One of the first subjects we tackle as little humans is the ever fascinating, cause and effect—What happens when I drop my food over the highchair? We come to count on cause and effect patterns that we learn, for a lifetime. Every time I go to Whole Foods with my kids, they hop into the “race car” shopping cart and we roll into the elevator. We want to go to the second floor for our snacks and salads. To cause that to happen, we push the elevator button, because we have learned repeatedly this causes the elevator to take us up to where we'll be rewarded with yummy (read: kale!) treats. One day, we push with confidence, but nothing happens. Bewildered, we push again, harder. We really don’t want to be down here in this elevator hungry, so we jab repeatedly at that second-floor button—still nothing. Next, two things happen and they are universal: One, we give up (feeling frustrated, we get out of the race car and take the stairs, and two, we learn that this elevator is unreliable! Pushing that button doesn't work like its supposed to.
This little scenario is so universal in human and animal behavior that it has a name in the sciences. It’s termed, “extinction.” It may surprise you that the cry it out (in which baby is left alone to cry to sleep) method is, in fact, called the “total extinction” method by scientists who study such things (“controlled crying” methods are termed “partial extinction.”) The problem is, unlike in the elevator example, young babies are not able to take the stairs; they are stuck in a potential toxic avalanche of emotional “dysregulation.” As this blog post by Darcia Narvaez, PhD, pointedly outlines, this carries a host of legitimate concerns for neurological development. This is because contrary to popular myth, babies are unable to soothe themselves from extreme distress; they don’t have the brain function to do this, so extinction “teaches” them to self-soothe like tossing them in the ocean teaches them to swim. When they are tossed into extreme distress and comfort is withheld, the stress hormone cortisol actually destroys nerve connections in critical portions of an infant’s developing brain. It seems clear that extreme prolonged and repeated distress is cause for concern during the time the brain is growing and wiring exponentially more than it ever will again.
But is it really that stressful? I’m just in the next room from little Junior's safe plush, CPSC-approved crib. There really is no cause for intense distress. We have to keep in mind that babies are operating primarily from their base-level survival instincts, which demand he keep his parent close to protect him, he actually doesn’t know he’s safe—he’s very likely afraid for his very life, as illogical as they may be to us, when he's suddenly left alone to sleep. This biological perspective puts the cry-it-out debate in a new light. Stress level vis-à-vis baby’s survival instinct and the neurological damage possible from it is one concern that’s been overlooked by advocates of the total extinction method.
Now remember all that desperate jabbing of the button that we did at Whole Foods when the elevator failed to respond as expected? There’s a scientific name for that specific behavior, too: “an extinction burst.” This is when baby increases his cry to a higher, more desperate pitch when his trusted care-giver doesn’t respond to him. As a parent, you can practically hear the blood-pressure and stress hormones skyrocketing (or you can just look at the studies that have measured them). The extinction burst, before the behavior is extinguished, produces a different type of crying, far more severe than normal everyday crying. Mommy’s instinct is correct in feeling this level of distress needs attention. If you don't want extinction, the extinction burst is your cue to step in.
This leads to another concern that rears its ugly head when we understand the process of extinction: What exactly are we are extinguishing? Is it the need for soothing, or the communication of that need? Scientists know that infant crying is communication, plain and simple. But researchers at the University of Texas took the understanding of crying communication to a new level when they set out to see what happened to stress levels of infant and their mothers when babies’ cry for help at sleep time went ignored. Inadvertently, this study busted the “teaching to sleep” myth used to prop up the cry it out method. Just as you’d expect, stress levels were extremely high when babies were left to cry, and mothers’ stress levels, of course, mirrored those of their screaming babes’. But after babies’ crying stopped (because their communication was not causing the desired effect) and they were officially "sleep trained," their stress levels remained elevated—they just didn’t express it. Did they learn that it's okay to go to sleep alone? Their little bodies suggest otherwise.
But we already knew this communication suppression to be the true effect, because neglected infants found in Romanian orphanages didn’t cry at all, even though their discomfort was undeniable. John Medina, PhD, in his book, Brain Rules For Baby, says, “Indeed, you could walk into some of these hundred-bed orphanages and not hear a sound.” I'm not comparing a few days of crying it out to the orphanages level of neglect, but rather demonstrating what extinction is: stifling, not teaching.
Given that building trust (reliability) and establishing communication, which are intertwined, are the hallmarks of healthy infant mental development, it seems unwise to use a method that compromises both. Babies come hard-wired to expect someone to respond to them; the elevator button is supposed to work! Aside from the concern over cortisol levels produced by crying it out, is it a good idea to teach baby that his primary attachment figure is unreliable, like that frustrating elevator? Is it advisable to condition him not to communicate his needs, which are based on powerful survival instincts?
When I work with clients on baby sleep issues, we instead use an approach based on a brilliant psychological theory that originated in the 1930s: The Zone of Proximal Development, first asserted by the Russian scientist, Lev Vygotsky and validated and expanded over the following 80 decades. This allows me and the parents to create a sleep plan that pushes baby just enough to encourage real learning, without crossing a stress threshold that may break trust and dampened communication. We put baby in a sweet-spot that challenges him in just the right dose and frequency, based on his unique history, temperament, and age. It’s not cold-turkey; it’s not sink-or-swim; it’s not extinction; it’s actual teaching to sleep more independently. As for those cortisol levels of the mothers, after the babies stopped crying—they plummeted, no longer psychologically mirroring their still-distressed babies. The communication was broken, or as the researchers put it, “They no longer expressed behavioral distress during the sleep transition but their cortisol levels were elevated. The dissociation between infants' behavioral and physiological responses resulted in asynchrony in mothers' and infants' cortisol levels.”
Parents need sleep and there are many things we can do to get it short of putting baby down and walking out that nursery door. Isn’t it better to approach sleep-training with respect for parent-infant synchrony, protection of developing communication, and assurance of lower stress levels for both mother and baby? Remember, they can’t walk out of the crib the way we can walk out of the elevator. During whatever period these desperate, intense-type cries are ignored, in their baby-perception, their very survival is at risk.
For more on this topic, see my posts on Psychology Today with Dr. Darcia Narvaez.
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