BABY SLEEP MYTHS
Recently, a very popular sleep training account I'm sure most of you have heard of went on Instagram and made some BIG claims about sleep training and attachment, infant stress and perinatal mood disorders.
And you know what, whatever.
Sleep trainers say sh*t about baby sleep all the time that I know is just nonsense. I just sort of chuckle to myself and move on.
But this post, and the accompanying stories, hit different.
This person linked a whole bunch of studies to back up her claims, gave a little schpeel about what it means to be ‘evidence based’, and threw her and her husband's medical backgrounds out as further justification that she is a person of authority we can trust on the matter.
And it was… convincing. Like, really convincing. I am rock solid in my belief that sleep training isn't right, or even necessary, for our family. And yet - I found myself starting to feel anxious watching her stories. I knew I had to explore this further.
I clicked on the studies she linked and lo and behold - a couple were locked behind a 42$ paywall (did she know most people wouldn't pay this amount of money to access the studies? IDK).
I hesitated for half a second before swipety swipe. Studies purchased.
I needed to know what the research she linked was saying, and if everything I thought to be true about child development, sleep and attachment was suddenly… wrong.
tl;dr : it wasn't.
Now, before anyone comes at me for ‘cancel culture’… here's the thing.
This is a public figure. With a very public account. Making her claims on a public platform. She is free to say what she wants, and -
I am free to respectfully - and openly - disagree with her.
I know a thing or two about sleep. I've read the research, I understand the science, I'm aware of the nuance that exists in the field enough to know when what she's saying isn't completely accurate.
Most people don't.
If no one is openly pointing out the fallacies she is perpetuating, how will people be able to make informed decisions for their families?
Like I legit faltered for half a second thinking I was doing my baby wrong for not sleep training her. That's how convincing her speech was. And I'm a sleep coach! I have hundreds of hours of sleep education and I do this for a living. Imagine what parents with no formal training in infant sleep were thinking watching her?
So I read the studies. They do not conclude what she claims they conclude. Like, at all.
Lemme break it down for you.
Here's the first big claim this sleep trainer made:
“Sleep helps our babies’ brains mature and lays the foundation for consolidating memories. Research proves that babies who have more consolidated night time sleep actually have higher cognitive scores. Furthermore, babies that sleep more at night have been found to have “easier” temperament, being more approachable, less distractible, and more adaptable.”
Here's the study she used to back these claims up:
Sleep and infant learning, Tarullo, A., Balsam, P., Fifer, W. 2011.
In her stories she makes it sound like this study provides concrete evidence that babies and young toddlers neeeeeeeed consolidated sleep. Except… this study looks at newborn sleep?
And it explicitly says how normal frequent wakings are:
It also says that more “active” (REM) sleep is not only common in infancy, but important! Which goes against the prevailing sleep trainer mindset that we need to get our newborns sleeping longer and more deeply right from the get go…
There is no mention of consolidated nighttime sleep leading to higher cognitive scores in this study. The study does cite another study where 15 months old were given a language test. The toddlers who took a nap between the learning and the ‘testing’ did better…
Do I even need to stay what a stretch it is to extrapolate the benefit of taking a nap before a test being the same as needing consolidated nighttime sleep for higher cognitive scores?!
The study does talk about memory consolidation in adults, but comes right out and says we cannot confound adult findings with infants:
And there was absolutely nothing about temperament in the study she linked. I had to read it a second time to make sure I didn’t miss anything, because I was surprised she would just throw that out there. But nope. Nada. Nothing.
So here’s my take on the claim that “babies that sleep more at night have been found to have “easier” temperament, being more approachable, less distractible, and more adaptable”…
Could it be that babies who sleep more at night do so because of their easy-going temperament? That the easy-going temperament was there already, and contributing to their relatively ‘easy’ ability to be sleep trained in the first place? Temperament is innate… we are born with it, something that is well-supported in developmental research.
The next big claim made was:
“The review of 52 treatment studies indicates that several well-defined behavioural approaches produce reliable and durable changes in bedtime problems and night wakings in infants and young children. An overwhelming majority of children respond favourably to these behavioural techniques, resulting in not only better sleep, but also improvements in child and family well being.”
The study she used to back this up: Mindell et al., 2006. Behavioral Treatment of Bedtime Problems and Night Wakings in Infants and Young Children.
First of all, it’s important to note that in this review, “durable” means 3 to 6 months:
The review comes right out and says that it was the parents who identified a sleep problem, and that this perception is very much influenced by the cultural norms, expectations, and education of the parents.
The review also states that infant night wakings are not, in and of themselves, problematic, but rather, it’s the infant’s signaling for the parents that caused the parents to perceive a problem. (This rather contradicts the sleep trainer’s earlier statement that consolidated night sleep is sooo important, don’t you think?)
The study also refers to bedtime (sleep onset) problems as “limit-setting problems”. Which isn’t wrong! But a parent’s difficulty setting loving limits is not a sleep problem… it’s a relationship one.
The review then says that learning to consolidate sleep and self soothe largely boils down to maturation, not unlike language and bladder control, but that environment does play a role.
Yet we don’t teach language or toileting skills by isolating the child… we support them in their learning. So why must sleep be different?
In terms of research integrity, it’s pretty problematic that the studies included in this review used multiple different interventions within the same group. So it’s impossible to say which methods – extinction, gradual exctinction, bedtime fading, scheduled wakes, or parent education – had the biggest impact on sleep. A better approach would have to have separate groups, with their own controls, for each method.
And lastly, I personally question the ethics of some of the studies included in the review. The first is this 1993 study done by Pinilla and Birch, which aims to teach newborn babies to sleep through the night by 8 weeks of age (!) by stretching out night feeds.
In the study, the authors claim that this helps protect the breastfeeding relationship, since the breastfeeding parent doesn’t have to nurse so frequently. Yet we know that scheduled feeds – especially scheduled feeds at night, when prolactin (the milk making hormone) is at it’s highest – can actually endanger the breastfeeding person’s milk supply and lead to premature cessation of breastfeeding. This is especially true in the first 12 weeks postpartum, when milk-making hormones and breastmilk supply are still being established.
Another study included in the review used medication – yes, actual medication! – combined with cry it out to achieve their results.
I actually don’t have words for this last one. I don’t understand how it passed an ethics board in the first place?! But at the end of the day, research that even contemplates the use of drugs and cry-it-out on newborns is not research I’m going to let sway my stance on this matter.
The sleep trainer’s third claim:
“Maternal stress moderately decreased over the first month of sleep training. Infant stress, measured by salivary cortisol levels, was slightly lower in the infants in the sleep training groups. And the security of the child-parent attachment was not different among the sleep training or non-sleep training groups.”
The study she used to back this up: Shaughnessy et al., 2016. Getting an Infant to Sleep: Graduated Extinction and Sleep Fading are Effective.
This study is locked up behind an academic paywall, and I couldn’t actually access it.
Buuuuut the good news is this is a study I’ve picked apart in some of my continuing education, so I went back to my notes to see what I had written.
This study does, in fact, conclude what the sleep trainer claims: maternal stress did decrease.
But what’s so interesting about this study is that although the parents reported that their babies’ sleep improved after the interventions, actigraphy results did not support this in any meaningful way (actigraphy is this cool thing where they hook you up to a bunch of wires to record how often you wake on a machine – it’s the most objective sleep measure we have at the moment).
The total sleep time in controlled crying group went from 8.56 hours to 8.72. In the fading group it went from 8.64 hours to 9.30, and control group from 8.36 hours down to 7.99 at the 3 month follow up. This is a difference of less than 20 minutes a night.
The parents were likely sleeping better, leading to an improvement in their mood. But that doesn’t mean their babies were.
In terms of infant stress, the cortisol measures were only taken before the bedtime routine began and again the following morning. Obviously, this doesn’t tell us anything meaningful about the stress the babies might have been experiencing during the intervention.
But most importantly, this study is too flawed to draw any conclusions one way or another. There were only 43 participants in the study, and they were divided into three groups (controlled crying group, faded bedtime group, and a control group that didn’t receive any intervention). This that each group only had 14 or 15 participants. In order to come to any statistically significant results, there would have to be at least 21 participants in each group. The sample size was way too small to say anything conclusively.
And the last claim the sleep trainer made in her stories was:
“Significant improvements in maternal stress, anxiety and depression were also observed.”
The study she used to back this up: Symon et at., 2012. Reducing postnatal depression, anxiety and stress using an infant sleep intervention.
This study recruited mothers who had self-identified that their babies had a sleep problem. They filled out a mental health questionnaire at the original meeting, where the intervention group also received information about infant sleep and sleep training. Cutting out parental support to sleep “cold turkey” was recommended:
The thing is, we already know that in most cases, cry it out leads to babies who stop signaling (there are exceptions to this – some babies with particularly persistent temperaments will literally never stop crying no matter how long you let it go on for).
So, if the babies stopped signaling for support, it’s fair to assume that the parents got longer stretches of uninterrupted sleep at night. Is it even surprising that their mood increased and anxiety decreased as a result? We know that sleep plays an important role in mood stabilization… although I will caution, it’s not the only factor. It is possible to get more sleep, and thus improved mood, in other ways. Sleep training isn’t the only way to achieve the same results.
Anyway.
As I’m sure we all know, cherry picking the facts is nothing new. But that doesn’t make it any less frustrating when really big public figures with really huge followings on social media spin the research to fit their narrative.
If you spiraled a little bit watching her stories / reading her post, remember this:
Sleep scientists can't even agree what amount of sleep and nightwakings constitute sleep deficiency in the early years. The range of normal for infant sleep is huge.
And-
As of yet there are no good sleep training studies that conclusively say one way or another the effect sleep training has on attachment in the long term.
And you know what? There probably never will be.
Least of all because attachment is fluid, ever changing, and the result of lots moving pieces working together. It would be nearly impossible to tease apart the impact that one parenting practice has on something that is so dynamic.
Does it impact the attachment of some babies? I personally think so. Does it impact the attachment of all babies? My personal opinion is no - I think some babies walk away relatively unscathed. But that's my opinion. No one can say with absolute certainty that a child's attachment will or will not be impacted by sleep training (or any other singular practice, for that matter!).
We simply do not know.
It makes it hard for parents to make informed decisions for their families. They spend money (lots of money - these courses aren’t cheap!) to learn how to ‘train’ their babies to sleep, and the worst part is: even if / when it doesn’t feel good, they don’t stop. They can hear the voice of the sleep trainer in their head, telling them their baby needs this sleep, needs to learn to self soothe… their health and development depend on it… when that’s just not rooted in fact.
So I’ll leave you with this: do your own research. Actually read the studies people are linking to support their claims before you believe them. And above all else—
Trust your intuition.
If it doesn’t feel good for you or your child, chances are, it isn’t.
What makes my approach different:
The whole gist behind most sleep training programs is that you have to follow their rules for it to work… even if it feels awful.
That’s not what we do here. I will never ask you to do anything that goes against your intuition.
You’re the expert, and you get to call the shots.
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