Research & Articles
“Crying it out:” A critical review of the literature on the use of extinction with infants. Poster presented at the World Infant Mental Health Conference, Paris, France (Gordon & Hill, 2006).
ABSTRACT: While a variety of approaches to managing infant sleep exist, a recent survey indicated that the most popular approach involves the extinction of crying behavior through the withdrawal of parental response (“crying-it-out”) in order to encourage “sleeping through the night.” Indeed, a number of popular advice manuals advocate letting an infant cry at bedtime as early as three or four months of age.
A review of the literature on extinction reveals that empirical inquiry has been limited to measuring the intervention’s effectiveness in influencing sleep behaviors. Existing research concludes that children whose crying was not rewarded by parental response consistently slept through the night sooner than controls.
While extinction is widely advocated for use with young infants, few studies have been conducted with young infants in the sample and only one, to date, has focused on infants exclusively. Further, existing research spans wide age ranges (e.g. 6- to 48-months) and fails to address possible variations in effects by age. As a result, outcomes for infants under 1 year have not been assessed.
Some research has indicated that no ill effects were found in terms of infant behavior, but the studies that included infants in the sample relied on one instrument (Flint, 1974) that has not been reviewed for accuracy in evaluating infant behaviors. Though popular advice further submits that prolonged crying will not harm an infant, no research on this point could be found.
It is currently unknown how episodes of unmodulated distress impact infants at various stages of development. A review of the emotional regulation literature indicates that overwhelming or prolonged distress actually compromises self-soothing abilities. Sleep which follows prolonged crying may then represent, not an indication of self-calming, but a retreat from arousal that is beyond the infant’s capacity to regulate.
Parents face conflicting information regarding how and when to respond to their infant. While the stress that a crying or wakeful infant places upon a family cannot be minimized, this poster nevertheless recommends that strictly behavioral approaches to infant sleep be reexamined in light of new research on early brain development and the role of distress modulation in an infant’s developing self-regulatory capacities.
What to do about sleep? A survey of parents' experiences with infant sleep and popular advice. Poster presented at the International Society for Infant Studies, Vancouver, British Columbia (Gordon & Hill, 2008).
ABSTRACT: Background: At one time, sleep deprivation was synonymous with early parenting. Today, “sleeping through the night” has grown in importance and urgency and parents increasingly turn to the popular media for guidance (Simpson, 1997). Such sources, however, can be inconsistent and even inaccurate in matters concerning child health and development (Impicciatore et al., 1997). In fact, an examination of parenting books and magazines on infant sleep reveal stark differences in reported sleep milestones, appropriate age for starting, and amount of crying to allow. Further, advice content stresses the critical importance of extended sleep for infant brain and behavioral development. It is not surprising, then, that parents may be stressed and anxious about sleep. This survey aims to assess how popular advice influences what parents know and do about infant sleep, and whether there are differences in experience and outcomes based on their chosen approach.
Methods: First-time parents of infants under 12 months were recruited via targeted email and search engine ads. The survey includes questions about the infant's current sleep behavior, parental use of sleep advice, and implementation of the intervention. Parents' perceived levels of infant sleep difficulties, as well as worry, stress or conflict around sleep were also assessed. Based on answers to key questions, respondents were placed into one of three groups: Crying approaches, No Cry approaches, or Cosleeping. Descriptive statistics for the sample as a whole were calculated. Intervention subgroups were compared for differences in parental perceptions of advice, implementation and experience.
Results: Survey respondents (N=185) are predominantly white, married, well-educated mothers. 29.7% (N=51) were classified as Crying, 18.6% (N=45) as No Crying, and 51.8% (N=89) as Cosleeping. (The remainder of the sample either had completed their sleep approach or they were currently not doing anything to alter their baby's sleep.) Preliminary data analysis revealed no significant differences between groups in parents' use of sleep advice, knowledge of infant sleep development or the infant's current sleep behavior. Significant differences, however, were found in the level of worry about managing sleep F(2, 169) = 21.58, p<.01), the goodness of fit with their parenting values F(2, 111=27.54, p<.01), and assessment of the approach's effectiveness F(2, 111) = 6.698, p<.01).
Conclusion: While infant nightwaking is a known stressor for parents, it appears that sleep interventions themselves—especially those that necessitate infant crying—are also a source of additional worry and stress for parents.
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