I am a social worker specialized in infant mental health and I ultimately chose not to sleep train my baby. I will explain why in this article. I will also explain sleep training and sleep without sleep training methods.
Was your head spinning from trying to make sense of all the different sleep training methods out there? desperate to find sleep but also dreading having to “do it”? My head was spinning too as I tried to figure out – how does sleep training information fit with what I have learned about infant mental health in my professional training? to learn more about me visit this page or scroll all the way down this article.
Full disclosure: Although I am a proponent of alternatives to sleep training, I also believe your capacity to decide what’s best for your own baby and family. I also believe that you do your best with the information, knowledge and resources that are available to you at the time of making a certain decision. Based on my professional opinion, I endorse and recommend sleep without sleep training methods. In this article, I explain the different methods as well as the risks and benefits, so you can make your own choices.
What is Sleep Training?
A quick google search will give you this definition: “The process of training young children to fall asleep on their own, typically by means of techniques in which the child is left to cry without being comforted, either for gradually increasing periods of time or until they fall asleep.”
What is Crying it out?
Also from google: “Cry it out, also known as the extinction method, is a sleep training technique that involves putting your baby to bed and allowing her to fuss or cry until she falls asleep — without help from you. That means you won’t go back into her room to comfort her until she goes to sleep on her own”
What is sleep without sleep training?
These are newer approaches that typically take into account more current evidence and knowledge of babies and their needs. It considers biologically normal infant sleep and does not assume your baby needs to be taught to sleep independently (or needs to be taught to sleep) because babies are born knowing how to sleep. These methods are focused on helping you to set up the ideal environment for your baby’s sleep while always meeting their needs and understanding that their cries mean that they need your help.
What is Wait it Out approach to sleep?
Wait it out is an approach to sleep in which parents wait for their baby to “grow out” of their sleep challenges. The main challenge of this approach is that if baby does indeed have an underlying health related issue that is disrupting their sleep – it may go undiscovered.
What is self-soothing?
Self-soothing is a term that is often misunderstood to mean self – regulation – one’s ability to calm oneself down from distress.
However, the person who coined the term, never intended it to mean self regulation at all. From google: “The term Self – Soothing was a term created by Dr. Thomas Anders in the 1970s to mean the opposite of signalling. It was certainly never meant to be used to promote the idea that a child could calm down from a state of extreme stress (and relax), eventually falling asleep peacefully”
So what self-soothing actually means – is stopping to ask for help. Contrary to popular belief, it does not mean, calming oneself down (self-regulation). Babies are incapable of self-regulation. The foundation of this ability is the baby’s experiences of their caregiver’s timely, sensitive, consistent and appropriate responses to their distress (also the basis for a secure attachment).
Babies cannot learn to self soothe by being left alone. That’s kind of like placing your 4 month old on their feet and letting go in order to teach them how to walk. “The capacity for self-soothing is born out of hundreds and hundreds of instances of being soothed by someone else” – Rachel Samson
Why do we care about attachment (secure attachment is the healthiest form of attachment)?
Secure attachment is the foundation of the ability for self-regulation and resilience. It is the template for all future relationships and how they work. It is an ingrained sense on whether the world is a safe place to be. The absence of secure attachment is linked to negative outcomes later in life including mental illness, difficulty engaging in healthy relationships, difficulty with learning and self-regulation. An inability to regulate one’s emotions interferes with the ability to focus, concentrate, pay attention, persevere through difficult tasks, manage impulsivity and other crucial skills for health and success in adulthood.
Common Sleep Training and Cry it Out methods explained
Cry it Out (Extinction)
Extinction Sleep Training created by Dr. Marc Weissbluth. Popular in the 1980’s this doctor’s methods are widely cited by sleep consultants and trainers as the ultimate guide to baby sleep. This method is likely older than you are which should be the first red flag when you talk to anyone who endorses it. Parents are asked to feed and change baby (assumes that babies have no needs other than being fed and dry which is false). Place them in their crib at 7pm, walk out of the room and not return (no matter what your baby sounds like) until 7am the next morning. Sounds cruel? It indeed is.
The Ferber Method (also known as ferberizing, gradual extinction, timed checks, controlled crying)
Named after its creator and also a hit in the 1980’s, this method instructs parents to respond to their babies in timed intervals. This method is also based on the idea that leaving your baby alone to cry will help them learn the skill of “self-soothing” with the aim for it to result in solid, uninterrupted sleep.
Dr. Ferber and Dr. Weisbluth were the original creators of the idea that you could teach, or train your baby to sleep (when you want them to, rather than when their body and biology has designed for them to sleep).
These methods flourished at a time when we didn’t know the important of skin to skin, immediate contact between mothers and babies after birth and the crucial importance for responsiveness for babies (back then infants were not considered to have “mental health” which today we know is false).
The Ferber method intended to encourage a child to fall asleep and get back to sleep independently by withdrawing parental involvement, at various intervals, or “timed checks”. Ferber advises parents to put their child to bed in their own crib or bed and not to hold or rock them. Parents are instructed to wait a certain predetermined amount of time before responding to their baby using a chart that outlines how long they should wait. The amount of time that parents should wait, becomes increasingly longer as the evening goes on. The parent’s response is based on the chart, NOT the sound of their baby’s cry (or the throw up that’s on their crib sheet. True story. Parents are instructed to simply clean it up, and continue with their plan. I am sorry for the image in your mind, but it makes me feel sick, too).
Dr. Ferber did retract some of his theory later on, stating that mothers should follow their gut. He created a second edition to his book and noted “I went to great pains in the second edition to clarify that that treatment (gradual extinction) is not appropriate for every sleep issue, of which there are many.” He also shares if your baby is 9 months, and experiencing separation anxiety, putting them in a dark room by themselves “would not be the best idea.”
The Sleep Lady’s Good Night Sleep Tight by Kim West (Sleep Lady Shuffle, Chair method)
In her book, she describes the Sleep Lady Shuffle as “a gentle behavioural modification technique” to help babies fall asleep independently, but with a parent’s supportive presence. She advises avoiding having a baby nurse to sleep and that they should be put in their crib“drowsy but awake”.
The “shuffle” method includes putting the baby in the crib “drowsy but awake” and sit in a chair beside the crib, offering touches, sometimes. Consistent touch or communication is discouraged and parents are advised against it for fear of creating a “sleep crutch” (also known as sleep association, sleep prop, bad habit). Parents are told to do this for 3 nights. On the 4th, they are to move their chair halfway to the door. At this time, they can make use their voice to soothe baby but are told to avoid touch. Throughout the process parents are threatened that if they don’t follow it precisely, they will “defeat the whole process” (this is problematic because if you are doing it, and feel you need to stop because your baby is distressed, you should stop). She does advise parents to pick baby up if they become “hysterical” but make it brief. She advises parents to ensure that baby does not fall asleep in their arms as then baby has “trained you to pick him up” (the idea that babies can manipulate you is so old and outdated believing this is like recommending your friend’ to use a 1983 version of a cell phone – google that). She goes on to say that if your baby continues to try and get parents attention, they should go ahead and use Ferber’s method instead (doesn’t sound so gentle after all).
The Baby Whisperer by Tracy Hogg (E.A.S.Y, Pick Up/Put Down)
The often quoted E.A.S.Y. routine for babies suggests that regardless of baby’s age, they should follow an Eat, Activity, Sleep, Your time sequence (the reality is that babies nurse to sleep and this is healthy and normal). She also suggests a 7:30pm bedtime for all babies (the problem is, it ignores the fact that we are talking about baby humans – one baby’s ideal bedtime will be different from another baby’s and it actually changes as they develop).
Pick Up/Put Down: when using this method parents are instructed to pick baby up when they are crying or upset and as soon as they stop crying, placing them back in the crib. The idea is that baby will eventually tire out from crying and being picked up and put down and will go to sleep (or maybe the parents will tire out? Or both? sounds exhausting to me)
Pushes a structured routine for babies including structuring feeding (if you’ve become aware of the importance of feeding on demand when breastfeeding, you may notice why this is very problematic from a breastfeeding perspective)
This book also describes a practice of “accidental parenting” which in itself should give you an idea of the validity of its claims. Lots of blame to go around if you follow the steps but your baby human isn’t doing what the book says (hint: you are not doing it wrong. Your baby is not broken. This method is not working because of biology; you are dealing with a baby human, not a robot).
The Happy Sleeper: The science-backed guide to helping your baby get a good night’s sleep – newborn to school age, by Adele Faber (The Sleep Wave)
The Sleep Wave is a more structured form of Ferber’s timed checks. Parents are instructed to put baby in the crib, drowsy but awake, pat and comfort their child, and create a “script”, such as “It’s time for sleeping. Mommy’s right outside. I love you.” Parents are told to remain consistent at every “check in”. If their baby cries, they are asked to wait 5 minutes before going to them and when they do, not to touch or pick up their child, only be seen and heard. The idea is not for the parent to soothe their baby, but for the parent to communicate that they expect the baby to go to sleep without being soothed. Again, highly problematic from an attachment perspective. Back to the method – parents are instructed to continue this every five minutes until the baby goes to sleep. The hope is that the baby will realize that the parent will decide when they need soothing. This idea is extremely problematic from an attachment perspective in which communication between parent and baby, and the baby’s expression of their needs (and the parent’s responsiveness to their needs) is critical.
This method also assumes babies need to learn to self-soothe. You already know by now why that’s a problem. If you need a refresher, scroll back up and re-read “what is self-soothing”.
Benefits and Risks of Crying It Out and Sleep Training Methods
Okay time for some more definitions before we dive in.
What are risks?
Risks are potential negative consequences. They are NOT a guarantee of a consequence. For example, a risk of pregnancy is Post Partum Depression (PPD) – will all pregnant women develop PPD? no. But all who are pregnant are at risk and certain factors will put certain women at greater risk. ⠀
What are benefits?
A positive outcome to a chosen intervention. Like risks, it is NOT a guarantee that you will get the “benefit” from following a certain set of steps. Will all parents experience the benefits? No. But some will.
4 BENEFITS of Crying It Out and Sleep Training Methods
- It “works”: here is the thing, the promise of an end to your sleep deprivation and improvement in well-being in as little as three to seven days in exchange for hearing your baby cry, is an enticing one for sure. When you add social pressure of your well rested friends all telling you how happy they are that they sleep trained combined with your pediatrician announcing that your baby is ready, and your brain having difficulty thinking clearly as a result of sleep deprivation is an effective formula for thinking this will solve all your troubles. It is true – sleep training works – what that means is – parents who sleep train report that THEY are getting more sleep after sleep training.
- It works quickly: Sleep training and crying it out proponents promise and often deliver you the results – full night sleep within 3 – 14 nights, depending on how “gentle” they claim to be and how your baby responds.
- No proof of harm (NOTE: we don’t have *proof of no* harm, either): Proponents of sleep training cite research that claims that there is no proof that sleep training is harmful. This is true, there is no research currently that demonstrates the direct relationship between sleep training and its potential negative consequences (outlined by risks below). And before taking this as sufficient reason to go ahead and sleep train – I invite you to consider that it’s just not so simple. While we don’t have proof of harm we also do not have proof that sleep training does not harm. Until we have proof that sleep training does not harm, I do not feel comfortable recommending it to parents.
- Many families report positive effects (which means harm may, or may not, have happened. Anyone who knows anything about research will agree that self-reporting is not exactly the most reliable set of information): Ending sleep deprivation is glorious. Ending it in a few days and thinking there was no risk or cost – is awesome. And again, I invite you to think about it – does it sound too good to be true? It is. While sleep training sure does get parents more sleep, it does not necessarily get baby more sleep (they sleep just as they would otherwise – the only difference is that they have been taught not to call for help at night).
4 RISKS of Crying It Out and Sleep Training Methods
These risks are based on parent’s reports and experiences of sleep training that didn’t go so well. Just as widely cited pro- sleep training research is too, based on parents reports (and that is the huge flaw in it and what makes me uneasy about using the current research as a reason to sleep train). Simply because we do not yet have reliable ways to measure things like attachment (while attachment style can be assessed, the degree of security and how it was impacted before and after sleep training cannot. Even if we could reliably measure it, it is unlikely that it would be ethically possible), baby’s trust in the parent before and after sleep training cannot be reliably evaluated, how it impacted their nervous system and their template for relationships and baby’s sense of whether the world is a safe place will only come to light later in their life.
So here are the risks:
- Sleep training may not work: it works for some babies and does not work for others. So it’s possible that you go through it, and your baby will continue waking up just as they would otherwise (depending on the method and your baby’s response to it, you may or may not be aware that they are waking).
- Parents may experience guilt, shame or regret: Do you have lots of friends who sleep trained and get really passionate about you doing it too? Others around you who become emotional and insistent when you mention that you are questioning this practice? Remember they are recommending an option that feels right for them and their baby. They are not necessarily focused on helping you make a decision for you and your baby.
- Parent and baby attachment/relationship may be injured: The most important accomplishment in the first year is a secure attachment. Secure attachment in the first year sets the foundation for baby’s sense of safety in the world, their templates for how relationships work (do people in relationships stay together and support each other through difficult times?), they are learning whether they can count on their caregivers to care for them when they are hurt, sick and are in distress. Experiences which combine distress with separation from the parent can impact a baby’s sense of the security of their relationship with their caregiver.
- Development of trauma response (for baby or parent): Very simplistically, trauma develops when one is in a situation of perceived harm to themselves or another during which they experience a sense of loss of control coupled with suffering. When parents are asked to follow a set of rigid rules (e.g. don’t touch, don’t make eye contact, stay in the room…or don’t) and experience conflict between what they feel they need to do (go and pick up baby) and what they should do (stay away) – the result is a recipe for a potential trauma response in which the parent may perceive their baby being harmed (crying and in distress) and not being in control (doing what they are told, rather than what they feel they need to do).
Sleep Without Sleep Training
The approach to sleep that I use in my practice (full disclosure as always) is a combination of my qualifications and the Baby – Led Sleep Approach.
The Baby-Led Sleep™ approach:
· Respects and nurtures the attachment relationship;
· Supports the natural progression of development;
· Gives parents an understanding of what “normal” baby sleep looks like;
· Appreciates your baby’s developmental age and stage
· Encourages parents to believe and to follow their own instincts; and
· Empowers parents to make changes to improve the quality of their baby’s sleep.
How does it work:
- We complete an assessment to understand your unique family and baby and to identify WHAT is the root cause for your baby’s disrupted sleep (unrealistic expectations of normal infant sleep? health conditions? something in their environment? a pattern that no longer works for you or your baby?).⠀⠀⠀⠀⠀
- Ruling out, and either referring you out or treating (if the issue is within my scope) underlying health conditions which may be causing your baby’s disrupted sleep. For examples of health related conditions, check this blog post.
- Helping you set realistic expectations and goals, through education about biologically normal infant sleep, sleep disruptors, and your unique baby’s and family’s needs, so that you CAN set realistic expectations for your specific baby, lifestyle and values and also get your needs met (and end sleep deprivation!)
- Supporting you to make changes at your and your baby’s pace – trying specific strategies and tailoring them based on your baby’s response and your experience. Never asking you to follow a generic schedule or plan. Never asking you to leave your baby to cry alone or not pick them up. Always encouraging you to follow your intuition. Keeping the things you love and changing the things you don’t – by swapping them with something that meets your baby’s needs but is also comfortable for you.
- Giving you the knowledge and skills to manage future sleep struggles independently or with just a little maintenance
A Final Note
Just as the methods vary widely so do the definitions of when someone says “sleep training”. What I mean when I say sleep training/crying it out is I am referring to any method to get your baby to sleep that:
- Ignores biologically normal infant sleep
- Assumes that babies only need to be fed and dry (your baby’s ability to thrive DEPENDS on you providing them with responsive care, comfort and connection).
- Assumes that babies need to learn to sleep and can learn to self-soothe
- Asks you to ignore your intuition and how you as the parent feel you need to support your baby
- Encourages limiting comfort, connection or breastfeeding
- Applies adult sleep expectations to infant sleep (they are simply different)
- Any method that make you feel afraid, guilty or shamed if you don’t follow the “instructions” all the way through
Sleep training and Crying it Out methods are not your only options to get through the postpartum period and sleep deprivation. You can meet your needs and your baby’s at the same time. Your mental health matters and your baby’s mental health matters too.
Want sleep without sleep training support?
Information about the different methods in this article is based on summary of the books shared in my Baby-Led Sleep and Well-being Certification. More about Baby-Led Sleep here