Controlled crying is effective but painful and not the only way

Recent research from Flinders University, and media coverage on most major news stations, has re-sparked the debate on controlled crying, but where does this study fit in the vast literature to date?

In a nutshell controlled crying is a quick and about 70% effective means of reducing sleep disruption for parents of children 6 months and older. Theoretically, controlled crying recommendations appear damaging for the parent-child relationship, but research finds no detrimental effects or even mild advantages. Why? Dr Nicole Weeks, child-sleep expert from Practical Research Parenting, says “Sleep Deprivation can severely impact parents’ ability to respond patiently to their child. Any means of reducing sleep deprivation can have positive effects on the parent-child relationship. Controlled crying is painful to implement and not the only way to achieve this outcome.”

Cry it out and derivatives like controlled crying are always controversial. Even researchers often have opposing views on the topic. Here’s an overview of the evidence to date.

Controlled Crying Effectiveness

The effectiveness of controlled crying for improved sleep is not in question. Controlled crying is highly effective at reducing parent-awakenings, and making bedtimes easier (child falling silent within 10 minutes) usually within a week (Review by Kuhn and Elliot 2003). Controlled crying also produced moderate reductions in the frequency of bedtime tantrums, and large reductions in the length of bedtime tantrums (Adams and Rickert 1989).

Drawbacks

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Acknowledged drawbacks of controlled crying is that problem behaviours spontaneously resurface, and parents need to repeat the approach to maintain improvements (Kuhn and Elliot 2003). It does not work for all cases. One study found it only resolved sleep problems for 70% of parents (Hiscock and Wake 2002). Possibly more importantly, 60-70% of parents are not willing to follow through on controlled crying approaches (Blunden et al 2016).

Suspected harm – Relationship security

There are many theoretical reasons to expect controlled crying might be harmful. One concern is that controlled crying methods ask parents not to respond to their child’s distress signals at night. This is concerning because responsive parenting is central to the development of a secure child-parent attachment and emotional regulation (Davidov and Grusoc 2006). However, studies particularly examining attachment and emotional regulation outcomes find no effects of controlled crying interventions, or even post-intervention improvements (Gradisar et al 2016, Eckerberg 2004). Post-intervention improvements are promising for controlled crying. Studies finding no effects are inconclusive unless they have adequate sample sizes. Gradisar’s 2016 study did not have enough participants to detect meaningful harm even if it existed.

Suspected harm – Stress

Another concern is that infants continue to feel distressed, even after they have learned not to cry through CIO approaches. A 2012 study found that babies had elevated cortisol levels (stress hormone) even after falling asleep “peacefully” on the third night of the intervention (Middlemiss 2012). The recent study from Flinders University does little to mitigate this concern. It measures cortisol the morning after not immediately after controlled crying interventions, suggesting that stress does not remain high all night but may still be elevated at bedtime (Gradisar et al 2016).

Alternatives

All considered controlled crying effectively combats sleep deprivation. As a result it tends to have positive short and long term effects on sleep and mental health. However, only about 30% of parents are willing to follow through with controlled crying, and in some cases it still won’t work. Clearly parents need viable alternatives. Thankfully there are now many alternatives that are gaining in empirical support. Dr Nicole Weeks from www.practicalresearchparenting.com has collated these alternatives into an interactive online parent-support system. The Sleep Options Wizard for 0-5 year olds.

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References

Adams, L. A., & Rickert, V. I. (1989). Reducing bedtime tantrums: comparison between positive routines and graduated extinction. Pediatrics, 84(5), 756-761.

Blunden, S., Etherton, H., & Hauck, Y. (2016). Resistance to Cry Intensive Sleep Intervention in Young Children: Are We Ignoring Children’s Cries or Parental Concerns?. Children, 3(2), 8.

Davidov, M., & Grusec, J. E. (2006). Untangling the links of parental responsiveness to distress and warmth to child outcomes. Child development, 77(1), 44-58.

Eckerberg, B. (2004). Treatment of sleep problems in families with young children: effects of treatment on family well-being. studies, 11, 12.

Gradisar, M., Jackson, K., Spurrier, N. J., Gibson, J., Whitham, J., Williams, A. S., … & Kennaway, D. J. (2016). Behavioral interventions for infant sleep problems: a randomized controlled trial. Pediatrics, e20151486.

Hiscock, H., & Wake, M. (2002). Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. Bmj, 324(7345), 1062.

Kuhn, B. R., & Elliott, A. J. (2003). Treatment efficacy in behavioral pediatric sleep medicine. Journal of psychosomatic research, 54(6), 587-597.

Middlemiss, W., Granger, D. A., Goldberg, W. A., & Nathans, L. (2012). Asynchrony of mother–infant hypothalamic–pituitary–adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Early human development, 88(4), 227-232.