The new infant sleep study article

I usually don't like saying "I told you so." But this time, well, I told you so.

You know how the tagline of this site is "You are the best parent for your child"? Well, you are. And now it's been proven by a research study.

(OK, "proven.")

The article "Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep Intervention: Randomized Trial " published September 10, 2012 by the journal Pediatrics details the methodology and findings of an Australian study conducted in 2003-2005 called the Infant Sleep Study, along with the methodology and findings of a follow-up with the participants in the Infant Sleep Study conducted in 2009 and called the Kids Sleep Study.

The initial study was designed to discover if there was any harm to infants above the age of 6 months whose parents used "interventions" (meaning various so-called "sleep training" methods, some involving crying), and the follow-up was designed to see if there was any harm to these methods after five years. What they found was that the babies in the group of parents who had used interventions had better sleep (as rated by the parents) and the mothers were less likely to be depressed than those in the control group during the initial Infant Sleep Study, and that there were no noticable differences in the two groups five years later during the Kids Sleep Study.

A lot of the headlines around the study are misleading at best, so I read the article and looked at how the Australian researchers did the initial study. Here it is, in non-scientific language:

First, parents were asked the question "Over the last 2 weeks, has your baby’s sleep generally been a problem for you?" abouth their 7-month-olds. Those who said "yes" were eligible to become part of the study. Note that there was no objective measure of "good sleep" vs. "bad sleep." Instead, they went by how the parents felt about the way their child was sleeping. That's important, because as we've seen here over the years, it's more about how you feel about how your child is sleeping than about any objective measure. If you're happy with where your child is sleeping and how attentive you have to be in the night, it's all good. (And you wouldn't have been able to participate in this study.)

Then, the researchers separated the participants into the "interventions" group and the control group, with the participants having no choice over which group they were in, but they were told which group they were in once they were assigned.

Next, the participants in the control groups came to their regular well-child visits and could ask the nurse about sleep, but weren't specifically told about any interventions they could use.

Meanwhile, the participants in the "interventions" group were told about a variety of sleep interventions, including controlled crying (aka "the Ferber method") and what the study calls "adult fading" or "camping out," which sounds to me like the old "I'll lie on the floor next to your crib until you fall asleep" that many of us know and still have the rug marks on our faces to show for it. Here's the kicker: Participants in this group were allowed to choose how many and which interventions they wanted to use.

Yes.

To recap: Parents said that things weren't working the way they were currently going, so were given a whole bunch of techniques, and told they should choose the ones they thought would work best and try those with their child. Who else thinks this sounds an awful lot like what's been happening here in the comments section of this site for the past almost-7 years? Because I do.

Essentially what this study did (which is not the same as what the study proved, which I'll get to in a minute) is provide support to parents to try techniques they may not have known about or understood or felt they were able to try before with their kids. I am not one bit shocked that the parents reported fewer sleep problems and greater maternal emotional health compared to the parents in the control group, who didn't get the same support.

The control group participants were not prevented from trying any method/intervention to get their children to sleep. They just weren't taught/informed about any interventions by anyone involved in the study. The difference in the two groups was that one got information and support, while the other didn't.

It is important to note that (contrary to all the headlines about this study) the study did NOT show that "CIO is good" or that every baby needs to be trained to sleep or anything like that. What it showed was that parents who chose controlled crying or other interventions for their own specific babies felt better about how their babies were sleeping after doing those interventions and felt better about themselves. In other words, controlled crying doesn't do harm to babies and parents when the parents think it will work and try it.

I think this study says way more about how beneficial support for trusting your instincts about what your specific child needs is than it does about any specific sleep intervention.

The new findings of this study (based on follow-ups with the original babies and families when the children were 6 years old) are that by the time the kids in the study were 6 years old, there were no differences in the kids and families in the control group and the intervention group in terms of stress level, sleep, child-parent closeness, and other measures of wellbeing of the family. In other words, how or where or what you do about your child sleeping when they're a baby has little correlation with your lives when your child is 6. Don't get too cocky or depressed when you're in the baby years, in other words.

So: Carry on with what you're doing if it's working for you. If it's not working, try something different. (It might help to figure out if crying helps your child release tension or if it increases tension.) Surround yourself with people who are going to support you, and protect yourself from the people who are giving you crap and telling you you're doing it wrong.

You ARE* the best parent for your child.

 

* Scientifically proven!

23 thoughts on “The new infant sleep study article”

  1. For the under-6-month period (4 1/2 months?) interventions have no impact on results in terms of hours of sleep (different study). So under 6 months, hunker and get through, after 6 months try what you think will work for you and your child.This also reflects the longitudinal study of cosleeping/bedsharing, which showed that at 18 years old, kids who slept in a parent’s bed earlier in childhood/infancy were effectively indistinguishable from kids who did not.
    The statistical distinction causal factor in turning out mentally healthy kids was ‘warm, authoritative (not authoritarian), and respectful parents’ ended up with mentally and emotionally healthy kids at the end, regardless of sleep location, duration of sleeping in any location, etc. Abusive, controlling, distant, disrespectful, authoritarian parents all ended up with emotionally less healthy kids at the end of 18 years, ALSO regardless of where the kid slept, when, for how long.
    Choose what fits through the filters for you (safe/respectful/kind, or whatever parental filters you use), consider whether your overall approach is warm, authoritative (democratic function, authority through knowledge and with participation), and respectful, and then get sleep however you manage with those in place, knowing your child and how they respond to whatever mechanism, knowing yourself and how you function, and all of that. One big package.
    And get good support. Yeah, that nonjudgy support thing helps. Go Moxie!

  2. What timing! I started back to work a couple of weeks ago and between that and S’s sleep being jacked up (developmental spurt! teeth! growth spurt! GAH!), I’ve been questioning myself.So thank you for the reminder to trust my instincts.
    Me and Gloria Gaynor – we will survive!

  3. Sometimes we just need permission to do what we, as parents, feel is best for our kids and ourselves. (At least, I do…anyone else?) Thank you, Moxie and commentors, for providing a safe place to ask question and gather information! You were my support system through many a sleepless night.

  4. We’re attachment parent-y so I’m always a little bit embarrassed to admit that we did CIO with both our babies, in the 7.5-8.5 month zone. But we did and it worked beautifully. They were both babies who overstimulated easily and who did not like to/could not sleep with us (see overstimulation above). I held out longer with #2 but his overall sleep was worse. As I’ve said here before, my #2 woke up every 45 min – 1.5 hour from 2.5 months to 7.5 months. Yes, he never slept longer than 1.5 hours. We almost lost our minds. Anyway, in both cases the CIO worked *exactly* how our ped said it would – they both cried for a “short” (in scare quotes because a half an hour of baby crying is tortuous to say the least) period of time 20-25 minutes then slept through the night, then the second night cried less, and the third night not at all. Other than the big sleep regressions (I’m looking at you, 18 months!) they slept through the night since then, and it has made a huge difference in our sanity. They’ve never been big sleepers (my 4 y.o. sleeps about 10 hours a night, seldom more), they both need dark and silence and white noise machines and to be alone. But I think the key is to wait until 6 or even better 7 months, or more. Then you can nightwean and sleep train simultaneously (if you want to!). (With my #2 I did feed him at 3 AM until he was 11 or 12 months, if he woke up, because I was worried my supply would drop, and that’s something to be aware of, esp if you work of the house and rely on pumping.)

  5. The only place I have seen a good side-by-side of all the different sleep training methods is in Baby 411, and there it comes with “grades” based on how the authors think the methods jive with the latest research on infant sleep. But it helped us pick one that sounded best for us, get right to amazon and order it, and put it in place forthwith. And, given it worked, and we slept more, I would say DH and I were much happier people afterwards.

  6. To be fair, Moxie, you have stated on this site before that you think CIO is cruel. That statement haunted me when my husband and I were wrestling with the decision of whether or not to “feberize” our baby.It’s this article from your archive that I’m talking about:
    http://moxie.blogs.com/askmoxie/2006/06/babies_and_cio.html
    – about 5 paragraphs down.
    We did end up having to do CIO. There was a LOT of crying those first two nights. But it worked for us and we went from having the baby wake every 90 – 2 hours (for SIX STRAIGHT MONTHS) to getting 4 – 5 hours of quality sleep at a stretch.
    I know there are a lot of women out there who would judge me for our decision to let our boy cry and cry. I can deal with that, but it does really hurt to think you might be one of them – because you’ve helped me in so many other ways.

  7. My favorite part of the study (at least according to the articles I’ve read about it) is that it says there is little effect – positive or negative – on the child at the age of six but that it leads to, as you said, “greater maternal emotional health.” Isn’t that a long term benefit for the child?And, just like you, when I read all about this, I just thought, oh – they’re telling us that science backs up our instinct to do what is right for our child/our family. I didn’t need a study for that…

  8. One of the things that have struck me most is how the headlines that I’ve seen about the study are all about CIO being OK and the methods are not “abandon your child to cry until he/she has no more tears,” which is what CIO (just the initials) always sounds like to me. I’m afraid that the headlines are doing a disservice to families who are not actually reading the articles and only the headlines.The other thing that is that I bet the non-judgy support,suggestions from someone who is not sleep deprived, and feeling like you are “doing something” might be more helpful than the actual techniques to the parents mental health.

  9. What Moxie said in the linked post was “If you have a kid who increases tension by crying, doing full-blown CIO is, in my opinion, cruel.” It was not a blanket condemnation.

  10. So far I’ve only heard the CIO vs. no-CIO debate raging on Facebook and in the media. Nice to hear a different perspective from you on this study – bravo!! I can’t believe I just discovered your blog 🙂

  11. Thanks, science! Thanks for having our backs. I hope this does something to end the smugness of those who think that only their particular practices with sleep/feeding/toileting/etc. will lead to a well adjusted kid (though somehow I doubt it). Every time I hear someone saying they’re doing AP so their kid will feel secure and attached I want to scream “You do know that formula fed babies who sleep in cribs can also have healthy attachment with their caregivers, right? Not doing AP does not equal putting your kid in a Romanian orphanage c. 1986.” And every time I hear someone saying extended breastfeeding and co-sleeping will lead to your kid being a whiny freak with Mommy issues, I want to say, “You do realize that boobs aren’t sexual to a toddler, right? And some people actually get *more* sleep with their kids in bed!” In other words, science says “Do what works for you and shut your pie hole as far as others are concerned.” (This is also a crude summary of what I got told by Hedra last week. Oh, snap, was she right!)Disclosure: I breastfed my kids for a year a piece, supplemented the second baby with formula after 7 months, found baby wearing to be a lifesaver, had both my kids in cribs by 5 months despite starting out wanting to co-sleep and did some form of modified CIO with both of my adorable and by all accounts exceedingly well-adjusted children. Moderation, people. Moderation and doing whatever works to survive. Just sayin’.

  12. @Justaregularreader, I do think letting your kid cry and cry for hours with no endgame and no check-ins is cruel. There are people who advocate that, even going so far as to say that if your child cries so hard that they throw up you should go in and clean up the vomit without interacting with your child and then just leave them to cry again. For however many nights it takes, every night. That is punishment, not teaching.But that’s not at all “Ferberizing” or controlled crying. That’s also not knowing that your particular child needs to cry to tap off to be able to fall asleep. That’s not looking at how your child is reacting to stimuli and figuring out that they may be waking up out of habit or something else that you don’t see as necessary. I can’t imagine that you let your child cry for hours and hours and never even checked in. Especially since you say it only took two nights.
    Ferberizing isn’t CIO, in my way of using CIO.

  13. Oh, and Justaregularreader, I’m sorry this still seems to be such a tender spot for you. If it worked for you guys and everyone’s happy, then it doesn’t matter one iota what anyone else thinks of it, especially me. I’m guessing your child is still very young, because by the time your child is in school you won’t have any idea what any of your parent friends did or didn’t do about sleep. It just becomes a non-issue (as proven by this study, even).

  14. My footnote, as always: if you’re going to use a controlled crying method, buy Dr. Ferber’s book (the new edition, presumably, since he has more stuff in there), and do it properly. Properly doesn’t mean ‘harder’ it means understanding how, why, when, etc. I do know someone who didn’t bother to buy or read it because their sister’s best friend’s cousin (or someone) told them how, and they let the child cry for hours, vomiting from stress every night, for TWO WEEKS without any improvement, and because she had invested so much agony in it, she was afraid to stop (because it might be ABOUT to work, and if she stopped, she’d have wasted all that misery for nothing!). I understand the stuck, but advise people to buy the book and do it right.Some people think they’ll somehow be kinder than Dr. Ferber, but that’s because they don’t know that Dr. Ferber is fabo, kind, gentle, and decent, and also doesn’t oppose cosleeping if that’s what works for your family. There’s more than one option in his book, so having many options to choose from is probably useful.

  15. “The new findings of this study… are that by the time the kids in the study were 6 years old, there were no differences in the kids and families in the control group and the intervention group in terms of stress level, sleep, child-parent closeness, and other measures of wellbeing of the family. In other words, how or where or what you do about your child sleeping when they’re a baby has little correlation with your lives when your child is 6.”But wait, that’s not what that means. It means how much info and support you got about sleep training methods has little correlation with your lives when your child is 6. Right? The parents in the control group were not forbidden from using whichever sleep training methods they found out about on their own.
    Your summary makes the Nightly News piece I saw on the study even MORE misleading. It’s like the reporter didn’t read the study AT ALL.

  16. I think moving beyond every parent being the best parent for their baby, the key in this study (and Moxie’s philosophy) is that it’s about working *with your baby to find the best solution for your baby, you, and your family*. I find a lot of people seem to perceive babies like lumps of clay, to be moulded or ignored. But babies have their own specific wants, needs, and personalities, separate from its parents, and figuring that out early helps a LOT. What I’ve always liked about AP is that it keeps the parents focused on their individual child and its specific wants/needs (as well as everybody else’s). That of course is the biggest danger of sleep books, because they tend to promote a one-size-fits-all approach (and why having options is so important). I never imagined co sleeping wouldn’t work for every baby, until I had my own who slept better alone (as older babies, not newborns).

  17. This post is to help people understand the process that one typically goes through to get diagnosed with sleep apnea and also to find the pressure setting ideal for that patient. Thank you!

  18. Jean DTry not to stress too much,difficult,but not imlspoibse.Your 2 yr old needs guidance,for appropriate stuff at the right time. Business at home is important,as it pays the bills.Relax as best you can.Good luck.References :

  19. I totally agree with junmipg in with arms wide open. I left a safe and secure job for a new position that required me to obtain a certification in a new field. It was scary but I needed a new challenge. I love my new job and I’m definitely challenged in a good way.As a loyal member of the Moxie Squad, I do have one tip to share. I like to review some of my accomplishments when I need a confidence boost. Re-reading a paper that you wrote or pulling out a glowing performance review can remind you that you are a cool chick and deserving of success.Kathy Scasino, Epic Principal TrainerYale Universty

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