from their parents during the first 6-12 months of life. This is especially crucial for formula-fed babies, who already face higher risk. While SIDS most often occurs in the 2-4 month age range, following safe sleep guidelines is advisable until at least one year old.
The clash arises between safe sleep practices and sleep training methods that advocate for babies sleeping alone. Since the impact of sleep training on a baby's brain activity remains unknown, it is unclear whether babies who cease crying for their parents are experiencing normal sleep or an altered state. Furthermore, there is a lack of data on SIDS occurrences in sleep-trained babies versus those whose families promptly respond to their cries.
Your baby's emotional development is just as crucial as their physical and neurological growth. Emotional development in babies, also known as Attachment, revolves around the strong bond between a baby and their primary caregiver. Promoting secure attachment involves responding to your baby's cues indicating the need to connect, such as smiling, reaching out, vocalizing, and crying. Crying is typically a baby's last resort to communicate when other methods have failed.
The Australian Association for Infant Mental Health Inc. (AAIMHI) is worried that practices such as controlled crying may not align with the emotional and psychological requirements of infants and toddlers for ideal health, potentially resulting in unintended adverse effects.
The AAIMHI Position Paper 1 (updated): Controlled crying clearly states: “Any methods used to assist parents to get a good night’s sleep should not compromise the infant’s developmental and emotional needs. Controlled crying is not appropriate for use before the baby has a real understanding of the meaning of the parent’s words; the infant or toddler needs to know that the parent will return and needs to feel safe when the parent is absent….
The controlled crying method has not been rigorously assessed in terms of the impact on the infant’s emotional development. Other strategies, apart from controlled crying, should always be discussed with parents as preferable options.”
A recent study in the US found that up to 40% of children lack a secure attachment. Research is needed to determine the potential impact of Extinction Methods of sleep training on this issue. Despite parents resorting to these methods out of concern for their mental health, the consequences for the child must be carefully considered and prioritized.
Further reading: How Your Doctor Might View Night Waking
