Thursday, July 28, 2011

Softening up the Tough Love of CIO

Before we found a sleeping situation and routine that worked well for our family, I was pretty sure we would have to resort to cry-it-out. I knew I didn't like the thought of it and I knew that, at least for me, it didn't feel right. But a mama's got get sleep at some point and I know that for some mothers, you're desperate and sleep deprived enough that for safety's sake, you've got to resort to something. No one likes the thought of leaving their baby to cry but I know some people resort to it as a last-ditch effort.

As I started doing some research on CIO methods, I discovered that they're not all created equally. The most common methods are Ferber check and console and the Weissbluth extinction cry. I'm not sure which one I personally find better. Check and console seems gentler to me because you're reassuring your baby but, at the same time, most baby's really aren't reassured by words. Also, until they're 8-9 months old, babies don't have object permanence. So, once you leave the room, they don't really know you're still out there. Extinction cry, from what I gather, has faster results so at least it won't last as long. Either way you choose to go, there are some things that a parent can do to gentle-up the tough love. Here are a few suggestions I've found for those who find themselves resorting to CIO:

* Sears method: Stay in the room and in physical contact with baby. Place baby in her crib with a hand on baby's tummy or back and let her cry-it-out. This method ensures that baby is not relying on sleep props such as sucking or rocking, but you're also not leaving her to cry it out alone.

* Have a loving nighttime routine: This one might help everyone, whether you choose to CIO or not. Have a loving, relaxing routine that you do before going to sleep to signal sleep and to calm baby down for a good night's rest. A warm bath, massage, read a book, sing a song, etc. It might be best to establish this routine for a few weeks before choosing to begin CIO.

* Teach baby to be a self-soother: If you're okay with thumb sucking, put baby's thumb in his mouth as he drifts off to sleep or help him learn to twirl his hair, etc. With time, he might choose those soothers instead of a parent.

* Wait until 4 months old: This is where I really get fired up about CIO and most of my disdain for CIO comes. Many people who have heard of CIO but haven't done their research start CIO earlier than 3-4 months. A baby less than 12 weeks old is incapable of self-soothing (Weissbluth). When they wake up crying, it's truly because with mom gone, they wake up thinking they've lost their arm or something (Mom is like an appendage to them). In those early weeks a baby does not recognize the difference between others and themselves. They are, so to speak, "enmeshed." Respect your baby's need for touch and feedings during the early weeks and you'll build a trust that is less likely to be diminished by CIO.

* Leave a piece of you behind: Babies have an unusually good sense of smell and your scent is comforting to them. Sleep on their crib sheets for a couple nights, leave a breast pad, or once your baby is 4 months old, you can introduce a small, safe lovey that you can wear in your shirt throughout the day.

* Use your baby as the barometer: By around 3-4 months, your baby has settled into his temperament and it's easier to read your baby for signs that what you are doing is helpful or harmful. If your baby is still himself during the daytime then all may be well. If he's clingy, whiny, withdrawn, or otherwise acting differently, reconsider your approach.

* Increase your daytime cuddles: This is especially important before going to sleep at night and when arising in the morning. Communicate to baby to that you're still here for him and that you still value touch and cuddling.

* Do your homework: If you've chose to do check and console, read Ferber's Solve your Child's Sleep Problems. If you're on board with Weissbluth's extinction cry, do the same with Healthy Sleep Habits, Happy Child. If the sleep training method you've chosen does not cite independent studies or outside resources, beware. If an author cites another author, you might want to check out that author (i.e. in the book On Becoming Babywise, the authors cite Weissbluth as their resource for the importance of good sleep and the AAP's statement about crying. However, both have been taken out of context). Remember that just because it's in print doesn't make it legitimate.

* Keep listening to your baby's cries: While it may be easier to get the job done if mom does something other than listening to her baby cry, remember that your baby's cries mean something and that no one knows them better you. Though most of your baby's cries may be "protest" cries, you want to be sure to be aware of any cries that slip into cries of desperation or discomfort. Remember that you're teaching baby that they need to sleep without your help, not that they can't count on you to change a diaper or to be there when you truly need them.

* Make sure Mom (or whoever is the primary caregiver) is supportive of the idea: I hear too many moms talk about how they felt awful but Dad thought it was the right thing to do. Remember that whoever is home the most with baby is the one who knows baby the best. This isn't to say that it shouldn't be a well-thought decision between partners, but if mom has a bad feeling about it, that should be respected.

* Check with your pediatrician first: Overall health and safety should be a higher consideration than 8-12 straight hours of sleep. Some babies have conditions that require night feedings and/or limited crying. Your pediatrician will likely give the go-ahead if your baby is healthy and thriving. However, if she's abnormally small (which is judged by more than percentages) or not thriving, night feedings should, of course, be continued.

* Formula vs. bottle: Remember that formula-fed babies do actually sleep more total hours (daytime and nighttime together) than breastfed babies. This does not mean that your breastfed baby is not sleeping enough but that formula-fed babies actually sleep more than the average (Huggins, The Nursing Mother's Companion).

* Naps and Nighttime: Since your objective is to help your baby learn to sleep without props, try to be as consistent as possible in putting your baby to sleep. If the car is the place for naps then of course, she will assume that she's going to get a nice ride to sleep at nighttime too.

* Establish the "sleep place": If your goal is to have baby sleep in his own bed, establish this before beginning CIO. Moving bed locations and removing sleep props at the same time might be a little overwhelming.

* Make sure baby is comfortable: clean diaper, full feeding, not teething, not in the middle of a move, etc.

* Keep perspective: Whether you choose to cry-it-out or not, remember that those few days of CIO (or months of night wakings) are really so very short in your life as a mother. Your baby will not wake up every night forever. How many 14 year olds do you know of who can't sleep? Soon you'll be wondering how in the world you're going to get them up in the morning.

I know this list isn't exhaustive. For you parents out there who have either researched or resorted to CIO, do you have any suggestions to help lighten the blow?


  1. I can't believe people would try any kind of sleep training before 3 or 4 months. Our pediatrician reccomended CIO with very specific instructions and one of them was to wait until our babies were AT LEAST 6months and really we had better luck with it around 7 or 8 months. The girls were sleeping really well at that point but both of them preferred falling asleep in our arms which was just not practical for is anymore.

  2. I completely agree Ellen. I really should make that clear when I tell people that I hate cry-it-out. I mean, I'm personally not a fan at any point but I'm REALLY not a fan before the 3-4 month mark. It just seems entirely unfair to me. I seriously have shed a few tears myself when I've head or read of this.