Warning: Baby Sleep Training May be Harmful to Mental Health
I know what you are thinking. Is she saying that sleep training harms infant mental health?
That is not what I am saying. I don’t actually know whether sleep training will harm a child’s mental health, because babies can’t tell us what they are experiencing and nobody can do a randomized controlled trial on babies. As a midwife and lactation consultant, I do know that it is normal for babies to feed at night and many need to feed at night to sustain weight gain and growth (and their mother's milk supply). I also know that babies who sleep alone and for long stretches are at increased risk of Sudden Infant Death Syndrome, and babies likely would have been preyed upon or frozen to death if early humans had followed current sleep training practices. But is sleep training damaging to infant psychological and mental health?
My instincts and my many years of experience with babies tell me that it certainly could be damaging, but I don’t know it for a fact. If you left me, as an adult, to cry, alone and helpless, and ignored my requests for help, I would feel pretty abandoned and unloved, but I can’t say for sure what a baby is experiencing. Research on sleep training and stress has shown that while mothers’ cortisol (stress hormone) levels go back to normal after their sleep-trained baby stops crying, their babies’ cortisol levels are just as high as they were during the cry-it-out phase. We know that long term exposure to stress hormones is terrible for human health, and that chronic stress can be toxic to neurons and cognitive development, but we don’t really know whether it will harm your baby’s emotional, social, cognitive or mental development long term. The Australian Association for Infant Mental Health is one medical authority which does believe that it may be harmful, but even they cannot say for sure:
AAIMHI is concerned that the widely practiced technique of controlled crying is not consistent with infants’ and toddlers’ needs for optimal emotional and psychological health and may have unintended negative consequences. 2013
Yet, there are just as many experts and researchers who believe that there is no long-term harm to children who undergo sleep training. We know that human babies are remarkably resilient and adaptable, and kids survive and thrive in a huge variety of environments and parenting practices. So, no, I am not going to argue here that sleep training will be psychologically harmful to your baby, though I encourage you to check out another blog post with my Top Ten Tips for Coping With Your Baby's Sleep.
I am going to be talking here about someone who I KNOW for certain can be damaged by sleep training advice: MOTHERS!
I know this because mothers reach out to me all the time weeping and raging and beating themselves up because of the sleep training advice they have received. I am constantly shocked by the things that these mothers report having heard from so-called sleep “experts,” though after all these years of hearing it I don’t know why it shocks me anymore. How a health care professional or anyone who claims to care about mothers’ well-being can say these things, I will never understand. Some presumably must believe what they are saying, while I imagine some just enjoy the steady income they are bringing in from desperately tired and unsure parents. Either way, I find it unconscionable.
Here are some of the heartbreaking things that mothers have recounted to me about the sleep training advice they have received:
1. “I know you are going to think this is terrible, but my baby will only go to sleep if I nurse/feed/walk/rock/hold/pat/lie down/sleep with him.”
I have heard this a thousand times and it never ceases to shock me. Contrary to popular belief, it does NOT shock me that mothers are doing these things to help their babies fall asleep. It shocks me that they think I will disapprove of them. What health care professional or experienced mother would EVER judge a mother who does those normal baby-soothing things to help her little one calm down or doze off? Many, apparently, because these mothers have all either been judged by an “expert,” or judged by another parent who is parroting an “expert,” who told them these are bad habits and a sign of bad mothering. These mothers are doing what mothers have done as long as there have been mothers, and yet they are made to feel guilty, anxious, and ashamed about it, and they expect to be told off by someone like myself once I learn their "dirty little secret,"
The harm that these so-called “experts” are doing to the reputation of my profession aside, making good mothers feel anxious and ashamed is NOT HELPFUL and may be harmful. There is a fascinating study about how powerful the words of “experts” are when spoken to emotionally vulnerable new mothers. Mothers believe what professionals tell them about their babies and about their mothering capabilities, and when we tell them that their baby is lazy or greedy or spoiled or naughty, this can change the way that mother sees and relates to her child—potentially forever. When we question her instincts and her abilities, we can seriously damage her confidence as a mother. See these recent (and very common) examples from mothers in Dubai:
2. “She made an example of me and my baby as "what not to do" and made me cry during the workshop.” I recently was approached by a mother who recounted a horrifying story about attending a baby sleep workshop where her baby was identified to the entire group as “terrible” and was used as the example of everything that should NOT be done when it comes to sleep practices. This woman felt like she was repeatedly and publicly shamed (and her baby criticized) to the point that she cried, and she was tearing up as she recounted this humiliating experience.
Her baby, who was so obviously a healthy, thriving, and happy 4-month-old, was gazing lovingly at her mother throughout this conversation and was clearly aware that her mother was distressed. She was the picture of a securely-attached infant, and fortunately her highly attuned mother did not accept that insane assessment of her parenting abilities or her child. But she definitely felt like she had been harmed by the experience, and she and her husband were especially angry that she had paid money for this unnecessarily cruel treatment. What must the “expert” have been thinking when that mother broke down in response to her words??? How did she not alter her approach to, at the very least, not publicly criticize and traumatize a new mother???
3. “I feel like I am failing at motherhood.” Another mother phoned me recently while sobbing that she had paid 2 different sleep “experts” thousands of dirhams to help her get her high-needs 4-month-old sleeping through the night and yet she was utterly unable to achieve what they advised. While trying to follow their advice she had stopped nursing her boy at night, trusting this person who presented herself as a highly trained, highly knowledgeable "expert." As a result, her exclusively breastfeeding son had stopped gaining weight and was being monitored for potential failure to thrive (because, of course, babies often get most of their calories at night, which is quite biologically normal).
She said she was really trying to follow the sleep trainer’s advice, but it was very obvious to her that the “expert” thought that it was her incompetence that was causing her baby to want to nurse at night. This experienced mother, who has an older child who also nursed at night and went through difficult sleeping phases and is now a bright, happy and well-adjusted child, truly felt like if she couldn’t accomplish the goals set by the sleep trainer than she would be causing her son harm and she would be unable to survive the sleep deprivation. We talked for at least an hour about normal infant sleep and feeding patterns, the varying needs of individual children, and common coping strategies such as co-sleeping, taking naps, asking for (or hiring) help and scheduling in self-care, all of which breastfeeding mothers have always done to survive this high needs stage. By the end of our discussion, she had come to the realization that she and her son were doing very well, actually, and were going to be just fine.
This is such a common discussion that I have with mothers (usually for free, and often while I am at a coffee morning, cleaning up after a class, on the phone standing in the grocery store or pulled over on the side of the road) it would not even be memorable. This mother stands out because she sounded so hopeless at the beginning of the call and so hopeful and ready to help others in the same position by the end of the call that I have already referred other parents to her for support. Not only is she NOT FAILING at motherhood; I would argue that she is truly the baby sleep “expert” because she has been helping struggling babies fall asleep for years, using all of her best mothering skills and instincts. She just needed some encouragement and empathy herself to remember what hard, but important, work that is.
4. "The sleep trainer tells me her system will work if I can just be tougher, or more consistent, or better at reading sleep cues, or I need to eat more fat or drink more water or take more supplements, or I need to space out feeds or give a bottle of formula or start solids or do a dream feed or put her down "drowsy but awake," but no matter what I do my baby still won’t cooperate and still wants to nurse every couple hours!" The common theme always seems to be that the problem is with the parent, not the sleep training instructions. Mothers are left feeling like only they are too dense or too lazy to grasp the secret or make the schedule work, or crack the code.
Despite what the sleep trainer or the book or your friend has promised, there is no quick fix, one-sized-fits-all, guaranteed "solution" to end night waking and night feeding. Both are biologically normal for human babies and it is a very recent development that we expect babies and toddlers to sleep for long stretches alone without frequent nursing. If your baby is growing along a WHO growth curve and is hitting developmental milestones and is happy and full of energy during the day, then he or she is getting the amount of sleep AND nutrition she needs to thrive, and you are doing everything just right. If a book or a consultant works for you, great, but if it makes you feel like a failure or increases your anxiety or seems like the goal keeps moving out of reach, then throw it away! Remember that what works for one mother will not necessarily work for another, and what works for your first child will not necessarily work for your second or third child.
5. “The sleep consultant told me that the only solution was to make my baby cry it out, and I cannot do that (or I tried it and it didn’t work, or it felt terrible, or I am just not ‘tough’ enough to do it.”) If you have been given this advice and already realized that this one-sized-fits-all approach is absurd and can’t possibly apply to every family, then it may make you angry that you wasted your time and money, but it is unlikely to damage your mental health. But if you believe, as MANY mothers do, that your baby will be harmed by lack of sleep, or will not be getting “quality” sleep, or will not “learn” how to sleep or will never learn to “self sooth,” than this advice can definitely cause you mental anguish and stress.
I am called all the time by mothers who are truly distressed that they are unable to follow this rigid and non-scientific advice, because they fear they will damage their child by not doing it. If this theory was correct, how on earth did humans manage to survive all those millennia without sleep trainers?!?!?! It is completely ridiculous to suggest that children need to be taught to sleep or that humans learn self-soothing alone in a crib during infancy. It’s nonsense—babies already know how to sleep just fine, and it is biologically normal that they need nighttime parenting during their early years. OF COURSE they will be able to fall asleep and stay asleep on their own in their own time as they grow and mature and develop, we all do! (Though let’s be honest, most of us adults quite like having someone we love sleeping next to us, and don’t pretend that you do not!)
6. "I don’t actually mind getting up/feeding/co-sleeping, I enjoy cuddling her and I love our quiet times alone at night, I just worry that I am causing harm, or I am doing it “wrong” or my friend’s baby sleeps through the night or my husband/mother-in-law/doctor thinks it is a bad habit." I hear this ALL THE TIME from mothers who are coping just fine but are wracked with guilt and worry! This is not something that mothers need to be concerned about, and that is not just my opinion, because here is some science: In a 2018 study, Canadian researchers found that 38% of typically developing infants were not sleeping 6 hours consecutively at 6 months of age and over half of them were not sleeping 8 hours straight. By the time they were 12 months old, 28% still were not sleeping 6 hours a night straight and 43% still were not sleeping 8 hours. The babies were followed for 3 years and there was no difference in the healthy development of babies who slept longer compared to those who do not. If what you are currently doing is working for you and your family, then keep doing it, and no need to feel guilty or anxious.
Interestingly, this study also found that there was no link between how long a baby slept and the mood of the mother. Mothers who did report feeling stressed reported being worried that their child SHOULD be sleeping more, not that the mother’s sleep was being interrupted. Billions of mothers worldwide sleep with their babies, nurse them to sleep, (many times in the day and night, on no particular schedule) and enjoy those baby cuddles for as long as they can. And every baby grows up and develops and no longer needs or wants all of that mothering forever.
Other research also shows that exclusively breastfeeding mothers who sleep next to their babies and nurse on demand at night (sometimes called 'Breastsleeping') actually get MORE sleep overall than mothers who are formula feeding or are sleeping apart from their babies. Safe c0-sleeping or bed sharing is how many mothers and babies make night feeds manageable, and the hormones of breastfeeding and physical closeness tend to help both baby and mother avoid waking completely and ensures they both fall easily back to sleep. Even working mothers may find that bed sharing works better for them, as both they and baby may enjoy having the physical contact that they miss during work hours, and baby may nurse a lot at night to make up for time apart and to boost mum's supply.
I know that sleep training advice must work for some parents, because I see them recommending and raving about these same “experts” all the time on Facebook. I also know that my BabyCalm, "Breastsleeping' approach of trying to understand and cope with infant night waking as a normal and temporary stage of parenting is not going to be satisfactory for every mother. I know that every family is different and must find what works for them. My goal is that anyone I consult with will feel more confident and relaxed about her abilities to night parent her baby, and more realistic about how much she might be able to actually change her baby's sleep habits. And I always hope that you will feel better about yourself after we talk than you did before!
To make it clear, baby sleep "consulting" is not a money-maker for me. I choose not to offer individual "sleep consultations" other than the free chats I have on a regular basis with mums who reach out to me, because I frankly do not find them as interesting or effective as group sessions. I run a small BabyCalm Sleep workshop 2-3 times a year, which provides a lot of science about what normal infant sleep looks like, why babies sleep the way they do, and why you should feel proud of all the hard work you are doing, both day AND night. We look at the pros and cons of various sleep training methods, and discuss them in the context of your own long term parenting goals. In the workshop I suggest coping strategies (including co-sleeping and naps) and offer some gentle, NO-CRY techniques and tips that you may want to try to encourage more independent sleep in the future. I think one of the best parts of the BabyCalm sleep class is being in a roomful of parents who are going through the same thing that you are, and finding that it isn't something you are doing wrong. Unfortunately, I do not promise to get your baby sleeping through the night any time soon, nor do I guarantee that you will get any more sleep after the workshop than you did before. The one secret trick or guarantee that I do offer? The reassurance that THIS TOO SHALL PASS!!! Whatever you are experiencing this month will be different next month, so learning to roll with it may be your best solution. Regardless of what we do, all children will manage to sleep through the night on their own one day, in their own time, as they grow and develop. In fact, I guarantee it!
What has your experience been with sleep advice? Did it make you feel better about yourself and your parenting abilities? If it didn't, how did you come to terms with it? What would you recommend to another parent with the same struggles? We would love to hear your tips!
Amy Vogelaar is a former midwife, an International Board-Certified Lactation Consultant, a licensed BabyCalm and ToddlerCalm consultant, a Certified Infant Massage Instructor, co-founder of Love Parenting UAE, and a mother of 2 girls, one of whom was a "terrible" sleeper for the first couple years of life and one who was easy, through nothing that Amy did or didn't do. Both girls sleep great now!