Baby Sleep Training: Mistakes “Experts” and Parents Make

A world of “experts” and journalists tell parents about the safety of “controlled crying” or “cry it out” techniques to make babies sleep. The advice has multiple mistaken premises and conclusions about what is normal and good for babies.

Here are several foundational mistaken premises:

Mistaken Premise 1: The notion that sleeping through the night at 6 months is normal and developmentally/physiologically appropriate, therefore not sleeping through the night at age 6 months is a disorder.

Mistaken Premise 2: The notion that there is such a thing as self-soothing, and the accompanying idea that when babies do not sleep through the night at age six months it is because parents have interfered with their ability to self-soothe

Mistaken Premise 3: That sleeping through the night should accompany breastfeeding which contradicts the social and biological realities of breastfeeding and the fact that breastfeeding beyond 6 months is a widely agreed-upon public health goal,

There is an incredible disconnect between mainstream medical notions of normal infant sleep and sleep advice for parents.

What is normal? Study after study shows that breastfed babies wake up more often than bottle-fed babies (ergo, night waking is arguably normal in breastfed babies).

Some breastfeeding advocates don't seem to like to talk about frequent waking perhaps because they are afraid mothers will be discouraged from breastfeeding.

Sleep experts typically don't like to talk about breastfeeding at length because they can't be seen to be anti-breastfeeding. But their focus/obsession is that babies simply have to sleep through the night, even though this is unnatural.

What is the core message parents need to hear? Breastfeeding is natural, normal, and necessary for optimal development (more here). It is the kind of feeding that babies and mothers were designed to experience. Night waking to varying degrees is normal in breastfed babies. So if a breastfed baby is waking, parents may not like it, but should understand that it doesn't mean that anything is wrong. Parents can choose to live with it rather than trying to fix it.

How to cope with night-waking?

• Make breastfeeding at night easier and less intrusive for the baby. This means co-sleeping (same room) and/or bedsharing (including sleeping units added to the parental mattress).
• Understand the true (and limited) risks of co-sleeping.
• Learn gentle strategies for calming babies generally.
• Learn gentle strategies for gradually moving older babies and toddlers in the direction of less parental intervention at night and perhaps fewer wakings.
• The overall goal should be nights that parents can live with, not eliminating night waking at all costs. In our experience, both personal, from talking to parents and from doing research is that many parents do not find one relatively short wakening per night to be hard to cope with.

Controlled crying should never be presented as the default, best, or only option. But it is difficult to say that it should never, ever be an option that might be right for certain parents (based on consideration of a number of factors).

If parents want to try a controlled crying method, they should understand the risks. These include:

• It will be hard for them.
• It will be stressful for their baby, regardless of whether the baby continues to cry or stops crying.
• It may not work or it may work only temporarily.
• Parents should also get guidelines on when to give up when controlled crying isn't working and outside limits in terms of how long to let babies cry.

We will discuss more details of these points in other posts in this series on baby sleep training.

Co-authors: John Hoffman, Wendy Middlemiss, Sarah Ockwell-Smith, Kathleen Kendall-Tackett, Helen Stevens.

Note on basic assumptions: When I write about parenting, I assume the importance of the evolved developmental niche (EDN) for raising human infants (which initially arose over 30 million years ago with the emergence of the social mammals and has been slightly altered among human groups based on anthropological research). The EDN is the baseline I use for determining what fosters optimal human health, wellbeing and compassionate morality. The niche includes at least the following: breastfeeding on demand for several years, nearly constant touch, responsiveness to needs so the young child does not get distressed, playful companionship, multiple adult caregivers, positive social support, and natural childbirth.

All these characteristics are linked to health in mammalian and human studies. Thus, shifts away from the EDN baseline are risky. My comments and posts stem from these basic assumptions.