Sweet Dream or a Beautiful Nightmare: Exploring the Controversy of Sleep Training for Babies

When you welcome a new baby, your loved ones are often eager to know: "Are you getting any rest with the new addition to the family?". This is because the experience of major sleep deprivation and exhaustion after welcoming a new baby is a universal one, but the question often leaves parents wondering- should I be doing more to ensure my baby gets adequate sleep? When is a realistic time to expect longer stretches of sleep? When can I start ‘sleep training’? Is ‘sleep training’ beneficial or emotionally damaging? How do I even ‘sleep train’ in the first place? Let's explore the evidence behind ‘sleep training’- more affectionately known as ‘behavioral sleep interventions’ in the medical literature- to help answer those questions.

Understanding Behavioral Sleep Interventions:

The universal goal of the various methods of behavioral sleep intervention is to teach infants to self-soothe and establish consistent sleep patterns. It encompasses various methods, from the Ferber method to the Weissbluth approach, each emphasizing a gradual transition to independent sleep. Now for what the scientific literature tells us:

Improved Sleep Patterns:

Studies suggest that sleep training can contribute to more extended and more consolidated sleep for both babies and parents. Establishing a routine helps infants learn to fall asleep on their own, reducing nighttime awakenings.

Enhanced Cognitive Development:

Adequate sleep is linked to cognitive development. Research indicates that babies who sleep well may demonstrate improved learning skills, memory, and overall cognitive functioning at around 1-2 years of age (admittedly, other studies looking at older children have less consistent results). While these studies do not directly link behavioral sleep interventions to these outcomes, they do find an association between improved sleep quality and enhanced cognitive development. In the absence of harm from sleep interventions (see below), one could gather that behavioral sleep intervention = improved sleep quality = improved cognitive development.

Emotional Well-being:

Contrary to concerns about stress during sleep training, studies propose that well-implemented methods do not harm a baby's emotional well-being. The methodology of these studies is controversial, but overall they suggest no difference in stress hormones or long-term emotional development in children who have or haven’t undergone behavioral sleep interventions. In fact, achieving better sleep may contribute to a more content and less irritable baby.

Parental Well-being:

To me, parental well-being is the biggest driver of the decision to implement a behavioral sleep intervention (and that’s okay— we need healthy parents for healthy babies!). Evidence shows that when babies learn to self-soothe, parents experience improved sleep quality, leading to enhanced mental health and overall well-being. Research even suggests that behavioral sleep interventions are related to reduced rates of maternal postpartum depression. Notably, similarly reduced rates of postpartum depression were seen in families that were provided with education about the normal newborn crying and soothing methods.

Safety Considerations:

Although sleep training is generally considered safe, it's essential to follow evidence-based guidelines. The American Academy of Pediatrics (AAP) provides recommendations to create a safe sleep environment, emphasizing the importance of placing babies on their backs and avoiding soft bedding. I will create more content about safe sleep and the interplay between safe sleep and many other important topics- including infant feeding and parental wellbeing.

Mommadoc IRL Conclusion:

The evidence behind sleep training for babies supports the notion that, when implemented thoughtfully, it can lead to positive outcomes for both infants and parents. It’s important to note, though, that the studies on behavioral sleep interventions were done is babies over 3 months old (most studies even older at 6 months or greater).

As a pediatrician, I would discourage behavioral sleep interventions in a newborn under 3 months old. I would, however, encourage a cyclical routine (eat, play, sleep) starting at 4-6 weeks. I can write more about newborn sleep specifically in a future post. I do not, on a personal or professional level, support ‘cry it out’ (extinction) method of sleep training in this young age group.

For babies over 3 months of age, I am supportive of whatever behavioral sleep intervention (or lack of) fits your goals and lifestyle best. If baby’s basic needs are met- well fed, growing, clean diaper, comfortable temperature, and safe sleep environment, then the evidence tells us that behavioral sleep interventions are probably helpful and not likely to be harmful.

As with any parenting decision, it's crucial to consider individual circumstances, consult with healthcare professionals, and choose a method that aligns with your parenting philosophy. Ultimately, a well-rested baby contributes to a healthier, happier family.

Sources:

Gradisar, M., Jackson, K., Spurrier, N. J., Gibson, J., Whitham, J., Williams, A. S., Dolby, R., & Kennaway, D. J. (2016). Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial. Pediatrics, 137(6), e20151486. https://doi.org/10.1542/peds.2015-1486

Price, A. M., Wake, M., Ukoumunne, O. C., & Hiscock, H. (2012). Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial. Pediatrics, 130(4), 643–651. https://doi.org/10.1542/peds.2011-3467

Hiscock, H., & Wake, M. (2002). Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. BMJ (Clinical research ed.), 324(7345), 1062–1065. https://doi.org/10.1136/bmj.324.7345.1062

Paul, I. M., Savage, J. S., Anzman-Frasca, S., Marini, M. E., Mindell, J. A., & Birch, L. L. (2016). INSIGHT Responsive Parenting Intervention and Infant Sleep. Pediatrics, 138(1), e20160762. https://doi.org/10.1542/peds.2016-0762

Hiscock, H., Cook, F., Bayer, J., Le, H. N., Mensah, F., Cann, W., Symon, B., & St James-Roberts, I. (2014). Preventing early infant sleep and crying problems and postnatal depression: a randomized trial. Pediatrics, 133(2), e346–e354. https://doi.org/10.1542/peds.2013-1886

Tham, E. K., Schneider, N., & Broekman, B. F. (2017). Infant sleep and its relation with cognition and growth: a narrative review. Nature and science of sleep, 9, 135–149. https://doi.org/10.2147/NSS.S125992