BawlingBabies

I am a social worker and parent in Australia concerned about the western practice of a method called 'controlled crying' that is used on infants to get them to sleep. This blog talks about the use of this method and other parenting methods. Search all the information on this site to be better informed about the practice of controlled crying. For any comments or questions, my email is bawlingbabies@yahoo.com.au

Saturday, October 11, 2008

SA study to settle battle of cry babies debate
THE long-term health impact of controlled crying on babies will finally be determined by a world-first study in South Australia.
http://www.news.com.au/adelaidenow/story/0,22606,24305993-5006301,00.html


The wording of this article seems to indicate a bias on the part of the researchers, which - if true - would then indicate that the researchers need to seriously consider and document that they are indeed already biased, if they are to conduct any decent credible research.

http://socsci.flinders.edu.au/psyc/students/KateJackson/index.php

But if there is any possible risk to the babies, then how is the research being permitted through the ethics committee?

Many professionals and mothers have asked this question and the resulting petition can be signed at this link;

http://www.gopetition.com.au/online/21782.html


We the undersigned strongly object to the conditions of the study on Infant Sleep Disturbance, which is being conducted by Kate Jackson at Flinders University.

We are concerned that the children involved in the study will be subjected to ‘sleep training’, otherwise known as controlled crying, cry it out or controlled comforting. This aspect of the study is inconsistent with Flinders University Ethics policy [1], which requires researchers to protect the rights of their experimental subjects.

The Australian Association for Infant Mental Health [2] does not support the practice of controlled crying stating that the technique “is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences”. If there is ANY concern that controlled crying could be harmful to infants, then the rights of the child are not being protected and the study should cease immediately.

We are also concerned with comments that Kate Jackson has made to the media which display bias unfit for someone conducting a scientific study, “Conflicting advice about controlled crying meant some parents were being scared off the technique” [3] .

As informed individuals we question the theoretical foundations of this study, in particular, the definition of 'sleep problems' [4]. There is evidence to support that it is completely natural for infants to wake often during the night throughout their first year and beyond [5,6]. This is NOT a 'sleep problem'.

Controlled crying and other similar regimes may indeed work (although one Australian baby magazine survey found that only 8% of mothers who used controlled crying said that it worked for more than a week [7]) to produce a self-soothing, solitary sleeping infant. However, the trade-off could be an anxious, clingy or hyper-vigilant child or even worse, a child whose trust is broken. Unfortunately, we can't measure attributes such as trust and empathy which are the basic skills for forming all relationships[7].

We suggest that a study into the true causes of parent fatigue would benefit families much more than this proposed study.


References:

1. Flinders University, Ethics and Biosafety.
http://www.flinders.edu.au/research/info-for-researchers/ethics/

2. The Australian Association for Infant Mental Health,
http://www.aaimhi.org/documents/position%20papers/controlled_crying.pdf

3. The Sunday Mail, Adelaide Now.
http://www.news.com.au/adelaidenow/story/0,22606,24305993-5006301,00.html

4. http://www.ssn.flinders.edu.au/psyc/students/KateJackson/
http://www.ssn.flinders.edu.au/psyc/students/KateJackson/ISDwebflyer.pdf

5. Pub Med, http://www.ncbi.nlm.nih.gov/pubmed/8680184?dopt=Abstract

6. Goodlin J, Beth L, Burnham M M, Gaylor E E, Anders T F, 2001, Night Waking, Sleep-Wake Organization, and Self-Soothing in the First Year of Life, Journal of Developmental and Behavioral Pediatrics, Volume 24, Issue 4. View abstract at http://www.ncbi.nlm.nih.gov/pubmed/11530895?dopt=Abstract

7. http://www.pinky-mychild.com/index.php?option=com_content&view=article&id=22:the -con-of-controlled-crying&catid=11:sleep&Itemid=36

Being "Fully Informed"

Read all the reputable articles on this Blog to be fully informed about the practice of controlled crying. Once you have read this information and sought further information in support of controlled crying, then you should be comfortable in knowing you are making a fully informed decision.

In Australia all material risks must be disclosed (as in the case of Rodgers vs Whitaker) in any proposed treatment. So you are within your rights to discuss any issues or questions you have with your health professional (and you should expect them to be able to discuss it with you) before using this method on any child.

Informed consent is a legal condition whereby a person can be said to have given consent based upon an appreciation and understanding of the facts and implications of an action. The individual needs to be in possession of relevant facts and also of his or her reasoning faculties” (Wikipedia)

“In the United States, Australia, and Canada, a more patient-centered approach is taken and this approach is usually what is meant by the phrase "informed consent." Informed consent in these jurisdictions requires that significant risks be disclosed, as well as risks which would be of particular importance to that patient” (Wikipedia)

Tuesday, August 21, 2007

Trust in Yourself!

The best advice I can give to anyone reading this blog, is to simply trust in yourself. If you truly feel happy when your baby drifts off to sleep in your arms then there is nothing to worry about. If you truly feel happy and elated while you listen to your baby cry to sleep, then obviously you have made the right choice for you. However, I would be suprised if you truly felt joyous when you heard your baby cry. No-one I know of feels deeply happy to hear their baby crying and upset, and I would worry about them if they did. This is obviously a simplistic way of viewing things, but it is the best way to judge your experience of life. If it feels good, then do it, but if it doesn't make you feel good, you need to seriously and deeply consider WHY, and change your actions.

You are the one who knows your baby best, you are the one who knows what feels right to do for them. After those first few weeks of getting to know their cries and expressions and ways of communicating, you know deep down how to respond to your baby. Trust in yourself and have confidence that what you feel in your gut as the best thing to do, is what you need to do. If you truly feel good helping your baby to sleep by rocking or feeding or in any other creative and gentle way, then this is the only choice to make.

If you are still not sure how you feel about how to settle your baby, read this blog and try to gauge how you feel after reading the articles. Go online and read articles that support controlled crying. Use your head but also tune into your feelings. Imagine yourself in your babies shoes. Imagine the experience of leaving your baby to cry. How do you feel? This will hopefully help you decide how to make your decision. In the words of the famous poet SriChinmoy;


Be happy, be happy!
Unless you are happy,
Your outer life will not succeed
And your inner life will not proceed.


Be happy, love your baby, live with confidence and trust in yourself. Know that you are doing all you can to be the best parent you can.

Saturday, June 23, 2007

Controlled Crying - some facts and information

Controlled Crying - Some Facts & Information

By Jayne Garrod

What is Controlled Crying?

In recent years, there has been a concerted effort among many health professionals, in particular baby health nurses, to promote the Infant Sleep Training method known as Controlled Crying (sometimes referred to as “Controlled Comforting”) as the preferred ( and indeed in some cases the only) desirable method of settling a baby to sleep. The idea behind Controlled Crying is to teach babies to “self settle” or put themselves to sleep, and to stop them from crying out during the night. It involves leaving the baby alone to cry for increasingly longer periods of time before providing comfort. Originally Controlled Crying was not suggested for babies less than 6 months of age, but increasingly it’s being suggested for use with younger and younger babies, right down in some cases to newborns. In fact one of the originators of the Controlled Crying or “Cry It Out” form of sleep training, Dr Richard Ferber, originally intended it to be used in babies 18 months and older.

So why is Controlled Crying undesirable?

There are several reasons why many health professionals and mothers alike have deemed Controlled Crying to be an unsuitable technique. Here are some of those reasons:

Controlled Crying can be harmful to the breastfeeding relationship.

Newborns need to be fed around the clock, so that the mother establishes her milk supply in the early stages.

Babies have very small stomachs, which are biologically designed to empty quickly, and to be immediately re nourished.. It is unrealistic to expect little babies to go for long periods without milk, and not to become distressed. This also applies to formula fed babies - babies simply cannot be expected to go long amounts of time, without sustenance1

Furthermore, breast milk contains a hormone designed to induce sleepiness in both mothers and babies. This hormone is called Cholecystokinin (CKK) and is released in the mother when the baby starts suckling, and travels through into the breast milk. So it’s natural for babies to go to sleep on the breast-nature designed it this way. Yet proponents of Controlled Crying insist that babies should not be allowed to develop the “bad habit” of falling asleep on the breast. However, feeding a baby to sleep is not “spoiling them” or making “a rod for your back” as these advocates would claim. Rather, attending quickly to a crying baby teaches a child they are loved and are worthy of attention. A baby left alone to cry, may develop what psychologists call Learned Helplessness - in other words, they discover their needs are not worthy of being met, so they give up in despair.

Controlled Crying compromises the development of Secure Attachment, and healthy parent-child relationships.

Infants are far more likely to develop secure attachments when their cries are responded to promptly. Secure attachment in infancy is the basis for good adult mental health. According to child psychologists,babies left alone to cry, are more likely to suffer from poor self esteem as older children, teenagers and adults. The research conducted by Ainsworth and Bell at John Hopkins university showed that when parents responded to a child’s cry quickly, the result was a secure, happy child, who was far more likely to initiate independence at an earlier age ii

Babies suffer separation anxiety when left alone for long periods.

It is normal for babies to go through a period of separation anxiety, when separated from their caregivers. This usually occurs from around 6 months through till 12 months, peaking at around 9 months. In some children it may even last up to 18 months, in correlation with the child’s personality and how well the child is supported during this sensitive period. This also coincides, and is related to children learning about “Object Permanence” In other words, learning that when an object (or person) is removed from sight, it actually does still exist. Babies younger than 8-9 months do not understand that when a parent leaves them, they will come back, in fact the child can’t see the parent, so they may conclude the parent is gone for good. The concept of Object Permanence is not fully developed in children until around the age of four.

Crying and Baby Stress
According to a study conducted by Dr Michael Commons of the Harvard Medical School, researchers found a link between babies crying for extended periods of time, and a higher level of the stress hormone cortisol in babies’ brains.Commons suggested that constant stimulation by cortisol in infancy caused physical changes in the brain.
Dr Commons stated "It makes you more prone to the effects of stress, more prone to illness including mental illness and makes it harder to recover from illness," Commons said. "These are real changes and they don't go away." iii

Babies sleep better when close to their caregivers

This is a basic biological fact. There is no developmental reason for babies to sleep apart, and in fact in the case of our ancestors, it would have been perilous to do so. Imagine if our Stone Age ancestors had decided to separate bubs in a different cave or hut, so they could learn to “self settle” They would have been attacked by marauding wild animals! Babies have this biological instinct to respond to perceived danger, in the form of crying. It is the only way they know how to communicate their needs. The fight or flight instinct is still a vital part of our biological makeup. Parents also possess the instinct to pick up and soothe a crying baby-to tell parents this is “wrong”, is to deny them one of the most vital and enjoyable aspects of parenting



Experts speak out against
Controlled Crying…

In 2003 the Australian Association for Infant Mental Health released a paper stating their opposition to the Controlled Crying technique, based on research they had conducted:

“AAMHI is concerned that the widely practiced technique of Controlled Crying” is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences” iv

They further stated that other strategies should always be discussed with parents, as preferable options.

Other prominent medical professionals have also spoken out against this practice. The following is a quote from well known US paediatrician
Dr William Sears:

“With most of these baby-training regimens you run the risk of becoming desensitised to the cues of your infant, especially when it comes to letting baby cry it out. Instead of helping you to figure out what baby's signals mean, these training methods tell you to ignore them. Neither you nor your baby learns anything good from this…

He goes on to say:

“Clicking into the cry-it-out method also keeps you from continuing to search for medical or physical causes of night waking, such as GER and food allergies. Night feedings is normal; frequent night waking is not. v

In other words-there is a reason your baby is crying-and if it isn’t simply because they need to be held and to feel secure, then it is most likely there is another underlying medical reason, which should be investigated.

So what’s the alternative?

Many sleep deprived parents turn to CC because it seems to solve their sleep problems quickly. In some cases it works (at what cost is another story) However, many parents also find this method does not work, and simply causes the whole family incredible distress. So, what else can parents do?

Alternatives to Controlled Crying
Co sleeping. This is the normal way to sleep, for many of the world’s population. Dr Sears says: “Over the years of noting all the good things that happen to babies when they share sleep with their parents, one medical benefit that these babies thrive. The health benefits of sharing sleep have been recognized for many years” vi

If co sleeping does not appeal however, there are many other options. Baby massage, warm baths, soft soothing music, aromatherapy, a recognisable bedtime routine-these things can all help. There are many helpful websites out there, offering gentle solutions to sleepless nights with bubs, and books such as Elizabeth Pantley’s No Cry Sleep Solution, and Pinky McKays “100 Ways to Calm The Crying” and “Parenting By Heart” are excellent resources for parents wishing to discover the many alternatives to leaving a baby to cry itself to sleep.

This fantastic article can be read here;
http://www.joyousbirth.info/articles/controlledfacts.html

Tuesday, June 19, 2007

Reasons not to use "Controlled Crying"

Reasons not to use Controlled Crying or other similar methods;

There must be many reasons not to use this method, but here are just a few;


* There are no studies verifying that these methods are safe for a babies developing brain. Safety can not be assured.

* Neurology, Neuropsychology and other fields of Science are revealing more and more about how these methods could damage your child’s emotional, psychological and behavioural development, due to the effect it has on the infants brain

* It is an emotionally difficult experience for both children and parents, and this alone may alter your attachment or future relationship

* There is also the suggestion by some doctors and health professionals that using these methods could adversely affect the child’s sleep in the future. For example they may develop a fear of bedtime, bedwetting, or other behaviours such as head banging and so on.

* There are many examples of heartache experienced by mothers who have used controlled crying methods in the past.(Most of these examples listed have been told to me via emails from the mothers or friends of these mothers) Some examples are;

Death of child (the child died when left to cry. It would have been avoided if controlled crying was not used).
Burst blood vessels in the infants eyes
Vomiting / choking
Rejecting the mother afterwards, or severe and obvious effects on the attachment relationship. (See also Pinky McKays book "Sleeping Like a Baby")

* One of the best reasons not to try these methods is efficacy. The best available estimate on the effectiveness of this method is that it works in 70-80% of cases (Dr Harriet Hiscock), and other reports are as low as 20 - 40%. This means that, at best, 20-30% of babies go through this experience with the potential harmful consequences and it still doesn’t work. At worst 80% of babies and children go through this experience and it doesn’t improve their sleeping. Why take the risk?

Tuesday, May 08, 2007

The Play

Controlled Crying, a play written by Ron Ellisha, is mentioned here in a post 'Controlled Crying in the Meida'.
( http://bawlingbabies.blogspot.com/2006/08/controlled-crying-in-media.html )

It's on again! Read more here;

http://www.smh.com.au/news/arts-reviews/controlled-crying/2007/04/30/1177788010658.html

Mums told to ditch controlled crying

Here is a media article about Anni Gethin and Beth Macgregor's new book, "Helping your baby to sleep". As I have mentioned this is a great book (and my experience is listed in the book too!) and is very well researched.

http://www.smh.com.au/news/national/despairing-mums-told-to-ditch-controlled-crying/2007/03/10/1173478729137.html

There is abundant research that clearly indicates that leaving a baby to cry for any amount of time is harmful, however, people continue to assume that it isn't harmful. Just because something is a common practice, doesn't mean it's not harmful!

In the few research articles supposedly 'supporting' controlled crying or 'graduated extinction' (I can only find three), the only method used to measure the infants emotional state is maternal observation and a completed survey. Basically the mother watches the infant to see if they appear 'normal' or not. How can this be a credible measure of an infants emotional health? And even if the mother could tell if her infant was somehow different from before controlled crying, (which is most likely impossible!), then would she write it down in a survey for others to read? I doubt it. This is only one of the problems with this research.

The media article above mentions Dr Harriet Hiscock. It is her research that is quoted as support for controlled crying and is the only Australian* piece of research stating that controlled crying is important for mothers who suffer from PND. I fail to see how using a harmful behavioural technique on an infant can improve a depressive state in another person. How is this a valid scientific argument? Isn't there clear problems with the methodology? Is a normal infants behaviour a direct cause or even a symptom of PND?

At the moment the Victorian Government is training 200 maternal and child health nurses to use controlled crying on babies. They cliam this is evidence based practice. However, 'evidence based practice' is defined as using a large body of evidence to support a method. The Victorian Government uses just one study, and the validity of the methodology of this study is widely questioned.

Robin Barker is an author and mother who is also quoted in the article. She states that there is no concrete evidence that it harms babies, but fails to note that there is no concrete evidence that it doesn't. And I wonder why she mentions nine months old as an appropriate age? When is the right age to leave a baby to cry on their own? I was told 20 days was fine for my baby by a qualified Registered Nurse and Lactation consultant. I have been told by Harriet Hiscock that only from 6 months of age is controlled crying suitable. And Robin Barker states from nine months of age. I'm confused! Perhaps there is no real 'safe' age for this practice? Since no one can prove that it is NOT harmful, I tend to agree with Professor James McKenna, acclaimed SIDS expert, who describes controlled crying as social ideology masquerading as science.




*I am aware of another study conducted in New Zealand, with a similar invalid methodology and similar conclusions.

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