Dangers of “Crying It Out”

Damaging children and their relationships for the longterm. Post published by Darcia Narvaez Ph.D. on Dec 11, 2011 in Moral Landscapes

*See note on basic assumptions below.

Letting babies "cry it out" is an idea that has been around since at least the 1880s when the field of medicine was in a hullaballoo about germs and transmitting infection and so took to the notion that babies should rarely be touched (see Blum, 2002 (link is external), for a great review of this time period and attitudes towards childrearing).

In the 20th century, behaviorist John Watson (1928), interested in making psychology a hard science, took up the crusade against affection as president of the American Psychological Association. He applied the mechanistic paradigm of behaviorism to child rearing, warning about the dangers of too much mother love. The 20th century was the time when "men of science" were assumed to know better than mothers, grandmothers and families about how to raise a child. Too much kindness to a baby would result in a whiney, dependent, failed human being. Funny how "the experts" got away with this with no evidence to back it up! Instead there is evidence all around (then and now) showing the opposite to be true!

A government pamphlet from the time recommended that "mothering meant holding the baby quietly, in tranquility-inducing positions" and that "the mother should stop immediately if her arms feel tired" because "the baby is never to inconvenience the adult."  A baby older than six months "should be taught to sit silently in the crib; otherwise, he might need to be constantly watched and entertained by the mother, a serious waste of time." (See Blum, 2002.)

Don't these attitudes sound familiar? A parent reported to me recently that he was encouraged to let his baby cry herself to sleep so he "could get his life back." 

[Note: In other posts on infant sleep listed below, my co-authors and I point out flaws in studies of sleep training. Here is another example. Check out this article (link is external) and its table that lists the studies reviewed. The table shows that every study is flawed--either the intervention was not followed (fidelity) and/or only parent reports were used, not observation. Moreover, the age range of the children varied. Most importantly, note that most studies did not measure child wellbeing. So there is no responsible way to draw generalizable conclusions from this set of flawed studies. The standards for publishing such studies appears to be very low. In a forthcoming post, we note how many studies use an "Intent to Treat" criterion for distinguishing conditions, not bothering about what actually happened.]

With neuroscience, we can confirm what our ancestors took for granted---that letting babies get distressed is a practice that can damage children and their relational capacities in many ways for the long term. We know now that leaving babies to cry is a good way to make a less intelligent, less healthy but more anxious, uncooperative and alienated persons who can pass the same or worse traits on to the next generation. 

The discredited behaviorist view sees the baby as an interloper into the life of the parents, an intrusion who must be controlled by various means so the adults can live their lives without too much bother. Perhaps we can excuse this attitude and ignorance because at the time, extended families were being broken up and new parents had to figure out how to deal with babies on their own, an unnatural condition for humanity--we have heretofore raised children in extended families. The parents always shared care with multiple adult relatives.

According to a behaviorist view completely ignorant of human development, the child 'has to be taught to be independent.' We can confirm now that forcing "independence" on a baby leads to greater dependence. Instead, giving babies what they need leads to greater independence later. In anthropological reports of small-band hunter-gatherers, parents took care of every need of babies and young children. Toddlers felt confident enough (and so did their parents) to walk into the bush on their own (see Hunter-Gatherer Childhoods, edited by Hewlett & Lamb, 2005).

Ignorant behaviorists then and now encourage parents to condition the baby to expect needs NOT to be met on demand, whether feeding or comforting.  It's assumed that the adults should 'be in charge' of the relationship.  Certainly this might foster a child that doesn't ask for as much help and attention (potentially withdrawing into depression and going into stasis or even wasting away) but it is more likely to foster a whiney, unhappy, aggressive and/or demanding child, one who has learned that one must scream to get needs met. A deep sense of insecurity is likely to stay with them the rest of life.

The fact is that caregivers who habitually respond to the needs of the baby before the baby gets distressed, preventing crying, are more likely to have children who are independent than the opposite (e.g., Stein & Newcomb, 1994). Soothing care is best from the outset. Once patterns of distress get established, it's much harder to change them.

Rats are often used to study how mammalian brains work and many effects are similar in human brains. In studies of rats with high or low nurturing mothers, there is a critical period for turning on genes that control anxiety for the rest of life. If in the first 10 days of life you have a low nurturing rat mother (the equivalent of the first 6 months of life in a human), the gene never gets turned on and the rat is anxious towards new situations for the rest of its life, unless drugs are administered to alleviate the anxiety. These researchers say that there are hundreds of genes affected by nurturance. Similar mechanisms are found in human brains--caregiver behavior matters for turning genes on and off. (See work of Michael Meaney and colleagues; e. g., Meaney, 2001).

We should understand the mother and child as a mutually responsive dyad. They are a symbiotic unit that make each other healthier and happier in mutual responsiveness. This expands to other caregivers too.

One strangely popular notion still around today is to let babies 'cry it out' (aka total extinction or unmodified extinction) when they are left alone, isolated in cribs or in other devices.  This comes from a misunderstanding of child brain development.

Babies grow from being held. Their bodies get dysregulated when they are physically separated from caregivers. (See here for more.)
Babies indicate a need through gesture and eventually, if necessary, through crying. Just as adults reach for liquid when thirsty, children search for what they need in the moment. Just as adults become calm once the need is met, so do babies.
There are many longterm effects of undercare or need-neglect in babies (e.g., Bremmer et al, 1998; Blunt Bugental et al., 2003; Dawson et al., 2000; Heim et al 2003).
Secure attachment is related to responsive parenting, such as comforting babies when they wake up and cry at night (link is external).
What does 'crying it out' actually do to the baby and to the dyad?

Neuronal interconnections are damaged. When the baby is greatly distressed,it creates conditions for damge to synapses, the network construction which is ongoing in the infant brain.  The hormone cortisol is released. In excess, it's a neuron killer but its consequences many not be apparent immediately (Thomas et al. 2007). A full-term baby (40-42 weeks), with only 25% of its brain developed, is undergoing rapid brain growth. The brain grows on average three times as large by the end of the first year (and head size growth in the first year is a sign of intelligence, e.g., Gale et al., 2006). Who knows what neurons are not being connected or being wiped out during times of extreme stress? What deficits might show up years later from such regular distressful experience? (See my addendum below.)

Disordered stress reactivity can be established as a pattern for life not only in the brain with the stress response system (Bremmer et al, 1998), but also in the body through the vagus nerve, a nerve that affects functioning in multiple systems (e.g., digestion). For example, prolonged distress in early life, lack of responsive parenting, can result in a poorly functioning vagus nerve, which is related to various disorders as irritable bowel syndrome (Stam et al, 1997). See more about how early stress is toxic for lifelong health from the recent Harvard report, The Foundations of Lifelong Health are Built in Early Childhood (link is external)).

Self-regulation is undermined. The baby is absolutely dependent on caregivers for learning how to self-regulate. Responsive care---meeting the baby's needs before he gets distressed---tunes the body and brain up for calmness. When a baby gets scared and a parent holds and comforts him, the baby builds expectations for soothing, which get integrated into the ability to self comfort. Babies don't self-comfort in isolation. If they are left to cry alone, they learn to shut down in face of extensive distress--stop growing, stop feeling, stop trusting (Henry & Wang, 1998).

Trust is undermined. As Erik Erikson (link is external) pointed out, the first year of life is a sensitive period for establishing a sense of trust in the world, the world of caregiver and the world of self.  When a baby's needs are met without distress, the child learns that the world is a trustworthy place, that relationships are supportive, and that the self is a positive entity that can get its needs met. When a baby's needs are dismissed or ignored, the child develops a sense of mistrust of relationships and the world. And self-confidence is undermined. The child may spend a lifetime trying to fill the resulting inner emptiness.

Caregiver sensitivity may be harmed. A caregiver who learns to ignore baby crying, will likely learn to ignore the more subtle signaling of the child's needs. Second-guessing intuitions that guide one to want to stop child distress, the adult who learns to ignores baby needs practices and increasingly learns to "harden the heart." The reciprocity between caregiver and baby is broken by the adult, but cannot be repaired by the young child. The baby is helpless.

Caregiver responsiveness (link is external) to the needs of the baby is related to most if not all positive child outcomes. In our work caregiver responsiveness is related to intelligence, empathy, lack of aggression or depression, self-regulation, social competence.  Because responsiveness is so powerful, we have to control for it in our studies of other parenting practices and child outcomes. The importance of caregiver responsiveness is common knowledge in developmental psychology.  Lack of responsiveness, which "crying it out" represents can result in the opposite of the aforementioned positive outcomes.

The 'cry it out' approach seems to have arisen as a solution to the dissolution of extended family life in the 20th century. The vast knowledge of (now great great) grandmothers was lost in the distance between households with children and those with the experience and expertise about how to raise them well. The wisdom of keeping babies happy was lost between generations.

But isn't it normal for babies to cry?

No. A crying baby in our ancestral environment would have signaled predators to tasty morsels. So our evolved parenting practices alleviated baby distress and precluded crying except in emergencies. Babies are built to expect the equivalent of an "external womb" after birth (see Allan Schore (link is external), specific references below). What is the external womb? ---being held constantly, breastfed on demand, needs met quickly (I have numerous posts on these things). These practices are known to facilitate good brain and body development (discussed with references in other posts, some links below). When babies display discomfort, it signals that a need is not getting met, a need of their rapidly growing systems.

source: https://www.psychologytoday.com/blog/moral-landscapes/201112/dangers-crying-it-out

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