Controversies: Is Swaddling Dangerous?

For the most recent Carnival of Evidence Based Parenting, Melinda Moyer discussed the recent debate over swaddling.  Swaddling has been on my list of controversies to address, but I believe Melinda covers the research very effectively. So, instead of my reinventing the wheel completely, I suggest you hightail it over to her column on Slate to read her conclusions.

Melinda brings up six arguments against swaddling and then the rebuttals. I’ll excerpt from her article here.

1.) Sleep Positioning

As Melinda points out, one concern of the National Resource Center on Child Health and Safety is the possibility of swaddled babies being put to sleep on their stomachs. However, as she says,

Yes, swaddled babies left on their stomachs are more likely to die—you, too, would have trouble catching your breath if someone wrapped you like a burrito and put you belly-down. But it turns out that swaddled babies are also more likely than unswaddled babies to be placed on their backs, which means that swaddlers are more likely to adhere to the American Academy of Pediatrics’ safe-sleeping recommendation

2.) Rousing from deep sleep

While it’s true that arousal problems are considered a risk factor for SIDS, research on the swaddling aspect is conflicting. One 2010 Australian study found that babies who were regularly swaddled did not have any more trouble waking than did unswaddled babies. At the same time, it was slightly harder to wake swaddled 3-month-olds who were not used to being swaddled (though the effect didn’t exist among 3-to-4-week-old infants). A 2005 study conducted by French and Belgian researchers suggested that swaddled 10-week-olds were actually more easily awakened (but, paradoxically, sleep better) than unswaddled babies. Ultimately, it’s hard to say what swaddling does to arousal, but there’s little evidence that routine swaddling poses a problem.

3.) Hip displaysia

But the type of swaddling taught in U.S. hospitals and recommended by Karp allows babies’ legs and hips to move freely. Plus, “for the past ten years, Americans have been swaddling a great deal, and we haven’t been seeing reports of more hip dysplasia,” says Bradley Thach, a pediatrician at Washington University in St. Louis. Even the International Hip Dysplasia Institute agrees that with proper technique, swaddling is perfectly safe.

In addition to Melinda’s points above, I want to bring up three more concerns regarding swaddling.

4.) Neurological organization and soothing

Arms up or arms down? That, if you believe it, is a common debate on the baby boards.  Some parents think that swaddling babies’ arms down by their side is cruel and ‘mummifying’ and that arms crossed over the chest is more comfortable. Other parents point out that children seem much more calm if their arms are all the way down. There’s also a variation on the debate: whether the child’s hands should be accessible for self-soothing.

This is especially relevant when dealing with premature infants. A common medical concern regarding swaddling preemies’ arms tight by their side is that it restricts them from bringing their arms midline.  The midline position is the more natural position for babies in the womb.  As one neonatal nurse points out, everything happens at midline – rolling over, crawling, pulling up, etc.  The concern is that by restricting that positioning, we train babies to keep their arms by their sides as opposed to midline, creating a ‘flying W’.

Another common concern is that wrapping the arms tight by the side fail to promote neurological organization. Touch is very important to neurological organization, especially for preemies. Skin-to-skin kangaroo care is now well-regarded as critical to helping premature infants’ developments, and when swaddling, allowing a preemie’s hands to touch each other allows for that sense to develop.

For infants with hypotonia, doing what is called a developmental swaddle (a swaddle that promotes the midline position as opposed to an arms-down position), may even help promote development by keeping a baby’s arms midline and hands touching.

However, as swaddling-promotor Harvey Karp points out, what is true for preemies isn’t always true for full-term infants.  Neurological development and motors skills unfold more naturally for a full-term infant, and therefore a few hours of arms-down swaddling per day shouldn’t affect development.  In addition, full-term infants experience more intense and active bouts of crying, thereby leading to flailing arms, further distressing the infant. Arms-down swaddling can help prevent that.

Dr. Karp also takes on the idea of arms-down swaddling affecting self-soothing, pointing out that very young infants often are unable to self-soothe using their fingers. Therefore, they get even more frustrated when their hands hit their mouth and they try to suck but are unable to coordinate the whole shebang.

Others, however, point out that many infants suck their fingers in utero, and also that since thumb sucking is an early sign of hunger, allowing an infant access to fingers helps promote on-demand breastfeeding.

Unfortunately, without great research, both ends of this debate may just have to agree to disagree. However, the relevant point here is that if you are against arms down swaddling, you can always wrap a child with arms completely out or with arms flexed on the stomach. Anecdotally, I’ve found wrapping a child with arms completely out works only when the child is older. Wrapping with arms flexed on the stomach seems to work, but one has to be a pretty good swaddler to do it right (I have never been able to do it right  – every time I try to wrap a child with arms up on the chest, the child escapes the swaddle.)

If you are interested in trying to wrap a child with the arms in a more ‘natural’ position, I suggest trying the Australian swaddling technique.

5.) Motor development and 6.) Overheating and respiration

These are two areas I haven’t delved into deeply, but  Pediatrics review of all studies to date regarding swaddling has shown that motor development (including the age an infant begins to walk) and overheating are not issues when swaddling is done in an optimal manner.

 

What other information do you have on swaddling? Let me know in the comments! I’m especially interested in the idea of swaddling and rolling over; common wisdom is to stop swaddling before a child begins to roll, but some parents continue to swaddling into the 9th and 10th month of life.

Mommy Training Part One – Resources on Baby Sleep and Routines

"Ok, so you thought newborn sleep was bad..mwahahaha!"

“Ok, so you thought newborn sleep was bad..mwahahaha!”

First, a note-

Common sense

(Smack it up, flip it, Rub it down…er,highlight this)

Seriously, a parent that uses common sense and never reads a book is better than a parent who follows one book/philosophy religiously. I’ve seen more harm done with, “But Dr. So and So said this!” than, “Oh, huh, maybe she’s hungry. Let’s figure this out together”. I can’t stand going into forums for different parenting styles where parents try to mold their babies or lifestyles into what is clearly NOT working for them. Use your heads. Pediatricians can be stupid too. On that note, don’t blindly listen to even your own pediatrician or nurse, unless you want backup for a parenting decision you’ve already made.

On to the books…

Happiest Baby on the Block by Dr. Harvey Karp

Pros: Ok, this all seems like a no brainer to most experienced parents, but it was mind blowing when I read it years ago. Newborns are in their “fourth trimester” until they are 3 months old. They still need to feel like they are in the womb. Hence, swaddling, rocking, white noise, etc. Genius. Get the DVD if you’re too busy to read.

Cons:  No exit strategy, especially for swaddling. Luckily I”m a worry wart and immediately was like, “well, if I swaddle now, what happens at four months when she might no longer need to be swaddled but she thinks she needs it and….aaah!”. So we slowly around 2.5 months started experimenting with loose swaddles, or deswaddling her, etc.  Nothing really worked until about a week before she turned four months, when she fell asleep readily with only one arm swaddled. One week later, she was fully deswaddled. So this isn’t a major complaint about the book, because I think Dr. Karp believes babies will develop and let you know when they are ready to stop being swaddled, and that was true for us. But so many parents TIGHTLY swaddle (like legs and everything, which we didn’t do) until four months, and then they have a heck of a time weaning the baby off of it when they start rolling, or when the blankets get too small for them. I’m glad we started the deswaddling process slowly and without any time pressure. It worked great for us.

My son, on the other hand, didn’t really love swaddling or white noise in general,but in a pinch, using the 5 Ss (Ssshing, side/stomach, swinging, sucking, and swaddling) were super helpful.

For a really controversial take on the Happiest Baby on the Block, look here. I suspect the author is a proponent of RIE (Resources for Infant Educarers) which I hope to get into in another post.

A side note on swaddling..

There is definitely controversy on swaddling methods. Here is Dr. Karp’s swaddling guide.  However, not only are there concerns regarding hip displaysia (go here for hip friendly swaddling methods), there is controversy regarding putting the baby’s arms by its side (which is how I swaddled) vs. crossing them on their chest (which is considered by many parents ‘less cruel’).  There’s the ‘Aussie Swaddle’, which allows the baby to suck on his or her thumbs. There is apparently research out now that indicates that the baby’s arms should be completely free so the hands can touch, allowing for neurological development (I do not have a source on this one, and will try to find it…but I suspect as long as the baby isn’t swaddled all day long, this shouldn’t be a problem). Finally, there is the belief that swaddling may increase SIDS risk, because of a.) overheating and b.) the fact that the baby does sleep too long and too well, therefore not allowing the baby to wake up if there is a problem (many things that ‘lower the SIDS risk’ are actually tied to making sure the baby isn’t sleeping too well – ex: pacifier, breastfeeding [baby wakes up more to eat], and tummy sleeping [although there are other aspects of this including breathing, one is that the baby sleeps too well on his or her tummy].

On the other hand, I see claims that swaddling lowers the SIDS risk for the exact same reason (babies who are swaddled wake up more easily to problems, goes this hypothesis).  This means I absolutely have to do a Controversies post on swaddling!

Wonder Weeks by Hetty van de Rijt Ph.D.

Pros: It’s amazing in explaining why babies sleep well, then sleep badly, then sleep well – especially the dreaded 4 month sleep regression (yep) and the 18 month sleep regression (double yep). (Try having a four month old and an 18 month old at the same time.  Four months is when a lot of parents start cry-it-out techniques because their good sleeper all of a sudden turns horrible. I didn’t because I knew what was going on – a major developmental spurt that kept her awake. Also gave me peace of mind that she’d grow out of it after a month (until about 6 months when sleep turns a bit crappy again).

Note – I wrote most of the above when my eldest was 5 months old.  I tried the same philosophy with my son. He did not grow out of the 4 month sleep regression…instead he picked up a lot of bad sleep habits that I still haven’t quite broken.  In fact, I’ve found many previous ‘good sleepers” start going downhill at 4 months – due to the sleep regression – and then continue on with the habits learned while parents try to cope with the regression. Lesson learned – shortcuts (cosleeping, etc) are well and good for your sanity, but keep in mind those may become habits later (this does not apply if you have no problem cosleeping, no problem nursing to sleep, etc – this is only for parents who prefer their babies laid down awake in their cribs).

Cons: None really, because it’s not a parenting philosophy book. It doesn’t tell you what to do – it just tells you what’s going on.

For more information on regressions and wonder weeks, go here,here, and here.

There is a Wonder Week iphone app and this is the Wonder Week website.

Healthy Sleep Habits, Happy Child by Dr. Marc Weissbluth

Pros: Great research on how sleep is SO important and how naps are different from nightsleep (ex: a good night’s sleep does not make up for lack of napping – uses different parts of the brain). Explanations on how much sleep a baby actually needs (11-12 hrs of nightsleep, napping varies with age) Explanations on how long a baby can happily stay awake. Very helpful info.  Talks about teaching a baby to fall asleep on her own, so she doesn’t need to be rocked or nursed to sleep every times she wakes up.

Cons: Advocates in “extreme” cases the extinction method – which is just letting a baby cry forever, without even checking in.  Totally against “attachment parenting” (which I’ll discuss later) including EVER nursing or rocking a baby to sleep. I think you do what works. With my super-sleeper (my eldest), I tried to put her down “drowsy but awake” like they advocate, and it worked 95% of the time. But sometimes she needed to fall asleep eating, or be rocked to sleep. I really didn’t care, as long as I mixed up the various tricks to get her to sleep so she wasn’t dependent on one.  Same with my second child – who picked up habits more. When nursed to sleep a lot, that’s all he wanted to do to go to sleep. Right now he won’t sleep without being in bed with me. I’m at peace with that, but if it concerned me, the key is to start mixing up “going to sleep’ methods.

For more information on sleep training, go here. For wake time charts, go here.

On Becoming Babywise (Gary Ezzo) and Solve Your Child’s Sleep Problems (Dr. Richard Ferber)

Pros: I have not read either book. However, it generally does advocate the basic philosophy of cry-it-out with checks. Ferber has become the synonym for cry-it-out. Parents just a little older than us usually call it “Ferberizing”.

In addition, Babywise (like a few other books) advocates the Eat,Sleep, Play routine, something that worked really well with my elder child.

Cons: A few notes again on common sense – I like using things like Eat, Play, Sleep and maximum wake times as guidelines – but I by no means am slavish to the schedule. Some strict followers of Babywise really end up screwing their breastfeeding relationship because they are so focused on sleep and schedules. Breastfed babies are hard to fit into your convenient lifestyle. They are very inconvenient! It’s not really the fault of these books – it’s parents who are ‘all in’ or nothing.

Also, Babywise advocates Parent-Directed Feeding, which is in sharp contrast with the current zeitgeist of On-Demand Feeding. A comparison of the two (and the claim that on demand feeding raises IQ points) will make a good Controversies post.

The AAP has written an anti-Babywise commentary, linking it to failure-to-thrive. I again suspect some of this is related to the misuse of the Babywise idea. However, on a personal note, although I believe in on-demand breastfeeding, I did unconciously start scheduling my eldest’s feeds due to these ideas, which led to the death-knell of our breastfeeding relationship. My younger baby was completely on-demand while we were breastfeeding. The reason he is no longer breastfed has nothing to do with the success of our breastfeeding relationship and instead due to medical necessity.

Go here for more info on Babywise.

The Baby Book/Nighttime Parenting by Dr. William Sears

Pros: Your life DOES change when you’re a parent. Babies are supposed to be inconvenient, and they need you.  Great on breastfeeding advice (fully endorsed by La Leche League and every lactation consultant I’ve ever met). Love the relaxed attitude to parenting..love em, rock em, sleep with em, wear em, nurse em on demand…so lovingly earth-motherish. Oh and babies cry because they are trying to tell you something. Figure it out. The less babies are allowed to fuss or cry during the day, the better they sleep at night and the more confident they grow up as adults because they learn they matter.

Cons: Oh man, I feel like I can’t get into the cons without angering some parents. Let’s say it this way –  I’m not much of an attachment parent and my eldest wasn’t an attachment baby.  Cosleeping didn’t work for us, breastfeeding didn’t work out for us, baby wearing didn’t work out for us until she was older. We don’t quite look like an AP family, do we.. But we did what worked, adjusted ourselves accordingly, and many APers will subsequently see us as bad parents, even though I was as hyper-attentive to her needs as most APers are, to sometimes the detriment of myself.  There can be a lot of stress associated with the AP philosophy – but as I’ve indicated above, there can be a lot of stress associated with the Babywise philosophy too regarding sleep habits and schedules.

Go here for more Dr. Sears

Secret of the Baby Whisperer by Tracy Hogg

Pros: Eat, Activity, Sleep, You Time (EASY routine). That’s what my eldest did usually – she ate, she played, then she slept, all on a beautiful 3 hr schedule. Reading this helped me figure out my baby.

Cons: She dictates a three hour schedule then a move to a four hour schedule.  I don’t think it’s beneficial to dictate a schedule for a baby. Recognizing when a baby is likely to be hungry and likely to be sleepy has been a Godsend for me, but internet forums are full of parents trying to MAKE their kid eat every 3 hrs on the dot or make their kids wake up after eating. EASY works pretty well with formula fed babies (like my first) but difficult to implement with breastfed babies (like my second) In addition, a four hour schedule is quite difficult for any baby, including formula-fed ones.

Go here for the Baby Whisperer forums.

The books above vs. the books below

I actually wrote about the above books when my eldest was 5 months old, and then just went through and edited the reviews to make more sense in the context of now (and tried to edit down my biases).  At 6 months old, we had a few more sleep issues and I ended up doing some cry it out, with the support and advice of this forum. ( Before that 6 month mark, I was actually super-anti-cry it out, which is easy to be when you have the BEST sleeper ever.

Modified cry-it-out (I did a slightly more gentle/instinctual version than the strict Ferber method) worked great for my eldest and it wasn’t a big deal. There were still times when she was a crap sleeper, and there were still times I didn’t want to do any CIO and just ‘gave in’ like sleeping in bed with her. Again, this is where “what works for you” comes in. But anyway, the books I read gave me the tools I need, whether it was Dr. Sears or if it was Dr. Weissbluth.

Go here for the researchy take on the cry it out controversy.

Then my son came along. Slept through the night as an exclusively breastfed newborn. Hit the four month sleep regression hard. Needed to be nursed down to sleep even with brief night wakings, got to the point he didn’t want to sleep without being held upright or without being in his Rock N Play sleeper. At 6 months, I tried cry-it-out. Worst decision ever. He is way too sensitive a soul. It did nothing, and he ended up hoarse. (Go here for a discussion on tension releasers vs increasors). So I picked up two other books I had heard about but hadn’t had the occasion to read. (Spoiler alert- things got better, fast. Then I went away for a week, things were in upheaval around my house, and I came back to a baby who wouldn’t sleep unless he was in bed with me. Now we are cosleepers, but he is a great cosleeper who goes to sleep with no intervention as long as he’s in bed with me, and sleeps all night without waking once. I’ll take it.)

So I ended up reading the following two books:

The No-Cry Sleep Solution by Elizabeth Pantley

Pros:  This is perfect for the APer who is anti-sleep training but cannot take the family sleep situation any longer. Has tips on every stage and age. Advocates using gentle techniques to avoid crying. Focus on understanding why baby is waking and fixing problems with routines, new associations, and gradual changes in patterns. Supportive of breastfeeding and co-sleeping as well as crib sleeping and bottle feeding. Ideas like the ‘Pantley Pull Off“,which is delatching the baby before he completely falls asleep.

Cons: Only small incremental changes.  Will likely take more than the two weeks she’s talking about to see results,especially if you yourself are resistant to change (ie: believe there’s no way the baby will go to sleep without nursing completely down,and therefore don’t do the ‘Pantley Pull Off’ method appropriately. A lot of common sense stuff, so some parents may feel as though they did not get their money’s worth.

Go here for a Mothering.com support thread on the No Cry Sleep Solution. Take heart that your sleep situation is probably way way better than theirs.

I got frustrated with No-Cry and moved on to Good Night,Sleep Tight, butlLet me give it a plug – because of the No Cry Sleep Solution, I was able to implement the Good Night Sleep Tight method much more effectively.   I hadn’t realized it at the time, but the No Cry method did teach my son how to fall asleep by patting/shhing instead of nursing, which made it a lot easier when he woke up in the middle of the night or woke up as I tried to lay him in the crib.

Good Night, Sleep Tight by Kim West (aka the Sleep Lady)

Pros: This is sold as the gentle approach to cry-it-out.  Ideas on how to teach your baby how to sleep from birth onwards (gently) and thereby avoiding sleep problems later.  (Ideas on how to teach a newborn how to sleep are things I did instinctively with my first – I sat with her as she fell asleep on her own for all naps and bedtime for a while, and eventually she could do it herself. I credit that with the good sleeper she generally has been). Goes through each age/stage.  Advocates sitting with your baby as he falls asleep and then gradually moving further and further away. There will be tears involved, but most likely just some frustrated crying and/or fussing.

Cons: Don’t get me wrong. This is cry-it-out.  For highly sensitive babies like mine who screamed the minute he was laid in the crib, it was just as bad the first night as implementing Ferber.  For other babies, it probably is much more gentle, as the child can see you sitting right there.  She advocates not picking the baby up unless he is hysterical and that it is unlikely that the baby will be hysterical – my child was hysterical the entire time. What kept me going is that he was being hysterical at every bedtime and naptime no matter what – whether I was rocking him, or nursing him, or bouncing him, or sitting right there next to him. But I had to be prepared for those tears. After that night, it was much better – some tears, but no more screaming – however, I adjusted for his sensitive nature and picked him up much more than recommended and took much longer to move through the “shuffle” (moving my position farther and farther away from him). Also, for some babies, sitting with the baby may be worse than just leaving the room, because being right there may frustrate them more.

My recommendation

I really like the Good Night Sleep Tight method for parents who want to try cry-it-out but still freak out the entire time because they want to reassure their babies. Sitting with the baby really does help alleviate a lot of those feelings (although like I said, for some babies, leaving the room may actually help them more than sitting there where they can see you and be frustrated). I even implemented some of the methods with my elder child, who decided all of a sudden that she wanted to sleep in our bed, not hers, even if I was sitting right next to her in the room. I spent one night sitting on the cot next to her bed as she cried. She was old enough to tell me if something was wrong, and I was there next to her so she didn’t feel abandoned. That gave me incredible peace of mind (again, especially because she is a toddler and could tell me if something were wrong). After that, she slept fine in her bed, although right now she wants one of us on the cot next to us, which is a whole another issue (that we are indulging for now, because she’s at the age that separation anxiety gets pretty bad).

And yes, that means every night, the baby is in the big bed with me, while my husband is sleeping on the small cot next to the toddler’s bed. It happens.

For the most comprehensive and ridiculous review of infant sleep I have ever seen, go here.

Controversies: To Cry It Out or Not? There Might Not Be Much Research Either Way.

Look at this face. Could you let her cry?

Look at this face. Could you let her cry?

Few things elicit more controversy, advice, commiseration, and myths than infant sleep. Parents are asked early on if their babies have ‘slept through the night’ yet. Debates rage on regarding what exactly IS sleeping through the night and what we can expect at which age.  But by far the most controversial aspect of infant sleep is the concept of crying it out.

Let Me Sing You the Song of My People
First, what is crying it out? I will get into the how and when in the Basics portion of the site, but in general, it involves leaving a baby in the crib to put him or herself to sleep, after checking that they are clean, dry, healthy, and full.  For most people, crying it out involves a process of checking on the baby at intervals, to reassure him or her, and then leaving again, allowing the baby to ‘work it out’. Crying-it-out, especially in this form, is also referred to as ‘Feberizing’, after the work of Dr. Richard Ferber, who published his book, Solve Your Child’s Sleep Problems, in 1985. Some parents also refer to crying-it-out with the generic term “sleep training” although that of course can encompass no-cry methods as well.

Varieties abound. Intervals for checking on the baby can be shortened or lengthened. Some methods involve just a brief 30 second visit to the baby’s room with verbal reassurances, and some advocate picking the baby up until he or she is completely calm. There is also Attended CIO, which involve the parents staying by the baby’s crib until asleep, picking him or her up if hysterical crying ensues.  There are differences in opinion regarding what age to let a baby cry (Babywise by Gary Enzo seems to advocate it sooner than most).  Finally, there is the extinction method, best described by Dr. Marc Weissbluth in Healthy Sleep Habits, Happy Child, in which, in “extreme” cases, one just lets the baby cry to sleep, with no checks or reassurances.

As you can imagine, this is a deeply personal topic for many parents.  The attachment parenting philosophy, of course, is 100% against any sort of cry-to-sleep.  Dr. William Sears, the current guru of Attachment Parenting, states, “Baby loses trust in the signal value of his cry – and perhaps baby also loses trust in the responsiveness of his caregivers. Not only does something vital go “out” of baby, an important ingredient in the parent- child relationship goes “out” of parents: sensitivity. “  An essay I see commonly bandied about parenting forums is “Just Let Her Cry”, giving cry-it-out an adult perspective (“Sometimes,” she writes, “I’d be having a day where I felt I may be able to eat or drink something, and I would call out to him, asking for something.  Again, he would ignore me.  Sometimes he would poke his head in, but it was only to tell me that I needed to go to sleep and I was “fine”.  I had times where I grew very depressed.  On top of being sick and miserable, I missed my husband’s loving arms.  Sometimes I just needed to be held and comforted.  Still, he would ignore me.”).

On the other end, of course, are parents who state, first, that there was no other way to get the baby to sleep, that months of sleep deprivation were wearing on them, that this was as much for the baby’s health as theirs – babies need to sleep. “Walk a mile in my shoes,” they state.  The retort from the other side is often a mix of, “I did it, so can you,” “What did you expect? This is motherhood. Your baby needs you,” and “Your expectations were too high -babies are supposed to wake in the middle of the night, and we are supposed to comfort them.”

The fact that babies need sleep and the fact that babies do wake up at night are both valid, and I can get into that in more detail in the Basics section.  As you can see, just like with formula feeding vs. breastfeeding vs. who cares, there are so many variables in this discussion. Personal philosophy of the parent, disposition of the child, disposition of the parent, parental expectations, advice and comments from social circle, pediatrician advice, mental state of the parent, the extent of the child’s sleep issues (and related to expectations, whether or not the parent sees it as an issue), cosleep vs. not, nightwean vs. not, how much the parent thinks a child needing sleep trumps a child needing to not cry (and vice versa…), and on and on.

On the disposition of the child front, the concept of the tension releaser vs. the tension escalator is relevant, as well as the concept of fuss-it-out vs. full blown CRY it out.  As Moxie points out, some children, the tension-releasers, need to exert energy by fussing or crying a bit before sleeping.  If those parents let the child fuss or cry to sleep, it’s considered cry-it-out – but it’s quite different than the experience of a parent with a very sensitive child, who may scream his or her head off the minute when placed in the crib. Those parents look at CIO parents completely askance.

…. Of course, with the fuss it out part, Mothering.com, known for its strict forum guidelines regarding certain positions contrary to peaceful parenting, takes issue even with discussion of a child fussing in his or her crib.

However, instead of the dramatics of this particular Mommy War, what I’m interested is is what the research shows.  Can cry it out damage a child? Conversely, can the lack of sleep training actually harm a child’s ability to sleep well (and all that comes with it – learning and development) down the road?

This Psychology Today article seems to give the ultimate verdict – crying it out damages the neurons in a child’s brains, leaving to a lifelong feeling of neglect.  But where are the studies that actually say that? Every study cited in this article talks about the effects of emotional distress, significant stress, and low-nurturing parents. We have here a common conflation – cry it out = emotional abuse, a child ‘left to cry’ in his or her bed is exhibiting significant distress.

We return back to Moxie’s “tension releasers” vs “tension increasers”, and the fact that most parents likely can tell when a baby is crying out of anger vs when a baby is truly distressed.

Now, in one of the first articles she writes, talks about a Harvard study that shows that CIO changes the baby’s nervous system, making the baby sensitive to future trauma.  So a smoking gun, correct?

Perhaps not.

It seems as though the Harvard study cited everywhere as showing for a fact that CIO causes long-term harm to babies is…just the personal opinion of the researchers?

There goes one of the major ‘evidence-based’ arguments against cry-it-out, one that I see over and over again.

So I’m for crying-it-out, right? Not necessarily. I try not to take a stand on either side of these types of arguments. If I seem pro-CIO here, it is simply because I just want to dissect the claims of anti-CIO people I see, and unfortunately, most of what I see doesn’t hold water.

Wait, there’s a new study that shows CIO has absolutely no ill effect?

Not exactly.   Major news organizations implied the study showed that a group of children who were subjected to CIO and a group of children that were not showed absolutely no difference years later.  But as AP champion Annie at PHD in Parenting points out:

“The only difference between the intervention group and the control group is that the nurses that in the intervention group were given formal training on sleep interventions. From what I can the parents were never asked which sleep interventions they used (if any).”

So, again, I’m not here to tell you to use one method or the other.  All I can tell you is that there isn’t much to scientifically give you an answer one way or the other.

Here are some more breakdowns on the research (or, that is to say, a lack thereof) on crying it out:

http://answers.google.com/answers/threadview/id/774928.html

http://www.infantsleep.org/cryingitoutresearch.html

The studies cited in the thread and in the article are below:

http://www.ncbi.nlm.nih.gov/pubmed/14989452?dopt=Abstract

http://www.ncbi.nlm.nih.gov/pubmed/1527680?dopt=Abstract