I was sitting on the floor of an apartment in Manhattan, next to the mother of the sweetest 5-month old baby. We were taking turns making faces at Ella* on the floor while she was kicking and cooing back at us. I reached out and tousled Ella’s hair as she started giggling. “She’s sooo happy,” her mom marveled. I nodded in agreement, “she’s just the sweetest thing.”
Ella added her opinion to the conversation too as she kicked her feet in unison with the beat of her happy coos. “I think this whole cry-it-out thing needs a re-brand,” Ella’s mom laughed nervously. We were two days into my three day stay to help teach Ella to sleep through the night, and help her parents get through the initial intensity of sleep training. Ella had slept eleven magical hours the night before and was taking longer naps than she’d ever taken before. Her parents had been marveling all day at how alert and happy she was already, now that she was sleeping.
“How would you brand it?” I asked curiously. It had certainly occurred to me before that the language that is often used to describe sleep training can be off putting, but I wanted to hear the specifics from Susan.* Afterall, it wasn’t every day I got to have this conversation with an actual marketing expert. “Oh I don’t know,” she sighed, “it just felt like everything I read about it was so extreme. Cry it out! ‘Extinction!’– that one really gave me pause. Then every time I tried to find out more about the process, it seemed I just found more and more information about how terrible it was!” I nodded in agreement, “there is a lot of conflicting information out there about sleep training.”
“Right!” Susan exclaimed, “I kept reading ‘your baby won’t trust you anymore!’ and ‘you will be breaking the bond you have with your baby!’ I even read one that said the only reason sleep training works is because the baby gives up on crying for you and passes out so of course I told my husband right then, whatever we do, we are NEVER doing that!”
Ella was focused intently on her ball, shaking it vigorously as she examined it carefully. “But none of those things happened, did they?” Susan said as she gripped Ella’s fingers. “They certainly did not,” I affirmed, “I think it’s important to remember that most of the loudest critics of sleep training have never actually sleep trained a baby, and they know very little about what it actually looks like.” Susan nodded in agreement, “oh, absolutely that’s true– but still, Extinction? I mean, come on!” We laughed in unison.
As I said my goodbyes the next day and headed home, with another family happy and rested, I continued to turn over the question in my mind, Does cry it out need a rebrand? Or do we just need to be very careful who we take advice and opinions from? Perhaps both are true.
The terms sleep training, cry it out, and extinction are often used interchangeably, though each one can mean different things to different people. Sleep training is defined as the process of teaching your baby healthy and independent sleep habits including how to fall asleep without the aid of a caregiver, stay asleep for longer periods during the night, and put themselves back to sleep if they wake during the night. On the other hand, the term “cry it out” can be traced back to the book ‘The Care and Feeding of Children,’ written by Emmett Holt in 1894, wherein the author described that once a baby was old enough to go the night without feeding for growth, letting them cry when they wake for a feed out of habit would teach them to stop doing so. Extinction, on the other hand, is a behavioral psychology theory coined by B.F. Skinner, which describes the process of discontinuing the reinforcement that maintains an undesirable behavior. So in the case of extinction-based sleep training, responding immediately to a waking baby with rocking, shushing, or feeding the baby to sleep is discontinued in order to teach the baby to sleep on their own. As the caregiver stops responding to the child’s waking, the child learns to put themselves back to sleep, or eventually, to stop waking up at all. Do they all sound pretty similar? That’s because they are!
One of the most basic premises of sleep training is that in order to stop an undesirable behavior, you must stop responding to it in a way that’s encouraging it to continue. As you stop responding to every little whimper with prolonged rocking, bouncing, or feeding to sleep, the baby starts to learn how to fall asleep independently. They learn what position feels comfortable to them. They learn that they don’t have to immediately cry upon waking. They recognize their crib as a safe and secure place to sleep. They practice this skill over and over again and begin to figure out what works for them. It looks a little different for every child, but they all figure it out. Which is exactly what I like to call the process– ‘Figure it out!’
One of the main things that causes babies to continue waking in the night the most is the conditions a baby falls asleep in. Have you ever jolted awake to find your partner is not in the bed next to you? It wasn’t that they woke you up when getting out of bed, but suddenly you’re wide awake to find they are not there. This is because once you reached the light phase of sleep, your brain recognized the difference in surroundings and sent a signal for you to wake up. This is the same thing that happens to your baby when they fall asleep in your arms and wake up in the crib.
When we are asleep, our bodies cycle through different phases of sleep. When in our light phase of sleep, the brain is checking our surroundings for any dangers. Our bodies know how to check the temperature of the room to make sure it’s a safe temperature for sleeping; this allows us to wake up if the room gets too cold or too hot. Our subconscious mind checks our surroundings to make sure there is no danger and the conditions are the same that they were when we fell asleep. So if your baby falls asleep in your arms and you put them down in their crib afterwards, the brain sends an alert during the light phase of sleep that things are different. Not only does your baby wake up, but they wake up alarmed and searching for you.
In the process of sleep training, your baby learns to fall asleep in their crib without you there. This teaches their subconscious mind to quit becoming alarmed to find themselves alone in the room. When there’s no signal to the brain to wake up, your baby is able to keep sleeping peacefully, and eventually they stop waking up so much. They figure out that they are safe to sleep on their own so they start doing so. This is the opposite of your child giving up on their caregiver; it’s the process of your child learning to trust themselves and their surroundings. And that is a skill they will rely upon the rest of their lives.
I’m not sure a brand makeover is truly in the future for the term “cry it out.” Sleep training has existed in some form amongst mammals for as long as we have existed, and the specific term “cry it out” can be traced back to at least 1894 when Emmett Holt wrote his book. As sleep professionals, we can commit to confronting the emotionally-charged false narratives that so often accompany discussions about sleep training, with actual facts about how the process works. Each time we let parents know the truth about sleep training, and confirm that sleep deprivation is not just a normal reality we must accept for years after having a baby, the more we can help ensure a Happy Family After.
(*Names have been changed to respect the anonymity of a minor child.)