Do all babies need sleep training?

Posted by on Apr 7, 2016

(This post was written for and first posted at Moms Uniting Moms.com)

Sleep is a hot topic when you have a baby. Of course, most parents of small children have interrupted sleep. Some are severely sleep-deprived. All worry about whether their babies are sleeping enough. But on top of all that many worry that they might be ruining their baby’s sleep forever!

What if you nurse your baby to sleep? What if you let your baby become too dependent on a sleep crutch? What if you co-sleep? What if you don’t sleep-train at the right time? Or in the right way? What if you baby never learns to sleep through the night? What if you are not perfectly consistent? What if you are too tired, or like cuddling your baby too much, to insist that your baby sleep in his own crib? Do these things mean that your child will never learn to sleep on her own?

No.

It may take a long time. Many children wake up several times each night until they are 2 or 3 years old. Some children don’t go to sleep on their own until they are 6 or 7 years old. But they all do, eventually.

It may also happen easily. Some babies learn to fall asleep on their own as soon as the fussy period (the first 12-16 weeks) is over. Some babies take easily to being shushed and patted to sleep, instead of being nursed. Some babies can be laid in their crib and will coo and babble themselves to sleep.

What is the best way to cope with a baby who doesn’t sleep long stretches? Well, it depends a lot on how the parents are doing. If the breastfeeding mom is a good sleeper herself, if she can roll over and feed in her sleep, if she falls asleep quickly after her baby calls for her, she may not find her baby’s night-wakings difficult. If the baby’s other parent is happy to get up early and take the baby away to play and mom can catch up on sleep then, the family may cope just fine with the baby’s sleep habits.

But what if the mom feels anxious, or suffers from insomnia or depression? What if the mom is on her own with the baby and has no one to help her get a little extra sleep here or there? What if the baby weighs 20 pounds and still has to be bounced to sleep on the yoga ball? Then the parents might need sleep training.

Remember that books on infant sleep and sleep training are written to sell. They need to convince you that you need them. So they promise a fool-proof, fail-proof system for getting your baby to sleep, fast! Not only do they present their system as one that will work for everyone, but they also argue that everyone should use it.

The scientific research on sleep training is in its infancy (tee-hee). There has been very little research on how to teach parents to teach their children how to sleep. And the effects of sleep training have been very poorly studied. Claims are made on one hand that sleep training is entirely safe and has no negative effect on babies’ attachment to their parents. On the other hand, others claim that leaving babies to cry create enormous stress and destroys the bond of trust they have with their caregivers.

In the “sleep training is unduly stressful camp” is the 2011 study by Wendy Middlemiss and colleagues. As I read it, it seemed to me that the conditions were not well controlled. Babies of different ages were used, ranging from 4-10 months. This is a huge range in development. The testing for saliva cortisol levels did not include a baseline, so there was no way to compare the “elevated” levels to normal levels. And the technique used just involved leaving the baby alone to cry until the baby fell asleep, something very rarely recommended nowadays.

In the “sleep training is just fine and has no long term effects” camp, is a 2008 long-term, randomized study of sleep training by Harriet Hiscock and colleagues. It seemed to me to have much more carefully controlled conditions. All the babies were between 7 and 10 months and the parents were instructed in positive bedtime routines and controlled comforting or adult fading (also called “camping out”). The families in this study were followed frm 2003 when they first volunteered for the study, through to 2009, when their children were 6 years old!

The first publication of the study in 2008 reported that the families who received the sleep training information had children who slept better at 10 months, and less likelihood of depression among the mothers. So this would look like a win for sleep training, right?

But in the 2011 follow-up report on Hiscock’s study, Anna Price and colleagues tell us that the six-year-olds in the intervention group (the group that received information about sleep training) and the six-years-olds in the control group (that did not receive any information on sleep training) all showed similar scores when examined for emotional and behaviour problems, sleep problems, stress, and parent-child relationship. In other words, in the long term, sleep training makes no difference.

What this means is that parents should follow their own intuition. If your baby is over six months and is in good health, and you want to sleep train, go ahead. If you think it’s too much trouble, or you think it’s going to be too hard on your child and on you, then don’t.

Ultimately, you know the needs of your child and your family better than anyone else. So don’t let anyone else tell you how to parent your child at night. Do what makes sense to you, for now. If it stops working later, you can fix it then. And be reassured that by the time your child is six years old, you will have a whole new set of parenting issues to focus your energy on!

Papers Cited:

Hiscock H, Bayer J, Gold L, Hampton A, Ukoumunne OC, Wake M. Improving infant sleep and maternal mental health: a cluster randomised trial. Arch Dis Child. 2007; 92(11):952–958

Middlemiss W1, Granger DA, Goldberg WA, Nathans L., Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Early Hum Dev. 2012 Apr;88(4):227-32

Price A.M.H, Wake M, Ukoumunne O.C, Hiscock H, Five-Year Follow-up of Harms and Benefits of Behavioural Infant Sleep Intervention: Randomized Trial, Pediatrics 2012;130:643–651

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