Weighing up the evidence: Does Cry it out really work?

Many of you may have already heard of Cry It Out but for those that haven't here's some background.

The Ferber method, extinction & spaced soothing, rapid return, timed crying and crying down are all terms that can be used that generally refer to cry it out or cry based sleep approaches. These strategies generally require a child to be left alone to cry so they 'learn' to put themselves to sleep.

The main goal here is often around teaching the child to 'self soothe'. This is a term I sometimes feel really fails to reflect the capabilities of a small human.

Think about it: sometimes its really tricky to manage our own feelings and we get upset or frustrated by something. We might need to talk to another person about this or have a hug, this is whats called co-regulation. I am a huge advocate for co-regulation as I think its an incredibly powerful tool we can share in and use to emotionally and physically support each other. You can read more about it here.

However, self soothing expects a child to be able to get themselves from a place of distress to asleep, essentially to 'snap out of it'. This is actually far beyond the emotional and developmental capabilities of an infants brain (and even some adult brains!). What actually is often happening here is a thing called learnt helplessness. Essentially, a child is conditioned to expect a non-response and eventually gives up crying for help. But surely when they cry less after a rough week or so of training this is a good thing? Whist, this may appear a good thing on the surface that a child cries less, we can't say their bodies stress response isn't firing.

Now, some babies do respond well to this approach and families can find that this is a quick way for them to work on any sleep issues. Generally speaking the children this might be working for a dandelion infants. These children are relatively robust and independent with a balanced temperament and are good at regulating their sensory or attachment needs. Essentially, a child's level of resilience and attachment security can impact how well they tolerate controlled crying.

As sleep consultants its beyond the scope of our practice to assess, in enough detail therefore we can't be sure of the internal resilience of a child and their coping mechanisms to protect them from adverse mental health outcomes.

Lets go through some research about cry based methods.

There are three core studies that suggest cry it out as a credible approach in managing infant sleep. I have created a table below to show you some of the background and also some of the issues that this popularised research has! (Some of these limitations are really shocking!)

I never recommend using techniques that require a parent to not respond to their child and leave them to cry. There are many reasons for this but some of the main ones include:

1. Research into infant mental health has found they leaving a baby to cry induces high stress which results in behaviour coined 'Learnt helplessness'

2. There is very little know about the long-term impact of controlled crying.

3. We can't know how much is too much crying so it's preferable to avoid cry based approaches.

4. Leaving a child to cry doesn't provide them with any skills about managing stress, therefore I feel empathetic parental support is preferable!

5. There is no evidence that controlled crying works, and not enough to say it has lasting positive benefits.

6. There is very limited evidence that it reduces maternal stress significantly more than providing support and education.

It is my belief therefore, that any recommendations given to parents around sleep should promote response and build education and support around a family to enable them to feel empowered when supporting their little one to sleep.

Love & sleepy dust,

Imogen