There have been multiple important publications in the past few weeks which are pertinent to my patients. I’m really excited today to share the results of the Kids Sleep Study which was recently published in the journal Pediatrics and received a significant amount of press. This study was designed to address persistent concerns that sleep training may cause psychological damage to children.
The authors of this study were following up a prior study recruited a large number of families in Australian who had infants under six months of age. Families reporting a problem with their infant’s sleep were offered participating in the study. Half of the families were randomly offered either sleep training or standard care. I love the summary of the sleep training techniques taught which is incredibly succinct:
Two main sleep techniques were offered: 1) “controlled comforting” in which parents respond to their infant’s cry at increasing time intervals to allow the child to self-settle, and 2) “camping out,” in which the parent sits with the child as they learn to independently fall asleep, slowly removing their presence from the child’s room.
The original study showed persistent improved sleep in the children who had received intervention, and decreased symptoms of depression in their mothers when they were age two. The current study followed up the children and families at age six. There are several pertinent findings:
- There was no evidence that children who had sleep training in infancy had more emotional or behavioral problems in the children who were not.
- There was no difference in the stress response (measured by cortisol) in the two groups. (For a good summary of the significance of this, read this article at Science of Mom.)
- There was no benefit to sleep training at six years of age either.
These are tremendously important findings. First of all, parents should not feel guilty about sleep training their child as there are clear short and medium term benefits, and there is no significant risk of harm. Second, children who were not sleep trained did not seem to be suffering in any emotional or sleep related domains. So if you cannot sleep train your child, for whatever reason, that is OK as well.
There are some limitations to this study. Only children sleep trained in the first year of life were included, and they excluded children with significant intellectual disability or developmental delay, so it is difficult to extrapolate the results to other groups. However, as the authors point out, it is unlikely that larger or longer term studies of sleep training will be conducted, as sleep training is now the standard of care due to the strong evidence for efficacy and benefits (see Practice Parameters for Behavioral Treatment of Bedtime Problems and Night Wakings in Infants and Young Children for more info).
I wonder if this makes any parents out there feel better. Let me know.
Feel better? Nope. I always knew! And boy, how happy and rested my entire little family is! Thanks for the article.
Hi Dr. Craig,
A while back you kindly read an article I sent you from Psychology Today about “The Dangers Of Sleep Training”. Not only were you nice enough to read it, you also commented. I see that the author responded to you. I’m not sure if you saw her response, but would you once again be able to comment on it?
Here is your original response and the authors follows it.
by Craig Canapari MD on November 25, 2013 – 7:33pm.
This article presents a seeming impressive series of references and assertions but represents a biased point of view. Essentially, there is no direct evidence that sleep training causes damage to children. Many of the studies noted above describe the result of persistent patterns of neglect as opposed to isolated bouts of crying associated with sleep training.
The best examination to date of the effects of sleep training was the Kids Sleep Study out of Australia which examined the effects of a sleep training intervention in infancy after five years had elapsed. The authors found that there was no evidence of any effects of sleep training. Moreover, people who DID NOT sleep train their children also had children that slept well.
Kids Sleep Study results>
This to me is a hopeful finding very much at odds with the thesis of this article– which essentially states that parents using well established and studied practices are damaging their children.
There are many reasons why parents need to sleep train their children. Cry it out methods work for some families but not others. I feel that it is very counterproductive to make parents feel bad after the fact– there is no evidence that that is the case.
For further reading, I would recommend a great blog post on Science of Mom which takes a more objective look at the science of this:
Finally, here is an article I wrote on why parents should not feel guiltyabout sleep training if it is the right decision for them.
If you want to sleep train your child, and it is the right decision for your family do so, If you do not, that is OK too and your child will likely be OK. However, I have no patience for those who wish to make others feel bad about their parenting decisions in the absence of evidence that they are doing harm.
replyquote
baselines not acknowledged
Submitted by Darcia Narvaez, Ph.D. on November 29, 2013 – 4:18pm.
Dear Doctor,
Please read the critiques of what you call the Kids sleep study–the research study was horribly designed, does not at all “prove” what they claim, and the primary author profits from sleep training initiatives! See here:
http://pediatrics.aappublications.org/content/130/4/643/reply
The baseline for babies as social mammals is to be with adults while they rapidly develop in the first years of life. The onus for any study should be to show that no harm is done. But that is impossible. Researchers typically study only a handful of variables and never long-term outcomes. So you have to look at animal studies, which show longterm harm.
If a parent will otherwise shake or harm their baby, then of course it’s better to let the baby cry. Otherwise, the parent should try to nip in the bud any distress (and watch for it in the first months) or else the baby will “practice” getting distressed, making a stress-reactive brain. Just because a baby is quiet does not mean she is not distressed.
Thanks for your thoughts Dr. Craig!