The Case Against Ferber Sleep Training

I understand how desperate a parent can be to get a child to sleep, and I have many good friends who have used the Ferber method with their babies. But I've found that there are kinder, gentler ways to teach babies to put themselves to sleep. And with all due respect, Richard Ferber is trained in physical health, not mental health. He readily admits that he is not trained in infant psychology.

Most interesting, Ferber now says in interviews that he regrets some of the advice he's given. He's been quoted as saying that he feels badly that child health professionals are encouraging parents to leave very young babies to cry, and that it's ok to co-sleep.

Here's how Ferberizing works:

You never start this process with a baby younger than three months. First, you let the baby cry for five minutes, then go in to reassure him verbally and by patting him. You don't pick him up. Then you leave, let him cry for another ten minutes, then go back to reassure him again. This time, you let him cry for fifteen minutes, then go back to reassure him. If the baby vomits, you clean him up (preferably without picking him up), but leave him in the crib and continue with the Ferberizing. Each time you leave, you wait longer to return.

With a very determined and resourceful baby, this crying can go on all night, but more usually the baby will become exhausted and fall asleep after a few hours. When he reawakens later in the night, the process is repeated. Often the next interval of crying is shorter, either because the baby has given up on the parent staying, or because he is exhausted. Sometimes it is longer, because the baby is re-energized (or an extremely determined person, who will someday accomplish great things by virtue of his strong will.) Usually, though, the crying diminishes on subsequent nights, as the baby learns not to expect the parent to stay with him.

While listening to their baby cry is hard on parents (not to mention the baby), most babies do eventually give up calling for their parents, and sleep. Because they do not yet talk, and live so completely in the moment, we do not hear from them the next morning how they felt about the experience.

However, even when parents are consistent, this approach does not work on all children. Some babies are still crying on the seventh night in a row. It is not uncommon for babies to get an ear infection in the middle of it (from the congestion caused by the crying); it is recommended that the Ferberizing be discontinued during the round of antibiotics that follows, to be re-initiated later. In addition, since any change in the routine (a brief illness, a trip to Grandma's) requires parents to respond to the baby's cries and then to repeat Ferberizing on another night, this process must be endured repeatedly by both baby and parents.

There are many studies claiming that repeatedly leaving babies to cry it out is a risk factor that predisposes kids to permanent brain changes and mental health issues in later life. However, advocates of Ferberizing say that because the parent keeps returning to the child's room, this offers the child reassurance that he has not been abandoned, and therefore keeps the experience from traumatizing the baby in the way that just letting them "cry it out" does.

The most recent claim that letting kids "cry it out" without reassurance may cause lasting damage is the finding that when a baby is left to cry alone, her cortisol level shoots up, indicating distress. That's not surprising. What is surprising is the research study* showing that on subsequent nights -- even when the baby is put into bed and does not cry -- her cortisol level still shoots up. Researchers interpret this as an indication that she is distressed. So why doesn't she cry? Because she has been "trained" -- she knows that no one will come.

*Middlemiss, Wendy et al. "Asynchrony of mother–infant hypothalamic–pituitary–adrenal axis activity following extinction of infant crying responses induced during the transition to sleepEarly Human Development, Volume 88 , Issue 4, 227 - 232

Margot Sunderland's The Science of Parenting cites many studies that Sunderland claims support her view that repeated, sustained crying without adult reassurance causes babies' brains to develop less than optimally. My perusal of her sources showed some that probably should not be used to support her claim because they studied more extreme circumstances. But many of the studies seem credible.

Harvard Researchers who examined emotional learning, infant brain function and cultural differences claim that babies who are left to cry themselves to sleep suffer long-lasting damage to their nervous systems. The researchers claim that this makes these children more susceptible in later life to anxiety disorders, including panic attacks. The incidence of anxiety disorders has increased dramatically in recent years, but I personally don't think this is necessarily correlated to the practice of letting children "cry it out." My own view is that such a susceptibility could be caused by many aspects of childhood in 21st century North America and would need to be triggered by later trauma to play out.

So the question is whether the intermittent parental reassurance (but refusing to pick up the pleading baby) as specified by the Ferber method protects the child from the risks of just letting him "cry it out." Some anti-Ferber folks claim that the parent coming into the room and ignoring the baby's distress might actually increase the trauma by undermining the baby's trust in the parent.

It's hard to evaluate research in this area because there are so many other factors (many of which are arguably more important) in how babies develop. However, it is well-documented that sustained, uncomforted infant crying causes increased heart rate and blood pressure, reduced oxygen levels, elevated cerebral blood pressure, depleted energy reserves and oxygen, and cardiac stress. Cortisol, adrenalin and other stress hormones skyrocket, which disrupts the immune system and digestion. It's a reasonable guess that if this is repeated over time, these babies would build a slightly different brain, more prone to "fight, flight or freeze."

 

We know that with adults, even one panic-inducing experience like a car accident or mugging that causes an extreme stress response can have ongoing stress effects for years. Since babies' heart rates and blood pressure soar during Ferbering, I don't think there can be any doubt that sleep training without parental comfort causes the experience to be indelibly etched on the memory, much as any panic situation can evoke strong feelings years later. That the memory is sensory and preverbal just gives it more power, as it cannot be adequately processed.  

 

So there are a growing number of critics who see Ferberizing as barbaric. Their position can be summarized as follows:

1. Richard Ferber is a pediatrician with no psychological training.

While his approach works on some babies, it may not be simply "teaching them to sleep in their own beds”, as Ferber maintains. Other, less desirable lessons are unwittingly being taught.

2. Your baby is learning that you cannot be depended on,

and in fact will regularly desert her when she needs you most; that she is powerless to have an impact on her world in the ways that most matter to her; and that her world is a cold and lonely place. The most important developmental work your baby is doing right now is learning how to trust. Why sabotage that?

3. She learns that you will not help her when she needs it,

...by your coming back into the room and telling her to go to sleep. She concludes that she is not, in the deepest dark of the night, really lovable. She may even conclude that you are intentionally tormenting her.

4. It is possible that these early lessons will underlie her sense of self and worldview for the rest of her life.

Insomnia is rampant in our culture, and some Ferber critics argue that all those adults who can’t fall asleep without the TV on, or who wake up at night and can’t sleep, are Ferber casualties.

I should add that I've heard that there are families where the baby learns to fall asleep with a few minutes of crying and never needs to be retrained. In those cases, it seems to me a wonderful solution.

I should also acknowledge that I know many kids who were Ferbered as babies by their parents, who shall remain nameless because they are dear friends of mine. These kids all seem fine to me. So while I think Ferbering is a risk factor, it's hardly the worst thing you can do to your kids. Regular yelling because you're exhausted would be worse, in my view. And sleep deprivation definitely makes you a worse parent.

But Ferbering is a risk factor, and an avoidable one, so it's important for you to know there are other, gentler methods for teaching your baby to put herself to sleep. You can begin encouraging gentle sleep habits that make it more likely that your child will sleep at night even as early as three months; here's a whole article on how. You might also explore Elizabeth Pantley's No Cry Sleep Solution, which is explained in more detail in Helping Your Baby Get to Sleep So You Can Too.

What about teaching an older baby
or toddler to sleep without the parent?

I think kids do fine, after the age of one year, IF the parent stays with the child while she's learning. It isn't crying that affects little ones negatively, or even disappointment, or sadness. What's bad for brain development is being left to cry uncomforted. So parents need to parent at night, just like they parent during the day. I also believe that that once the baby becomes verbal, the risks are greatly decreased, because she understands so much better what's happening. But it's always essential for the parent to stay in the room with the baby while the baby learns to put herself back to sleep. There's lots more on this on the page Teaching your toddler to put herself to sleep.