09 June 2006

On "crying it out"

Amazon: Healthy Sleep Habits, Happy ChildHow to get kids to sleep -- one of the most heated parenting debates out there, with polarized camps on both sides. One groups says, "Let them cry it out! They must learn to soothe themselves!" The other says, "Nurture them to sleep! CIO is cruel!" Never the twain shall meet...but when they do, the fur flies.

That's why I was so impressed with Moxie's take on the "cry it out" (CIO) method of sleep training/learning. She's against it herself, but, in the most reasonable way I've seen, explains what she believes CIO to be. She suggests that, for those kids who cry to release tension, CIO is a fundamentally different experience than for kids whose crying increases tension.

My story, fwiw:

I have two kids of wildly different temperaments. My son, who's 6 1/2, didn't nap as a baby unless he was in a car or stroller, and was difficult to get to sleep at night. After months of rocking him for hours on end, we finally let him cry it out (he was about a year old). It worked after about a week, meaning we could put him in his crib awake and he'd go to sleep on his own, nary a peep. But it was extremely painful for all of us.

I now have the benefit of years between then and now. I don't believe he was traumatized by the event, and he's a fine get-to-sleeper -- has been since then. But, at the time, it was terrible. It went against every parenting instinct I had. Even so, I don't feel we had an alternative. We simply couldn't tolerate the rocking-for-two-hours-then-gingerly-placing-baby-in-crib-and- tiptoeing-out method anymore. We tried more gradual methods of helping our son get to sleep, and they didn't work for him or us. We were resentful, exhausted, and demoralized. In the end, I feel that this parenting decision, like every other, had to take the whole family's needs into account, not just the child's.

My daughter, on the other hand, has always preferred to be put down to get herself to sleep. She seemed irritated when we'd try to rock her. Even as a newborn, she just wanted a swaddle and her bouncy chair or crib, and she was out.

No earth-shattering insight here. But for those of you struggling with getting your kids to sleep, my heart is with you and I am virtually patting you on the shoulder. If you'd like to hear more of Moxie's advice, here's her Sleep category archive.

If anyone feels like sharing their own experiences, feel free to do so in the comments, or on your own blogs (include the URL so we can visit). I'd love to hear your takes on this.

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A lot of parents have found a third option- the family bed. I didn't have sleep issues with my 4 kids and managed to get enough sleep even with nursing babies. And they do leave eventually... my 8, 5 and 3 yo are in their own beds now.

Lucy is just over two and still likes to nurse before bed. Sometimes she wakes up at night, but not very often. For her (and us), the crying increased tension. Also, what she needed to go to sleep didn't take that much of our energy (well, in comparison to some stories I've heard) and since we haven't felt resentment, we continued with our preferred method. When she turned one, we did decide that crying lasting under 5 minutes was acceptable (as long as it was leading to sleep) and that really seemed to help her figure things out. We are happy we proceeded this way; she is not always asleep when I put her down and will often say, "I love you" and "night-night" which melts my heart. Just last night, she woke up only 30 minutes after she'd gone to bed. We tried to comfort her sans nursing and then left the room. After about 15 minutes, I went in and she was so very upset I regretted leaving her there for so long. She was sobbing and gasping and took quite a bit of time to calm down. I nursed her again, and she was asleep all night.
I understand the desire to want to "teach" kids to fall asleep, but crying just didn't work for our family. But even Pantly in "The No Cry Sleep Solution" says that the rest of the family is important; without parental sanity, the family will suffer. We read that book and realized that we were not going crazy -- in fact, the pressure we felt was from the outside, not from our daughter or ourselves.
Families should do what is best for them, but I will still remain disturbed by the idea of teaching or training (and I've even had someone tell me his months old child was "manipulating" them by crying) based on my (limited) knowledge of human development. Am I crazy to think that, eventually, kids will figure sleep out? Like you said, Asha, you don't see any negative effects of the crying method. This is wonderful and reassuring! On the other side, do the sleep training proponents really believe that my child will be a 10 year old insomniac without me leaving her, despondent, to figure it out now?
When I spend those 10 minutes alone with her, rocking in a darkened room, I cherish that time because I know it is so fleeting. When she is 16, she certainly won't be asking to hear "Goodnight Moon" in my lap as I hum a lullaby.

I don't usually share my story about sleep, but I think I will break my own rule, because I think maybe it will help someone in the future, or even now. Check out my blog http://melissaandjoshua.blogspot.com for the whole story.

We have a 4 1/2-month-old son who is going through a weird bump in his sleep patterns. He's stopped wanting to nap in his crib (or anywhere else) and will only nap in a sling or on our shoulders. He was fine before that. If he's asleep and we take him to his crib he wakes up and screams like crazy.

So we're in the midst of the cry-it-out vs. nurture-to-death debate which means that all we are really doing in reality is reading a bunch of books.

Ah well, he is really cute though.

Well our oldest is still in our bedroom, albeit in his own bed. He always had to sleep on/with us and wouldn't sleep otherwise as a baby. But he slept, and it was good.

Our second one, still a baby reacted differently, although the symptom of crying unless held was the same, he slept terribly. Finally we ended up doing the CIO at night and he miraculously fell asleep quickly and slept the night in a crib in his own room. He does not nap without being held though (will cry for a full hour during the day if we try and put him down and not fall asleep, just as we do at night with success...)

So the lesson? Kids are all different and you need to do what works for you, and works for the child.
Don't let society, family, experts, etc steer you wrong (yet be open to new ideas), you will figure out what your kid needs, and if you don't they'll probably grow out of whatever phase they are in eventually...and just because something works/doesn't work at 9 months, doesn't mean it won't work at 12 months, etc.

Whatever you do, make sure you don't get too sleep deprived, or you will go crazy.

I agree with the others that all kids are different and that you need to trust your instincts (or follow your needs). I just want to say that we rocked, held, co-slept, etc. with our kids and never did the CIO. They're 6 1/2 and 4 1/2 now and are fine sleeping in their own beds and don't have any sleep issues or problems. My best advice is never let anyone scare you into one camp or the other. The kids will probably end up sleeping the same regardless of your choice.

Ferber has some great advice on defining sleep, sleep patterns and sleep rhythms (very interesting). Learning about sleep before tinkering with your child's should help.

After many months of sleep deprivation, we decided to try Ferbers method. The first night I spent in tears listening to our daughter cry (in anger). The second night, my husband supplied me with earplugs and several cups of tea while he took care of her. Imagine our astonishment when, on night five, she went right to sleep. We've has never had a problem since. Five years later, she lets us know when she's tired, and asks to go to bed.

Our experience sounds very similar to Asha's with the exception that we had twins. We were against CIO but after a year of an hour or two of sleep a night for everybody we had run out of options. We had followed Pantly's book for more than eight months.

Night one was awful with one girl crying for over three hours, interestingly the other fell asleep in a half an hour. Both slept the rest of the night once they fell asleep. In the morning everybody felt better.

Night two was harder on us because we were actually rested. One girl was awake for over three hours but not crying, but also not happy. The other fell asleep almost immediately.

By the end of week everybody was sleeping. There were some rough spots over the next year but now, at three and half, they sleep 12 to 13 hours a night and go to bed happy.

All that said, I think CIO is a last resort method. It's hard and it's stressful for everybody involved. But don't feel guilty if you find yourself pushed into doing it. Sometimes it is all that that works.

One other note: someone above mentioned being disturbed at the idea of teaching or training their child to sleep. Personally, I think this is what we do as parents, we teach our children. Whether it's language or sleep habits, it's what we do as parents; And whether you're using no-cry or CIO you are teaching your children. For some children it's an easy lesson and for others it's more difficult.

One more note: On reading Moxie's post I suspect that with our 'identical' twins, one cry's to release tensions and the other gains tension while crying. It reinforces some observations from the first year where we were pretty sure that one of the girls wouldn't have given us any sleep problems on her own (the same girl who fell asleep very quickly when we used CIO).

I would just like to add to what everyone else has said. Every child is different. We tried CIO with our son at 8 months and gave up after he was still crying for two solid hours a week in. We tried again at 12 months with the same results. We finally got him to sleep through the night by letting him sleep in our room in his crib. My daughter who is now nine months old is the exact opposite. She seems to need to fuss for a few minutes before she can go to sleep and then (usually) she is down for the night.

My advice is to be aware of your childs temperement. Not everything is going to work for every child. My son was born "high-strung" and has been that way ever since. My daughter was mellow from birth. I learned it is a lot easier to work with my child's temperment then do what the so called experts tell me and have it backfire. Go with your gut, it's right 90% of the time.

We did CIO with our son just after the five-month mark. He's always been very independent and a good sleeper (once he got to sleep). Our problem was that we didn't have a schedule. Once we decided to do CIO, we established a fixed routine: every night at the same time, we had a bath, then a bottle, then a story, then bed. If one of us wasn't home, or if we were travelling, it didn't matter, we stuck as much to the routine as possible. The first couple of days were hard -- he's a persistent and stubborn little guy (even moreso at 17 months) -- and he'd cry for about an hour after we put him down. On the third night was was about 15 minutes. On the fourth night, and basically every night since then for the last year, it's been quiet and peaceful.

We still have occasional nights where he stays up and plays by himself in the crib, but he goes to sleep on his own schedule and wakes up on our schedule and rarely complains. When he's tired, he lets us know by grabbing a blanket off the crib and bringing it out to us, or prompting us to follow him into the bedroom.

Over the months, we've varied the routine slightly depending on circumstances (e.g., if he's really beat, we might skip the bath or start the routine early), but as long as we're reasonably consistent in our actions, he's consistent in his behavior.

http://www.breastfeeding.asn.au/bfinfo/crying.html
http://www.aaimhi.org/documents/position%20papers/controlled_crying.pdf

Just a few documents that cleared things up for us. We did controlled crying (CIO for you wacky americans *grin*) for a few months before reading these. Now when the little one is unsettled at least we have brain space to make a judgement call on what level of comfort we give, but there is ALWAYS some sort of response we never just leave her anymore.

Great links, Satch!

Also, anyone thinking of trying CIO should read Dr. Ferber's NEW book (he's the guy who 'invented it'). The old advice was based on research that isn't considered valid anymore. And even in that one, CIO was never intended for children under 6 months. Don't just do it, LEARN when, why, under what conditions it is to be done, and how. You'd be surprised how many people have done it horribly wrong without even checking how they're supposed to do it. or even if it is applicable to their case!

Last I heard, Dr. Ferber said 'crying isn't good for babies, or sleep'. The point is to get them to sleep without crying at all. And his main point with CIO was that babies wake up expecting what they went to sleep with, and it scares them when they wake up and the world has changed. Changing their expectations sometimes ends up causing tears, but the issue isn't 'make them cry to make them sleep' but 'wean them onto expectations that will be the same when they wake'. CIO was just one path to that goal.

We've done separate rooms, and family bed, and find that yep, it's very individual. But I'm glad we responded to our oldest son's night waking quickly and repeatedly - I'm relieved we did, especially since we found out that undiagnosed reflux and a physical problem with his neck were the source of his poor sleep. He was four years old before we found that out. I can look back and say 'at least I comforted him back to sleep when he woke in pain'. (Not that this is the issue for everyone, but looking at it from the perspective of 'would I feel bad if it was the case?' may help those deciding figure out what to do.)

Oh, and for those weird 'unexpected changes in sleep behavior' around 4 1/2 months, and 5 1/2-6 months, and about 8 1/2 months, 9 1/2-10 1/2 months, 13-14 months... those are likely normal fussy stages. Check out the book "The Wonder Weeks" (Plooij and Vanderijt) for info on when those stages are coming, what brain development is happening, and what you can do to help. You're not nuts, they really are more clingy, eating weird, and sleeping weird, and no, CIO won't change it any faster than anything else will. But you're likely to try CIO right around when it is about to go away on its own... (which tends to make people think it was the CIO that helped).

Hi, I'm a pediatrician who had a child who slept poorly and for whom CIO never worked. At 5, he was finally diagnosed and treated for a sleep disorder due to his allergies. Treatment dramatically improved his daytime behavior as well as the insomnia he was experiencing from his sleep disorder. This led me to become interested in the field of sleep medicine and write a book for parents called When "Crying it out" Doesn't Work. You can buy it on the Payloadz site or on my website. It's only $5 and can be a real life saver.
Thanks.

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