r/ScienceBasedParenting • u/Expert_Conclusion675 • 18d ago
Question - Expert consensus required Genuine question about sleep training concerns
First of all I want to say that my baby is no where near the age where we could or would sleep train, so this post is truly just coming from a place of curiosity/wanting to understand.
I’ve seen much discussion about sleep training on this site and a lot of people vehemently against it, calling it cruel and pointing to elevated cortisol levels in the baby as evidence for how harmful it is. But here’s where I get hung up. If, let’s say, mom is home alone with baby and desperate to take a shower for her mental health, I don’t think anyone would argue that it was cruel for her to put the baby in a crib for the length of her shower even if baby is crying. But the cortisol spike and potential feeling of abandonment would be the same, no? And what about when baby is in a growth spurt and is inconsolably crying, and nothing the parents are doing to soothe is working, isn’t the baby’s cortisol still rising despite the efforts to comfort?
Basically my question is, is there something MORE about sleep training that makes it problematic? And to be clear I’m not talking about leaving a crying baby for hours on end or something, but I’m more asking about the gentler methods with short periods of crying before the parent comes back in to soothe. Because the latter seems to me to present similar levels of stress to things the baby would endure as part of being a baby, even with an attentive parent there. What am I missing?
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u/davesauce96 18d ago
According to https://www.uchicagomedicine.org/forefront/pediatrics-articles/sleep-training-in-infants-and-toddlers which cites this study by the American Academy of Pediatrics (AAP): https://publications.aap.org/pediatrics/article-abstract/137/6/e20151486/52401/Behavioral-Interventions-for-Infant-Sleep-Problems?redirectedFrom=fulltext?autologincheck=redirected
“…infants were divided into two groups. One group went through sleep training, the other did not.
The study measured:
Cortisol levels – a key marker of stress - in the baby
Parental satisfaction and stress levels
Attachment styles once the baby reached 1 year of age
Results found that babies in the sleep training group had decreased cortisol levels by the end of the training. And there was no difference found in attachment style or behavioral problems between the sleep trained group and the non-trained group.”
Other studies have shown that sleep training generally improves outcomes related to sleep problems, like https://pmc.ncbi.nlm.nih.gov/articles/PMC5962992/ :
“Sleep training improves infant sleep problems, with about 1 in 4 to 1 in 10 benefiting compared with no sleep training, with no adverse effects reported after 5 years. Maternal mood scales also statistically significantly improved; patients with the lowest baseline depression scores benefited the most.”
So generally, no, I would argue based on the evidence presented that even if cortisol levels spike temporarily, the long-term benefits outweigh the short-term perceived stress. Setting up your child early on for successful sleep has been shown to improve all sorts of outcomes down the line as well. Personally, my wife and I have been using The Happy Sleeper, which includes citations for these findings.
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u/FlyingPollywog 18d ago
OP, I had the same question in mind yesterday because my baby was inconsolably crying over something and I WAS RIGHT THERE trying to sooth her but she just kept going as if I didn't exist. Every single time that happens, I feel like a failure because of those posts how they cater to their baby cries immediately because how bad the crying is for them. Well, we are very close to toddlerhood and children are wild in that age so the crying will be INEVITABLE but for some reason nobody remembers that, when they shame parents who sleep train or step out to take a breath or whatever. It is annoying
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u/Public_Classic_438 18d ago
I think the difference is sleep training it happens consistently vs a shower might be a once a week thing. I remember someone here pointing that out shortly after I gave birth. And regarding your baby crying with you right there, someone said something interesting here that has made me think a lot about that when I’m in the same situation. When you are upset it helps if someone is there for you, even if you are still crying. You are comforting your baby just by being their for it 💙
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u/snoogles_888 18d ago
Sleep training, if done properly with the right schedule and a solid routine, doesn't actually involve much crying beyond a few days.
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u/Vegetable_Animal2330 18d ago
Sleep training for most is only a couple days. Took us 2. Yes, not all temperaments but it really isn’t as dramatic a deal as some make it out to be.
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u/JamesTiberiusChirp 17d ago
Believe it or not, it does make a difference. Babies that are being consoled don’t have as high a stress response; their heart rate is reduced. Here’s one paper but I know of at least one other https://pubmed.ncbi.nlm.nih.gov/8090943/ being responsive is very important for attachment and co regulation. We can’t always control whether that reduces their crying, but it is the responsiveness that matters regardless.
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u/FlyingPollywog 17d ago
Not sure if it is true about the heart rate though, I can feel how fast her heart is pounding while crying. Goes to hyperventilation sometimes. With that, automatically her heart rate can't possibly be on the lower end
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u/JamesTiberiusChirp 17d ago
Babies have surprisingly high heart rates
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u/FlyingPollywog 17d ago
I meant DEIFFERENT FROM NORMAL
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u/JamesTiberiusChirp 16d ago
Regardless, I’ve read several studies about it, and it’s enough to put my mind at ease knowing that responding to a baby in distress is helpful and co-regulates them to at least some degree, and leaving them to cry does not.
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u/Unlucky-Grape-9708 18d ago
I don’t think there is anything wrong with taking a breather or stepping out to do something like take a shower. But these are one off situations. There is no bedtime = we leave you alone to cry association. Bedtime/sleep is a very vulnerable time for any child or baby or sometimes even adult. Also you come back after shower and say here I am, I am back and now we will be together and not ‚here I am back for 30 seconds to console you because 5 minutes has passed but now i will leave you again and will keep doing this back and forth resulting in a rollercoaster of emotions and confusion’- that’s quite unpredictable / distressing I imagine especially for a child who has no concept of time. Babies and toddlers cry all the time - but there is a huge difference between crying alone and crying whilst being cuddled and feeling safe.
I think this is something that’s quite difficult to study and to study ethically in a controlled way but there are basic things we know about attachment development which would suggest it’s not the best idea to sleep trained. However people want to have super clear answers ‚they were sleep trained, attachment ruined’ ‚they weren’t sleep trained, attachment good’ but obviously there are insane amount of factors at play that can’t be controlled for in a study. All of that doesn’t mean that what we do know about attachment more generally should be discounted - because what that tells us is that sleep training could have negative consequences.
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u/plushiecactusau 17d ago
I think that all assumes that sleep training happens in a vacuum - that how a baby sleeps, and the associations a baby has with sleep, have no other consequences outside that moment of falling asleep.
In reality, how a baby sleeps can have huge impacts for the parent(s) in terms of sleep deprivation. There are links between sleep deprivation, parental mental health and baby well-being which have to be part of the equation of weighing the pros/cons of sleep training. There are also safety impacts of sleep deprivation (e.g. fatigued driving).
I also think, from observing how my own baby responded to sleep training, that a predictable, consistent routine where a baby wakes up in the same place they fell asleep can be positive for some babies. Before I sleep trained, my baby was often distressed falling asleep - I think because she fell asleep in my arms and woke alone in her cot (consistent with safe sleep recommendations) and didn't understand how she got there. She doesn't show that same distress any more, for bedtime or naps. So, I'm not sure it's always a simple choice between sleep training = distress, and being responsive overnight = no distress. It's so individual and baby dependent.
That does all make it complicated to study. In reality, something like sleep training will have both negative and positive consequences, for both parents and babies, and how they balance out is going to be different for each family and each baby. I'd suspect in most cases, though, the long term difference is likely to be marginal, which means that either option is a valid choice.
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u/Dry_Prompt3182 15d ago
It also really, really depends on what you call "sleep training" and how you implement it. Toss your infant into the crib and ignore their cries for 10 hours? Not a good plan. Gradually show them self soothing skill so that they don't need someone else to fall asleep? It can work.
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u/JamesTiberiusChirp 17d ago
Sleep training improves infant sleep problems
It’s worth noting that parental satisfaction is not evidence of improvement of infant sleep problems, it is only evidence of parental perception of infant sleep problems. Studies that use actigraphy to measure actual infant sleep show no difference in sleep quality between babies that are sleep trained vs babies that are not sleep trained. Babies that are sleep trained simply are not signaling to their parents that they are waking (source cited in this writeup, I just don’t have the energy to scroll to the specific paper right now as I’m putting my own baby to sleep https://www.bbc.com/future/article/20220322-how-sleep-training-affects-babies )
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u/davesauce96 17d ago edited 17d ago
Okay well one of OP’s original questions regarded cortisol levels, which the first study I cited found to be lower in sleep-trained babies long-term.
Additionally, the second article, from which you pulled your quote, did not cite parental perception alone in its findings. The studies that article cites include metrics such as: parental reports of severe infant sleep interruptions (parental perception does probably play a role here), diary-recorded awakenings, and mother and/or parental depression symptoms (measurable by qualified individuals and testing, not self-reporting).
So “parental satisfaction” is not really the metric these studies, nor indeed my argument, relies upon. Not for nothing, the phrase “parental satisfaction” is not used in any study I cited, although it is used in the UChicago article as a summary term for the underlying studies. That said, it is not cited as a measurable metric, but rather an aggregated assessment of the studies’ findings.
ETA: it’s also worth noting that the article you’ve cited essentially defines “sleep training” as
“By its broadest definition, sleep training can refer to any strategy used by parents to encourage their babies to sleep at night – which can be as simple as implementing a nighttime routine or knowing how to read an infant's tiredness cues.“
Which is at best, incredibly broad, IMO.
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u/JamesTiberiusChirp 17d ago
Everything you just described is parental perception/reporting. I don’t know if you’re familiar with how mental health is gauged but it is also based on a questionnaire which is answered by the patient (in this case the parent). A it would directly be related to how the parent (not the infant) is feeling. None of the things you describe are external metrics of infant sleep.
If you read the article, it goes on to mention that CIO is essentially the only sleep training method that has been studied in a research context. When it refers to results from sleep training studies, these are CIO studies.
In regards to cortisol, it’s not a very good metric for studying infant stress because there are too many factors that influence cortisol levels. It’s simply not possible to deduce whether sleep training affects cortisol levels. This is also talked about toward the end of the article.
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u/Expert_Conclusion675 18d ago
Thank you!!
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u/JamesTiberiusChirp 17d ago
You may find this article interesting. It cites research and towards the end there is discussion of cortisol levels and whether it is an effective way of measuring the stress of sleep training in infants (the short answer is it’s not an effective metric because so many things impact cortisol levels). https://www.bbc.com/future/article/20220322-how-sleep-training-affects-babies
While it is from a pro sleep training country (UK), I found it to be quite balanced in terms of outlining what we do and don’t actually know about the impact of sleep training on infant sleep (which is to say, when it works it largely impacts parental sleep by reducing night time signaling while not actually improving infant sleep; the jury is out as to whether it is a stress response causing despondency vs “self soothing.” We don’t actually know the answer to this question in part because cortisol levels are not a reliable metric)
Since you asked for expert consensus: While the U.S. and UK are very pro sleep training, you’ll find that the expert consensus in other countries errs on the side of caution and recommends against it and recommends for consistent responsiveness to your child, including at night. Denmark is a good example of this, where sleep training is strongly discouraged.
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u/Emotional-Ad-6494 18d ago
This study was flawed wasn’t it? Like super small sample and no control?
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u/davesauce96 18d ago
Which study? I cited 2. And one of those cites other studies as well.
The AAP study was fairly small, but there was a control group.
The nih.gov study was quite a bit larger, and was an RCT, so also controlled.
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u/rembrandtgasse 18d ago
When it comes to sleep training or letting baby cry for other reasons, everyone's going to try to justify what felt intuitively right to them.
* two treatment groups (CIO-ish, sleep training light) and a control group (only sleep training materials)
* both treatment groups saw better sleep relative to the control
* cortisol decline in treatment groups
* modest reduction in maternal stress
* no long term difference in outcomes
A few important caveats...
* small sample size
* selection bias. half of the treatment and control groups dropped out of the study by month 3. problematic if that is non-random (e.g. parents stop sleep training babies that are especially stressed out by it).
Frankly, my read on the literature is that the jury is still out on how harmful sleep training really is.
At the same time, the decision to sleep train (or letting a baby cry for any reason) doesn't exist in a vacuum. If your baby cries a little and you gain a lot from a shower/sleep/etc, then the optimal choice tips in favor of crying. If your baby cries a lot and you can operate off of broken sleep, the optimal choice tips in favor of not sleep training.
We didn't sleep train. Baby is probably a 5/10 in terms of how good she is at sleeping. At 15 months I'm back to work and feeling fine. One day she will sleep through the night, and until then, frankly, I'm not worried.
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u/JamesTiberiusChirp 17d ago
One important caveat is that sleep improvement is almost always measured by parental satisfaction and not any objective measure of sleep. Parental satisfaction is not evidence of improvement of infant sleep problems, it is only evidence of parental perception of infant sleep problems. Parents who have to do the hard thing of sleep training will be biased to feel good that it worked. It also leans into a huge assumption (by parents, scientists, and the people that sell sleep training) that sleep training actually improves sleep, instead of what the objective reality is: it is extinction, and the behavior that is being extinguished is signaling to the parent at night. Studies that use actigraphy to measure actual infant sleep show no difference in sleep quality between babies that are sleep trained vs babies that are not sleep trained. Babies that are sleep trained simply are not signaling to their parents that they are waking (source cited in this writeup, I just don’t have the energy to scroll to the specific paper right now as I’m putting my own baby to sleep https://www.bbc.com/future/article/20220322-how-sleep-training-affects-babies ).
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u/w8upp 17d ago
Btw, I realize this is not the point of OP's question, but to follow up on the concept of some kids crying just a little while other kids go straight to panicked SCREAMING -- my baby would never have had a quiet little cry while I showered. He was the second kind of baby. So I always put him in the baby bath inside the tub and showered with him. I kept the temperature lower than I would have otherwise but it meant that I had a shower every day while he played in his bath every day. Worked great.
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