Many sleep-deprived parents hail controlled crying as a godsend, writes Danielle Teutsch, but a new book claims babies may suffer long-term damage as a result.

Frustrated mum Kate Grant turned to controlled crying as a “last resort”. At 10 months of age, her daughter, Maggie, was waking at 2 o’clock every night to be breastfed. Kate and husband Steve considered every possible cause for their daughter’s unrest.

“She wasn’t hungry, not hot or cold, not teething and not ill,” says Kate, 35, of Fairlight.

After speaking with an early-childhood nurse, the couple realised their daughter’s pattern was simply a habit.

“I didn’t want to do controlled crying,” Kate says. “I knew it was going to be hard. And, as a new mum, you don’t want to listen to your baby cry.

“But in the end, I had had enough of getting up at 2am. I knew it was unnecessary. Lots of other babies had been sleeping through for ages.”

The first night, Maggie cried for one hour and 15 minutes before she fell asleep. “It was horrific,” Kate recalls. “We just lay there and listened to her.”

The second night, the crying continued for 40 minutes. The third night, it lasted for 10 minutes. And Maggie, who will be one next week, has slept through the night ever since.

“It was a small price to pay for unbroken sleep.”

CONTROLLED crying is a guaranteed barbecue stopper among Australian parents, more divisive than the old breast-versus-bottle feeding debate.

For anyone who doesn’t have children, the meaning of controlled crying is not immediately obvious. It’s a weasel phrase, designed to obfuscate the fact that it refers to the practice of leaving babies to cry themselves to sleep.

It is controversial because it is so counter-intuitive. A normal human response to distressed, wailing infants is to pick them up and soothe them, not leave them to scream until they vomit. But controlled crying also has an army of fans because it can be stunningly effective.

Scan internet forums for mothers and the comments about controlled crying leap out: “works wonders”, “heaven”, “the best thing I’ve ever done” and “I finally look forward to bedtime instead of dreading it”.

But a new book says babies are paying a heavy price so their parents can enjoy the bliss of uninterrupted sleep. The Australian authors of Helping Your Baby To Sleep (Finch Publishing), Anni Gethin and Beth Macgregor, argue that controlled crying is detrimental to children and can have serious long-term effects.

Gethin, a health social scientist, and Macgregor, a psychologist, draw heavily on attachment theory showing the importance of secure parent-child bonding.

The authors say that when infants are left to cry for long periods, they become more and more despairing until they reach a state of “learned helplessness”. They stop trusting their parents, the precious bond is broken and the child is at risk of developing emotional and social problems, including depression, later in life.

“Depriving a baby of parental care and contact at bedtime does not teach a baby independence,” the authors say. “Instead he learns that his parents cannot be relied upon to provide comfort and reassurance and so gives up calling for help.”

The book also refers to recent research that shows an infant’s brain is flooded with toxic hormones following stressful situations, and that repeated trauma can damage neural pathways.

The book is bound to cause debate, especially as controlled crying is recommended by many early childhood nurses and well-known parenting authors.

In fact, there is little middle ground. Attachment parenting advocates are fiercely opposed to it, and argue for a gentle, child-centred approach to helping babies get to sleep. The opposing camp maintains that parents have a responsibility to impose some order on their babies’ erratic sleep patterns for the sanity of everyone in the household.

Until you’ve experienced prolonged sleep deprivation, it’s difficult to appreciate how debilitating it is. In the first few weeks of a baby’s life, the night waking is tolerable thanks to a cocktail of hormones and adrenaline and the support of family and friends. But, as the months go by, fatigue accumulates to an unbearable level. It’s no wonder parents become obsessed with finding a solution.

Almost one in three babies has a severe sleep problem that affects the mother’s health, says an Australian survey published last month in the Journal Of Paediatrics And Child Health.

The study found sleep deprivation put mothers at risk of overload and dysfunction, making it difficult for them to properly care for their babies. There are several studies that show mothers of babies who are poor sleepers are also at higher risk of depression.

Into this chasm of need has stepped an army of sleep experts, all professing to hold the key to peaceful nights. And that makes for a very lucrative publishing niche.

Dymocks says its bestselling infant sleep book is Save Our Sleep by Tizzie Hall. It has a spin-off website that sells articles, tickets to sleep seminars and, most expensively, a one-on-on consultation with Hall for $436.

Unashamedly commercial, Hall calls herself an “infant sleep solutions business”.

Many baby experts such as Hall offer varying versions of controlled crying. They are adamant that the best way to prevent long-term sleep problems is to teach babies how to settle themselves, essentially by letting them cry it out.

CONTROLLED crying is not new. Grandmothers will talk of wheeling their babies to the bottom of the garden until they dropped off to sleep.

But the method started to gain momentum after the publication of US pediatric sleep specialist Dr Richard Ferber’s book, Solve Your Child’s Sleep Problems, in 1985. The basic principle was that parents should put their babies to bed and leave, returning to comfort at three, five and 10 minutes, then longer intervals, until the baby learns to fall asleep alone.

Since then, Ferber’s method has been modified to make it more palatable to parents, and is sometimes called “controlled comforting” or “crying down”.

Even Ferber was sensitive to charges that controlled crying was cruel and callous. When his book was recently rereleased, he stressed it was not a cure-all, and was used for a specific kind of sleep problem.

However Ferber stands by his original controlled crying method, saying that for many parents, it is “sanity-saving advice”.

There’s certainly no shortage of published scientific evidence showing that controlled crying is effective. Studies state the method works 70-80 per cent of the time, says Dr Harriet Hiscock, pediatrician from the Centre for Community Child Health at the Royal Children’s Hospital, Melbourne.

Hiscock was involved in a 2002 study published in the British Medical Journal that found that not only did controlled crying help babies sleep better in the short term, it also reduced depression in their mothers.

What every parent wants to know, though, is whether it does any harm to babies.

Clearly, Gethin and Macgregor think controlled crying is detrimental to children. They have not done any original research for their book, but extrapolate from studies showing that stress caused by neglect in the early years can cause possible social and emotional problems, including depression, later in life.

This in itself is not controversial. The importance of loving parenting in a child’s early years is well established. Anyone who has ever seen the doleful faces of attention-starved Romanian orphans has no doubt of the tragic long-term consequences for a neglected child.

But what is less certain is whether three or four nights of controlled crying in a secure, loving home is enough to damage babies’ mental development and undermine trust in their parents.

Gethin freely admits that no studies have directly proven it, but she is confident that in five years’ time, controlled crying will be discredited.

“It feels wrong for parents,” she says. “It upsets them, and that’s the first worrying sign.”

Gethin’s views have been reinforced by her experience with the second of her three sons, Ben, who was a poor sleeper. She later found that her sensitive child, who would wake many times a night for the first two years, had an intolerance to certain foods.

She shudders to think of a blunt instrument such as controlled crying being used on high-need babies with underlying medical conditions.

The book also makes the point that babies have a sleep biology that is different from adults, and that it is quite normal for them to wake frequently seeking reassurance.

Gethin and Macgregor’s views are supported by the Australian Breastfeeding Association, and the Australian Association for Infant Mental Health.

However, their book has other experts, particularly those who have hands-on experience with mothers and babies, tearing their hair out in frustration.

Hiscock, who has spent almost a decade researching infant sleep, says controlled crying is a valid option for parents, and that scaring them into thinking they are potentially damaging their children is “really unhelpful”.

“If you don’t want to do it, don’t,” she says. “But if you want to, then go for it.”

Hiscock says the overall wellbeing of families has to be considered. “Yes, attachment is incredibly important, but a depressed mother is not good for attachment either. If after three nights of controlled crying, everyone is better rested, then why shouldn’t they do it?”

Hiscock says the Centre for Community Child Health has now done two randomised controlled trials (one is due to be published this year), following up families three years after they did controlled crying. There was no evidence of behavioural problems in the children.

A New Zealand study in 1992 also compared infants that had been taught to sleep with controlled crying with those who had not, and found no evidence of detrimental effects.

Robin Barker, who includes a chapter on controlled crying in her best-selling parenting book Baby Love, admits she is so sick of the polarised debate around the subject she is reluctant to wade into it.

“It’s like an atheist trying to debate a born-again Christian,” she says. “It’s become the metaphor for whether you are a good parent or not.”

Barker believes some academics and experts who are opposed to controlled crying are well intentioned but don’t have hands-on experience working with babies and their exhausted mothers.

In her 16 years working as an early childhood nurse (she stopped practising in 2000) and following up families after they did controlled crying, she says she never saw any harmful effects.

But she stresses that controlled crying doesn’t always work, isn’t appropriate for all families, and isn’t a permanent solution.

“My main reason I would advise it is in the case of a well-fed, healthy, six- to 12-month-old baby who is still waking up every two hours in the night, and whose mother is ready to jump off The Gap,” she says.

She is one of the few experts who is not a disciple for either camp. She prefers to give parents options, rather than solutions.

“There’s nothing wrong with the middle road,” Barker says.

Source: Sydney Morning Herald