"Gentle" sleep training methods, which tend to involve more parental input than modified and unmodified extinction/cry-it-out methods appear to be a perfect solution – they help you get the results of sleep training but in a way that seems to be better for your baby and doesn’t make you feel so bad in the process. But are they all they’re cracked up to be?
The exacts methods of “gentle” methods can vary depending on the sleep trainer or source but all are marked by parent-led comforting strategies that you slowly reduce until you remove support around sleep completely. Two common methods include “camping out” and “responsive settling”.
I have no doubt the rise of gentle methods is well-intentioned. Introduce more responsiveness into sleep training and it should mitigate any harm, right? Then you’re only left with the benefits: a baby sleeping independently for long periods of time and a parent getting more sleep too. Win-win! The question is, does the baby really experience gentle sleep training any differently to other variations of sleep training, and if they do, is it “better”?
Let’s break this down into parts
First, let’s talk about evidence. There is no research that directly addresses the question of whether "gentle" sleep training is experienced differently by babies than CIO or modified CIO. This isn’t surprising since evidence in support of sleep training in general ranges from poor to woeful quality and mostly focuses on parents' perceptions as opposed to the baby's experience or outcomes.
The “best” evidence we have that sleep training (in general, not “gentle” methods specifically) doesn’t cause long-term harm is one five-year longitudinal study with serious methodological issues. In this study, it wasn’t clear if the sleep training and non sleep training groups actually did what they said they intended to do (to sleep train or not. It also relied on parent reports of child emotional development (an inherently flawed method to gather these data, particularly in relation to assessing the link between something a parent chose to do and its potential negative effects). Finally, drawing conclusions of "no harm" of sleep training based on the reported outcomes at five years old when most mental health issues don’t emerge until adolescence or adulthood is inappropriate and beyond the scope of the research.
This isn’t a criticism of the research as such - adequate research would be complicated, expensive, and time-consuming. The conclusions of no harm are what is problematic, considering the extreme limitations present. Keep in mind this is the BEST research we have. The vast majority of sleep training research focuses on “success” of sleep training from a purely behavioural standpoint (parent reports of less waking/better sleep) and parent mood; it generally doesn’t even look at the baby’s short- or long-term emotional well-being.
Without specific evidence about sleep training to draw on, let’s look at some other relevant research that might be able to be applied to a typical "gentle" sleep training scenario. Keep in mind this isn’t proof of anything but provides a basis from which to theorise how your baby may experience “gentle” sleep training.
The still-face experiment
The still-face experiment by Edward Tronick in the 1970s tells us a lot about a baby’s need for connection and what it is like for them when the connection they expect does not occur. It starts with a mother and baby facing each other and the mother plays and interacts with the baby. Then the mother stops interacting and turns away before showing their baby a still face or lack of responsiveness for 2 minutes. Initially the baby tries everything they can to get their mother’s attention. At first, they attempt to play, then they become distressed, cry, scream, lose postural control. Toward the end of the experiment though, they change. They withdraw and are no longer crying or trying to get their mother’s attention, showing hopelessness and signs of dissociation.
How is this relevant to "gentle" sleep training? Because although you are more present during gentle sleep training (and theoretically this is what differentiates it from CIO) if you are not responding in an expected or comforting way, then it is not necessarily meeting your baby’s emotional need of connection.
This experiment also shows that it only takes a baby a short period of time to give up, withdraw, and show signs of learned helplessness. In this sense, how much (or little) your baby cries during sleep training, or how fast they stop crying, isn’t telling you they are learning to sleep or “self-settle”, only how quickly they begin to employ maladaptive coping strategies to survive the unexpected and distressing situation they are in that they have no control over.
Updated theories of learned helplessness (reviewed here) pose that passivity and anxiety are default responses to prolonged bad events through activation of a part of the brain called the dorsal raphe nucleus. In turn, the symptoms of learned helplessness map into symptoms of depression and post-traumatic stress disorder.
We don’t even need a study to prove sleep training (including “gentle”) might not be good for a baby or our relationship with them though, do we? Imagine you were upset, and your partner only comforted you from the doorway when what you needed was physical contact? It’s possible you would feel even more upset than if they weren’t there at all. When you put yourself in your baby’s position, it becomes quite straightforward to understand their needs and how you should respond to meet them.
Other risks of gentle methods
Some of the other risks of using "gentle" methods are the same as any other sleep training method. This is because the risks are not only in the process but also the outcome. “Success” is measured by longer duration of sleep, “self-soothing”, and often being night-weaned and sleeping in a separate room. Let’s look at these in turn:
1. Night-waking is protective against SIDS
It is debatable whether sleep training causes babies to sleep any differently (studies using objective measurement says it does not). However, if we are to pretend that it does, this isn’t necessarily a good thing. Night waking is thought to be protective against SIDS because arousals lead to an increase in the amount of oxygen the baby takes in. Decreasing arousals could be particularly detrimental for babies with preexisting vulnerabilities in the arousal systems of their brain; something you have no way of knowing beforehand.
2. Night weaning and early cessation of breastfeeding
Night weaning can lower milk supply and is associated with overall shorter breastfeeding duration. Breastfeeding is protective against SIDS and protective against cancers for mother and baby and there are countless benefits to breastfeeding beyond early infancy.
The benefits of night feeding isn’t exclusive to breastfeeding either; if you are bottle feeding, night feeds still offer both caloric benefits as well as connection and comfort to your baby.
3. Separate room sleeping
Red Nose Australia, and most other peak bodies recommend same room sleeping until 6-12 months of age because this lowers the risk of SIDS. This includes all night sleep and naps. Sleep training usually involves separate room sleeping in order to be "successful", so this is another risk factor.
4. The development of emotion regulation
A baby’s brain is not capable of learning to self-soothe; they do not have the brain parts necessary. The healthy development of emotion regulation is slow and relies on the consistent and reliable presence of a responsive and attuned caregiver, especially in the critical period of the first three years. Emotion regulation skills are still emerging into adulthood; you simply can’t teach them over the course of a couple of nights or weeks in infancy and definitely not by withholding or limiting responsiveness in a parent-led approach.
The goal is the problem
The inappropriate goal of independent sleep for long chunks of time at as early as 4-6 months old remains. In turn, the methods that involve restricting responsiveness and the outcomes both carry risks.
The way the research defines infant sleep problems is hugely flawed and also contributes to ongoing sleep training culture and rhetoric. A model that results in much of a typical and otherwise healthy population being labelled as having a “problem” that requires intervention makes no sense. It defies basic logic, let alone science. Until this routine and baseless pathologising changes, sleep training will continue to be prescribed as standard care and the solution to this made up problem.
A combination of social and cultural factors also drives sleep training in Western countries around the world. In some parts of the world, abysmal parental leave is also a factor. However, Australia has pretty decent parental leave but sleep training is still standard, so leave is clearly not the biggest factor.
It doesn’t help that most peak bodies are reluctant to change their zero-tolerance approach to shared sleep. This is despite several developed countries with high rates of shared sleep (e.g., Sweden and Japan), having some of the lowest rates of SIDS. The USA on the other hand has some of the highest rates of SIDS in the developed world but also the lowest rates of shared sleep. This isn’t to suggest bed sharing itself prevents SIDS per se, although some research suggests it trends toward protective after 4 months of age in the presence of certain factors, and room sharing is also considered protective as detailed above. The takeaway though is that risks can be minimized (or heightened) in any sleep environment and the relationship between sleep location and SIDS is not as straightforward as safe sleep recommendations would have you believe.
Red Nose Australia now includes safe bed sharing guidelines, but there is still a lot of stigma and shame around shared sleep despite it being a biological and cultural norm in most of the world (including the Western world until 100-200 years ago). Bed sharing is not a one-size-fits-all solution but education around safer bed sharing and co-sleeping options such as bedside sleepers or floor beds could contribute to a multifaceted approach. It’s also not all-or-nothing. For example, a floor bed can offer flexibility where a caregiver can lie with their baby or toddler as and when needed but also maintain their own separate bed if desired. In short, there are multitudinous options for sleep beyond solo crib sleeping that has become the expectation and norm but in reality, works for very few families (especially without sleep training).
Education and support are paramount
Parents could also be better prepared and educated about normal infant sleep and how to optimize rest and well-being in a way that does not compromise anyone’s needs. Mainstream representations of infant sleep tend to be that it is worst in the first few months, and then it progresses in a steady and linear fashion. Infant and toddler sleep is more like a rollercoaster. Simply knowing this and being reassured by healthcare providers could help many families to feel confident in following their instincts to support their baby.
Parents do not need to fear that their baby’s broken and messy sleep is detrimental to their development, and they certainly shouldn’t be led to believe that responding to them is a bad habit. To the contrary, it is supportive of their social and emotional development and independence, and parents need to be told this.
Many factors contribute to emotional well-being, attachment, physical well-being, and prevalence of SIDS. Reducing it down to sleep training or not sleep training would be a huge reach, and not a claim I'm making. However, given what we know about how healthy emotional development and attachment do occur (e.g., co-regulation and responsiveness to distress); how withdrawal of responsiveness produces symptoms of learned helplessness; and the many factors that contribute to SIDS risks, it is certainly plausible that sleep training poses a risk in several ways.
“Gentle” sleep training methods sound like a good option in theory, and likely feel better to parents. But we do not know if they are safe, and evidence suggests there may be some level of risk in both the process and the outcomes. It goes without saying that all families are in different situations and there is no one-size-fits-all. However, families deserve to have all the information and alternatives, so they are empowered to make informed choices for them and their baby.
Your options for sleep challenges are not cry-it-out or wait it out. There are many ways you can optimise sleep and well-being while parenting responsively and intuitively. Follow me on instagram for free daily resources, tips, and reassurance, and sign up from the landing page to receive your free guide "How To Survive Sleep Regressions".