Monday, 5 December 2011

Crying It Out - The Damage We Can Measure, The Damage We Can't

'Crying it out'...'controlled crying'...'sleep training'....when I had my first baby nearly four years ago, I was told that I needed to do it by everyone from my hair-dresser to my Baby Massage teacher, who handed out badly baked cakes and half baked parenting advice and told me my baby would never sleep through the night. The practice of leaving a baby to cry alone in a cot in order to encourage them to learn to be less dependent on their parents at night is so common and widespread in our culture that it is considered an absolutely normal if not essential part of a baby's first year. The number one best selling author of childcare books in the UK, Gina Ford, recommends it in several of her books, and even the NHS endorses it: on their website and in the book 'Birth to Five', handed out to all new mothers in England, they state:

By the time your child is six months old, it’s reasonable to expect them to sleep through most nights. If there’s no obvious cause, and your child continues to wake up, cry or demand company...teach your child to get back to sleep by themselves. First check that everything is alright. If it is, settle your child down without talking to them too much. If they want a drink, give them water but don’t give them anything to eat. For this approach to work, you need to leave them in their cot or bed. Don't take them downstairs or into your bed. Let them cry for around 5-10 minutes before you check on them. Over the next few nights, gradually increase the amount of time you leave them before checking. It might take a week or two but if you keep the routine going, your child should start falling asleep on their own.

This approach is understandably controversial; CIO is probably the most hotly debated topic in parenting forums and facebook groups. Those who are opposed to it denounce it as 'dangerous', sometimes even stating that it 'causes brain damage' and is tantamount to child abuse. On the other side of the fence, those who have used such methods on their own children claim that it is entirely harmless, and that a happy and well rested mother equals a happy baby. So who is right? 

In such instances it's helpful to look for actual concrete evidence, but, I'm sorry to say, there isn't any. That is, if you're looking for a study that says, 'We took twenty babies, left half of them to cry alone for prolonged periods, while we cuddled the other half, and the ones we left crying grew up to be miserable, whilst the ten we hugged are all happy well adjusted adults.', well, you're just not going to find it, for obvious reasons. Not only can we not treat babies this way in the name of scientific research, but it would also be impossible to separate out the night time sleep training from the myriad of other factors that contribute to the development of a person, successful or otherwise.

What we do know is that stress produces the hormone cortisol, and that this can and does have an effect on the brain, particularly a tiny and rapidly growing one. One study has shown that too much cortisol can affect  the development of the orbitofrontal part of the prefrontal cortex, the part of the brain thought to be most concerned with our social and emotional interactions. Another study suggests that the hippocampus may also be affected, with its numbers of cortisol receptors being reduced by early stress, leading to a reduction in the growth of the hippocampus itself and thus a reduced ability to cope with stress in adulthood. And from studying Romanian orphans, who were left in their cots and entirely deprived of love and affection, we can see just how much of the brain's development is dependent on responsive human interaction - many areas of their brains being visibly less active and 'a virtual black hole where their orbitofrontal cortex should be' (Gerhardt, 2004). 

All of this evidence, (and there is much more available), is telling us something: stressful experiences have a negative effect on our babies, and love, responsiveness, cuddles and touch have a positive effect. But how much stress does just a week or two of 'controlled crying' actually cause? Can we be sure that this is going to cause real lasting damage? Or will it just be a negligible 'blip', and worth it in the long run for the sake of a good night's sleep? Maybe we just need to switch off our baby monitors and get it over with? Right?

For me, crying it out is about more than cortisol, as valid and concrete as that evidence might be. For when we switch off our baby monitors, we switch off another connection - the two way radio we share with our babies from their very first moments of life, the delicate dance of the mother child dyad, the vital and vibrant message of unconditional love and care. When we shut the bedroom door and walk away, we are required to turn off our emotions and our instincts in a manner that, unlike cortisol, cannot be measured, but may damage our attachment, our essential link to our small child, in subtle and far reaching ways.

And what of our babies experience? Like much of their first two or three years, they will almost certainly have no real memory of being left to cry. For some people, this alone makes the practice acceptable. But I can tell you from my own work with adults who have experienced severe trauma as babies, that, whilst they cannot actually recall the painful events themselves, they nevertheless remain affected by them for the rest of their lives. Often the fact that the trauma occured at this 'pre-verbal' time can make it even harder for them to process and overcome their difficult feelings, by which they remain constantly haunted but which they are unable to name or articulate.

A baby left crying will not, as a relative once assured me, 'soon learn that it's not going to get them anywhere'. In fact, a baby or small child has great difficulty 'learning' anything of this nature, as their understanding of concepts like cause and effect / time / reward and punishment are extremely limited (as anyone who has ever tried the 'If you don't put your socks on we are not going to the park' approach to parenting will testify!) What they do learn if they are left crying is that nobody is responding to them, in that present moment, and that it feels awful. They will learn that they are 'helpless', and some babies, although not all, will eventually give up crying for this reason. Often it is said that CIO teaches a baby to 'self soothe', but how can you learn to 'self soothe' if you don't yet have a full concept of 'self'? A small baby doesn't yet understand themselves as a separate person - this happens gradually, and it's not until around 18 months that a child can even look in a mirror and understand that they are seeing their own reflection.

Rather than learning to self soothe, a baby left crying may instead be learning how to 'split off' or dissociate. This is one way of coping with trauma or distressing events that threaten to overwhelm us - to go somewhere else. If we can't escape in our body, we can in our mind. As a parent, we can help a baby or child to learn how to cope with distress by the way that we ourselves respond. If we take our child in our arms, hold them, say soft words, and offer calmness and love, they will begin to learn how to make this a part of themselves, and how to respond in this way to difficult situations without our presence or help. But if our child is in distress, and no one is there to hold them? They may learn that the only way to deal with such intolerable feelings is to escape. Later in life, this desire to drift away from the pain instead of facing it may manifest itself in the form of addictions, eating disorders, and other serious mental health problems.

Of course, not all babies left to cry will end up with major difficulties in later life. Like everything else, there are degrees of damage, some obvious and clear, some subtle and barely noticeable. We all deal differently with distress, and perhaps it's worth pausing for a moment to consider what you personally do when your emotions are rising and churning. Do you reach for a drink, a cigarette, a sleeping pill? Do you eat more or less than you need? Do you write, do you run, do you paint pictures, do you drive your car too fast? Do you think you cope well with distress, or is this a difficult area for you? And now that you've thought about this, here's another one - how do you deal with the distress of others? When your baby is crying, what happens to you? How do you respond, in your body, in your breath, in your mind, in your heart? What do you find easier to contemplate - leaving your baby to cry alone, or holding your crying baby? If we find if hard to cope with distress, CIO might seem a better alternative than nights spent giving comfort, and so the cycle continues.

Distress is complicated, and we are all of us damaged in some way. As parents, we are in the game of damage limitation. In our material world, a baby who sleeps through the night is highly prized, they are a 'good baby', they are likely to have less negative impact on our youthful looks and our earning capacity than a baby who wakes up often and renders us tired and inarticulate. But if the good baby comes at the price of CIO, is it worth it? I think not. This might feel like bad news if you are sleep deprived and desperate. But I can tell you from personal experience, that your child will eventually sleep more deeply, more independently and for longer stretches, no matter what you decide to do. Suddenly, rather like childbirth, the pain is over, and you are in a new phase, with its own new challenges. And both you and your child will be intensely glad that you didn't risk causing damage, not just to the orbitofrontal cortex or the hippocampus, but to your relationship of love, trust, kindness and comfort, through which your child is learning so much about how to find this comfort in themselves.