Wellness Parenting
Cry It Out Westersoe/iStock.com

Cry It Out, also known as “controlled crying,” is an “extinction method” of ending – “extinguishing” -- the cuing for attention, help, nourishment, hydration, support, and loving, physical comfort that is programmed into the biology of young mammals.

January 26, 2015

Screaming to sleep, Part One: The moral imperative to end 'cry it out'

Part one of a two part series on CIO

“A Little Throw Up Never Hurt Anyone”

While in Philadelphia for business, Gabriel pulls up to his cousin Janet’s home to visit.

“You made it!” Janet notes with joy. She embraces him with one arm. Her 5-month-old son Tyler is in the other.

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Two hours pass. Gabriel, Janet, and her husband, Keith, share stories and dinner. At various points throughout the conversation, Gabriel plays peek-a-boo with a drooling 5-month-old. 

“OK, it’s 7:30,” Janet abruptly notes. “Tyler’s bedtime.” She lifts her son up from his multicolored bouncy seat, wherein he has spent much of the evening. She walks him down the hall to his football themed nursery. 

Gabriel and Keith each pick up a fresh beer and retire to the family room. Keith clicks on the television. Within five minutes, Janet joins them. 

“Well, that was easy,” she says with a smile. Janet sits on the couch next to Keith, reaches for the remote, and turns up the television.

Suddenly, Tyler is screaming. Screaming. Tyler’s screams could pierce through the din of any commercial. They could break glass. Gabriel sits up with a start, his heart racing. 

“No need to panic,” Keith mutters while kicking his feet up on an ottoman. “Welcome to the land of ‘sleep training.’ The doctor told us that it could take awhile, but Tyler’s got to learn. He always falls to sleep eventually.” 

Gabriel looks at Keith in disbelief. “What does he have to learn exactly?” Tyler’s screams punctuate each word.

“He’s got to learn that we don’t come to him every time he cries. Janet totally indulged him those first few months.” Keith continues, “But we are in charge. We are the parents. He’s got to learn his place.” 

“It’s called self-soothing,” Janet adds. “Look, it’s not as if I like it. I particularly hate it when he throws up. But our pediatrician assures us that it’s a normal and necessary part of parenting.”

“He throws up?” Gabriel asks with concern.

“We’ve invested in some high-tech ear plugs,” Keith laughs. “Plus, a little throw-up never hurt anyone.” 

“OK, but you never clean up after him…” Janet not so playfully jabs her husband in the side with her elbow.

As Gabriel listens to the new parents justify their inaction to nature’s most basic impulse, nothing about the situation seems remotely normal. “You mean, you purposefully let him cry knowing he’ll throw up from the stress?” Gabriel looks at his cousin. She turns away. Her cheeks flush.

“Just watch the show, would you?” Keith speaks sharply and turns the television up again.

Fifteen minutes pass.

Tyler continues to wail, but now his sounds are full of despair. He has giving up on any chance that his parents will respond. His cries sound hopeless, exhausted, and pitiful.

Gabriel can’t focus. “I got to go,” he says standing suddenly. “I’m tired. I’ve got an early meeting tomorrow.” 

“See you later,” Keith states matter-of-factly without taking his eyes off the screen.

Tyler’s little body, covered in sweat and tears, soon exhausts itself from relentlessly crying out in panic, anger, and despair. Due to the mechanism of self-preservation, his body shuts down his conscious self and falls into a forced sleep. 

Janet walks her cousin to the door. “Is everything alright,” she inquires quietly.

“Look, Tyler is not my son and I’ve never put a baby down to sleep, but I can’t listen to him cry for another minute. I’m sorry.” Gabriel turns to her. “I’ll call you tomorrow.”

As Gabriel drives away, Tyler’s little body, covered in sweat and tears, soon exhausts itself from relentlessly crying out in panic, anger, and despair. Due to the mechanism of self-preservation, his body shuts down his conscious self and falls into a forced sleep.  

What is Cry-It-Out (CIO)?

“If your baby is sick, then this is about as tough as controlled crying gets and you will have to be strong-minded not to scoop him into your arms to comfort him. But do try to resist as you’ll only prolong the process and his misery. Try to be efficient and calm as you change the sheet… Don’t speak to your baby, and be as quick as you can so that you don’t get his hopes up allowing him to think that he’s going to be cuddled and fed.” 

-- Dr. Caroline Fertleman and Simone Cave, “Your Baby Week by Week: The ultimate guide to caring for you new baby” 

We, as a culture, do very little to support new parents. Gross misconceptions about what constitutes normal sleep patterns in infancy and early childhood abound, even in professional circles.

We, as a culture, do very little to support new parents. Gross misconceptions about what constitutes normal sleep patterns in infancy and early childhood abound, even in professional circles. We have no federal maternity (let alone paternity) leave and our entire adult population is overworked and sleep deprived. Is it any wonder that the “sleep training” of babies/toddlers has become such a popular phenomenon? Akin to debates about circumcision, corporal punishment, and vaccination, the question of whether or not it is right to let a child Cry-It-Out (CIO) deeply divides American parents.

CIO, also known as “controlled crying,” is an “extinction method” of ending – “extinguishing” -- the cuing for attention, help, nourishment, hydration, support, and loving, physical comfort that is programmed into the biology of young mammals. While popularized by Dr. Richard Ferber in his 1985 book, “Solve Your Child’s Sleep Problem,” advocates of CIO date back to pre-Ferber days. In his 1946 classic entitled “Baby and Child Care,” Dr. Benjamin Spock advised parents to "say good night affectionately but firmly, walk out of the room, and don't go back."

This “don’t go back” approach perfectly describes CIO in its “unmodified” or “total extinction” form. Some pediatricians who subscribe to this method of CIO advise parents to shut the door to their baby or toddler’s room and not open it again for a full twelve-hour period. The only caveat to this involves assuming nighttime parenting duties if the child is physically ill. Yet, throwing up due to the stress of nocturnal abandonment doesn’t constitute a sign of physical illness and parents are advised by proponents of “total extinction” CIO to clean up the vomit promptly without touching the child or displaying emotion. 

In its “modified extinction” form, CIO advocates argue that parents should leave a baby or toddler alone to cry to sleep. But this stressful experience is best practiced when punctuated with intermittent, and increasingly less frequent, check-ins from the caregiver. The intention of such visits is to persuade the little one verbally, or with minimal physical touch, that their nighttime expression of distress, thirst, and/or panic will not lead to the comfort being sought. 

In both methods of CIO described above, babies and/or toddlers are repeatedly left alone to fall into cycles of sleep. Over time, they learn not to signal to their caregivers as the bonds of attachment fray. Proponents of CIO mistakenly refer to the resulting detached state as one in which the child has learned to “self-soothe.” This is patently false.

Recent research conducted at the University of North Texas clearly reveals that the cortisol levels of babies left alone to CIO remain at unnaturally high levels even days after they learn to stop crying/cuing for help. However, the cortisol levels of mothers -- which register as abnormally high when their babies cry -- return to normal levels in the silence. At this point, mothers and babies are no longer biologically in sync. The mothers assume all is well; they interpret their babies’ silence as proof that their little ones have learned to self-soothe. Yet, physiologically babies can’t self-soothe. Rather, CIO teaches them to panic silently and detach from those whom nature intends for them to trust. 

Sarah Ockwell-Smith, a psychotherapist, doula, and UK-based author of the soon-to-be published book, “The Gentle Sleep Book: A Guide for Calm Babies, Toddlers and Pre-Schoolers” argues that the erroneous pursuit of a baby that self-soothes profoundly misleads parents. She writes: “You are categorically not leaving your baby to ‘soothe,’ you are leaving him to cry, even if it is only for periods of two minutes at a time… Is it possible to train a baby or a toddler to not call out for their parents when they are in need? Yes, it is, but this is categorically not indicative of an infant who is happy, calm and soothed.”

“Three Schools of Thought”

A human infant is born with a brain that is only 25% developed. Babies’ brains grow rapidly in the first two years of life -- up to 70% of their adult size. Hundreds of trillions of neural connections are established and billions of nerve cells develop. It’s a majestic biological orchestration requiring a great deal of REM sleep. Babies spend most of their nighttime hours in REM sleep (much more than adults) and this contributes to their frequent night waking and notorious patterns of light sleep. While frustrating for parents, these patterns are actually healthy for babies. During REM sleep, key proteins central to the construction of nerve cells are manufactured and blood flow in the brain doubles. Consider that premature babies spend 90% of their sleep time in REM. 

Given our sleep-deprived, over-worked culture that embraces a hyper-independent vision of success, the question of how best to respond to the normal sleeping patterns of babies and toddlers is a loaded one. In her popular “Aha Parenting” blog, New York-based child psychologist Dr. Laura Markham, author of “Peaceful Parent, Happy Kids: How to Stop Yelling and Start Connecting,” explains there are “basically three schools of thought” with regard to the matter.  

The first approach consists of “the family bed.” Here, the primary caregiver (usually a breastfeeding mother) chooses to sleep nearby her baby or toddler -- either in the same bed or in the same room. Mother and child sleep close enough to each other so that nighttime cues and signals can be responded to quickly and comfortably. Not needing to walk down a hallway after checking a bleary-looking monitor at 3am, a co-sleeping mother simply brings a night waking baby or toddler to her breast wherein they both can fall back to sleep with ease. Advocates of this approach, argue that co-sleeping, when practiced safely, is the most natural and instinctive way all breastfeeding mammals sleep.  After all, consider that we are the only social mammal which can be persuaded to purposefully separate our young from their mothers during nighttime hours.

In the second approach, one finds proponents of gentle sleep training techniques such as those advocated by Markham herself as well as by Elizabeth Pantley in her popular book “The No Cry Sleep Solution.” In this school of thought, young children are not left to cry alone. However, they are taught, when developmentally appropriate, to learn to sleep, or fall back to sleep, without the constant reassurance that they naturally crave. This may involve crying. Should parents walk away when crying occurs? “Never, in my view, if you want an emotionally healthy child,” answers Markham. She continues: “Crying is fine, as long as you’re there.” It’s important to note that these gentle techniques are not taught to babies. After all, it is natural and appropriate for babies to breastfeed to sleep. “Nursing to sleep is no more a ‘bad habit’ than peeing in a diaper,” Markham writes. As children grow, they leave behind diapers as well as breastfeeding in an organic and supported way.

Eighty-five percent of the neural pathways relating to how we respond and interpret the world are formed in the earliest years of our development. Sensitive caregiving, particularly in the first three years, correlates with professional and social success/happiness in later life. 

Finally, standing in stark contrast to co-sleeping and gentle sleep training advocates, one finds proponents of CIO. Like Keith and Janet in the opening story, parents practicing CIO choose to let their children cry alone into an exhausted sleep, over and over, until the little ones learn that protesting their situation is futile. Advocates of CIO may argue that Keith and Janet’s story is too extreme. “I’d never let my son cry until he vomits,” they may say. Or, they may openly admit that such a sign of distress is par for the course. Consider this recent post on a parenting FB group:

I just saw a post on another web site from a mom doing controlled crying. The poor bub has vomited from distress and is sweating to the point he needs his clothes changed - out of distress also. The other moms are commenting - be strong, stand your ground and my LO [little one] vomited too, and it gets easier... So heart breaking. 

How parents and caregivers choose between these three schools of thought matters. While we may not consciously remember how we were treated in our earliest years, the first three years of human life are vital to the development of our implicit memory serving as the foundation for how we feel about relationships, trust, and love. In fact, eighty-five percent of the neural pathways relating to how we respond and interpret the world are formed in the earliest years of our development. Sensitive caregiving, particularly in the first three years, correlates with professional and social success/happiness in later life. Yes, how babies and toddlers are treated matters -- a great deal. 

It may be popular to assert that the three schools of thought described above are equally viable options for consideration and practice. In the July 2014 issue of Parents magazine, readers were told “whatever sleep training method feels most comfortable for you is just fine.” Yet, parents bear the responsibility of being certain that the practices they employ do not harm their children. A growing catalogue of peer-reviewed studies clearly assert that CIO harms normal brain development and damages a child’s capacity to develop secure attachment bonds -- essential to the cultivation of empathy, pro-social behavior, and future, healthy long-term relationships. CIO is anything but “just fine.”

Click here for Part Two of "Screaming to Sleep."

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