The Fussy Baby Site

New Research Says Cry It Out (CIO) Doesn’t Cause Harm

CIO - Cry it out research study

According to new research out of Flinders University in Australia, the cry it out (CIO) method of sleep training does not lead to emotional problems or attachment issues in babies.

Researchers worked with 43 sets of parents of infants between the ages of 6 and 16 months. Infants were divided between three groups: One group of parents used controlled crying, a method in which they left the room, then waited increasing amounts of time to return to their baby.

The second group did what is referred to in the study as “bedtime fading”. Parents put their babies to bed later and later until their child was able to fall asleep. Parents were allowed to remain in the room.

The third group, the control group, were given information about infant sleep, but did not engage in any interventions for their baby’s sleep.

Researchers found that those in the first group – the ones who used graduated extinction – fell asleep faster than those in the control group.

Infants in the “bedtime fading” group also fell asleep more quickly than the control group, however it took them slightly longer than those in the extinction group.

These findings shouldn’t surprise anyone. It’s well known that extinction works – we know this from multiple peer-reviewed research studies.

The real question parents and researchers have is this: Does the extinction method of sleep training result in lasting harm to the child, or to the parent/child relationship?

Does CIO cause lasting harm?

This study seem to suggest there are no long-term, negative effects on attachment, behaviour and stress levels…at least according to the university’s press release. They write,  “[T]here was no significant differences in stress levels based on salivary cortisol readings of the infants, parental stress or mood, or measurements of parent-child attachment.”

However, even the lead researcher on this project believes more independent research needs to be done to replicate their findings.

It’s entirely possible that another study will be published in the near future with different results. The headline might be: “New research proves that extinction cases long-term damage”.

Do you see the problem here?

Despite not currently having any definitive evidence to support either side of this debate, we need to make decisions based on what we know, feel and believe now. Our baby’s sleep problems can’t always wait a year or two until a definitive answer is found (although I doubt we’ll ever have total certainty due to the many variables involved).

So, where does this leave us, especially as parents of chronically non-sleeping, intensely fussy babies?

I have heard several experts (and many non-experts) say that cry it out – meaning extinction, and sometimes controlled crying – simply doesn’t work for high need babies.

In my experience of running this site for over 9 years, I know this is simply untrue.

That said, there are certainly some high need babies for whom CIO (meaning extinction and/or controlled crying) simply doesn’t work. There are many reasons why this may be the case.

Why CIO doesn’t work for all high need babies

Lest you think you’re the only one for whom CIO hasn’t worked, think again! You’re not alone. There are many reason why it may not have worked for you. Here are a few of the most common.

  1. Some high need babies get so incredibly worked up when crying that rather than fall asleep, they just cry more and more intensely. High need babies tend to be more sensitive, more persistent, and less able to self-regulate, so this isn’t necessarily surprising.
  2. The stage may not have been set properly for the baby to be able to fall asleep. This may happen if age-appropriate wake-times aren’t being followed, the sleep environment isn’t conducive to sleep, a proper sleep routine hasn’t yet been established, etc.
  3. Another important factor is this: at what point do you say CIO hasn’t been effective? Deciding ahead of time how much crying is acceptable to you is key. If your crying threshold is say, 60 minutes, and you stop the process at 61 minutes, CIO obviously won’t work (I’m not in any way passing judgement here…just stating a reason why CIO may not be effective in this situation).

OK, so we’ve dealt with why CIO may not be effective for every high need baby. But does it work for some high need babies?

Absolutely. In fact, I’ve been surprised at how often parents have told me it worked much better and faster than they thought.

Many parents of high need babies expect their little one to cry for hours and hours, even when some parental help is offered. Surprisingly, this is something I’ve rarely heard from parents (of course, there’s always the chance parents just don’t tell me their worst case scenarios!).

So, does this mean you have to do CIO to help your high need baby sleep?

I reached out to Macall Gordon, adjunct faculty in the psychology department at Antioch University and owner of That First Year gentle sleep coaching, to ask her this question, as well as to get her take on the study mentioned above.

One of her primary concerns about this study is that parents may feel compelled to use CIO methods of sleep training, even if that doesn’t fit with their parenting philosophy: “The lack of research support for alternative approaches does a disservice to parents. We do know that a variety of approaches can work. Parents should be offered choices that resonate with their parenting style and values. Compelling parents to tough it out with CIO is just not necessary.”

She also believes much more research needs to be done on who CIO works for, who it doesn’t work for, and what we know about the infants for whom CIO doesn’t work.

And because other methods aren’t studied as frequently as CIO, she believes there’s an imbalance in the literature. She writes, “Very rarely is CIO compared to another intervention. In the current study, CIO was compared to “fading” or sleep education. “Fading” involves pushing back an infant’s bedtime until they fall asleep more easily. This is not, technically an intervention. Further, for infants, a later bedtime results in more nightwaking. So, in this study, the deck was in some sense stacked in favor of CIO. We need to know more about how CIO works in comparison to other behavioral approaches that do not involve as much crying.”

The million $$ question: Should I use CIO for my high need baby?

I hope at this point you’re not waiting for me to give a definitive answer to this question!

This is a personal decision that only you can make. You know your child best, and you need to be true to your own parenting style and beliefs.

That said, here are a few of my personal thoughts on the topic:

  • I don’t recommend full extinction as a first-line strategy for parents of high need babies. Instead, I recommend starting with methods like The Sleep Lady Shuffle or the “soothing ladder” which may be easier on both you and your baby.
  • I’ve talked with hundreds (thousands?) of parents who have used a wide variety of sleep training methods with their high need baby. Much of the time, it works. Sometimes it doesn’t. Sometimes it doesn’t work, but then a few weeks or months later it does. If you try something and it doesn’t work, it doesn’t necessarily mean it will never work.
  • While I don’t advocate for long periods of unattended crying, there is something that gives me pause: when a parent tells me they tried every other method without success, then used extinction…and now their formerly fussy, high need baby sleeps well, is happier, and is no longer high need, it’s hard to say CIO is wrong. It makes me wonder, is it better to let a baby cry themselves to sleep for a few nights and then be happier and better able to cope with life, or to avoid the crying and live in a chronically discontent, overtired state?
  • I don’t believe any parent should ever feel compelled to use CIO (or any kind of sleep training, for that matter). Parents should help their child sleep using whatever methods work best for themselves and their child.

If you’re struggling with the decision to use CIO or not, you may find my ebook, Sleep Training and High Need Babies helpful. In it, I share personal stories from parents of high need babies, so you can see which methods worked for them (and how quickly!). I also cover a variety of sleep training methods you can use, as well as practical tips from 3 sleep coaches I regularly work with (and who KNOW high need babies!).

Finally if you’re looking for more help and support with your high need baby (sleep stuff or anything else!), please join our awesome private Facebook community! We’d love to see you there 🙂


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