A Sob Story for All Ages

First published in Sydney Morning Herald, August 9, 2008

When Amber Jones* was a year old she was left to sleep in her own vomit by her parents as part of a popular baby sleep-training regimen known as controlled crying. The technique involves leaving babies alone in their cots to cry for increasingly longer periods of time until they fall asleep by themselves.

“The advice we were given by the infant health nurse was not to go in, even if she vomited,” says Amber’s mother, Georgia. ” ‘A baby will only sleep in her own vomit once,’ was what she said. I was horrified but she was right.”

Amber had gone from being a dream sleeper to waking every hour, after the family moved house when she was six months old.

For two nights Amber screamed, slept, woke and screamed some more. By the end of the week, she was sleeping 12 hours a night. “It was like we had a new baby,” Georgia says. “I was terrified she’d hate us but the first night she slept through she woke up with a smile on her face.”

Today Amber is a vibrant and happy four-year-old. However, there is a growing body of concern about cry-it-out sleep-training techniques and their impact on brain development and lifelong emotional health. Critics of the technique say babies that are crying themselves to sleep are not learning to settle – they are shutting down.

“These babies are learning to disassociate to escape the overwhelming emotional anguish they experience when their cries are not responded to,” says psychologist Robin Grille, author of two books on the emotional effects of early childhood experiences.

Grille says parenting customs that force babies to become independent before they are developmentally ready, such as going to sleep alone, are to blame for a range of personal and societal ills, such as depression, relationship difficulties and violence.

The Australian Association for Infant Mental Health recommends strongly against controlled crying. The association says leaving babies to cry is “not consistent with what infants need for their optimal emotional and psychological health and may have unintended negative consequences”.

For many exhausted parents, however, controlled crying is a last resort. Susie Stanton was diagnosed with depression when her daughter, India, was two. She says controlled crying helped her rein in a situation that was rapidly spiralling out of control. “She’d be awake for hours in the middle of the night and there was nothing I could do to settle her,” Susie says. “One day when India wouldn’t go to sleep I screamed at her and kicked her toy stroller across the room. I realised I’d crossed a line in terms of losing control.

“In my situation [controlled crying] didn’t feel inhumane at all. It felt like the most humane thing for both of us. I needed to get back some control and get some sleep.”

A Victorian study published last year found that teaching babies to sleep helped relieve symptoms of postnatal depression in mothers. Dr Harriet Hiscock, a pediatrician at the Centre for Community Child Health at Melbourne’s Royal Children’s Hospital, co-authored the study in which parents chose controlled crying or another approach, dubbed “camping out”, in which they stayed on a bed by their child’s cot, which was gradually moved further away before being removed from the room.

Hiscock says a three-year follow-up on the families involved in the study found no difference in behaviour, anxiety levels or response to stress between the children who were left to cry and the other group. Eighty-five per cent of parents said it had made their relationship with their baby more positive.

“If there is any emotional harm being caused, and I’m highly dubious, then it’s certainly not long-term,” Hiscock says.

But for many parents the experience of leaving their child to cry is heartbreaking. Amber’s father, Dominic, says the two nights they left her to scream were “the hardest thing” he’s ever done. Grille says asking parents to harden themselves to their child’s distress can cause lasting feelings of guilt and betrayal. “I’ve spoken to many mothers and some fathers who describe listening to their child crying as an agonising experience. It asks them to violate their deepest, most heartfelt instinct.”

One parenting organisation, Karitane, has recently developed a new set of guidelines which encourage parents to respond to their babies in sensitive ways. Teaching a baby to sleep is one thing. Leaving a distressed baby to cry unattended is another.

“Lots of new mums are told to leave their baby to cry,” says Ann Simpson, a nurse educator at Karitane. “They end up absolutely beside themselves and often feel terribly guilty. There’s no need for that.”

“The key is listening to your child and following your instincts rather than a strict routine.”

Originally recommended for problem sleepers aged 18 months and older, controlled crying is often suggested for younger babies, even newborns. Child-health experts agree that to grow and thrive, a baby may need one or two night feeds up to about nine months of age. Strict sleeping and feeding routines for babies under six months have been linked to poor weight gain, dehydration, breast-milk supply failure and involuntary early weaning.

Robin Barker, a former maternity nurse and author of three bestselling parenting books, doesn’t recommend controlled crying for babies younger than six months. But she believes leaving a well-fed, well-loved baby to cry itself to sleep is nothing for parents to lose sleep over. She gives detailed instructions in her book, Baby Love.

Hiscock says 45 per cent of Australian babies aged six to 12 months have difficulty sleeping.

Amanda Hutchins found co-sleeping with her daughter Nara, now 20 months, in a sidecar arrangement, where one side of the cot is removed and pushed up against the parent’s bed, made dealing with night waking relatively stress-free for both of them. “Of course she has her bad nights. But often just a hand on her back is all it would take and we’d both be back to sleep in a few minutes.”


*Names have been changed for web publication