MYTH 4 OF 10
The number one concern related to sleep training that I hear from clients is this idea that sleep training will damage a child. And I don’t blame them! There is A LOT of fear mongering information out there that scares parents away from sleep training.
Here are a few concerns mentioned directly from my clients prior to our time together when asked if they had any regarding sleep training: "Long term trauma for letting her scream or cry too long." "[I] do not want to psychologically damage my child if that is even possible." "Damaging him." "Causing developmental issues." "Causing behavior issues." "Unsure how to safely go about it while giving my son what he needs."
All of these parents knew their children needed better sleep, yet, this fear can still linger until you go through the process and see the results yourself!
When making decisions regarding our children's health, we obviously want to keep their best interest at heart. And when doing so, it helps to make sure we are armored with valid information. The risks involved for a child who does not get the proper sleep necessary for growth and development outweighs the risks of sleep training when you dive into well-done peer-reviewed journal articles.
When you are reading information that might instill fear when you are aiming to guide your child to better rest (or anything parenting!), consider asking the following questions:
1 - Is the information being provided coming from a valid source? A valid source meaning it isn’t just someone’s opinion or biases.
If this is the case, ignore the information and find a source that is valid! Examples of invalid sources are blog posts without links to evidence, someone who lacks the education, someone’s opinion, etc.
If the source is valid, peer-reviewed journal/scientific article, move onto the following questions.
2 - If it is coming from a valid source, double check that the information extracted from that source was not manipulated to fit someone else’s agenda. Here, we need to consider two different scenarios.
A - Is the study being used related to the topic of discussion? In this case, does the resource used provide information on behavioral sleep interventions?
When I went through my FSI certification program, one of my assignments was to find peer-reviewed journal/scientific articles that hypothesized both sides of the cry-it-out (CIO) argument. The point was to understand what kind of information is out there and how crying in relation to sleep training does or does not affect children.
When looking for evidence related to whatever topic, it seems like it should be a no brainer that we want the evidence to be related to... the topic. Right? Unfortunately, this isn’t always how people use the information.
For example, Dr. Sears is pretty good at doing this to argue against CIO and pretty much any sleep training method as he claims they are “modern versions of CIO.” He argues that excessive crying while unattended is bad for an infant for many reasons.
While there is some truth to this, he spins this truth to instill fear in parents considering sleep training. The excessive crying that has shown to have a negative effect on children (or other animals) is not the same as the short-term crying potentially involved when helping your child get better quality sleep. Let’s take a look at some of the resources Sears uses for his argument.
Dr. Sears states that “Research has shown that infants who are routinely separated from parents in a stressful way have abnormally high levels of the stress hormone cortisol, as well as lower growth hormone levels. These imbalances inhibit the development of nerve tissue in the brain, suppress growth, and depress the immune system.” (https://www.askdrsears.com/topics/health-concerns/fussy-baby/science-excessive-crying-harmful)
Wowza! Yeah! That is a freakin’ scary paragraph! But let’s look at the resources he is using.
Resource number one is a study titled Maternal Behavior as a Regulator of Polyamine Biosynthesis in Brain and Heart of Developing Rat Pups. Resource number two is a study titled Selective Depression of Serum Growth Hormone During Maternal Deprivation in Rat Pups. Resource number three is titled Endocrine and Immune Responses to Separation and Maternal Loss in Non-Human Primates. Resource number four is titled Transition to Child Care: Associations with Infant-mother Attachment, Infant Negative Emotion, and Cortisol Elevations.
None of them discuss how short term crying that might occur when working to improve sleep affects children who have their needs being met. Nor do they have anything to do with sleep training! Yet Dr. Sears uses them to argue against it. With most of the points that Dr. Sears makes regarding crying in relation to sleep training, you will find this pattern repeated over and over again.
B - Is the information provided being manipulated in any way? Are the results being used to provide a message that does not support the study?
Here is an example I recently experienced. An image that read, “80% of 6-18 mo wake 1-3 times at night to feed,” was circulating on social media by some fellow doulas and lactation consultants. The image being shared had no link to a source.
Due to my experience of night feedings usually dropping between 6 and 9 months of age for an infant able to fall asleep and connect sleep cycles independently, I knew something was off. After doing some digging, this is what I found.
The source they were using was the peer-reviewed journal article Trajectories and Predictors of Nocturnal Awakenings and Sleep Duration in Infants from June 2014. Here is what just the abstract read:
“Results: Nocturnal awakenings were frequent among 6 month old children. Although there was an overall reduction in both sleep duration and nocturnal awakenings from 6 to 18 months, the chronicity of sleep problems was high and impacted by prior sleep behavior and sleeping arrangements. Bedsharing was an independent and graded predictor of nocturnal awakenings and short sleep duration, also after controlling for prior sleep. Breastfeeding was related to concurrent nocturnal awakening but was not negatively related to later nocturnal awakenings.
Conclusions: Considering the chronicity of nocturnal awakening and its association with bedsharing, our findings support current recommendations of reducing bed sharing to improve sleep among infants...Bedsharing, but not breastfeeding, was an independent risk factor for a short sleep duration and more frequent nocturnal awakenings from 6 to 18 months...The longer the infant is bedsharing, the higher the risk of nightly awakenings 1 year later.”
It is also important to note that the sample of this study consisted only of Norwegian mothers, a population where the rate of bed-sharing is very high.
3 - If it is coming from a valid source, is the study well done with the data used properly?
We want to look for a few parameters to determine a study well done.
A - Is the study randomized? The answer is generally yes for a well done study.
B - What is the sample size? The larger the better!
C - Is the study a controlled study? The answer is generally yes for a well done study with a few exceptions.
D - Are the conclusions being made congruent with what was actually measured? The answer is yes for a well done study.
E - Was the data used properly? Were the right tests used?
This is not always easy for someone without a statistics background to identify. Or really even with some statistics background at that! So the first five questions will help!
However, it is important to note that different statistical studies exist. And while one is more appropriate than the others based on the data, the tests can be used in a way to provide the outcome that the authors are trying to show. I personally am not someone who can decipher this without reviewing my statistics books.
Let’s, first, use one of the most popular studies used to argue against crying in relation to sleep training - Asynchrony of Mother–Infant Hypothalamic–Pituitary–Adrenal Axis Activity Following Extinction of Infant Crying Responses Induced during the Transition to Sleep by Middlemiss. The purpose of the study was to show whether or not cortisol levels changed for mothers and their infants during a five-day period of sleep training that occurred within a hospital setting.
This specific study started with 25 infant-mother dyads from the Northern Y District of New Zealand who were “referred to the program by their midwives, doctors, or other medical-based practitioners following reported difficulties either with infants' sleep routine and ability to self-settle or expressed concerns regarding infants' feeding and physical growth. Many of the mothers reported a lack of support in caring for their infants at home. No mothers in the study were receiving medical treatment for postnatal depression because antidepressants affect cortisol.”
The program consisted of a 5-day inpatient sleep training program. During wake periods, the mother and child would hang out in the lobby. During a period of sleep, nurses and mothers would both help to prep the baby. Then the nurse would take the baby into a separate room to transition for sleep while the mother stayed in the lobby. Twenty minutes after the baby fell asleep, a nurse would swab the infant’s mouth to check cortisol levels.
This study is riddled with flaws! Yet it is commonly used to argue against sleep training. First, this sample size is EXTREMELY small! Second, it was not randomized. Third, there is no control group to compare results in order to know what is even normal. Fourth, several other questions need to be answered prior to making any conclusions!
Just a few of the questions that I have. Does having the study done in a hospital contribute to a spike in cortisol levels? Does the fact that nurse is the one putting them down for bed affect cortisol levels? What are typical cortisol levels of infants to even begin with? This is where a control group would help!
This study is highly inappropriate for drawing any conclusions related to the effects that sleep training have on the individuals and their relationships with one another.
Now let’s look at another study - Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep Intervention: Randomized Trial from 2012. This study aimed “to determine long-term harms and/or benefits of an infant behavioral sleep program at age 6 years on (1) child, (2) child-parent, and (3) maternal outcomes.”
This study was randomized and included a control group for comparison. The sample size consisted of 326 children (173 intervention) with parent-reported sleep problems at age 7 months selected from a population sample of 692 infants recruited from well-child centers. Two-hundred twenty five families ended up participating fully. While the results of this study would be stronger with a larger sample size, it is still really well done compared to the one we just covered.
With the results they had, they were able to ethically conclude that “the 6-year-old findings indicate that there were no marked long-term (at least to 5 years’ post intervention) harms or benefits. We therefore conclude that parents can feel confident using, and health professionals can feel confident offering, behavioral techniques such as controlled comforting and camping out for managing infant sleep.”
While there are well done studies that prove a certain type of method is ineffective at a specific age, there are no studies to prove sleep training to be harmful for a child of which my Child Sleep Consulting community or myself are aware. Instead there are several studies that show crying in relation to sleep training has no negative or positive effect long term.
I feel like the best way to end this post is to just say...
Mic drop!
But rather than do that to ya! Ha. I've got something for you if you are struggling with your child's sleep. Because I hope that you now understand sleep training will not ruin your child. If you need some guidance on helping your child get better sleep, check out my freebie all about the five components that I take into consideration when I am creating a sleep plan. Hint? It takes a little more than just choosing a sleep training method to improve your infant's or toddler's sleep.