Dennis Rosen M.D.

Sleeping Angels

Responding to a crying baby: how much is too much?

Responding to a crying baby: how much is too much?

Posted Apr 28, 2009

Elle, a reader, writes:

I could be wrong, not being an expert on the subject at all, but I read somewhere that repeatedly not responding to the child would teach them that, in a vaguer, younger sort of way, they can't count on people, or that exhibitions of emotion won't help, eventually leading to introversion. But since you said sleep training works over the course of a week or so, maybe what I read (sorry I can't remember where from) meant this only in situations where it's important to react to a child's crying.

If you know anything about this or have opinions on it, I would gladly like to hear them!

I think that there is a big difference between being non-responsive and indifferent to a child's crying, which can generate feelings of anxiety and abandonment, and not submitting or giving in to what s/he is demanding, which typically leads either to frustration, further crying, and escalation, or to acceptance.

Very young children (infants under the age of three-four months) lack the cognitive faculties to distinguish between being abandoned, and being responded to, albeit without achieving the desired outcome. They are also not really capable of being manipulative, and their crying is the main way in which they express their needs. If they are hungry, they cry; if they are uncomfortable, they cry; if their diaper needs changing, they cry; if they are startled, they cry. It isn't reasonable to expect to be able to "educate" a child at this age, and I agree that routinely ignoring a crying infant may have implications on his or her development.

However, as children grow and develop, it does become possible to teach them new behavior patterns. When setting out to teach new sleep behavior patterns to overcome sleep association disorder (the association of a specific item or stimulus with the ability to fall asleep instead of self soothing), there are a number of approaches, which include:

  • Unmodified behavioral extinction, entailing putting the child to bed, closing the door, and not returning until the morning, letting him, in effect, "cry himself to sleep"
  • Extinction with parental presence, which involves putting the child to bed with the parent remaining in the room, though without coming into physical contact with him until s/he falls asleep
  • Graduated extinction, which involves putting the child to bed, and returning to the child's bedroom at designated intervals to check in on her without picking her up, stroking or feeding her
  • Positive routines with faded bedtimes, entailing establishing regular bedtime routines, and regular and appropriate sleep scheduling
  • Scheduled awakenings, preemptively, at the time of anticipated awakenings
  • Combination(s) of the above (for example, graduated extinction with positive routines and faded bedtimes)

Studies looking at the efficacy of the different approaches have found all of them to be effective, and no evidence for one being more effective than another. It then boils down to personal choice and preference.

My own feeling is that a combination of graduated extinction with positive routines and faded bedtimes, as well as a regular schedule, not only marshals the inner circadian clock and the sleep deficit, makes going to sleep a more defined process for the child (many children do very well with rituals), and is also a more humane approach in that it signals to the child that s/he has not been abandoned, or is being punished for some transgression, but rather that there are simply new ground rules for sleep being implemented, and that this in no way reflects upon a change in the parents' love and commitment to the child.

If this is the message the child receives, while she may still cry, it will stem not from anxiety or fear, but rather from frustration at not getting her way and what she wants. And while no one wants to see their child upset, almost all would agree that learning how to cope with not always getting what you want is a very important lesson that one has to learn again and again throughout life, and that while actually doing so can be both difficult and challenging in the short term, in both the medium and long terms it is definitely well worth learning.

Best,

Dennis

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Dennis Rosen, M.D.

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