Sleep Training – Cry It Out!
Infant wakefulness and crying are completely normal during the first year. Crying communicates to parents of the child’s need for food, comfort, or relief. However, for some children, night-time wakefulness persists past the first year.
Parents often go to the internet to find out what to do and whilst Dr. Google can sometimes be a useful ally, it is often an unhelpful friend offering bad advice! There can be a lot of different websites offering advice, not always evidence-based, and some may provide more harmful hints than true help.
One commonly suggested method for parents struggling with persistent night-time wakefulness is known as the “Cry It Out Method” (CIO). Let’s break down specifically what CIO is, what it is not, and help you make the decision on whether it is the right approach for you and your child.
What is the cry it out method?
Research tells us that night-time wakefulness is normal during the first year. Infants cry to let their parents know of their need for food, comfort, or relief. Night-time wakefulness usually declines during 3-6 months of age. However, for some infants night-time wakefulness persists leading to infant and parental distress.
Because of this, sleep training methods, such as the CIO method, are recommended to parents (Judy A. Beal, 2017). In the field of ABA, the CIO method could be simply referred to as ‘planned ignoring’, a form of extinction. In very basic terms, it consists of parents ignoring the child’s cries when they wake up from their sleep.
Parents can choose to either completely ignore their infant’s crying, or follow a graduated method of slowly removing their presence when the child cries. For example in the graduated method, when the infant first cries the parent would pick him/her up, then on the next instance they ‘graduate’ to standing next to the crib, later standing in the room next to the door and then standing outside the door. In this way, the parents are slowly removing their proximity and presence from the child when they wake.
Pros and Cons
Pros:
The CIO method can result in a very quick reduction of crying and night-time wakefulness which can be of high benefit for parents in need of a good nights sleep! (Mindell J, et al, 2006). It has specifically been found that night-time wakefulness can be reduced as quickly as three months with long-term effects.
When comparing some different behavioural sleep interventions for under 5-year-olds, it was found that CIO method was effective with 80% of children (Etherton, Blunden and Hauck, 2016). That means there is a very high likelihood that CIO method would be successful with your child.
Cons:
Now onto the cons of the CIO method. Fairly obviously, crying is the only form of communication for infants. During the CIO method, parents are advised to simply ignore their child’s cries. As the child does not yet have an alternative form of communication, this can result in the child having no other way to have their needs met. They cannot simply tell you they are hot, and you are no longer responding to their crying to check their needs and hence their needs go unmet.
The principle behind CIO method is for infants to self-settle, however they have not yet been taught how to do so, nor do they have the needful skills at such a young age. This is supported by physiological research where the heart rate variability and autonomic nervous system activity during sleep of infants was monitored. During CIO method there was a dramatic increase in heart rate variability (176%). In addition, infants who were left to CIO method had higher stress (cortisol) compared to their peers (Middlemiss, Granger, Goldberg, & Nathans, 2012) (Waynforth 2007). Therefore, it would seem logical to say that infants are not yet prepared to self-settle or to cope with the stress of CIO method (Morgan, Horn and Bergman, 2011).
As any parent will be able to attest, it is instinctive to respond to your child’s cries. AAs such, it would be quite difficult to expect a parent to ignore their child’s cries. Most studies attest this and show that parents find it very difficult to ignore their child’s cries. It is very important to note that if deciding to go ahead with the CIO method, children will go through [what is known in ABA as] an extinction burst. This means that once you start CIO, your child’s cries will be higher in frequency, intensity, and duration for a short period before subsiding completely. Therefore, it is needful that parents are aware of the distress this may also cause them.
Conclusions
CIO method has some significant pros, but more significant cons. In our professional opinion, this method is not one to be considered lightly or taken as a first option due to the long-term effects this may have on your child. There are many sleep training alternatives, and as always prevention is the best method. This means equipping yourself with tools and strategies as soon as you have a newborn. This way, you will be better prepared to set god sleep habits from day one and avoid the need for sleep training methods.
If you feel that the CIO method is not for you and your family, you can look at alternatives to night-time wakefulness such as The Montessori Approach to Sleep Training. You can look out for our next blog where we will go into detail regarding this approach.
