Sleeping and settling services

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04.An expert's view

Between a sleep-deprived parent and the almost overwhelming amount of advice out there is also some controversy around some of the sleep techniques that are used. One of the best known techniques is controlled crying – hailed by many as the solution to sleep time problems, but derided by critics as emotional abuse that could cause long-term psychological problems.

CHOICE spoke to Dr Monique Robinson, Associate Principal Investigator at the Telethon Institute for Child Health Research at the University of Western Australia.

CHOICE: Can you outline the difference between "controlled crying" techniques and leaving a baby to "cry it out"?

Robinson: This is a really important distinction. Controlled crying is about responding and returning to the baby, though at increasing intervals so that the baby learns to self-settle and doesn’t rely only on the parent to settle. Crying it out or "extinction" is where the parent closes the door and does not respond at all, and this is where most of the controversy is focused in terms of the impact of this stress on the baby.

Parents who are having trouble working out how to enact controlled crying and where the boundary between controlled crying and extinction lies might find the resources offered by Tresillian and its equivalents of benefit.

Many parents who are struggling with sleep issues say they are wary of using places such as Tresillian or Tweddle because of the techniques they use. Is there any research that has been done into this area to allay their concerns?

Tresillian and Tweddle (and their interstate counterparts) may not suit every parent, but for some parents a short stay program or education session can be of immense benefit. The really important factor with controlled crying (or controlled comforting, self-settling, and so on) is that the baby should be six months or older, and parents need to distinguish between controlled crying and "extinction" or crying it out.  

The comprehensive Pediatrics study by Anna Price and colleagues did not find any difference in behaviour or emotional functioning, sleep problems, attachment or maternal mental health six years on, indicating that controlled crying techniques did not cause long-term damage, so this should be reassuring for parents who are looking for some support. 

There is also no shame in accessing these agencies for support. We don’t know why some babies find sleep more difficult than others, but there is no need for mums and dads to feel guilty about needing some advice and support.

Are there a lot of myths around sleep and teaching to sleep techniques? 

I think the biggest myth is that there is one technique that will be the answer for everyone, which is often either subtly or not-so-subtly the message promoted by some infant sleep books.

I have seen mothers who have read every book they can find and trawled Google for answers and sometimes it just results in increased anxiety in addition to the lack of sleep. So while it is important that families look for a solution that will suit them and access relevant supports, it is also really important that we don’t assume there is a solution out there if only we look hard enough! 

Sometimes problems will resolve with time and some babies may never be great sleepers.

 What would you say to a parent struggling with sleep problems?

As a psychologist working in this area I would encourage parents to seek support for sleep problems as we all know that lack of sleep (especially over a long period) can be a major factor in determining our overall wellbeing. These problems are really common and even the very best parents find themselves needing to ask for help, so it is no reflection on parenting if a baby is having trouble with sleep patterns. The controlled crying technique has not been shown to be harmful and in fact it has many benefits for mums in terms of reducing depressive symptoms. 

However, not all parents will feel comfortable with this technique and that is okay too, it’s just important that parents look into different techniques and ask around for advice so that hopefully they will come across something that feels right and works for them.



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