As part of CAPPA’s Postpartum Doula Scope of Practice, doulas DO NOT teach a “cry it out” approach for infant sleep. Why is that? There has been an abundance of research on infant sleep and the possible results of using a controlled crying method to get babies to “sleep through the night”. The bottom line is that the chronic stress these methods produce, is bad for the infant’s brain, just as chronic stress is bad for anyone. Many studies have shown that even though the baby seems to be quiet and sleeping after a controlled crying method has been implemented, their cortisol levels are still very high. Neurons die when the baby is stressed. Chronic stress in infancy and early childhood has been identified as a major contributor to adult health problems.
The rise of Behaviorism over the last few centuries has said that if you respond to crying babies you are just reinforcing the crying. Anthropological and psychological research demonstrates that the opposite is true. Babies whose cries are answered in infancy tend to cry less in later infancy and beyond. Neuroscience confirms that letting babies get distressed is a practice that can damage children and their relational capacities in many ways over the long term.
Self-soothing and regulation is not something babies are able to do. Human babies are one of the most immature mammals at birth and are not ready for the world for another 9 to 18 months. Unrealistic expectations about infants’ abilities to self-regulate and sleep longer, uninterrupted cycles, cause parental anxiety and more stress for the whole family. Understanding that babies don’t self-comfort in isolation when left to cry alone, they learn to shut down in the face of overwhelming distress. They stop growing, stop feeding and stop trusting. Responsive care is what’s needed for all infants at least for the first year. This means meeting the baby’s needs before he gets stressed. This tunes up his body and brain for calmness. Forcing independence on a baby can lead to greater dependence. Research has proved that giving babies what they need can lead to greater independence later. Sleep training is the opposite of this responsiveness. Caregiver responsiveness is also related to intelligence, empathy, lack of aggression or depression, self-regulation and social competence.
Sleep training assumes that babies can be taught to sleep, wake and be hungry on someone else’s timetable, and to understand that they are really safe and cared for even when they are left alone and unattended. There is also the assumption that babies can and should adapt to parents’ desires rather than parents adapting to babies’ needs. Sleep training techniques work for about 80% of babies and parents are generally pleased with the short-term results. But research confirms that sleep training of any kind can be damaging in the long-term and isn’t actually doing in the short-term what is claimed. Sleep training research tends to gauge success by adult satisfaction and the speed and extent of infant compliance, not by the physiological effects and long-term consequences. The Australian Association of Infant Mental Health was so concerned about the controlled crying techniques for infant sleep that they issued the following statement, “controlled crying is not consistent with what infants need for their optimal emotional and psychological health and may have unintended negative consequences.”
Decreasing parents’ perceived need for sleep training is a great goal for professionals. Making sure they have a realistic understanding of what normal infant sleep looks like is extremely helpful. Educating parents about the nature of nighttime care and infants’ developing and fluctuating sleep patterns can be part of the postpartum doula’s role. Night Waking is often a normal sleep pattern for infants and toddlers and is biologically adaptive. Many parents who think their babies have sleep issues are misinformed and have very unrealistic expectations around their baby’s sleep abilities. When it comes to infant sleep, intentions are much more helpful than expectations.
Healthcare providers and care givers need to share information about different approaches to nighttime care and their benefits for families and infants. Providing information about safe infant sleep is critical but it needs to move beyond scare tactics and fear mongering and be more nuanced about what makes infant sleep healthy.
Topics to include are:
Benefits of responsive parenting
Information about safe bedsharing
How to balance infant care and provide for their own needs
Working on ways to circumvent sleep problems is a great first step for a preventative focus. The following is a list of suggestions for care providers that have been shown to help support families and their infants’ sleep:
Establish on-demand breastfeeding especially during the day
Help parents learn to enjoy keeping their babies close by carrying or wearing them
Establish home routines for parents and babies that help babies sleep at night, like exposure to light early in the day and avoidance of light in the evening
Model behavior to treat babies as equal human beings
Provide in-home support
Finding a balance between essential aspects of best-practices and policy recommendations with parents’ role in the decision making can promote healthy infant sleep expectations without parents perceiving a need for sleep training. Healthcare providers often tell parents what to do rather than discussing options. Instead, they should help parents find approaches that meet babies’ needs and increase family well-being.
Child well-being in the US has become among the worst in the developed world with self-regulation, mental, and physical health continuing to deteriorate. The stress that infants experience around sleep training can contribute to this problem.
Understanding that sleep training offers no actual advantage and that, in fact, the opposite is true can go a long way to help parents create more responsive ways to deal with infant sleep perceived issues. Parents need information about what normal infant sleep looks like and options on how to create safe sleep environments for their babies that fit all their needs. Having these tools before babies are here and starting good sleep routines early on can forestall any future needs for sleep training.
Postpartum doulas can support parents through these sometimes exhausting times with their newborns by providing overnight support and evidence-based information, while honoring and incorporating the individual differences of each family, as well as practicing and sharing safe infant sleep guidelines.
Disclaimer:
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
Credit: Carolyn Butler, CPD, for CAPPA
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