Controlled crying: friend or foe?

New parents can often find themselves in a frustrating position when it comes to trying to get their little one off to sleep.  They struggle with torn emotions and hearing that heartbreaking cry.  Do I go in and pick them up? Or do I allow my child to cry?  This is a debate that has emerged in the parenting world with many strong opinions forming on both sides.  It is important as a parent to make an informed decision based on available evidence.

As a doctor I can tell you that my main concerns when it comes to young children focus around the following questions: is the child feeding? Is the child gaining weight? Is the child thriving? Is the child in a happy home? Is the child sleeping?  Is the parent sleeping? And is the parent coping?  Sleep can often be a big concern for parents and lack of sleep can have consequences for both parent and child.

But there is hope! Behavioral interventions recommended by family doctors for sleep in children include controlled crying and camping out.  With controlled crying, parents respond to a child’s cry at increasing time intervals, allowing the child to fall asleep alone.  With camping out parents sit with the child until the child falls asleep and then gradually reduce their presence over a period of 1–3 weeks.

These techniques should be used in children aged >6 months as younger children may still be establishing a mature sleep–wake rhythm and require night feeds.  How do I know if my child has a sleep problem? If you child wakes more than 5 nights a week, wakes more than 3 times a night, takes more than 30 minutes to fall asleep or requires parental presence to fall asleep then you should keep reading…

Children with sleep problems are more likely to sleep in the parental bed, be nursed to sleep, take longer to fall asleep, and wake more often and for longer periods.  It is also very important to note that the presence of a sleep problem in children is a strong predictor of depression in mothers.  Child sleep problems and postnatal depression are also both associated with increased marital stress, family breakdown, child abuse, child behaviour problems and maternal anxiety. Postnatal depression can adversely affect a child’s cognitive development.

The debate in online forums usually has a focus around the infamous controlled crying debate.  So what’s wrong with controlled crying?  As a parent it can be difficult to hear your baby crying and it is easy to run into the room, embrace them and rid them of all their fears.  How could this possibly be a bad thing!? Babies and children are at a heightened stage of learning and absorbing information, if a parent picks up a child when they cry the child then learns that crying leads to being picked up.  The danger in this is that it can have negative consequences for children and their families and can also extend into later childhood.  It will not only affect your sleep and your ability to function as a parent but it will affect your child’s sleep and their ability to learn and absorb new information.

There have been ‘rumors’ floating around on parenting websites that leaving a child to cry can have negative effects for that child.  There is no evidence that controlled crying or any of the above mentioned techniques are harmful for children.  Children will cry for many reasons throughout their lifetime- because they can’t have that candy or because they hurt their finger.  Crying is a normal part of childhood and a normal part of learning.  Behavioural sleep techniques have no marked long-lasting effects (positive or negative) on children.

I often promote the controlled crying technique, I advise parents that when their baby cries to go into the room and check on them at set intervals and comfort them in the cot or bed as needed.  Then slowly increase checking intervals. This will comfort the baby but not allow an unhealthy pattern to develop.  This allows you as the parents to feel more at ease that you are not leaving your baby to cry alone.

Alternatively parents can try the camping out method.  This involves initially staying with the child as they fall asleep then gradually withdrawing your presence over a few weeks.  For the first few nights you pat your child to sleep (in their bed).  When the child is settled with being patted you spend the next few nights by the bed but not touching the child and waiting for them to fall asleep.  When the child is used to this then the following night stand or sit a few feet away without touching the child until they fall asleep.  Gradually move further away each night until you are out of the room.  If during either technique your child is crying and you feel the need to enter the room remember to comfort them in their own bed and not to pick them up (as hard as that may be)!

It is important to note that these techniques are effective at reducing short to medium term burden and depression in mothers.  These interventions have shown no long-term effect on children, no impact on child behavior, parent–child relationships or parenting style, but have shown a prolonged reduction in maternal depression!  Controlled crying is no monster but a valuable technique for parents struggling with sleep issues.  No parent should be judged negatively for following evidence based sleep techniques recommended by doctors.

-The Doctor

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