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When "Crying It Out" Doesn't Work
by Mary Kathleen Fay, M.D.
Chapter 1
My Story
I’d like to start by telling you my personal story as a mother struggling to raise a child with an undiagnosed sleep disorder. Given the fact that I was a pediatrician, fresh out of training and knowledgeable of the most advanced theories and treatments, I think you will find it interesting.
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Pediatricians routinely counsel parents about childhood sleep problems, the most common being “bedtime battles” and night waking. During residency training, I learned that parents caused these problems by failing to “set proper limits around bedtime” or “not allowing the child to learn how to fall asleep alone.” This led to night waking because the child never learned how to “self-soothe“ and continued to associate falling asleep with having a parent present. Once I learned this, I no longer felt sorry for these families. To me the children were spoiled and the parents were spoiling them. Instead of complaining to pediatricians about their problems, I believed all these parents just needed to be stronger and take command of the situation. That’s why I told them to use “behavioral interventions,” the best known of which was “crying it out.” Maybe by listening to some crying these parents could teach their children some better sleep habits and rectify the problem.
Most parents came to me having already tried “crying it out” and failed, but that didn’t prevent me from telling them to try it again, since invariably they were still doing all the things I was taught caused sleep problems, like rocking or feeding the child to sleep. I assumed treatment failed because the parents couldn‘t change their bad habits. I’d go over what they should have done in greater detail, emphasizing that they needed to be consistent, and not give up, and that they might have to listen to some crying, but if they stuck with the program, it would work for them.
Most parents returned to tell me they had failed yet again, which I assumed was because they weren’t tough enough or devoted enough or psychologically intact enough to take control of the situation. If they returned yet again, I would refer them to a psychologist or behavioral therapists who would hold their hands during treatment, and get rid of the problem.
I did this even though in 17 years of pediatric practice, only once have I seen a child who quickly responded to behavioral interventions the way my textbooks claimed they would. In that one case, the mother left her 11 month-old alone in the crib to cry and didn’t return until morning. After several nights of what she described as “hell,” her child no longer woke her, but how many parents could endure what this mother did? I had trouble even listening to her story.
That’s why when I advised parents about treatment, I gave them limits to the amount of time they should listen to crying, and if the child could cry longer, they should go in and briefly comfort the child, not to taking them out of the crib, then leave again. Most parents could do this, but it certainly didn’t seem to be as effective. No one ever came back saying the problem was gone. Everyone just slowly got better, and it took months, not days, like my textbooks implied it would.
Eventually, I got tired of telling parents about behavioral interventions. I had to spend a great deal of time explaining them, and they never seemed to help. The textbooks didn’t talk about alternative treatments, and it was depressing trying to be enthusiastic about something I had no faith in. I got the feeling that some of the parents quit complaining to me even though the problem wasn’t gone, probably because they knew I would have nothing else to offer them.
As I grew more frustrated with the situation, I started asking other pediatricians about their experiences, and it appeared they weren’t doing much better. The longer they used behavioral interventions, the less enamored pediatricians became with them. Many admitted they had given up and were using medications, like Clonidine® or BenadrylÒ that would make children feel drowsy, even though this was discouraged in the pediatric textbooks. Some even told me that they had learned tricks to get out of the exam room before parents could ask about sleep problems, because as one of my colleagues put it, “nobody ever gets better.“
Being more proactive, I started advising parents of newborns on how they could develop good sleep habits from the beginning. I explained how to be firm about bedtime and establish a good sleep schedule, and I stressed the importance of letting children fall asleep on their own. I warned parents never to rock or feed their children to sleep, and then sneak them into their cribs that way. This taught the child to associate the parent being present with the process of falling asleep, and if the child awoke during the night, they would call out for the parent in order to help them fall back to sleep. I reasoned that if parents didn’t make these mistakes, then everyone would sleep better.
I got the impression this may have helped a little, but almost as many children still developed bedtime and night waking problems. When they did, the parents claimed they hadn’t encouraged it, but when I asked what the parents were doing, they were doing all of the things that I‘d warned them not to, so I didn‘t believe them. As I listened to them complain, I had little sympathy for their plight, and I vowed that I would never end up like them. I swore that my as yet unborn children would sleep through the night as soon as possible and never wake me unless they were hungry. All I had to do was not make mistakes and refuse to be manipulated by a baby, or so I thought.
Once my son was born, I realized just how naïve I was. By now a very busy pediatrician, I desperately wanted my child to be a good sleeper, but he wouldn‘t cooperate. The older he got, the more he fought bedtime, and he continued to wake me at night, even though I knew he didn’t need feeding. When he developed separation anxiety around 9 months of age, all hell broke lose. The only thing that seemed to help him sleep was bringing him in bed with me, which I viewed as a failure.
I tried unsuccessfully to use “crying it out, “but there was only so much of my son’s tortured crying I could listen to. For him, 20 minutes was just warming-up, and if he actually did succeed in crying himself to sleep, it wasn’t long before he was rested and would waken, crying out for me to come get him because he had learned exactly nothing about “self-soothing.” Each time I vowed I would follow through with the program, I’d become exhausted by the effort and end up taking him in bed with me. He just refused to learn how to fall asleep alone, and if anything, my failed attempts at “crying it out” seemed to make the problem worse, because my son grew more vigilant and more determined not to let me out of his sight, fighting sleep that much harder.
I felt guilty when I couldn‘t make behavioral interventions work. When I discussed this with my son’s pediatrician, she sympathized, but she had nothing more to offer than what I told parents - to keep trying harder with behavioral interventions. Eventually, I stopped mentioning the problem to her, and she never asked. Obviously, I was paying a price for all the bad things I’d felt about other parents with this problem, and my fate was to be a failure and let my son sleep in my bed. I had nothing against co-sleeping, I had just looked forward to sleeping with my husband in my bed.
Once there, my son wasn‘t exactly the ideal bed partner. He tossed and turned and moved all night, making his parents learn very quickly to keep clear of his arms and legs so we didn’t get whacked. Often I would end up trapped in a corner while he practically ran laps around the bed while fast asleep. He also slept with his mouth open, so there was always plenty of fresh drool, and occasionally he slept in strange positions, the oddest one being where he would lie with his cheek and chest on the mattress, but his but sticking straight up in the air. Occasionally, he would be covered with sweat, so I started dressing him more lightly. He absolutely refused to give up his night bottle, and would fall asleep with it clenched between his front teeth. If it fell out and he wanted it later, he would suddenly sit straight up and start looking for it, only to take a few sips and fling it across the bed or fall back to sleep with it clenched between his teeth again. But by far, the most annoying thing was how restlessly he slept. Never having learned this was abnormal, I viewed it as a minor inconvenience and didn‘t worry about it. At least we were sleeping.
Over time his sleep habits seemed to improve. He had never been easy to get down for a nap, and somewhere between 2 and 3 he eliminated them completely, much earlier than most children did. His usual pattern was to go at high speed from the time he got up until I forced him into bed at bedtime. Once settled, it didn’t take him long to fall asleep, the trick was getting him to lay still long enough. Eliminating naps had seemed to improve the restlessness of his sleep at least. Now he hardly moved at all, and he slept so soundly that no amount of noise would wake him. When sleep came, it hit him like a ton of bricks, and he didn‘t seem to move till I woke him up in the morning. I also noticed it was harder to wake him in the morning, and started joking that he wasn’t a morning person. He would fight getting up and be crabby for a good hour after waking, something I also didn‘t worry about because he always had more than enough energy the rest of the day.
My son was what I politely refer to as a “difficult child.” He was obstinate and contrary on a daily basis and disciplining him was almost impossible. Telling him “no” or trying to use “time outs” didn’t work, because he seemed to take it as a personal challenge. Whatever it was I wanted to discipline quickly got lost in the ensuing power struggle. These battles were exhausting and pointless, and I quickly learned it was much easier to distract him with a toy or a cracker than to get him to stop doing the thing that I didn’t want him to. He was also borderline hyperactive and not the most popular child on the street, often playing too rough for the other children. I told myself things would get better, but when he entered school and quickly ran into trouble, I could no longer fool myself.
It’s one thing for your child to fight you about going to sleep or getting into the car at the playground; it’s quite another to have a teacher tell you your child isn’t keeping up it in kindergarten. Things were so bad that a few weeks into classes, my son’s teachers called me in for a conference. He was having trouble completing his projects and was always forgetting things he needed to tell me or bring in for school. In fact the only reason I knew his teachers wanted to see me was they had resorted to pinning a note on his chest where I‘d see it.
Needless to say, I was worried. I went to observe him in class where he didn’t stand out, but then he didn’t really fit in. He often seemed to be dreamy, inattentive and uninterested in what was going on. If the teacher called on him, he was likely to give wrong answers, not because he didn‘t know them, but because he just wasn‘t paying attention. I regretted not sending him to preschool and wished I’d held him back a year like the other mothers of children who’s birthday fell close to the deadline for school entry. But it was more than being behind or immature compared to his classmates. My son wasn’t acting like the other children, and I got the impression his teachers blamed me for his problems. So did me.
He was tested for entry into special education classes, but he was too smart to qualify for the help. (His IQ was measured at 120, even though he grew bored with the test, threw the pencil down and refused to complete it.) It wasn’t that he couldn’t do the work, he just didn’t care if he finished, and the moment he got frustrated, he was on to the next thing. Eventually, his teachers decided he would have to repeat kindergarten, this time attending both morning and afternoon sessions, instead of only one like the other children. In other words, my son flunked kindergarten twice. Imagine how happy I was.
I decided that if I had spoiled him and was causing his problems, then it was up to me to cure them. I started working part time and paying out of pocket for him to see a child psychologist. But the more I tried to change him, the more he refused to change. He refused to care about the things his teachers and I were worried about, so he wasn‘t motivated to improve. I had the sinking feeling he would stay this way forever, and although he was eventually promoted to first grade, I no longer looked forward to it the way I used to. Now, it just meant more guilt-ridden parent-teacher conferences and more shame, and if you had asked me at this point what I thought of motherhood, I would have told you it was highly overrated.
Then a miracle happened…..really |
