*Co-respondent is Angela Braden

Hi Dr. Narvaez,

I need help! I have a lovely 11 month old baby girl and my husband and I both work full-time. I have been trying to do some research on sleep training methods and came across some articles and blog posts that you have written. It seems that your opinion is that cry-it-out (CIO) methods are not appropriate and can be harmful to children. Instinctively I agree, although I have resorted to sleep coaching recently because I was terribly exhausted and desperate.

We used a modified approach where we stayed in the room with her but let her cry to go to sleep and during night wakings. However, recently she got sick and all of the work that we had done to get her to sleep better is now down the drain. I don’t think I can handle sleep coaching again based on my research this second time around. I am afraid that we have already done irreparable damage to our sweet baby.

GENERAL RESPONSE: Babies evolved to need the constant presence of a responsive caregiver to keep brain development on track. Evolution has done the experimenting over millions of years and a set of caregiving practices emerged that optimize development. Babies expect this evolved care.

One of the characteristics is constant physical presence of a caregiver, a baseline that when violated the baby will protest and stress will be caused. Physiologically, responsive presence helps the child build properly functioning physiology (e.g., breathing, heartrate, endocrine system development) and learn to self-regulate little by little. The brain develops rapidly during the first 5 years of life so any extensive distress is harmful and undermines growth. Cortisol is toxic at high levels, which can occur with high stress, dissolving synapses and redirecting energy toward self-preservation instead of growth. The stress response system is one of many systems that is setting its parameters and thresholds in early life. When a child is made deeply distressed regularly, it will set this and other systems to be highly sensitive, leading to a disposition to be easily distressed (or emotionally detached).

1.      Based on your research, is the positive touch provided by bedsharing needed in order for children to grow into emotionally and morally healthy adults? Or, is positive touch during the waking hours enough? Does it make a difference if both parents work full-time? Does bedsharing have a different impact then?

RESPONSE: We can’t do experiments on human babies to know the specific influences of touch exclusively at night or during the day. Animal studies show epigenetic effects during critical windows—if affectionate touch is not regularly provided to a rat in the first 10 days of life (6 months for humans) some genes are never expressed properly, leading to lifelong problems (anxiety with new things). There are multiple epigenetic things occurring in the first 5 years.

Not being in physical contact with a young child who desires it is an experiment. One does not know what growth should be occurring during the separation that instead stops or slows down without the caregiver’s touch. In a recent study of ours we looked at touch over the first year of life as reported by mothers every 3 months or so. At 12 months, children with more positive touch and less negative touch over the first year had fewer developmental delays and more self control.

Your baby knows you and your husband through multiple senses, so if you are absent, she will know it in subconscious ways.

ANGELA: I would add that it’s the total amount of touch and the type of touch that makes the impact. Attachment is also relevant to both of these factors. In other words, if the same loving caregiver holds your baby a lot during the time you and your husband are at work and offers consistent, compassionate responses to distress, your baby is a lot better off than if her care-giving staff is rotating strangers who don’t have a nurturing style. Your baby knows how much touch she needs (age and past experience play into this) and she has an amazing signaling ability built in from birth to let you know this. At 11 months, babies who have been responded to consistently and been given the touch they signal for typically can transition from co-sleeping provided they are getting enough affection during the day. Still, most wake at least once or twice during the night for a dose of nurturing and nourishing touch and breastmilk for hydration and brain growth. Again, the best way to know is to tune in to your baby. She will let you know what she needs.

2.      My only real interest in sleep coaching is due to my utter and complete exhaustion stemming from lack of sleep. We were bedsharing until she woke up one night and crawled over our pillow barriers and fell off the bed. What are exhausted parents supposed to do if CIO (cry-it-out) is harmful and bedsharing is dangerous? She wakes up 3 or 4 times most nights.

RESPONSE: Hmm, it seems like you could fix your sleeping arrangement—get cushions by the bedside for her to fall on if she does fall off the bed, or put your mattress on the floor.

We all wake up through the night, but often don’t realize it. She is looking for reassurance/comfort but also for breastmilk which is intended to be ingested frequently to help the body (e.g., immune system) and brain (e.g., neurotransmitters) develop well.

ANGELA: If co-sleeping was working for your family and the only reason you stopped was the falling incident, then absolutely it’s worth making the accommodations to provide a safe sleep surface, on which Dr. McKenna has great information. Then you may feel more assured that your baby is getting the nurturing she needs during the night and the bonding with you, since you are separated much of the day. However, if you don’t sleep well or your baby sleeps better on a separate surface, as many do entering toddlerhood, there are gentle ways to make this transition without resorting to CIO. This is carefully orchestrated and nuanced with detailed steps, which I’d be happy to provide you. (Angela offers private coaching at http://sciencemommy.weebly.com/coaching.html)

3.      Has any of your research indicated immediate behavioral issues following using CIO methods?

RESPONSE: Children will be less trusting and more desperate to keep you around if you force them into separation. They learn to be deceptive or extreme to keep you around. It messes with their psyches, which should be kept calm to develop in our normal (evolved) human way (to be calm and happy as adults).

ANGELA: What I’ve noticed with my clients who have CIOed is that it takes longer to actually transition the baby toward the sleep goal naturally, because we have to first rebuilt the security. So when we are gently nudging the baby and respecting the baby’s comfort during transitions, that comfort level is far lower than usual and less is possible. In other words, it backfires in terms of more independent sleep and less night waking. The only reason CIO “works” when it works is that the baby learns not to signal. They don’t learn not to need. I explain this here: So, in addition to the cortisol concerns and how that affects the nervous system, it seems clear that security in general is affected, but you can repair that.

 4.      Other than slower response times, does sleeping in a separate room from the parents have any significant impact on development? Her crib is currently upstairs while the masterbedroom is downstairs.

RESPONSE: Being alone at night is torture for a baby. Not being heard or attended to is a horror. Some speculate that the desperation that babies experience when left to cry, even vomit, and go into an almost catatonic state to preserve life can haunt them latter in adolescence when they experience a similar sense of abandonment and no way out. Just because they stop crying doesn’t mean they are not in distress. Wendy Middlemiss has done some research on this in lab settings. Thought parents’ cortisol returns to normal once baby stops crying baby’s cortisol is still high indicating that they respond to sleep training as a stressor.

5.      If you have used a CIO method (as we have) and then reverse course, is the damage already done or can reverting back to quick responses to crying stave off some of the potential negative affects?

RESPONSE: It’s popular to say that brains are plastic and not to worry because you can re-grow/ re-vamp things. But this does not take into account developmental windows. There are some sensitive or critical windows, as noted earlier, for the development of certain capacities. Most we don’t know about. So I would worry about some gap in her brain development that was missed during those desperate hours, which may not show up for years. However, we always hope that being sensitive and caring after trauma can make up for it.

ANGELA: The nervous system effects seem the most troublesome in terms of critical periods and I think the Drs. would agree that the fact that your baby’s CIO happened after six months can bring us some comfort, rather than at 2 or 3 months as many sleep trainers recommend, in terms of stress set points and brain development. (More of the brain and nervous system is formed at six months. In a personal interview with Allan Schore, he agreed with this in terms of gently nudging the baby, but of course, would not recommend CIO).

We have to tell you the truth about CIO, but hope that you will forgive yourself. You were misled and you did what you thought was best. You don’t have energy to waste on guilt, rather focus your energy on loving and nurturing your baby according to her signals and in the ways your inner voice tells you is best. It absolutely will make a difference in the person she becomes that you’ve changed course now. The same influences that tell you to CIO take many other forms throughout childhood. Now that you recognize them, you can resist them at every turn. They fooled you once, but now you are creating a different existence for your child. Continue to listen to your child and trust your instincts and you will both thrive.

6.      Are there any particular research articles or studies that you would/could recommend for further reading?

 RESPONSE: Most published research on sleep training is unethical and misleading. My colleagues and I have written about this and other aspects of sleeping in young childhood and you can find all the links at the bottom of this post.

I would look up James McKenna’s work on co-sleeping.

Check out Angela Braden's helpful guidance: www.facebook.com/sciencemommy

Check out trade books by

Stanley Greenspan, MD (e.g., The irreducible needs of children; with TB Brazelton)

Sue Gerhardt

Penelope Leach

Attached at the Heart by Nicholson & Parker

If you want to read about the moral implications, you can look up my new book, Neurobiology and the Development of Human Morality.

7. Are there any studies that indicate that the length of breastfeeding affects social and moral development?

That is the type of research we are doing in my lab. This is what we found in one study with Chinese families where mothers completed surveys about their parenting practices and their 3-5 year old children's behavior:

"Breastfeeding choice, length, and attitudes. We hypothesized that breastfeeding variables would relate to all three of our predicted child outcomes, with stronger relations to behavior regulation and empathy than to conscience development. These expectations were partially supported with small effects. Breastfeeding choice did not significantly influence any child outcomes, but breastfeeding length was positively related to children’s inhibitory control, as well as to both conscience variables (guilt and concern).  In addition, maternal attitudes towards breastfeeding were positively related to children’s empathy and concern.” (Narvaez, Wang et al., 2013)

This is what we found in another sample, as presented in another manuscript:

“Elsewhere, using an existing dataset, we demonstrated that longitudinal effects of touch and breastfeeding were established early (by 18 or 24 months) and maintained through the last tested timepoints of 30 and 36 months, even after controlling for maternal responsivity; for example, breastfeeding initiation (attempting to breastfeed at all) predicted less externalizing behaviors at 24 months and greater social competence beginning at 24 months; positive touch at 4 months predicted behavior regulation and social competence at 18 months and cognitive development at 36 months (Narvaez, Brooks, Gleason, Wang, Cheng, Lefever, & Centers for the Prevention of Child Neglect, 2012).”

Final words

As our dear colleague and sleep training researcher, Wendy Middlemiss, reminds us, what is important to remember is that parents love their children and want to positively contribute to their development. A parent’s presence and responsiveness will have positive influence even when a baby’s habits are changing. Responsive parents help their babies learn to trust and regulate their emotions. Parents should listen to their own senses of what is right, be responsive and avoid long periods of distress.  Working from these central principles will help parents figure out what the right thing to do is in a particular situation.

Move forward from this day, being responsive and affectionate, and don’t fret over what has happened in the past. Know that being with her soothes and strengthens her to be more autonomous and happy in the future. (Middlemiss, private communication)

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