My health visitor did something impressive this week – she phoned me up to tell me about a research study she’d read in Pediatrics. Impressive, huh?
My gorgeous baby boy, who’s just turned one, still feeds to sleep and wakes up quite a lot in the night. We’ve tried all sorts of gentle ways to encourage him to sleep better but with no luck. My health visitor has been recommending that we get tough and try some sort of controlled crying method for getting him to sleep, something that just feels completely wrong to me. I’m partly against it because I think it’s a horrible thing for my son to learn that I’m not always there for him when he needs me, and partly because I don’t really expect it to work for him anyway – he’s a very lively boy with lots of personality, who knows what he wants.
The paper turns out to be really interesting. It’s from a long-term Australian study looking at the effects of sleep-training. The first paper, published in 2007, evaluated the effectiveness of a sleep training intervention. Mothers who reported that their 7 month old had a sleep problem were randomly allocated to a control group, who received care as usual, and an intervention group, who were offered specialised advice on sleep with a choice of either controlled crying or gradual retreat. Of the 174 mothers in the intervention group, 100 took up the offer of advice. Of these, 53 opted for controlled crying, 7 chose gradual retreat, and 40 chose general sleep advice (bedtime routine, use of dummies, etc.) So the study more or less looks at the effectiveness of controlled crying. Here’s what it found. Of the 695 families who completed the questionnaire at 7 months, 328 (47%) reported a sleep problem (“Over the last two weeks, has your child’s sleep generally been a problem for you?” yes / no). At 10 months, 56% of the intervention group and 68% of the control group still reported sleep problems. At 12 months, 39% of the intervention group and 55% of the control group still reported problems. The analysis (with all the right controls and so on), showed that this was a significant reduction in sleep problems in the intervention group compared with the control group, i.e., controlled crying works – to some extent.
The interesting thing about this study is that the kids were followed up at 2 years and then again at 6 years. At 2 years old, 27% of the intervention group and 33% of the control group still had a sleep problem. There was no longer a significant difference between the groups. At 6 years old, 9% of the intervention group and 7% of the control group had sleep problems, and again, there was no significant difference. The important thing about the latest follow-up is that they looked to see if sleep training did any damage – does leaving your child to cry lead to behavioural problems or affect the mother-child bond? The study showed no difference between the intervention and control groups for lots of different measures, including the children’s emotional and conduct behaviour scores and sleep habits, child-parent closeness and conflict, and parent depression, anxiety, and stress scores. So no, according to this study, no long term damage from leaving your child to cry.
I’m in two minds about this study – on the one hand, I’m really glad there’s some evidence out there about the effectiveness of sleep training and its long term impact. On the other hand, I’m frustrated that it’s not clear how many of the intervention and control mothers actually tried controlled crying, and how many were successful. It’s a useful study for funding bodies who need to know if the sleep intervention is worth funding, it’s not so useful for individuals who want to know the odds of controlled crying being effective (and / or damaging). I think the real take-home message for me is that although sleep training might be good for my sanity (at 1 year mothers in the intervention group had better mental health, and at 2 years they were less likely to report symptoms of clinical depression), it’ll still be traumatic for me and my baby and there’s a fair chance that it won’t work anyway (27% of the intervention group were still sleeping badly at 2 years). The search for a good night’s sleep continues…
Evidence-based rants 