Breaking My Silence: CIO

There has been so much discussion lately about cry it out (CIO) as a form of sleep training. Particularly since there have been a few recent studies suggesting it does no harm and it has been a topic of conversation, it has bothered me immensely - both personally and as a developmental psychologist. I usually keep my personal parenting practices on controversial topics to myself, but in a moment of inspiration this morning, I've decided that I'm going to share my personal and then my professional (which does differ) philosophy as a developmental psychologist about it. 

First, I do want to say that there is a difference between cry it out and staying in the room with them to support them - also there is a difference between fussing and crying. So if you leave them to work it out when they are "fussing" that is not CIO. Pure CIO, which I am going to comment on here, is the screaming and cries you hear which initially increase when the child realizes that no one is coming and then they gradually decrease until the cries are extinguished as a behavior. There has been some research on this topic and a great amount of discourse among psychologists on the topic.

Personally, I don't use cry it out for three main reasons: 

1. I don't believe that infants and toddlers cry for no reason. It is scientifically supported that infants cannot manipulate because they don't really have an understanding of separation of themselves from their caregiver (called theory of mind). So, if they are crying, they need something - a hug, food, a diaper change or they are sick. Some kids are incredibly needy at nighttime (I had one of these - he didn't sleep through the night until 1 year old and often got up 4 to 5 times every night - it sucked) leading us to think that something we are doing MUST be wrong. But some kids just suck at sleeping and need a huge amount of support. My second son already sleeps better than my oldest did at a year old. And I have done NOTHING differently.
2. Only a small portion of world cultures would even entertain the idea of CIO. Coming from a collectivist perspective, this idea of just letting your child cry to teach them something was literally foreign. You immediately respond to a baby's cries because something is wrong. CIO is pretty much an American (and some European countries) phenomenon. It speaks to the cultural ideal of independence which pervades these same countries - other countries are collectivist and interdependent. Coming from my perspective as a collectivist, I always thought it was incredibly weird that we expected babies (who were just inside of us) to be independent sleepers in a cold foreign environment without us almost immediately. Infants have a biological imperative to sleep next to mom for safety, security and attachment. It is reasonable to think that they need to time and support (which may take a year or more) to detach and sleep independently.
3. My Motto for parenting is "Everything I do teaches them something". It's an annoying reminder to myself that I can't just tell my child what is right; I have to look at what I am doing at all times and what message it sends. One of the largest lessons I want my children to learn from me is empathy - to be sensitive always to the needs of others, be kind and respectful. To me, ignoring cries, under any circumstances, doesn't teach this - it teaches that it is perfectly acceptable to ignore the pain of others in some situations. I personally can't imagine listening to a crying adult and saying, "I think you can handle this independently; I'm going to leave the room now so you can self-soothe..." Since empathy is my number one goal for my children, this is something I never want them to hear from my behavior. I sincerely believe the world would be a much better place if everyone had empathy for each other.

That's my biased personal philosophy. Now here's my professional opinion as a developmental psychologist.

1. It is highly doubtful that you can harm your child with a few days of cry it out given that they are over 6 months of age (some research suggest a year), have an easy temperament AND that this method does not pervade into the daytime. Children are incredibly resilient and outside of biological conditions, only sustained trauma can typically cause developmental harm and delays. Please note that I said easy temperament - you can absolutely harm children with slow to warm or difficult temperaments by not being responsive. Children who are slow to warm need an increased level of support due to an increased inborn anxiety. Ignoring them will INCREASE that anxiety that could reach threshold for a mental health disorder. When a child develops a mental health disorder like anxiety, it is more likely that they will have that disorder their entire life, will have a more severe form of the condition and will need more intensive treatment. A child with a difficult temperament has a decreased or completely lacking ability to self-regulate; this means that they CANNOT self-soothe. Ignoring them will only lead to them becoming more angry and potentially aggressive. Wilson unfortunately fell into that category, making the first 2 years of his life a freaking nightmare of sleep problems. There were some nights that I had to wake Mike up because I wanted to throw him down the stairs. Not kidding. Between the sleep deprivation, stress and difficulty trying to help a child with no self-soothing and sleep issues, I simply couldn't take it sometimes. But that is why it is so important to get support. When I got to that place, I would set him back down, run and get Mike and say, "Tag, you're it. Peace. I'm out."
2. I don't think that CIO is the best option for baby, but sometimes parents need a relief from the strictures of modern parenting without a community of support. Without the help of family, friends or a co-parent, you may have limited options. If your choice is no sleep and potentially becoming depressed because you have no support, I would say that CIO is a viable option. Because as a depressed caregiver, you are going to do more harm to attachment than CIO could (with an easy tempered baby). As a developmental psychologist, I would suggest safe co-sleeping first, however; since this usually helps mom sleep better, keeps the responsiveness there and is also used successfully in the vast number of cultures around the world.
3. It is important that parents understand this is NOT teaching "self-soothing". This is extinguishing a behavior, pure and simple. They learn that crying does not work to bring aid during the night. It does not teach what to do instead, so you could end up with a variety of outcomes - including increased anxiety, behavioral problems, insomnia and other sleep issues OR self-soothing. Easy children typically can self-soothe to begin with, so they just use that as their replacement behavior. So in other words again, temperament matters.

I think that this is such a controversial issue because in one extreme perspective, it causes harm and is neglectful. In another, it is the responsible way to make your child independent. Personally and professionally, I do not want any parent to feel judged for making a responsible decision about their child - and unfortunately these conversations usually go in that direction. When it comes to the utility of CIO, I would say, as any good psychologist would, that IT DEPENDS. It depends on temperament, your situation and your parenting philosophy. It also sucks to think that we could be doing something that has harmed our child, as the culture is constantly blaming caregivers - particularly mothers - for everything and expecting them to be perfect, leading to increase depression and anxiety among mothers. Honestly, these conversations make me long for the days where there was more daytime and nighttime community and family support for mothers. Which is why, at the end of the day, I always say, I trust that responsible parents make the right decisions for their own children - just follow your instincts!!