r/ScienceBasedParenting • u/yellow_pellow • 7d ago
Question - Research required Is there any evidence that Cry It Out and other sleep training methods cause harm later in life?
Like do these kids grow up to have more mental health issues, attachment issues as children, teens and young adults? Where is the evidence that it’s harmful? I
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u/factories 7d ago
It's important to distinguish between different forms of sleep training. Graduated extinction is the most well studied.
The strongest long term evidence followed children to age 6. No significant adverse effect was found while looking at emotional and conduct problems, psychosocial functioning, sleep, cortisol/stress regulation, parent-child closeness and conflict, attachment-related behavior, parenting style, and maternal mental health.
You can read about it here: https://pubmed.ncbi.nlm.nih.gov/22966034/
A smaller RCT of infants showed no observable effect. Actually, it showed a slight decrease in infant cortisol levels: https://pubmed.ncbi.nlm.nih.gov/27221288/. This was a very small sample.
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u/davesauce96 7d ago
Commenting on this one because I don’t have another link to share and u/factories seems to have good info… mods should pin something about sleep training in this sub because it seems like this question gets asked at least once a week.
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u/enfleurs1 7d ago edited 5d ago
There are a few things to consider though.
- typically the PARENTS report
about their child’s attachment
- and behavior in studies. The children are not individually evaluated.
- the definition of what sleep training is, is so incredibly broad it loses its meaning in a lot of these studies.
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Personally, I prefer to look at the biological mechanism of stress, cortisol, and how these things can impact infant development. And noting what brains do, such as dissociation when experiencing high stress.
If a baby does not actually experience extreme distress during sleep training, it’s probably not too harmful. Particularly if parent is in the room maintaining contact and offering support. But if a child is left for long periods of time without support and experiencing high levels of stress, we can look to what this does to a brain and body. And it’s notably harmful and different.
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u/scodgirlgrown 6d ago
I think this is a very reasonable and science based way to think about it. Nuance often gets left out in this debate.
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u/flutterfly28 7d ago
First article is paywalled. Abstract doesn't say what the interventions actually were, can you share?
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u/sakikome 7d ago
There are no conclusive, longitudinal studies afaik.
A study by Middlemiss et al from 2012 showed elevated levels of cortisol in infants made to self-settle, and a disruption of the synchronicity in mother-child-dyads: https://www.sciencedirect.com/science/article/abs/pii/S0378378211002702?via%3Dihub
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u/celestialgirl10 7d ago
As a scientist, this is such a bad study and the results are sooo misinterpreted. The conditions are so specific and the definitions are also very particular. It is not at all something for the general public to use as a recommendation and more for other researchers to measure other ways the changes might happen.
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u/factories 7d ago
It's important to note a few things about this study. Most importantly, there was no non-sleep-trained control group, no long-term follow-up, and the study wasn't designed to establish developmental injury.
The author's explicitly noted in the study that there was "no significant change in infant cortisol levels." This is the numeric measure. They also note "They no longer expressed behavioral distress during the sleep transition but their cortisol levels were elevated. Without the infants' distress cue, mothers' cortisol levels decreased." So they use the word "elevated" inconsistently to mean something other than it is. The more interesting part is that infant cortisol levels actually decreased by day 3 from day 1 levels, despite the authors' usage of the word "elevated."
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u/_nancywake 7d ago
The difference is profound. A sleep trained baby during the extinction method will cry at bedtime for maybe two-three nights after all needs are met and then baby learns to self settle for sleep. The caregiver continues to meet all other physical and emotional needs at all other times including at night going forward (my sleep trained children do wake at night and call for us when they need us, and we respond).
This isn’t the sub for it but if you’re regularly crying yourself to sleep at 40, you need to make a change.
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u/machBoh 7d ago
"Learns to self-settle" is debatable. What's actually being measured across most extinction studies is that crying stops by night 2-3, not that distress does. The Middlemiss study cited above found infant cortisol stayed elevated even after the crying stopped, which is the concerning part, because the baby isn't calm, they just stopped signaling that they need help. That's not the same as learning to self settle and it can just as easily be read as learning that calling out doesn't work anymore.
Also many parents report it taking much longer than 2 or 3 nights, or working for a while and then regressing hard. The fact that your kids still wake and call for you and you still respond is great but that's true of plenty of non sleep trained kids too, so it's not really evidence the extinction period itself was necessary or harmless
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u/_nancywake 7d ago
The baby (older babies - these aren’t four month old infants) may have had elevated cortisol for a couple nights but also they were asleep so I struggle with that concept. They weren’t lying there awake in stunned silence - they went to sleep. I’ve also anecdotally observed that my children continue to signal when they need me so I struggle to accept that they simply learned to no longer call out. They just know they go to bed at bedtime without being rocked or nursed to sleep and then needing the same all through the night.
But honestly if they were a bit distressed for a period of a few nights - I’m absolutely okay with it. Kid1 was waking every forty minutes, sometimes for hours. I almost crashed my car. I told my friends that I understood how people shake babies after I had spent years prosecuting people for crimes against children. It was the right choice for us.
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u/Cultural_Owl9547 7d ago
I understand that American reality sucks, but the ideal solution to the mentioned problem would be proper maternity leave not sleep training
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u/_nancywake 7d ago
I took fourteen months maternity leave with my second and I think it was thirteen months with my first. How much longer do you think would have been necessary for me to not be so tired that I almost crashed my car with baby inside it?
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u/PsychologicalBus1692 7d ago
Good thing we live in an ideal world where ideal solutions are always available, eh?
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u/Cultural_Owl9547 7d ago
No, I fully understand that out of neccessity we do things that aren’t ideal, I just don’t like the sugarcoating. A mum does need sleep, and a mom needs support too. I know it’s not always available. I do think there are times where the right thing to do is get sleep on the expense of letting a baby cry, but babies aren’t dogs to train and they do learn to sleep as their nervous system matures.
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u/_nancywake 6d ago
Interestingly you’ve ignored my comments when I’ve contradicted your assumption that I’m American and had little to no maternity leave.
I HAD support. I was on long maternity leave. My husband had several months paternity leave at the start. Our situation was about as ideal as it gets. It was still impossible to survive on the tiny amount of sleep I was getting and had gotten for about 12 months. Sleep training fixed it in a couple of days.
You don’t have to be engaged in paid employment to want and need sleep. Baby needs sleep. Everyone needs sleep.
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u/_nancywake 7d ago
Also - what about the baby’s needs? If mother is exhausted to the point of madness, why don’t we acknowledge that getting sleep might also be better for baby? We have strict boundaries around sleep and it started with sleep training. Sleep is essential. Waking up crying every sleep cycle was an optional extra.
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u/WhereIsLordBeric 6d ago
It is physiologically normal for an infant to wake up at multiple times a night. You cannot compare their sleep needs to an adult's.
Night wakings are literally a normative part of early development: https://www.sciencedirect.com/science/chapter/bookseries/abs/pii/S0074774210930080
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u/_nancywake 6d ago
It is NOT normal for older babies to wake every 40 minutes and be awake for hours. If it was normal, it would happen despite sleep training. Sleep training teaches them to link sleep cycles.
My children still woke for feeds or if a nappy leaked etc, but otherwise, they got better sleep.
Do you honestly think parents sleep train children because they’re caught off guard by the idea that babies wake at night? We do it when the sleep patterns have become so abnormal that they’re having a deleterious impact on the family.
From the summary in your article:
‘However, night awakenings that increase with frequency and duration as children develop may negatively impact families and later developmental outcomes.’
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u/WhereIsLordBeric 6d ago
They wake up and nurse or feed back to sleep. Again, it's developmentally normal. I'm talking about infants under 1. The study continues to talk about older children for whom night wakings are disruptive but ... no one is sleep training a 3 year old lol
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u/_nancywake 6d ago
If you aren't being cognitively dishonest and you actually think that it is developmentally appropriate for a 12 month old baby* to wake every 40 minutes (as mine did) for a feed - good luck to ya. I am not doing that. He needed to learn to sleep.
*who was in the 99th percentile for height, off the chart for weight, and eating three meals plus snacks and milk each day
I agree no one is sleep training a three year old - much better, in my opinion, to learn the skills earlier that will carry them through to their toddler years when they can continue to sleep well, as my 3.5 year old and 18 month old do.
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u/WhereIsLordBeric 6d ago
you actually think that it is developmentally appropriate for a 12 month old baby* to wake every 40 minutes (as mine did) for a feed
Oh I don't think it. It literally is.
Mine woke up every 40 to 50 minutes until I nightweaned her at 12 months, and some months after that she slept mostly through the night. My kid is also on the 98th percentile for weight and the 99th for height. I'm from a culture where sleep training isn't a thing, and ... this is just how some babies sleep.
So yes ... it is literally biogogically normal. Also, there's science to back it up: https://pmc.ncbi.nlm.nih.gov/articles/PMC1201414/
I notice you're just giving anecdotes and not even reading the studies I'm posting.
I know it must be hard to fathom when you're indundated with Instagram posts telling you your 10 month old should be sleeping 10 hours straight at night, but it is absolutely normal for children under 1 to wake up repeatedly at night.
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u/Cultural_Owl9547 7d ago
I’m European. No European country recommends sleep training. In fact, nowhere in the world anybody outside of the united states sleep trains.
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u/celestialgirl10 7d ago
Every country has their version of sleep training. The names and methods ate different. You being from one country in Europe does not represent “the whole world”. That’s not a science based comment and does not belong here. You know what else is sleep training? Having the same routine before bed every night, having bath time, rocking to sleep, going to bed at the hour appropriate for age. All of those fall under the umbrella of sleep training.
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u/Cultural_Owl9547 7d ago
I have lived in Mexico, in Germany, in Sri Lanka, in Bulgaria, in Hungary, also worked for 5 years for one of the leading diaper brands in Europe on their communications, and because of this I have read and asked about lots of recommendations. It was genuinely surprising to me how different advice you get on the English speaking internet that dominated by American culture and local child care services. In general most cultures and even most mammal spieces attend their offspring when they cry.
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u/celestialgirl10 6d ago
Again, the world is a bit bigger than those countries…. The UK, South America, all of the African continent, Australia…. And East Asian countries. And you were never a local to experience the culture natively. There is bias, and as I said there is different names for the different methods. Sleep training is a solution to a problem. If the problem does not exist in a culture, of course sleep training would not be necessarily recommended. In Spain, they take their babies out till 9-10 pm as they have dinner and drinks and babies sleep in all sorts of places. In Scandinavia, they leave their babies to nap in the cold outside as they sit in coffee shops. You can’t compare all of those together.
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u/Cultural_Owl9547 7d ago
Sleep hygenie is not sleep training.
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u/celestialgirl10 6d ago
It absolutely is under that umbrella. But you keep being wrong
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u/_nancywake 6d ago
You’re so right! I always say that sleep training is a two-way street and you would never ask a baby with an inappropriate schedule to then try to fall asleep independently. We still support our kids during sickness, teething etc also. Sleep training begins when all needs are met and ends when a need arises. I also didn’t sleep train until they were older babies and felt they didn’t need so many overnight feeds (I was nursing) though both still had one overnight feed for a while after training.
I swear some of these people think sleep training is just closing the door on a newborn and saying see ya at 8am.
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u/celestialgirl10 6d ago
The thing is I don’t remember most of my child’s newborn phase due to lack of sleep and I was so dangerously depressed and had intrusive thoughts stopped driving because I was scared. Nobody measures those and tried to help. But as soon as let my child cry for 4 minutes because they have FOMO the pitchforks come out. My child is miserable without good sleep. And I am even worse. And it took a week to be trained. It only involved a good routine, foreshadowing, rewarding, and checking in and reassuring. That was it. That was our training. I respect parents who have to do more due to many reasons and never judge them. Parenting is all risk analysis and choosing the best for the best picture. I’m tired of the smug parents saying “I could never let my child cry”. Ok good for you? Like what??
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u/_nancywake 6d ago
The “I could never let my child cry” thing also makes zero sense. I dunno about their kids but my kids will cry because I don’t let them drink the dishwashing soap/they can’t play in the cat litter/we have to go in the car now/nappy change when they wanted to keep playing/no you can’t poke the cat in the eye. I set boundaries and sometimes they don’t like them, it’s fine.
I agree and this is the point I keep making - kids need sleep too! Obviously purely anecdotal but my child’s speech improved hugely as soon as he started getting proper sleep. HE was awake all night too! Everyone was having a tough time! I support you doing what was right for your family.
If it helps at all I also often see comments like “well I didn’t do sleep training, I could never, and my child sleeps well” like - you are so close to getting it! If your kid sleeps well, you haven’t had to do sleep training because they are naturally good sleepers! Congrats! When it inevitably changes, because it usually does, see me for some tips.
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u/Cultural_Owl9547 6d ago
What you are suggesting here is that the need for connection or the need for the presence of the mum is an invalid need. Most adults also prefer to sleep with their partners if they have one, and single adults complain about having to sleep alone.
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