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Yet another CIO study which shows no deleterious effects on infants

Some of the main critiques of the current research on CIO by APers which shows no adverse effects is that the infant populations studied contain relatively few children under the age of a year, the studies themselves are rather small, and there is a relatively short follow-up period. Some APers suggest that this lack of absolute evidence is sufficient to recommend against using behavioral methods, and CIO in particular, in children under a year old. I disagree with this position, as I find there is no evidence whatsoever that suggests CIO might be harmful in the first place (despite some rather blatant scare tactics by APers who compare the practice to child abuse/neglect), and that assuming a priori that the practice may be harmful merely because it’s unpleasant for the parents is not a logical approach. A new study on the subject is in last month’s Pediatrics which addresses these issues and – not surprisingly to me, at least – helps confirm this.

Long-term Mother and Child Mental Health Effects of a Population-Based Infant Sleep Intervention: Cluster-Randomized, Controlled Trial by Hiscock et al studied sleep-troubled infants who were randomized to be given information about a sleep-training method of their choice by a nurse (intervention, 174 families of which 100 took the nurses up on their offer) or to regular well-baby care (control, 154 families). Of the 100 families who accepted the sleep intervention from the nurse, 53 chose graduated extinction (akin to the Ferber Method), and an additional 7 chose “adult fading” – where an adult stays by the child until he falls asleep, and gradually moves away from his room over a period of weeks (this often also involves crying, as usually the child is not to be cuddled or picked up).

Mothers handed in questionnaires assessing the existence of sleep problems, the degree/existence of maternal postpartum depression, their parenting practices, and indicators of the infants’ mental health when the babies were 10, 12 and 24 months old.

This study has several strong points in that: 1) the study population is randomized, 2) all the infants studied were between 6-12 months old, 3) it’s a relatively large study for this topic, 4) infant mental health was assessed, and 5) there’s a year+ period of follow-up. The study’s main flaw, IMO, is that a rather large proportion of infants in the intervention group (43%) did not actually receive an intervention, and of those that did, the intervention wasn’t the same for all families.

The results?

The intervention group’s mothers displayed a significant decrease in maternal depressive symptoms, and 55 of the mothers who used interventions strongly endorsed their use and reported them as having a positive effect on their relationship to their child. Most importantly, no long-term differences either in parenting practices or effects on the children’s mental health (positive or negative) were seen.

Like in all other matters, I would like to see this research replicated, perhaps with all the mothers in the intervention arm receiving the same sleep-related advice, and with follow-up on if the advice was implemented and how well it went. But this is, overall, good and very welcome news on the infant sleep front for parents using CIO or similar methods.

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10 Responses

  1. I think it is so much better to have a child cry it out than possibly lose your temper with the baby.

  2. While I am opposed to a systematic approach to letting MY OWN BABIES cry it out so I can sleep better at night, the reality of being a mom of three young kids causes crying it out to happen more than my AP friends believe it should happen.

    For example, one baby wakes up other baby and both are crying. While I am tending to one, the other falls back to sleep.

    Example 2- my third son cried for the first 2 months of life. There was one day that I realized I hadn’t brushed my teeth. . .in a while. After hours of crying, I laid him down so I could brush in peace, and within seconds, he stopped crying and fell asleep. Heck, my constant holding was probably keeping him awake. To this day, when he is tired, he likes to be put down to sleep.

    I wish parents could realize that all cries are not created equally. My middle child never cries. Not as a baby, and not as a toddler. When she does cry, I know something is really wrong. My oldest cries all the time about little things- the seam of her sock could be wrong on her foot. My youngest only cries for a second, and then he realizes he’ll probably have to wait to be tended to, so he gives up crying and goes about his business.

    It’s too bad there are studies that lead parents to believe all babies need the same type of parenting.

  3. RedOne, I think you make a great point. My daughter started fussing at 5am this morning. I didn’t get up until 6 when she actually woke up. I could tell from the sound of her crying that she was still mostly asleep and didn’t need attention at the moment. But on AP boards, they would consider what I did to be the same as letting her scream bloody murder for an hour (which I wouldn’t have done).

  4. The studies don’t lead parents to believe all babies need one-kind-fits-all parenting, RedOne. It’s some of the “experts” that (mis)interpret the studies for the parenting public that do so. I recently had a look at Margot Sunderland’s The Science of Parenting (You can peek inside the book on the Amazon website, too) – and oy vey! She makes Sears’ hatchet job on the literature regarding infant sleep/crying look almost honest. You can see some of her overblown claims here as well.

    Which is why I do my best to present the full-text study when I’m making a given point on this blog – I want you to go and read the whole thing yourself, and see if I’m misinterpreting anything that’s written. Not many do, and more’s the pity.

  5. Estherar, I think you misunderstood me. I wasn’t speaking about the studies you posted. I didn’t even read them. I meant that many people who think they are AP feel that all crying should be immediately tended to. (sorry to end my sentence in a preposition, but that’s the best I can do after my night last night.)

    To further clarify, I do not think CIO is dangerous to the well-being of older babies. I also think that parents who must let their kids CIO so they can sleep better are probably better parents during the day when they are well-rested.

    I tried other methods that either worked or my baby just matured, and I wasn’t at the end of my rope, yet. No well-meaning parent lets her baby CIO because it is fun.

    For me personally, I tried other things that eventually worked after many months of sleeplessness. Maybe I would have been a better parent to all my kids during the daytime if I had let my baby CIO. Moot point now, because the barn door is closed. No more babies for this momma.

    I realize I am dangerously close to sounding like a “Best Parent Ever,” but I while I was typing and reading about good parenting, my kids were watching cartoons and eating magazines so momma could have just one more cup of coffee before the breakfast rush.

  6. RedOne – I’m sorry if I came across as being annoyed at you! That wasn’t my intention at all.

    I have no problems whatsoever with people who make different parenting choices, short of true abuse/neglect. I’m sure some of my parenting choices would also qualify me for a BPE medal! :)

    My issues are with, as I said, “experts” – or parents who quote them (and there are plenty of those!) – who make “scientific” claims completely unsupported by the actual scientific literature…hence the blog and the attempt to gather the actual raw evidence so people can read it themselves.

    If a parent doesn’t want or feel the need to CIO , I don’t think anyone – least of all me – can take issue with that. If a parent doesn’t want to CIO and then claims nobody else should either, because [insert false evidence of harm here], thus conning other parents into not using a good technique which might work for them…that’s the part I have a real problem with, and what would qualify one for BPE status. I don’t see you as doing that at all!

    I completely agree that there are cries, and there are cries , BTW.

  7. esther, did you look at that Science of Parenting book because of that other blogger on the Skeptical Parent Crossing? Because she sure seemed less than skeptical to me (i found that blog kind of grating, actually). I’m interested in your take on it.

  8. Tricia – In a nutshell, yes, though I was looking to get it locally already.

  9. Interesting article. It’s great that you link the actual study. I tried all forms of CIO without much luck, it would work for a few weeks for my son (my daughter not at all), and then he would revert back.

    The study though doesn’t really talk about the type that I do feel could be harful (FULL extinction), if you have any studies disproving that I’d be interested to read it.

    Mom to 3 year olds who still haven’t slept through the night and sleep in my bed!! Though I wish some form of CIO would have worked

  10. Stacy – nothing works all of the time. But CIO can and does work for quite a few kids.

    There’s an article by Dr. Jodi Mindell at the end of this post regarding behavioral methods of sleep training in general that you may find informative and also discusses full extinction.

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