Tuesday, January 8, 2013

'Let Crying Babes Lie'

PSYCHOLOGY TODAY
Sleep Training Ignores Baby’s Need
Published on January 6, 2013 by Darcia Narvaez, Ph.D. in Moral Landscapes
"Because the mothers in our study described infants with many awakenings per week as creating problems for themselves and other family members, parents might be encouraged to establish more nuanced and carefully targeted routines to help babies with self-soothing and to seek occasional respite," said Weinraub.

The above quote, taken from a news story in the Temple University website, suggests that Dr. Weinraub, author of a recent and widely reported study on infant and toddler sleep and night waking patterns, sees only one possible solution for parents who are stressed by their babies’ nightwaking.

Yes, we agree…that NUANCED and carefully targeted routines are ESSENTIAL for infants’ development and family wellbeing. After all, nuanced simply means taking care of each child based on who that child is and what that child needs.

BUT, can care of infants be NUANCED and carefully targeted, if it IGNORES BABY’s needs…if it focuses only on self-soothing and respite for parents?  No, nuanced care can only be provided if it does look at the needs of each child and focuses on what is important for babies. So,

What is important for babies?

Nuanced and carefully targeted routines for infants, especially those with have difficult temperamental characteristics

Care for the specific needs of the caregivers, such as when mothers are depressed
Learning healthy sleep patterns, that ensure that everybody in the family gets sufficient rest by supporting emotional and physiological regulation in the first year

Letting crying babes lie ISN’T nuanced care. It is the exact opposite. Letting crying babes lie presumes that what is wrong is the crying. And it presumes that the crying stems from either wrong types of care or infants’ bad habits. 

Contrary to the conclusions they draw, Weinraub and colleagues (2012) clearly find that the majority of  babies who continued to wake at night were not “bad sleepers.” Instead, they were babies who needed attention and guidance, in the form of comfort, physical contact and, in some cases, their mother’s milk, to help them regulate their responses.

Letting these crying babies, who have specific needs (such as difficult temperaments), lie would create harder to manage sleep routines and leave infants with an overactive stress response system that would make settling of any sort—day or night—even more difficult.

Every baby has INDIVIDUAL Developmental, neurologically-based Needs…needs that are not BAD, but needs that help them grow and flourish.

Why do sleep researchers imply that it is all right to ignore these needs?

Weinraub’s team explained throughout the report of their research that babies who were waking were those babies who had a reason for waking. Some infants were reported to have a difficult temperament. What does this mean? Temperamental characteristics associated with a difficult temperament include being very sensitive to stimulation, environment context, and to change. This is why research has often reported a connection between these temperamental characteristics and infants’ sleep.

So, what will help these babies? Certainly not leaving them to cry and become more distressed and unsettled. Although parents may be able to “train” these infants to sleep through the night, what these infants need is help in guiding them to regulate their responses. 

And parents need to understand what type of NUANCED and CAREFULLY TARGETED routines will help their infants—not just help their infants’ crying. Parents need to know what will help to regulate their emotional and physical responses. With this type of care, infants will grow to be children who have learned to deal with some of the temperamental characteristics that are part of who they are. This is type of NUANCED CARE is called goodness of fit.

Depression as a risk factor. As noted in her research, some of the mothers whose babies were waking had experienced depression prenatally and were still experiencing depressive symptoms. This presence of depression has resulted in two concerns…all related to cortisol responses to stress, not to parenting choices! First, the infant has experienced higher levels of cortisol from the mother’s depression during pregnancy, thus changing their developing stress responses system. Second, mothers’ responses during early care can be impacted by the continued presence of depression. 

Given these two factors, what is needed is guidance in helping to establish physiological and neurological systems that will support infants’ ability to settle. What is not needed is the continued overstimulation of the  infants’ stress responses system that would from leaving infants to cry.

So, what advice should NOT be given to mothers with depression? Telling them that infants will and easily can sleep better—this contributes to a misconception about sleep and sets up the mother for failure—both in getting the infant to sleep and caring for her families’ needs.

What might families do when faced with the challenges of mothers’ depression? Thome and her colleagues (2005) have found that NUANCED UNDERSTANDING helps. Understanding that some infants do not sleep well because they have difficult temperamental characteristics was successful in achieving both reductions in mothers’ depression AND better infant sleep. Again, this is NUANCED CARE.

The bottom line is that NUANCED CARE addresses the needs of infants and families. A focus on only whether babies wake and cry in the night is an absurdly unhelpful approach. WHAT IS NEEDED is to look at what babies need, provide that, guide them gently to healthy outcomes, and be comfortable with the ability as parents to provide that guidance. WHAT IS NEEDED is NUANCED CARE focused on EACH INFANTS’ NEEDS.

Almost none would recommend that parents routinely leave a baby to cry if the baby had a cold and had trouble breathing. Rather they would advise parents to be responsive and caring in ways that are nuanced to the baby’s needs. Parents would suction their noses, provide for their needs, hold them or rock them because adults have seen firsthand how such actions help babies to settle. Care would be NUANCED to the baby’s needs because babies are too young to care for themselves.

The babies still waking in Weinraub and her team’s study are infants who needed guidance and nurturance to sleep. NUANCED CARE is the OPPOSITE OF Letting Babes Lie and Cry. Indeed, the essence of nuanced care is being attentive in order to see what this baby needs and responsive so we can help the baby accordingly. This approach, which human beings are wired to do, and which babies are wired to thrive under, is beneficial not only for the baby, but also the parent and the family as a whole

References

Thome, M. & Skulladottir, A. (2005). Evaluating a family-centred intervention of infant sleep problems. Journal of Advanced Nursing, 50, 5-11.

Weinraub, M., Bender, R.H.l, Friedman, S., Susman, E.J., Knoke, B., Bradley, R. , et al. (2012).  Patterns of developmental change in infants’ nighttime sleep awakenings from 6 to 36 months of age. Child Development 48, 1511-1528.


Dangers of “Crying It Out”
Damaging children and their relationships for the longterm.
Published on December 11, 2011 
by Darcia Narvaez, Ph.D. 
in Moral Landscapes

Letting babies "cry it out" is an idea that has been around since at least the 1880s when the field of medicine was in a hullaballoo about germs and transmitting infection and so took to the notion that babies should rarely be touched (see Blum, 2002, for a great review of this time period and attitudes towards childrearing).

In the 20th century, behaviorist John Watson (1928), interested in making psychology a hard science, took up the crusade against affection as president of the American Psychological Association. He applied the mechanistic paradigm of behaviorism to child rearing, warning about the dangers of too much mother love. The 20th century was the time when "men of science" were assumed to know better than mothers, grandmothers and families about how to raise a child. Too much kindness to a baby would result in a whiney, dependent, failed human being. Funny how "the experts" got away with this with no evidence to back it up! Instead there is evidence all around (then and now) showing the opposite to be true!

A government pamphlet from the time recommended that "mothering meant holding the baby quietly, in tranquility-inducing positions" and that "the mother should stop immediately if her arms feel tired" because "the baby is never to inconvenience the adult."  Babies older than six months "should be taught to sit silently in the crib; otherwise, he might need to be constantly watched and entertained by the mother, a serious waste of time." (See Blum, 2002.)

Don't these attitudes sound familiar? A parent reported to me recently that he was encouraged to let his baby cry herself to sleep so he "could get his life back." 

With neuroscience, we can confirm what our ancestors took for granted---that letting babies get distressed is a practice that can damage children and their relational capacities in many ways for the long term. We know now that leaving babies to cry is a good way to make a less intelligent, less healthy but more anxious, uncooperative and alienated person who can pass the same or worse traits on to the next generation. 

The discredited behaviorist view sees the baby as an interloper into the life of the parents, an intrusion who must be controlled by various means so the adults can live their lives without too much bother. Perhaps we can excuse this attitude and ignorance because at the time, extended families were being broken up and new parents had to figure out how to deal with babies on their own, an unnatural condition for humanity--we have heretofore raised children in extended families. The parents always shared care with multiple adult relatives.

According to a behaviorist view completely ignorant of human development, the child 'has to be taught to be independent.' We can confirm now that forcing "independence" on a baby leads to greater dependence. Instead, giving babies what they need leads to greater independence later. In anthropological reports of small-band hunter-gatherers, parents took care of every need of babies and young children. Toddlers felt confident enough (and so did their parents) to walk into the bush on their own (see Hunter-Gatherer Childhoods, edited by Hewlett & Lamb, 2005).

Ignorant behaviorists then and now encourage parents to condition the baby to expect needs NOT to be met on demand, whether feeding or comforting.  It's assumed that the adults should 'be in charge' of the relationship.  Certainly this might foster a child that doesn't ask for as much help and attention (withdrawing into depression and going into stasis or even wasting away) but it is more likely to foster a whiney, unhappy, aggressive and/or demanding child, one who has learned that one must scream to get needs met. A deep sense of insecurity is likely to stay with them the rest of life.

The fact is that caregivers who habitually respond to the needs of the baby before the baby gets distressed, preventing crying, are more likely to have children who are independent than the opposite (e.g., Stein & Newcomb, 1994). Soothing care is best from the outset. Once patterns get established, it's much harder to change them.

Rats are often used to study how mammalian brains work and many effects are similar in human brains. In studies of rats with high or low nurturing mothers, there is a critical period for turning on genes that control anxiety for the rest of life. If in the first 10 days of life you have low nurturing rat mother (the equivalent of the first 6 months of life in a human), the gene never gets turned on and the rat is anxious towards new situations for the rest of its life, unless drugs are administered to alleviate the anxiety. These researchers say that there are hundreds of genes affected by nurturance. Similar mechanisms are found in human brains--caregiver behavior matters for turning genes on and off. (Work of Michael Meaney and colleagues; e. g., Meaney, 2001).

We should understand the mother and child as a mutually responsive dyad. They are a symbiotic unit that make each other healthier and happier in mutual responsiveness. This expands to other caregivers too.

One strangely popular notion still around today is to let babies 'cry it out' when they are left alone, isolated in cribs or other devices.  This comes from a misunderstanding of child and brain development.

Babies grow from being held. Their bodies get dysregulated when they are physically separated from caregivers. (See here for more.)
Babies indicate a need through gesture and eventually, if necessary, through crying. Just as adults reach for liquid when thirsty, children search for what they need in the moment. Just as adults become calm once the need is met, so do babies.
There are many longterm effects of undercare or need-neglect in babies (e.g., Bremmer et al, 1998; Blunt Bugental et al., 2003; Dawson et al., 2000; Heim et al 2003).
Secure attachment is related to responsive parenting, such as when babies wake up and cry at night.

What does 'crying it out' actually do to the baby and to the dyad?

Neurons die. When the baby is greatly distressed, the hormone cortisol is released. In excess, it's a neuron killer (Panksepp, 1998). A full-term baby (40-42 weeks), with only 25% of its brain developed, is undergoing rapid brain growth. The brain grows on average three times as large by the end of the first year (and head size growth in the first year is a sign of intelligence, e.g., Gale et al., 2006). Who knows what neurons are not being connected or being wiped out during times of extreme stress? What deficits might show up years later from such regular distressful experience? (See my addendum below.)

Disordered stress reactivity can be established as a pattern for life not only in the brain with the stress response system (Bremmer et al, 1998), but also in the body through the vagus nerve, a nerve that affects functioning in multiple systems (e.g., digestion). For example, prolonged distress in early life, resulting in a poorly functioning vagus nerve, is related disorders as irritable bowel syndrome (Stam et al, 1997). See more about how early stress is toxic for lifelong health from the recent Harvard report, The Foundations of Lifelong Health are Built in Early Childhood).

Self-regulation is undermined. The baby is absolutely dependent on caregivers for learning how to self-regulate. Responsive care---meeting the baby's needs before he gets distressed---tunes the body and brain up for calmness. When a baby gets scared and a parent holds and comforts him, the baby builds expectations for soothing, which get integrated into the ability to self comfort. Babies don't self-comfort in isolation. If they are left to cry alone, they learn to shut down in face of extensive distress--stop growing, stop feeling, stop trusting (Henry & Wang, 1998).
Relatedf Articles: 
Jan 6, 2013 - Baby Sleep Training Mistakes Experts And Parents Make
Dec 11, 2012 - Dangers of “Crying It Out”
Jan 12, 2013 - Criar un niño de “forma moderna” impide su desarrollo mental y emocional
Dec 18, 2011: Recovering Cry It Out Parenting Adult