Tuesday
Aug172010
Emotional Availability and Infant Sleep
Tuesday, August 17, 2010 
Over the past few days, several people notified me about a Globe and Mail article called Coddle or let the kid cry? New research awakens the sleep-training debate with a header that read: "While many moms and dads reluctantly allow their infant to ‘cry it out,’ some experts now say the practice can cause real damage."As someone who believes, based on my instincts and research on excessive crying in general, that the cry it out method can be damaging, but that has also been told over and over again by commenters that none of the research about the damage of excessive crying can definitively point the finger at the cry it out method, I was intrigued.
Then I was disappointed.
I was disappointed because the study, Maternal Emotional Availability at Bedtime Predicts Infant Sleep Quality by Douglas M. Teti et al and published in the Journal of Family Psychology, doesn't actually demonstrate that the cry it out method can cause real damage. Unless you define "real damage" as "poorer sleep quality". Personally, when I read "real damage" I was thinking more along the lines of long-term psychological damage or significant damage to parent-child attachment. Instead, what the study concluded was that:
...parents’ emotional availability at bedtimes may be as important, if not more important, than bedtime practices in predicting infant sleep quality. Results support the theoretical premise that parents’ emotional availability to children in sleep contexts promotes feelings of safety and security and, as a result, better-regulated child sleep.
If that is true, then it certainly makes a good case for trying to be patient, calm, and responsive when dealing with sleep difficulties. It also seems to go against the stereotypes of the sleep deprived parent that responds consistently to their infant's cries versus the well rested sleep trainers. But perhaps those two groups are just the most vocal and not really representative of the sleep experiences of the average family.
Let's explore...
Methodology used
The study involved 45 families with infants 24 months and under (however, due to technical difficulties data was only available for 39 families). The families were divided into cohorts based on the age of the infants (1, 3, 6, 12, and 24 months). There was a mix of male and female babies and a mix of firstborns and later borns. There was some variety in socioeconomic factors, but not enough (this is noted as a limitation of the study).
For each family, a variety of methods were used to record information on the infant's sleep pattern, on parenting practices and on parental emotional availability at bedtime. This included:
- Sleep Practices Questionnaire (SPQ): This questionnaire, which was adapted from a questionnaire previously used by other researchers, was used to get information on the sleep methods and parental satisfaction with their infants' sleep arrangements.
- Infant sleep diary: Over the course of a week, parents kept a sleep diary indicating the number of times the parent had to return to the infant during bedtime (note: this number also counted incidences of re-settling an infant if the parent remained in the room during bedtime), the number and duration of night wakings and of infant naps during the previous day, and infant sleep location.
- Infant Sleep Questionnaire (ISQ): Another questionnaire, this time on the parent's perception of the frequency with which infants signaled to parents during bedtime and now often infants awakened at night, as well as the parent's assessment of whether the infant has sleeping difficulties.
- Parent-infant video recording: Using three different cameras, bedtime practices and night wakings were recorded on video. The video was coded independently by two researchers who were trained by Dr. Teti. The coding involved recording data on the presence or absence of parenting behaviours (in 30-second intervals), the bedtime length, and parental emotional availability at bedtime (using Biringen, Robinson and Emde's Emotional Availability Scales (1998)) on four different scales, namely:
- Sensitivity: "parent's ability to read accurately and respond contingently to child signals with warmth and emotional connectedness"
- Structuring: "parent's capacity for appropriate scaffolding of child activities and setting appropriate limits"
- Nonintrusiveness: "reverse-scored, refelcting parent's capacity to respect the child's autonomy and personal space"
- Nonhostility: "reverse-scored, assessing parent's ability to interact with the child without signs of covert or overt irritability/anger"
Interestingly (or perhaps shockingly), of the 39 families for which data was recorded, the emotional availability of the parent at bedtime could not be coded for four families because there was little or no parent-infant interaction at bedtime (less than 1 minute). The complete absence of a bedtime routine (i.e. expecting an infant to go from 100% on to 100% off without an aided transition period) is incomprehensible to me and for that to have been the case in 10% of the families studied is shocking.
Emotional availability and cry it out
In the study "only three families reported that they were currently using a sleep training method." This doesn't mean that some of the families hadn't used sleep training methods in the past, but they weren't being actively used at the time of the study except in a small handful of families. That meant that no meaningful comparisons could be drawn between families engaged in sleep training and families not engaged in sleep training.
Despite this, the researchers do use their definitions of emotional availability (as outlined above) to draw certain conclusions about parents that use the cry it out method. Dr. Teti is quoted in the Globe and Mail as saying:
An emotionally available parent would probably not let their baby cry it out. Quite frankly, there aren’t too many researchers that advocate that any more. I don’t want to diss sleep-training programs per se, but the way we construed emotional availability is that an emotionally available parent is not a parent who is going to abandon a child at night and let the child cry it out.
It is this quote that initially intrigued me and made me want to learn more about the study. On this point, I certainly have come across people who believe emphatically that cry it out is the best and only method to teach an infant to sleep. To be perfectly frank, I think that a certain emotional distance is required in order to believe something like that. However, I have also come across parents who want to be emotionally available and who are trying hard to be there for their children, but who find that sleepless nights are making them irritable and depressed. These parents have come to a point where they believe that in order to be emotionally available to their infant during the day, that they need to let them cry it out at night, even though they find it extremely painful to do so. I am not going to argue that cry it out is the right approach under those circumstances (because I don't think it is), but am also not ready to label everyone who does resort to cry it out in desperation as emotionally unavailable (but I will concede that at that point, where they are not responding, that they are being emotionally unavailable). I do see a big difference between someone who sees cry it out as the optimal solution and someone who sees it as a last resort in a downward spiral. I make similar distinctions when discussing spanking, i.e. I would distinguish between someone who thinks spanking is the correct way to discipline a child (which I think is wrong) and someone who thinks spanking is wrong, but who ends up spanking once or twice while at the end of their rope and feels horribly about it.
Chicken or egg? Emotional availability or good sleeper?
As indicated in the introduction, the study concluded that "parents’ emotional availability at bedtimes may be as important, if not more important, than bedtime practices in predicting infant sleep quality." Specifically, it found that parents who were less emotionally available also had to return more often to their infants at bedtime, experienced more frequent infant night wakings, and were more likely to say that their infant had sleep difficulties. However, the study did not find any linkages between specific bedtime practices (e.g. nursing to sleep) and infant sleep disruption.
In order to have a detailed discussion of emotional availability, I think some examples are important. In addition to listing the criteria used to assess emotional availability, the study also included the following descriptions, which I think are useful:
Differences between mothers in EA become evident in the following descriptions, taken directly from our videorecordings. One mother, rated high on EA, directed quiet and gentle vocalizations to her 6-month-old infant while breastfeeding. She continuously gazed at the infant’s face and, whenever the infant vocalized, she responded promptly (e.g., “It’s OK.”). When necessary, the mother adjusted the infant’s position for easier access to the breast, and hugged and patted the infant’s back to burp the infant following nursing before putting the infant down to sleep. Another mother highly rated on EA responded to her 24-month-old’s questions during book reading with explanation and reassurance. When the book was finished, the mother said a brief prayer, caressed her child’s head, kissed and hugged her, then spoke softly to her, and sung to her. She then handed a soft toy to the child, tucked the child into bed, and left the room. Low EA, by contrast, is exemplified by another mother, who used stern directives with her 24-
month-old during book reading whenever the child got up out of bed, and at one point physically pulled the child back to her. This mother continually attempted to engage the child in the book despite clear signs that the child was losing interest (e.g., child was fidgety and continually turned his attention elsewhere). The child continued to squirm in bed after the book reading was finished and was having trouble settling down to sleep. The mother repeatedly directed the child to lie down and close his eyes, threatening to take his toys away if he does not settle down. At the same time, she asked for hugs and kisses from him, to which he did not comply. The child got up and left the room four times before
he eventually fell asleep.
As I read these examples, I had flashbacks to various stages of sleep with our two children in our home. While none of them corresponded exactly to our bedtime practices, I could see some of our family in all of these (despite the fact that we have never left our children to cry it out and that we always remained present and in close physical contact as long as they needed us at bedtime).
Seeing some of us in these descriptions, and realizing that there were scenarios where we were more emotionally available and scenarios where we were less emotionally available led me to send the following question to Dr. Teti:
As a mother of two children reflecting on my own experience, I can remember being more emotionally available when my children fell asleep easily and didn't wake too frequently at night. I also remember being less emotionally available at times when they fought bedtime and fought sleep. I wonder (and know my readers will wonder too), whether the infant's sleep quality could be a predictor of the mother's emotional availability rather than the opposite being true.
The response I received from Dr. Teti was as follows:
I think that is certainly possible, and in order to address directions of influence, these phenomena need to be examined longitudinally. We are doing so in an NIH-funded study (SIESTA II), which is ongoing and hopefully will be contributing more to this topic in the not-so-distant future. The preliminary findings we are getting, however, appear to support a causal link between earlier parenting and sleep quality in infants at later points (e.g., by 6 months of age).
I'll be interested to read more of the findings from the further research that they are doing. I would certainly characterize our earlier parenting as being high on the emotional availability scale, except perhaps by about the 10th night waking during a particularly bad sleep stage, at which point irritability may have set and could have been apparent in my behaviour while responding to my child. However, it is more so with toddlers who refuse to stay in bed and keep trying to get back out of bed, that I get the flashbacks of us perhaps being less emotionally available at times (whoever said "whatever you do, ensure you follow the same bedtime routine each night and do not interrupt the routine" forgot to inform parents what they are supposed to do when the bedtime routine is done and the child decides to get out of bed).
All that to say, I found it easier to be fully emotionally available to an infant than I did to a toddler, but certainly tried my best with both. However, I didn't suffer from postpartum depression (PPD) and I can see how things might be different for a mom who is suffering from PPD and is less able to be emotionally available until she is diagnosed and treated.
Gender roles and mother blame
You may have noticed that the name of the study contains the word "maternal" but that I have been using the term "parental" or "parents" throughout my post (except in direct quotes). That is because I wanted to save the discussion of gender for the end of the post.
In other studies that I have read, I have been disappointed to learn that they didn't even consider the father. When I read the first sentence of the abstract of this study, I thought that might be the case here too:
In the present study, linkages were examined between parental behaviors (maternal practices) at bedtime, emotional availability of mothering at bedtime, and infant sleep quality in a cross-sectional sample of families with infants between 1 and 24 months of age.
I cringed, but I read on. When I got to the section on the methodology, I discovered that fathers were recruited into the study but that too few of them interacted with their infants long enough (at least 2 to 3 minutes) during bedtime to be able to capture and code the data. As a result, the study had to rely exclusively on information from maternal bedtime behaviour.
The unfortunate result of the over-focus on the mother is that the conclusions sound an awful lot like mother blame (poor sleep can be blamed on the mother's lacking emotional availability). I'm not a fan of cry it out and I'm not shy about that. But I also think that the responsibility of caring for an infant is a shared responsibility. That doesn't mean that both parents have to get up every time the baby wakes up (in fact I think that is a good way to ensure that no one has any emotional availability left), but I do think that it means both partners need to support each other in order to ensure that whoever is caring for the infant has all the support necessary to be as emotionally available as possible. Sometimes that means trading off. Sometimes that means having the other partner take over other chores so that duties are more evenly distributed. Sometimes it means having one partner do most of the bedtime routine (e.g. bath, PJs, book, massage) and the other one just do the final stage (e.g. nursing to sleep).
The study does reference an earlier study by Countermine and Teti that found that spousal criticism of the mother about her handling of infant sleep behaviour makes it more difficult for the mother to adapt to infant sleep. This, plus the lack of fathers in this study, shows a need to emphasize and perhaps study further the role that the other parent plays (directly or indirectly) in emotional availability and sleep quality.
Something to sleep on?
My reading of this study does not support the statement from the Globe and Mail that cry it out can cause real damage. I do believe that cry it out can be damaging. I just don't think this study demonstrates that. That said, I do think that it contributes to a body of research that shows that being responsive at bedtime is a good idea and I look forward to further exploration of the themes in the research.
I also wish there had been some follow-up to the large scale survey that Thomas Hale conducted back in 2008. I blogged about the survey at the time, encouraging my readers to complete it, but have not seen him publish any results. If they are ever published, I think they also have the potential to contribute a lot in this field.
In any case, infant sleep research is important and I'm glad I read the whole story rather than just waving around the headline from the Globe and Mail.
Image credit: istockphoto
Reader Comments (35)
I didn't read the actual study, but the part that hit me from the article is that cry-it-out can affect the parent-child relationship. Some parents seem to think that you can have them cry themselves to sleep and things will go on being normal in the day. As if this baby isn't a normal human? I certainly wouldn't trust someone who abandoned me.
Speaking as the mother of a 3 yo who has been a terrible sleeper most of her young life, I'm happy not only that you wrote about this study, but also the way that you wrote about it. I consider myself pretty emotionally available to my kids so what I read about this study in the Globe & Mail (I haven't read the study itself) smacked of maternal blame. It's thorny stuff, especially when you're exhausted.
Claire:
Here is what the actual study had to say on that issue:
You rocked my world on this one. Fabulous, sensitive critique of the study. Thank you so much for this (and especially for adding the bit about PPD - definitely worth mentioning).
Very well argued, as usual. And funny timing for me, because I just came back from sitting with my 5-yo, holding her hand as she fell back asleep after a bad dream. But I've been holding her hand (so to speak) as she fell asleep her entire life. It's a pleasurem
I can definitely relate to not always being so emotionally available to my toddlers, as you described. When my daughter went through a phase where it took her 60 minutes to fall asleep most nights, you can bet that my emotional availability was not exactly abundant by the time we were 45 minutes in and I was frustrated with the process. Although, from what I read here, that may have less of an impact than the long-term emotional availability I did strive to provide, and still do, to both of my children.
While this study may not provide everything that we would like it to, I am pleased to see that researchers and experts are moving away from recommending sleep training. I see it so often discussed as the de facto solution, without much discussion about any potential downsides or long-term effects. I hope this is a sign that the tide is slowly turning on that front.
"While this study may not provide everything that we would like it to, I am pleased to see that researchers and experts are moving away from recommending sleep training. I see it so often discussed as the de facto solution, without much discussion about any potential downsides or long-term effects. I hope this is a sign that the tide is slowly turning on that front."
Yes. THIS.
I really appreciate your very detailed evaluation of this study. I read the Globe and Mail article and had a lot of questions about the actual details behind the study. What I find so interesting about this discussion is the concept of emotional availability, which I agree is critically important.
However, I don't think that all parental use of sleep training methods necessarily means a lack of emotional availability, which is always what has bothered me about the CIO/'no cry' debate. I agree that CIO shouldn't be the 'go to' method touted as being the cure all for baby sleep issues. Babies shouldn't be expected to sleep through the night. That being said, when we used CIO with my daughter, it was at a point where she had stopped being willing to fall asleep via our tried and true rock to sleep method and would scream, cry and arch her back no matter what 'no cry' method we used to try and sooth her. After weeks of long hours of bed time crying fits, which likely were not conducive to myself and my husbands emotional availability, we trusted our instincts which told us our daughter needed some space and time to release tension. We went through a nice soothing bedtime routine and then let her cry and fuss. I felt more emotionally available to her and she feel asleep with much less crying and distress then all our 'no cry' methods. She was calmer and we were calmer. We continue to be emotional available at bedtime and at any night wakings, but we recognize her preference for space to fall asleep on her own.
I guess what I am saying is if the conversation focused more on 'emotional availability' and less on 'did you let your baby cry' or 'did you stay with your child until they fell asleep', then we might be able to focus on what is important (namely emotional availability), while still accepting that different babies need different things.
Thank you for your thought provoking post! While I'm still in the phase of preparing my body for my first pregnancy and not yet a mom I still find your posts really informative as I research different parenting styles and it acts as a great resource for my clients!
I hope you'll come out to this chat Wed. afternoon at 1 pm ET. The Globe invited me to be a guest (they are hosting a chat because there has been so much discussion about Tralee's article) and I immediately thought, "Annie needs to be there, too!" (I know you are very passionate about this issue.)
Here is the link:
http://www.theglobeandmail.com/life/health/the-sleep-debate-should-you-coddle-or-let-your-baby-cry-it-out/article1676285/
PS: Kathleen, love your post to this comment thread. You make so many great points about why parents choose CIO. I hope you'll come out to the chat, too.
- Ann
My greatest goal in life is to bring babies back to their mothers at night in Western Culture (most babies in India for example sleep with their parents - makes breastfeeding so much easier). I researched this topic very deeply a few years ago, when I also had a strong feeling that 'crying it out' was completely wrong and could cause damage. A parenting centre priding itself on 'evidence based practice' said there was OVERWHELMING evidence that crying-it-out wouldn't hurt a baby. I searched and couldn't find the overwhelming evidence. So I asked them to provide it. They provided me with 2 studies - one not relevant, but suggesting worse long term behaviour in children left to cry it out, and one very small study which demonstrated every error in the research book including misrepresenting and misreporting of results.
There's a direct line relationship between sleeping with baby and breastfeeding success - some babies and breasts manage when placed apart, but most need a co-sleeping relationship. Nothing to suggest you'll hurt the baby unless someone in bed is drunk or on drugs - bad associations with smoking too.
Oh, not exactly the same thing I was thinking then. Still puts a link between the two though. Maybe parents will associate CIO with low quality of parenting?
You are, as usual spot on. I do realize that the children (1 &3) fall asleep faster when I provide them the attention (emotionally and physically) that they needed. If I am agitated, it is more difficult to settle the children.
As I was nearing the end of your post I am glad you mention the fathers. Because that is what we do. When I am too tired to handle the sleeping. I head off to bed with the younger child while Daddy entertains the older. When she's sleepy and ready, Daddy wakes me up to do the bits he can't... nurse to sleep. Sometimes She's sound asleep before the end of a song.
interesting write up. i read and enjoyed the original article for much the same reasons that Amber did, i felt that it was at least a step in acknowledging the right direction.
i'd be curious what they would classify if they observed bedtime at our house. my husband does bedtime, not me. no maternal influence needed! they usually read a quick book and then the kid snuggles down to sleep with some quiet music on and his lovey in <5 minutes. sometimes we're the less than one minute lay him down and BAM he's OUT family. but i think that's pure luck more than anything else that we have a calm sleeper. i credit early co-sleeping.
Nice take on the article and the issue. As usual, I appreciate your thoughtful analysis.
I AM pleased the article mentioned Ferber not advocating crying alone as much he is assumed to.
I can say was far less emotionally available during a particularly nasty bedtime period around 24 months with 2/3 of my kids. Both resist falling asleep- like me, it's hard for them to slow their brains down, I think- and with the youngest (now 26 months) the 2 hour bedtime saga made me Crazy.
Thank you so much for this analysis. I have to say, I came across the Globe and Mail articles and felt very confused. My son is now 16 months (and we do a combination routine of rocking at bedtime in his own crib, then co-sleeping later...and we sleep thru the night), but when he first started waking frequently at 3 months, I became so desperate for sleep.
Our pediatrician instructed me (at 4 months old!) to lay him in his crib, shut the door, and leave him there until morning. I was floored. Every "mommy" (and daddy) friend with children the same age told me to let him cry it out. His teachers at daycare told me he had to cry. I got story after story from veteran parents about how he "had to learn" and would eventually sleep. He didn't. It was horrible. I read all the expert books desperate for sleep for all of us. I read articles that linked sleep loss in babies to obesity, ADD, cancer, etc. I blamed myself. I felt lost, confused and exhausted.
And then I brought him to bed. People said we were "cheating" (but he was happy and sleeping?!). Eventually we created a flexible sleep routine that worked for us and was based on compromise, being available and consistent, and a blend of methods to get him to sleep and respond when he woke during the night (read: there were usually different reasons for the waking!).
In the end I went with my own internal parenting compass that told me when and how my child needed me. My husband was an integral part of the process as he has his own unique connection with our son and own parenting style, and is able to respond in different ways. It was like a light bulb suddenly went off: *I* knew what was best for my child and my family. *I* could respond to his needs one step at a time and figure out my own sleep process.
Analysis like yours reminds us all that our children are unique individuals and there can't be a silver bullet "one size fits all" method for all kids to meet their sleep needs, let alone one that will always work throughout their entire development. So much of the advice we get and read is "black or white" and obviously the issue is far more complex. Thank you for the supportive and encouraging post!
Annie, fantastic job breaking this all down. Thank you for your deep analysis and for not just running with the theme of the study to prove a point (not that you would ever do that anyway).
As a mother who successfully breastfed for 13 months, I recognize how great co-sleeping with my child when he was an infant was for that relationship. That being said, by the time he was 6 months old not a single person in this house was getting any sleep. He was up all night, crying, pushing us away in bed while wanting to nurse at the same time. We were all sick for a good 2 weeks straight because of the exhaustion. Co-sleeping wasn't for us beyond those first 6 months (and I get that that's an entirely different issue).
When we transitioned into his crib and he was still waking with the frequency that he was in our bed I was really and truly at my wits end, waking every 1-2 hours to nurse him and soothe him and be "emotionally available" left me a zombie, and quite an irritable one at that, during the day. I was drowning in guilt over not being all that emotionally available to him during the day after trying so hard at night. That was when we decided a very modified, gentle form of CIO was in order.
I sort of hate how whenever someone says they are doing sleep training, people assume that this parent is just locking their young baby in a room to scream themselves to sleep. There are so many levels and shades of gray and so many times it really comes from a place of love. Not only did I need to sleep, but my BABY needed to sleep. So while I may have been emotionally unavailable in intervals of 5,7 and 10 minutes at a time over the course of three nights, I think the total was far less than the hours I spent, frazzled and on the verge of snapping during the day.
What I'm most interested in is the point you make about the "chicken or egg." Many of my friends who had babies who were always great sleepers, who really enjoyed co-sleeping, would never consider sleep training. I, however, dealt with colic for an extremely long period and had what some would call a "high needs baby." So after 6-7 months of doing everything in my power to be emotionally available to a difficult sleeper, I didn't have anything left.
And, allow me to clarify, that I'm totally against the idea that so many prescribe to -that is to leave a baby to straight up CIO all night at any age, but especially at a very young age. I hate that this is a method that is recommended by medical professionals and done by parents without even considering the long term affects. If studies like this help to eliminate that type of approach to sleep training, I think that's fantastic. But, to me, there are circumstances that call for modified, gentle approaches to sleep training because the benefits to the baby and parents outweigh the costs, even if that means being emotionally unavailable for short periods of time.
So if letting my child CIO means I'm emotionally unavailable, what is my alternative? I didn't want to let my baby cry by himself. It physically hurts me to hear him hollering. However it has been 9 long, exhausting months of getting up to nurse him back to sleep every hour and a half to two hours. We've tried every no-cry technique I've come across and they all just seem to aggrevate him so he cries harder when I attempt to get him back to sleep. Cosleeping doesn't work for us, either.
I want to be there for my son, but when I'm so tired I want to scream with him, what choice do I have but to leave him alone in his crib to cry?
Erin:
It is hard to answer that question without more information. I have a list of gentle sleep tips here:
http://www.phdinparenting.com/2009/02/28/gentle-baby-and-toddler-sleep-tips/
I learned quickly that my children did not sleep well if they were not in close physical proximity to me. That meant that co-sleeping was the only option for us. Especially since it meant that I could meet their needs at night when they woke up without getting out of bed. I had one good sleeper (slept well as long as I was next to her) and one bad sleeper (woke regularly even when I was next to him), but I couldn't have survived either without co-sleeping.
I think if you've tried everything and have had him assessed to ensure it isn't a medical issue that is keeping him from sleeping, the best solution is to find a way to trade off with someone else. If you aren't a single parent, set up a schedule where you and your spouse can take turns.
"I wonder (and know my readers will wonder too), whether the infant’s sleep quality could be a predictor of the mother’s emotional availability rather than the opposite being true."
This is such an important point, and I'm so glad you brought it up as this is true of life, not just infant sleep, too, don't you think? The way the day is going often creates the way the day will go - law of attraction & all that. Its only human nature to respond negatively when things are going in a negative way. It is much more difficult to be able to respond in a positive manner when things are not so rosy.
Then toss into that all the negative parent-centered sleep advice: don't do that, your baby shouldn't be doing this, etc.... Then when baby doesn't sleep, what's a parent to do but get more negative? Because that's what all the books and all the advice say. If your baby isn't sleeping? Must be a sleeping disorder. If your baby is sleeping with you? Get them out of your bed or they'll never sleep alone. It makes a parent crazy and perhaps more prone to latch on to the desperate times call for desperate measures kind of logic when it comes to nighttime baby sleep.
The thing is, that sleep training methods don't seem to mention, is that what works to help a baby sleep one week (or heck, one day), won't work the next. The sleep books all come with strict routines, schedules, and guarantees for sleep - and never seem to concede that they're dealing with a moving target. Babies get sick. They get scared. They get stuck in their crib bars. They get hungry. They are teething. And also never seem to remind parents the most important part of parenting - this too shall pass.
Well, I digress.
Thanks for the thought-provoking post Annie. :)
Great synopsis and discussion.
I agree 100% that CIO is damaging. No infant or toddler should be left to feel scared, overwrought, alone, or abandoned. Not one of those things does anything except undermine the loving, trusting bond between caregiver and infant. I also understand that mothers and fathers need occasional breathing room, a minute or two of shutting themselves in the closet while baby wails in the other room, before heading back in to start over. That's completely different.
Having said that, attachment parenting is based on Bowlby's Theory and while I'm in NO way saying, go ahead and use CIO, I think it's also important to know that kids *can* re-establish healthy, secure attachments throughout their lifetimes. It just might not be with you. You can certainly (and without a doubt) give your kid a leg up in life if he's securely attached, but you're not necessarily sentencing him to a life of doom if you don't. I believe you can make up for it, but is it really worth it?
I think nighttime parenting has more to do with the adult relationships in the house than with the actual relationships between caregiver and infant, attached or otherwise. If there's a couple, and the responsibilities shared equally with no mother-blame, lots of support, and good mental/physical health, then the emotional availability should be much, much higher.
Also, parenting style during the day is probably also closely correlated. The more likely you are to be a securely attached pair during daylight hours, the more likely you are to be at night, as well.
I don't know why it's so hard to prove that ignoring an infant with millions of years of evolution coursing through its veins isn't the best idea. It seems like a no-brainer. Shaking this Puritan ideal of what a baby should and shouldn't do is a beast.
Thanks for the write-up. Honesty, I see so many flaws with this study, meaning the results don't really say much to me. I will be very curious to see what they come up with in the longer study.
You mention that the families kept a sleep diary for one week? Is that how long the whole study lasted? Looking back on our experiences, looking at a one-week chunk of time doesn't seem like it'd be very representative. D has always gone through phases (from a week or so up to a few months at a time) of sleeping better or worse, and any one week-long period during different phases may have shown very different things in relation to his sleep pattern, and both my and my husband's sleep-time emotional availability. It is nice to hear that they're working on a longer-term study, to help overcome that shortcoming.
It also would be interesting to see more about the "chicken or the egg" problem as you mentioned, since that also popped into my mind quickly. I know the way I handle bedtime is very different depending on whether I anticipate it to be an "easy" bedtime (pleasant, he falls asleep quickly) vs a challenging one (lots of whining, taking 1+hrs to fall asleep). Just noting and recording the two behaviors shows a correlation, but gives no reason to imply causality.
My experience is similar to what Kathleen and Jill @BabyRabies above mentioned. I don't necessarily think CIO is the best way to get kids to fall asleep, but it's a technique that can be helpful for parents who are at their wit's end. For every story of a child who cries for hours on end, there are also stories of families who spend months trying to figure out how to get their child to go to sleep more peacefully, and finally when they try one of the CIO methods their kid, low and behold, falls asleep more easily than before. That was certainly our experience, where D went from spending HOURS on end each day and evening (naps and bedtime) screaming in my arms, no matter what I tried, and then when we did CIO he cried less overall, and soon didn't cry at all at and bedtimes were a dream for a full year after (until we transitioned to a bed which brought its own challenges). My husband and I went from spending our entire "free time" in the evenings trading off on dealing with a screaming baby, to actually getting to sit down for dinner together and enjoy some time together before going to bed, which made a WORLD of difference. D still woke up some at night, meaning he clearly hadn't "given up" on us, but I was ok with it since, interestingly, he almost always went back to sleep easily after nighttime wakings so I'd only be up with him for 15-20 minutes or so (it was only for naps and bedtime that it took forever and involved much crying). And yes, the easier sleep times meant I enjoyed my time with him much more, since I was no longer so frustrated nor felt that resent at how difficult it was to get him to fall asleep.
I don't know what we'll do as far as sleep with this next baby. I'd like to avoid having to use CIO, but am not against resorting to it if it seems the best option. I wish there were different terms used, maybe, for different CIO approaches since I do think they are quite different and mean different things about the parent-child relationship and how "abandoned" the child may or may not feel. I am interested to hear any valid research on CIO vs other sleep approaches, to help make future decisions. I do hear about studies looking at "excessive crying" in infants but many of those sound like they're based more on outright neglectful/abusive situations (meaning a consistent approach of not responding to the child as a day-to-day habit for the entire child's life, as opposed to what I usually associate with CIO which is loving parents who normally are very responsive but decide to take a specific approach for a specific period of time-- few days to few weeks-- for this particular sleep goal, which seems to me an important distinction). I always read those results and wonder what they mean by "consistent" or "excessive" crying since I rarely see criteria for what those terms are based on.
I really appreciate the balanced approach with which you responded to this article. The study is limited in so many ways that it certainly does not merit a headline.
What I'm truly sick to death of is how we divide ourselves in to camps based on personal parenting preferences. It undermines the personal freedoms feminists have fought for in the past. So now men aren't allow to judge women (officially anyways) so we women oblige them by denigrating each other via parenting models. Just the phrase 'CIO is damaging' implies an unworthy abusive parenting relationship between mother and child. The truth is that NO ONE has studied your child and their unique likes, dislikes and personalities. How can they say that my behaviour at one small point in the day will result in much of anything? It is truly my overall interaction that creates the relationship with my children. Placing that much importance on one aspect of parenting only strengthens the dogma of maternal perfection that erodes self esteem and confidence. I'm tired of the 'camps' of women pitting their righteous parenting practices against one another. We need to respect each other's choices and variety of perspectives with sensitive balanced discussion, as we approach varying cultures, sexuality and religious beliefs. A rainbow of one colour would be very boring indeed.
Thank you for your balanced approach. It allows women to explore a perspective possibly different from their own without feeling judged or defensive. And doesn't that educate more effectively? :)
"The thing is, that sleep training methods don’t seem to mention, is that what works to help a baby sleep one week (or heck, one day), won’t work the next. The sleep books all come with strict routines, schedules, and guarantees for sleep – and never seem to concede that they’re dealing with a moving target. Babies get sick. They get scared. They get stuck in their crib bars. They get hungry. They are teething. And also never seem to remind parents the most important part of parenting – this too shall pass."
Yes! Yes! This! Kelly I totally agree with you. Baby and toddler sleep is such a moving target and I think it is so true that a lot of the books leave this concept out. Add that to what you refer to as the 'negative parent centered sleep advice' and it is recipe for frustration. I think what we need more then anything else is more parenting advice that reminds us to have realistic expectations.
Your depth of research amazes me. Really. I wish I had the time for the kind of probing you do. Thanks for this. I know we've disagreed about sleep training in rather blunt and harsh ways in the past. But I feel here you are not lambasting all families who make the choice to CIO. Because what so many of your readers said rings true. It differs from week to week. And there's not one single stereotype of a parent who uses CIO.
We co-slept every night for the first three months. Then we began slowly transitioning to the crib. With both kids, I nursed for about 16 months. So I used my boobs as a pacifier often, without realizing it. Each child was different and is different with sleep habits to this day. But waking up 3 times a night with a 16 month-old who has no clue how to get herself to sleep, let alone back to sleep, despite the loveliest of bedtime rituals to wind her down -- well that was exhausting. Not so bad when I was home on mat leave, but extremely trying when I'm supposed to be an editor and have an attention to detail 4 days a week.
I tried CIO at first, but you're right, it was torture. I joked about it, but I hated it. So we abandoned the mission.
We ended up using Tracey Ruiz, the Sleep Doula, who was not judgey, not insistant on one way versus the other. She simply offered a few different approaches and then explained roughly how long each method might take. We went with supported CIO, meaning I laid very close to my daughter's bed, but out of site, for three nights while I gently shushed her to sleep. There was no touching. But there was reassurance. Mama was close-by. And it worked.
Do I have a perfect sleeper 1.5 years later? No. There was teething and potty training and routine changes, and I still get up a few times a week. Just for a quick reassurance mostly, but on some nights I fall asleep beside her with a hand on her back (like I just did for a whole weekend in a tent!). But my daughter learned to fall asleep on her own and how to get herself back to sleep on her own for the most part.
And as Kathleen said, I felt like I could be more emotionally supportive with my batteries recharged. Anyways, I'm blathering. All this long note to say thanks for taking a more balanced approach. You were still able to voice your general opinion on CIO, but not in a way that made anyone feel bad about her choice as a mom. Cheers.
Ginger,
If I could stand up and give you a high five, I would. Could not agree more with everything you said.
And I second that Annie does a great job of keeping the discourse on this blog intelligent and measured.
Just a thought on poor sleep quality and whether that's damaging. I know I've read that in our children's developing brain, good rest is essential to continuing healthy development. If their have poor sleep, for whatever reason, there is likely some impact on their brain. If they chronically have poor sleep quality, such as feeling alone and afraid at every waking every night, I imagine this would potentially have deleterious effects on the normally restorative powers of a good night's sleep.
I know my brain feels cloudy when I've not slept well. I imagine the same could be said for our children.
Great analysis of a study that could have been done so much better.
I agree with those who've spoken against the one-size-fits-all (ages, stages and babies) approach. I loved cosleeping with my kids when they were tiny, but as a regular thing found it uncomfortable. Gentle transitioning from cosleeping to bassinette in our room to own room has worked for us for both kids. But apart from that, they're different... my daughter loved her pacifier, whereas my son wasn't interested in one... but she hated being wrapped and he loves it. However with both my approach is again gentle, responding to crying by offering a feed in early stages, later on resettling.
With the really frequent waking and consequent exhaustion I have felt less emotionally available. And general stress has a huge effect too. Last week I had some dental work done and he hardly napped -- far worse than any previous bad day! I'm sure they pick up a lot of out mental state.
[...] am Tags: attachment parenting, baby wearing, emotional availability, sleep Ever since reading the PhD in Parenting post on Emotional Availability and Infant Sleep I have been mulling over the concept of ‘emotional availability’. For us it was never [...]
[...] http://www.phdinparenting.com/2010/08/17/emotional-availability-and-infant-sleep/ [...]
[...] Emotional Availability and Infant Sleep — from PhD in Parenting [...]
I just discovered your blog/twitter account, and read this post. I had PPD and was certainly not EA to my child as much as I wished I was. She had horrible sleeping issues, but as you said about the chicken and egg, what came first? I feel I'm much better now with her as a toddler, although many nights you can hear us saying "close your eyes!" after we've been in her room for an hour :o) Great post...
[...] Emotional Availability and Infant Sleep — from PhD in Parenting [...]
I lived in Africa for many years. Child rearing methods are very different in various cultures. In Africa baby is constantly with mom, who nurses on demand for 2 or more years. No one talks about 'spoiling' a small baby, when baby cries she/he is offered the breast. Babies are never left to 'cry it out'. If that doesn't work, other approaches are investigated, diaper changes etc. I easily got into the African baby rearing model and did not regret it. My girls grew up confident and loved. I did not let them cry it out, as I realized they were only little things who did not know how to cope with this huge and scary world. Their egos were way more important than mine. Heck, they're not babies for long.
[...] 2010 study on Emotional Availability and Infant Sleep concluded that “parents’ emotional availability at bedtimes may be as important, if not [...]