Sleep training is without exception the most hotly debate of all baby care practices. Some claim it’s a cruel means of controlling babies’ sleep. Others believe it helps babies and parents to sleep better. Find out what sleep training means and what’s involved.
- RN, RM, CHN, MHN, IBCLC
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The great debate
No matter where you turn, you will find conflicting opinions on the topic of ‘sleep training’.
Supporters claim sleep training methods that encourage independent settling, reduce the risk of sleep deprivation for babies and parents, and thus provide physical and emotional benefits for the whole family. Opponents of sleep training, claim infant settling methods that involve crying cause babies psychological harm.
So, the question is, does sleep training help or harm babies? With over 20 years of experience assisting parents to resolve baby care problems, Rowena provides her perspective on sleep training.
What is sleep training?
Whether you realize it or not, you are teaching, in other words training, your baby how to sleep from the moment of her birth, by the way in which you settle her to sleep. Most babies learn to psychologically link particular conditions, activities or props with the act of falling asleep within days or weeks of birth. These are referred to as sleep associations. Repetition is all that is required for associations to be made.
Without awareness of how their actions influence their baby’s sleep, most parents accidentally and unknowingly train their babies to depend on parent-assisted sleep associations (something that involves a parent or caregiver’s direct assistance at the time of falling asleep).
The term ‘sleep training’ is used when parents knowingly make changes to their infant settling practices in a bid to improve the quality of their baby’s sleep. The most effective sleep-training methods are those that promote independent settling.
The difference between ‘accidental training’ and ‘sleep training’ boils down to awareness of how your actions will affect your baby’s sleeping patterns and behavior.
Around 60 per cent of parenting books support the use of sleep training methods that encourage independent settling. Just a few of the numerous supporters of sleep training include infant sleep specialists, such as:
- Dr Marc Weissbluth, Professor of Pediatrics at Northwestern University in Chicago, USA, and author of several books that deal with sleep disorders in young children, including Healthy Sleep Habits, Happy Child.
- Dr Richard Ferber, pediatrician and the Director of the Center for Pediatric Sleep Disorders at the Children’s Hospital in Boston, USA, and author of Solve Your Child’s Sleep Problems.
- Dr Jodi Mindell, Professor of Psychology at Saint Joseph’s University, Associate Director of the Sleep Disorders Center at The Children’s Hospital of Philadelphia, USA, and author of Sleeping Through the Night and well as numerous publications on children’s sleep disorders.
- Dr Harriet Hiscock, pediatrician, Senior Research Fellow at the Centre for Community Child Health, Royal Children’s Hospital, Melbourne, Australia, and author of numerous academic papers on infant crying and sleep problems, prevention of early childhood behavioral problems, and postnatal depression.
Why independent settling?
Sleep deprivation is the most common of all reasons for physically well babies and their parents to experience distress. (See Overtired Baby for effects of sleep deprivation.)
Without exception, the most prevalent cause of sleep deprivation relates to the baby’s learned dependence on a parent’s help to fall asleep or on props that a parent must provide in order for baby to sleep. Whether this causes sleep problems for a baby or not, depends on the parent’s awareness of their baby’s reliance on their help to fall asleep and remain asleep or to return to sleep if she wakes prematurely. And also on the parent’s ability and willingness to support their baby sleep for as often and for as long as their baby requires on a 24-hour basis. (See Sleep Associations for further explanation.)
Parents in general are unaware that their baby’s learned dependence on their help to fall asleep usually extends to dependence on the same help to remain asleep. Many parents find it physically exhausting to support their baby’s sleep on a 24-hour basis, day after day, for weeks on end. As a consequence, countless numbers of babies and parents worldwide suffer from mild to extreme sleep deprivation on a daily basis.
The solution to infant sleep problems caused by a baby’s learned dependence on parent’s help to fall asleep is to support her to learn to fall asleep independently. Independent settling minimizes the risk of broken sleep because it enables a baby to self-regulate her sleeping patterns. If baby is able to fall asleep independently, she can move from one sleep cycle to the next independently. She will, of course, wake if she has a physical need that requires attention. But she’s at reduced risk of waking prematurely from sleep simply because she’s able to sense that the help she has learned to depend on is missing during arousals that naturally occur between sleep cycles.
How independent settling is achieved
Parents generally only consider ‘sleep training’ after they have discovered that their ‘accidental training’ has created a situation that is causing their baby and themselves considerable distress due to sleep deprivation. In this situation, the parent needs to undo what they have already taught their baby to associate with sleeping and at the same time act in a way that encourages their baby to learn new sleep associations that support independent settling.
The actions a parent takes at the time their baby falls asleep will either encourage and reinforce, or discourage, their baby’s reliance on certain sleep associations. Parents must first change their infant settling practices before their baby will learn new sleep associations. If parents don’t change their infant settling practices in a way that encourages independent settling, their baby’s learned dependence on their help to sleep will continue to be reinforced.
How babies react
Could you imagine being told you need to sleep in a completely different way to that which you currently sleep? Would you be happy about it? Probably not! Change is challenging. No one likes change, not even when we know its good for us.
A baby could not possibly understand that falling asleep independently will enable her to get more sleep. She has no desire to switch from settling methods that are now familiar to her, to ones that will initially feel strange. She’s understandably going to get upset when her parents first change their infant settling practices. However, if parents persist, the new way of falling asleep will become increasingly more familiar to her. In a matter of days, any upset she experienced due to the change will lessen.
Sleep training is not a fail-safe method to improve a baby’s sleep. A baby’s sleep will only improve, and baby’s upset decrease, if the method used is effective, which not all methods are. The method also needs to be followed correctly, which not all parents do. And the method needs to be continued long enough for baby to learn new sleep associations, which is not always the case.
You will read or hear of numerous horror stories of parents’ failed attempts at sleep training, and cases in which sleep-training attempts actually made the situation worse. The most common reasons for failed attempts at sleep training are because parents…
- give up too soon before their baby has a chance to learn new sleep associations;
- use ineffective sleep-training methods;
- deviate from the method in a bid to make it ‘easier’ for baby, but in doing so unintentionally confuse and frustrate their baby;
- use sleep-training methods inconsistently, which can also confuse and frustrate a baby; and
- use sleep-training methods for an infant sleep problem unrelated to baby’s sleep associations; for example, a circadian rhythm sleep problem (related to the timing of baby’s sleep). While learning to rely on the wrong sleep associations is the most common reason for babies to experience sleeping problems, there are also other reasons.
One-third of all infant sleep books oppose using any settling methods that involve ignoring a baby’s cries or delaying responding to a baby’s cries, even for brief periods. A few of the many who oppose sleep training include:
- Dr Margot Sunderland, Director of Education at the Centre for Child Mental Health in London and author of The Science of Parenting.
- Dr William Sears, American pediatrician and author of Nighttime Parenting.
- Robin Grille, psychologist and author of Parenting for a Peaceful World.
- Elizabeth Pantley, mother and author of No Cry Sleep Solution.
- Pinky Mackay, mother and author of Sleeping Like a Baby.
Why people oppose sleep training
In general, opponents of sleep training don’t object to a baby learning to fall asleep independently, but rather their concerns relate to the way in which independent setting is achieved. Of particular concern is the effect on babies when parents temporarily withhold their response to their baby’s cries during sleep-time (which is done in order to provide opportunities for baby to learn to fall asleep independently).
The top five claims from critics are that sleep training causes:
- psychological harm;
- brain damage;
- teaches baby not to cry;
- break a baby’s trust;
- insecure emotional attachment.
Many opponents claim to have evidence that sleep training is harmful to babies but in reality what they have are opinions, theirs and other people’s opinions, that it causes harm. Rarely, do critics provide references to research to back up these claims, and when they do, references relate to studies on the effects of abusive and negligent parenting and not sleep training methods. There is no documented evidence that sleep-training methods that involve brief periods of crying cause babies emotional or psychological harm. There are only personal opinions.
What opponents promote
Opponents of sleep training typically encourage parents to settle their babies to sleep using parent-assisted settling methods, such as bed-sharing, feeding baby to sleep, cuddling, rocking or in some other way being actively involved in helping baby to fall asleep, so as to minimize baby’s crying. They recommend parents respond quickly to their baby’s cries. So, when a baby cries to be helped to sleep, parents should placate her cries by providing whatever help she has learned to expect - whether this is something that a parent may have accidently taught their baby to rely on or not.
Critics of sleep training appear to be unaware that the settling methods they recommend train babies to rely on parent-assisted sleep associations. So in effect, they are promoting a form of sleep training that encourages a baby’s learned dependence on a parent or caregiver’s help to sleep.
Like most health professionals, I am of the opinion that if something is not broken there’s no need to fix it. Whatever settling method makes a baby and parents happy is the method I support for an individual baby and family; whether this involves actively assisting baby to fall asleep or supporting baby to fall asleep independent of parents’ help.
There’s nothing wrong with accidently or deliberately training a baby to rely on a parent’s help to fall asleep, provided the parent or another caregiver is willing and able to provide the support for as long and as often as their baby requires 24/7. It would be unfair, and potentially distressing to a baby, to encourage her dependence on help to sleep but then not provide it.
Equally, there’s nothing wrong with a parent wanting their baby to sleep independently if this is what they prefer or if they find they’re not able to support their baby’s sleep on a 24-hour basis. No method will work for every baby and every family because each baby, parent and family circumstances differs.
While parent-assisted settling methods are without question the most effective way to encourage a baby to fall asleep without crying, reliance on parents’ help to sleep is associated with an increased risk of infant sleep disturbance compared to independent settling. (See Sleep Associations for further explanation.) Overtired babies often cry even when parents try to help them to fall asleep.
Many parents discover - often after their baby has received a number of medical misdiagnoses to explain his or her distress - that their baby’s learned dependence on their help to fall asleep, and the removal of their help once their baby has fallen asleep (thus the removal of baby’s familiar sleep associations), is the reason for their baby’s sleep is broken. >> Broken sleep leads to sleep deprivation. >> Sleep deprivation the cause of baby’s distress. (See Overtired Baby for more on the effects of sleep deprivation.)
Parent-assisted settling methods undoubtedly work well for many babies and their families. But they do not work for all babies or parents. How effective parent-assisted settling methods are depends on the baby’s temperament and awareness and the parent’s ability and desire to support their baby’s sleep. Babies differ in their awareness and sensitivity to change, so not all will be affected equally by the absence of parents’ help during sleep. Newborn babies are less aware of changing conditions compared to babies over the age of 4 months. Parents differ in regards to their state of health, responsibilities, commitments and supports. Many parents find it impractical to actively support their baby’s sleep for as long as their baby requires on a 24-hour basis.
Opponents of ‘sleep training’ appear to be oblivious to the distress that countless babies and their parents endure as a result of chronic sleep deprivation, and that parent-assisted sleep associations is the cause in most (but not all) cases. While sleep-training methods that promote independent settling can be upsetting for a baby and parents in the short term, chronic sleep deprivation is upsetting over the long term.
Every person is entitled to their opinions and beliefs about sleep training. However, what I object to is the misrepresentation of information from studies on the effects of abusive and negligent parenting to support claims that ‘sleep training’ methods that involve crying cause similar harm. Misleading parents by making such claims can cause parents to feel powerless to change the situation that is causing their baby’s distress. This has the potential to cause greater harm to a baby (and parents) over the long term compared than a few days of upset that baby experiences as a result of learning to fall asleep independent of parents’ help.
Supporters of ‘sleep training’, in particular health professionals who provide parenting education, need to be better informed about the range of effective sleep training methods, so that they do not provide flawed settling advice, simplistic instructions that can be easily misinterpreted, or limit parents options to ‘cry-it-out’ methods. (There are a number of settling methods that promote independent settling which are more sensitive and responsive to the distress babies experience while learning new sleep habits compared to cry-it-out.)
While every person you meet will have an opinion about the ‘best’ way to settle a baby to sleep. Ultimately, the only opinion that matter is yours.
To make an informed decision about the best option for your baby, you need to be aware of how your actions will influence your baby’s sleep. The actions you take, or don’t take, in regards to your baby’s sleep have the potential to influence her sleep for better or worse. So think about which sleep habits you would like your baby to learn, and consider what you need to do to support her to learn and maintain these habits.
Written by Rowena Bennett.
© Copyright www.babycareadvice.com 2004. All rights reserved. Permission from author must be obtained to copy or reproduce any part of this article.
Your Sleepless Baby book
In my book, ‘Your Sleepless Baby: The Rescue Guide’, I explain how babies sleep; how parents influence their baby’s sleep; and the type of support babies require from parents to sleep well.
Information is provided on a range of effective solutions to various infant sleep problems, including those related to sleep associations. There are step-by-step instructions for each problem and solution. Included are recommendations on how to make bed-sharing work, and 6 ways to encourage baby to sleep independently in a crib. There are options that range from gradual methods, which minimize baby’s upset, through to quick methods that are more upsetting for baby in the short term but which resolve any distress associated with chronic sleep deprivation much sooner.
There is also information on how to identify and manage the many medical, behavioral and developmental reasons for infant sleep problems including circadian sleep problems (the second most common cause of infant sleep problems).
Ebook and paperback copies can be downloaded or purchased from Your Baby Series website.