I am a social worker and parent in Australia concerned about the western practice of a method called 'controlled crying' that is used on infants to get them to sleep. This blog talks about the use of this method and other parenting methods. Search all the information on this site to be better informed about the practice of controlled crying. For any comments or questions, my email is

Friday, June 23, 2006

Quotes from various Doctors, Paediatricians, Nurses, Midwives, Scientists, Researchers, Academics and Child Health Organisations:

(Note: these are excerpts from larger documents, follow the web link to find the full article)

The Australian Association for Infant Mental Health (AAIMHI) says;
Babies have to adapt to a totally new world and even small changes can be stressful for them. Leaving babies to cry without comfort, even for short periods of time, can be very distressing for them. Crying is a signal of distress or discomfort from an infant or young child. Although controlled crying can stop children from crying, it may teach children not to seek or expect support when distressed.
Infants are more likely to develop secure attachments when their distress is responded to promptly, consistently and appropriately. Secure attachments in infancy are the foundation for good adult mental health.
Any methods used to assist parents to get a good nights sleep should not compromise the infants developmental and emotional needs.

Children, Youth and Women’s Health Service, SA Health Department says:
Secure attachments in infancy are the base for good mental health. A major need for secure attachment is for a parent to respond to infant needs and cues. It is important not to leave your baby to cry. Under the topic Attachment they list points for good attachment with your baby. These include; Make eye contact. Babies like to look into your eyes. Notice when your baby is trying to get your attention with looks, smiles or cries. Crying always signals a need. Provide comfort when your baby is upset. Try to relax and concentrate on the baby's world, what he is looking at, trying to do, feeling etc.

The Australian Breastfeeding Association (ABA, formerly Nursing Mothers Association NMAA) quotes these experts;
Sue Cox RN, RM, IBCLC says (for ABA);

I believe the semantics of whether it is controlled crying or comforting means nothing and the overriding impact is of dominance and restraint - a dominant attitude by the parent of 'you will do what I say' and a restraint from nurturing - an 'I mustn't let you get too close to me because I will no longer be in control' attitude. Any relationship built on dominance and restraint will not flourish and fulfil the parent's goal.
We need to ensure that the biological, physiological and psychological requirements of human babies are met as they are by other parents in the animal kingdom.
McKenna; 'At birth the human infant is the least neurologically mature primate of all, and the most reliant on physiological regulation by the caregiver for the longest period.'
Seventy five percent of human brain development, more than any other mammal, occurs after birth. As a consequence of its immaturity, the human infant is forced to rely on external regulation and support, especially in the first year of life.
..the negative effects of short-term mother-infant separation, from primate studies, are that the offspring is less able to fight infections with a depressed antibody count, has increased stress hormones, irregular heat rate, abnormal pauses in breathing rate, lower body temperature, disrupted sleep patterns, behavioural abnormalities with excessive self-stimulation, hyperactivity and depression.
“20th Century Gurus of Parenting pt 3. Controlled Crying... oops sorry controlled comforting”. Sue Cox RN, RM, IBCLC, ABA breastfeeding counsellor. From 'Essence' magazine, Volume 36, Number 6.
Lesley McBurney, Australian Breastfeeding Association Counsellor says;
…many in the association are concerned about the increasing popularity of 'controlled crying' techniques, sometimes called 'controlled comforting'. …Taylor says that typical behaviour of young mammals and birds is to signal distress and wait for a response. If there is no response, the juvenile understands that it has been abandoned, and will die unless it conserves energy. Crying expends energy so crying must be stopped to ensure survival. This leads to 'learned helplessness' where the baby whose needs are not met detaches from reality, and numbs itself into sleep.
….just being alone can make babies insecure and they will cry unless they are 'scooped up in parental arms'. Before about eight months of age, babies have no idea of 'object permanence'. This means that if they can't see something it doesn't exist. A baby does not know the parent will be back in five, ten or fifteen minutes. All it feels is abandonment.
Controlling or Spoiling, Lesley McBurney, Australian Breastfeeding Association Counsellor, Reproduced from 'Essence' magazine, Volume 37, Number 6.

Dr William Sears says:
Beware of using someone else's training method to get your baby to sleep or get your baby on a predictable schedule. Most of these methods are variations of the tired old theme of letting baby cry it out.
With most of these baby-training regimens you run the risk of becoming desensitized to the cues of your infant, especially when it comes to letting baby cry it out. Instead of helping you to figure out what baby's signals mean, these training methods tell you to ignore them. Neither you nor your baby learn anything good from this.
Clicking into the cry-it-out method also keeps you from continuing to search for medical or physical causes of nightwaking, such as GER and food allergies.
Sleep Training - Not for breastfeeding mothers. William Sears, Ph.D.

Dr Commons and Dr Miller, Harvard Medical School say;
Finally, it is apparent that U.S. infants must learn to cope early with being alone and specifically with being separated from their mothers. Tennes (1982) has shown that in human infants there is a positive linear relationship between amount of separation protest and the amount of cortisol secreted. The information we have about sleep patterns in American infants and children also suggests that these produce stress in them. Although we are not aware of studies that have measured cortisol levels in infants sleeping apart from their parents and those sleeping with their parents, there is some evidence that these sleeping practices are stressful for American infants. For example, bedtime rituals seem to occur in U.S. settings, where infants and children are put to bed at set times and in separate areas, but rarely in other settings (e.g. Morelli et al., 1992). These rituals may last up to an hour in some cases and seem to be a response to the difficulty the infant or child has with going to bed on their own. A majority of U.S. infants in the Morelli et al. study also required transitional objects such as pacifiers, "blankies" or stuffed animals. It is well known from studies of adults (as summarized by Fackelmann, 1998) that cortisol is produced during all types of stressful events, and that high levels of cortisol seem to be associated with a number of effects, including low immune system functioning.
As will also become clear, although there is considerable work on early emotional learning (during the first 6-8 months), there is little work explicitly and directly relating this early learning to later behavior. This paper will conclude with some suggestions for doing so. In particular, it is suggested that early stressful experiences may result in a differential ability to handle stressful experiences later in life. The mechanisms by which this is accomplished are: a) that early child care practices that produce stress in infants, may result in higher levels of cortisol on a long term basis, and b) that certain emotional behaviors may be learned sub cortically during the first few months of life, and that these behaviors will persist.
“Emotional Learning in Infants: A Cross-Cultural Examination” Michael Lamport Commons, Ph.D. (Harvard Medical School) Patrice Marie Miller, Ph.D.(Harvard Medical School and Salem State College)

Dr Commons and Dr Miller quoted by Alvin Powell;
America's "let them cry" attitude toward children may lead to more fears and tears among adults, according to two Harvard Medical School researchers.
Instead of letting infants cry, American parents should keep their babies close, console them when they cry, ..according to Michael Commons and Patrice Miller, researchers at the Medical School's Department of Psychiatry. The pair examined child-rearing practices here and in other cultures and say the widespread American practice of putting babies in separate beds - even separate rooms - and not responding to their cries may lead to more incidents of post-traumatic stress and panic disorders among American adults. The early stress due to separation causes changes in infant brains that makes future adults more susceptible to stress in their lives, say Commons and Miller. "Parents should recognize that having their babies cry unnecessarily harms the baby permanently," Commons said. "It changes the nervous system so they're sensitive to future trauma."
Harvard Researchers Say Children Need Touching and Attention, by Alvin Powell,Contributing Writer, Harvard Gazette.

Dr Commons quoted by John Hoffman;
"I'm not saying babies can avoid all stress," Commons says. "The point is, let's not leave them alone to deal with it. Put most simply, let's respond to and comfort crying babies, so they will learn that when they're stressed, people will help them cope with it.
“Tales from the Crib” By John Hoffman, Today’s Parent.

Dr Commons quoted by Maggie Fox;
Babies who are made to sleep alone or are not picked up and comforted enough may grow up susceptible to post-traumatic stress disorder (PTSD) and personality problems, said Dr. Michael Commons of the Harvard Medical School, and colleagues.
The idea that babies need physical contact is not new --that is why they are no longer swaddled in tight blankets and left to cry for hours. But researchers speaking at the annual meeting of the American Association for the Advancement of Science said they were starting to find evidence of physical changes in the brain caused by stress in infancy.
Scientists have also found levels of the stress hormone cortisol to be much higher in crying babies. Commons suggested that constant stimulation by cortisol in infancy caused physical changes in the brain.
"It makes you more prone to the effects of stress, more prone to illness including mental illness and makes it harder to recover from illness," Commons said. "These are real changes and they don't go away." In the West, children are encouraged to be self-sufficient and face danger alone. "They don't have the emotional resources to seek comfort and consoling and the experience becomes unspeakable," Commons said.
“Stressed Babies May be Prone to Trouble Later”, By Maggie Fox, Health and Science Correspondent. Quoted on the Alliance for Transforming the Lives of Children Website.

Paper presented by Robin Balbernie for SEBDA - Social Emotional and Behavioural Difficulties Association - for children and young people;
From the baby’s point of view the most vital part of the surrounding world is the emotional connection with her caregiver, it is this that she is genetically pre-programmed to seek out, register and respond to. “The ecological niche the baby has evolved the ability to adapt to is the relationship with the mother. Research suggests that emotion operates as a central organising process within the brain. In this way, an individual’s abilities to organise emotions – a product in part of earlier attachment relationships – directly shapes the ability of the mind to integrate experience and to adapt to future stressors." (Seigal, 1999, p.4.)
Nurture then becomes nature. “In the face of persisting threat and, depending upon the age of the child and the nature of the threat, the child will move along the hyper arousal continuum (the child's version of “fight or flight") or into the dissociative continuum.” (Perry, et al., 1995, p.279.) It has been observed that the over-development of the brainstem and midbrain in response to an early hostile environment is associated with hyperactivity, impulsive behaviour, anxiety and poor emotional control. Neglect alone can similarly alter functions in the brain, as: “any deprivation of optimal developmental experiences (which leads to underdevelopment of cortical, subcortical, and limbic areas) will necessarily result in persistence of primitive, immature behavioural reactivity. And, thereby, predispose to violent behaviour.” (Perry, 1997, p.129.)
Cortisol is produced in response to threat, this can occur outside of conscious awareness of danger, and it increases activity in the region of the brain that controls vigilance and arousal (the locus ceruleus, the junction box through which the sympathetic nervous system rouses up the rest of the brain). Those neurochemical reactions that went with the initial period of abuse or neglect are immediately reactivated whenever there is a reminder of that trauma, with the same end result whether or not the threat is real. It is an example of the natural process of state-dependant storage and recall. These surges of cortisol also cause cell loss in the hippocampus, destroying explicit memory recall, as well as corroding those regions in the cortex and limbic system responsible for emotions and attachment. Early traumatic experiences that affect the formation of the limbic and subcortical areas of the brain result in extreme anxiety, depression and a lack of ability to form healthy attachments. If the adverse conditions persist, then cognitive ability may become impaired, and the information-processing and problem-solving style that results is such that the inevitable situations of failure and frustration that life throws up generate aggression rather than consideration (in both senses).
The Structure of the Brain and Early Experience. Paper presented by Robin Balbernie at the AWCEBD (now the SEBDA - Social Emotional and Behavioural Difficulties Association - for children and young people) 50th National Study Course Royal Agricultural College, Cirencester, UK, 22nd March 2002.
Full text; Balbernie, R. (2001) Circuits and circumstances: the neurobiological consequences of early relationship experiences and how they shape later behaviour.
Journal of Child Psychotherapy. 27 (3) 237-255 (or email me for the full article)

Lauren Lindsey Porter clinical social worker says on the science of attachment;
What has emerged is mounting evidence that stress and trauma impair optimal brain development while healthy attachment promotes it. In psychobiological terms, babies are unable to regulate themselves. Despite being born with the capacity for feeling deep emotions, babies are unable to keep themselves in a state of equilibrium, lacking the skills to regulate either the intensity or the duration of those emotions.19 Without the assistance and monitoring of a caregiver, babies become overwhelmed by their emotional states, including those of fear, excitement, and sadness.20 In order to maintain emotional equilibrium, babies require a consistent and committed relationship with one caring person.
Attunement, in the simplest terms, means following baby's cues.
When the mother-baby dyad is in attunement, both will experience positive emotions. If out of sync, the baby will show signs of stress, such as crying, that indicate the need for re-attunement.25
To a baby, stress is anything that pulls it out of attunement and into a negative emotional state. Events that cause such painful emotions as fear, anxiety, and sadness create stress. This includes everything from short, unwanted separations from the mother to the extreme of abuse.
For example, if a mother sets her baby down to answer the phone and the baby begins to cry, the baby requires the mother's return and re-attunement in order to avoid becoming overwhelmed by sadness. Without this assistance, the crying intensifies and leads to a chain of internal reactions that put the baby in a survival mode. In a survival mode, the baby operates at the most primary level, forced to dedicate all resources to the basic functions necessary for existence, thus forfeiting opportunity for potential growth.
This chain of events is a cycle of hyper arousal and dissociation that begins when the baby becomes distressed.
The second, later-forming reaction to stress is dissociation. At this point, the child disengages from the external world's stimuli and retreats to an internal world. This reaction involves numbing, avoidance, compliance, and lack of reaction.32 This second stage occurs in the face of a stressful situation in which the baby feels hopeless and helpless.33 The infant tries to repair the disequilibrium and misattunement but cannot, and so disengages, becomes inhibited, and strives to avoid attention, to become "unseen."34 This metabolic shutting-down is a passive state in response to an unbearable situation, and is the opposite of hyper arousal. In biological and evolutionary terms, it is the same process that allows us to retreat from overwhelming situations to heal wounds and fill depleted resources. However, as a response to dyadic misattunement, it is devastating, and the effects of even short periods of dissociation are profound.35 In this state, pain-numbing endogenous opiates and behavior-inhibiting stress hormones such as cortisol are elevated. Blood pressure decreases, as does the heart rate, despite the still-circulating adrenaline.36 This ultimate survival strategy allows the baby to maintain basic homeostasis.37
Perhaps most important, behavior-based techniques of child raising, such as sleep training, must be shunned. Given the new body of sophisticated, cross-discipline research on attachment and brain development outlined in this article, it is clear that a baby's willingness to accept sleep training after reportedly brief periods of protest is no less than a cycle of hyper arousal and dissociation responses that is damaging to its development. To think that since the infant has passively accepted the new sleep system, the sleep training is thus "successful," is to misunderstand the workings of the infant brain. No longer can we accept the conventional wisdom that babies are merely "exercising their lungs" when they cry; nor can we tolerate interpretations of babies' cries as "manipulation." Babies cry to signal distress and in effort to engage caregivers to help meet their needs and foster their healthy development. It is an attempt at communication, not manipulation. Their goals are survival and optimal development. This is achieved through secure attachment.
The Science of Attachment: The Biological Roots of Love, Lauren Lindsey Porter, Issue 119, July/August 2003, Mothering magazine

Professor Megan Gunnar says;
Scientists believe our ability to manage stress as adults is formed in childhood through a combination of genes and experiences. For two decades, Megan Gunnar, child development professor and director of the Human Developmental Psychobiology Lab, has pioneered the field of measuring stress in young children as a way to unravel the mysteries of healthy development.Gunnar’s research finds that social relationships control cortisol levels in infants and young children. Children with secure attachments to their caregivers—even when emotionally upset—show stable cortisol levels, while even minor challenges raised cortisol levels among those in insecure relationships. She has shown the key ingredient to buffering stress is sensitive, responsive, individualized care, the type of care that leads to secure attachment relationships.
“How young children manage stress; Looking for links between temperament and experience” by Professor Megan Gunnar, child development professor at Research works, College of Education and Human Development, University of Minnesota.

Author Linda Folden says;
According to attachment researchers, the consequences of this parenting style are fewer behavior problems and mental disorders, less social misconduct, a greater ability to form lasting adult relationships, and improved overall health.
In contrast, when nursing is withheld from a baby and there is maternal separation during much of the day and night, high levels of the stress hormone cortisol are produced.7 This leads to permanently altered brain function, hormonal imbalance and reduced immune functioning, as well as increased mental and behavior problems and a decreased ability to deal with stress throughout life.8,9,10
Coming of Age in America (Much Too Soon), Linda Folden Palmer, DC (Author of Baby Matters) Reprinted from Dynamic Chiropractic, May, 1999

Researchers Palmer and Heller quoted in Friendly Village;
When babies are held close by a loving parent or caregiver, they feel calm and contented. There are far less stress hormones (high levels of cortisol) which interfere with normal bodily functions, including digestion and brain development. (Heller, S.) It is theorized that excessive amounts of cortisol over time could magnify their future responses to stress. (Palmer, L.) Research has demonstrated that even while a young child is crying during a stressful event (a doctor visit, for example), if she is comforted (held) during that stressful even, there is a much lower stress response. She still may be crying loudly, but there are much lower levels of cortisol measured. Human touch does make a difference.

Parenting expert, author and lactation consultant Ann Calandro says:
Mothers are sometimes berated by family members and visitors for following their normal and natural instincts of responding to their own babies' needs. It is a sad world when we worry about training a newborn to be happy alone. Of course he needs to be picked up! He is not mature yet, certainly not capable of thinking, "I believe I will make her get up out of bed just for fun and pick me up." I worry about mothers who do not respond to their babies. When babies are left in their cribs to cry or left in the nursery with nurses for hours on end, I wonder what is wrong.
Crying is not normal either. Despite the sage advice of some grandmothers, crying isn't good for Baby's lungs. When you hear your baby cry, your heart will tell you so. Crying causes your baby's cortisol levels to go up, his blood pressure to go up and his whole life to become unbalanced so that he doesn't feed or relax well. When your baby cries, your instinct is to do everything in your power to solve his problem so that the crying will stop. Newborn wailing is meant to be very grating and to spur you into action. Most times with breastfeeding babies, your touch or your breast is the instant solution whether baby is thirsty, hungry, cold or afraid.
Straight Talk About Real Babies - Defining New-mom Expectations, Ann Calandro BSN, RNC, IBCLC

North West Regional Educational Laboratory says;
A responsive, nurturing environment that allows the infant and young child to develop strong attachments to a limited number of caregivers enables the child to build neural pathways that encourage emotional stability. Sroufe and his colleagues found that both that quality of care and security of attachment affect children's later capacity for empathy, emotional regulation, cognitive development, and behavioral control (Kestenbaum, Farber, & Sroufe, 1989).
Gunner's research (1996) on cortisol--a hormone that is easily measured because it is present in saliva - helps to explain how a secure attachment helps children withstand stress, even later in life. In stressful situations, children who have experienced a secure attachment to a caregiver are more adaptive and produce less cortisol. This research also shows that adverse or traumatic events elevate the level of cortisol in the brain. Excessively and chronically high levels of cortisol alter the brain by making it vulnerable to processes that destroy brain cells responsible for thought and memory. Just as importantly, cortisol reduces the number of connections in certain parts of the brain - causing memory lapses, anxiety, and an inability to control emotional outbursts.
Emotional signals, such as crying and smiling, serve as the language of the baby. Babies whose mothers are responsive to crying during the early months tend to cry less in the last months of the first year. Instead, they rely more on facial expressions, gestures, and vocalization to communicate their intentions and wishes to mother (Bell & Ainsworth, 1972).
The Importance of Attachment: The First Relationship. North West Education Collaboration; Beyond Family Involvement (2002).

Dr Aletha Solter says:
A baby’s crying can invoke powerful feelings in caretakers. When asked to describe their feelings when they were unable to quiet their crying babies, new mothers confessed a range of emotions, including exasperation, lack of confidence, fear, anxiety, confusion, anger, and resentment. Some even reported feeling extremely hostile towards their infants (Jones, 1983). Not surprisingly, infant crying has been linked to child abuse (Frodi, 1985; Murray, 1979). In a survey of battered infants, eighty percent of the parents reported that excessive crying by their baby triggered the abuse (Weston, 1968).
Tears for Trauma: Birth Trauma, Crying, and Child Abuse. Aletha Solter, Ph.D.

Dr Aletha Solter also says;
But there is no doubt that repeated lack of responsiveness to a baby’s cries—even for only five minutes at a time—is potentially damaging to the baby’s mental health. Babies who are left to cry it out alone may fail to develop a basic sense of trust or an understanding of themselves as a causal agent, possibly leading to feelings of powerlessness, low self-esteem, and chronic anxiety later in life. The cry-it-out approach undermines the very basis of secure attachment, which requires prompt responsiveness and sensitive attunement during the first year after birth.1
Crying for Comfort: Distressed Babies Need to Be Held, by Dr Aletha Solter, Issue 122 January/February 2004, Mothering magazine.

The Sunday Times quotes Margot Sunderland;
One of Britain’s leading experts on children’s mental health… Margot Sunderland, director of education at the Centre for Child Mental Health in London. She is so sure of the findings in the new book, based on 800 scientific studies, that she is calling for health visitors to be issued with fact sheets to educate parents...Her findings are based on advances in scientific understanding over the past 20 years of how children’s brains develop, and on studies using scans to analyse how they react in particular circumstances.
For example, a neurological study three years ago showed that a child separated from a parent experienced similar brain activity to one in physical pain. Sunderland also believes current practice is based on social attitudes that should be abandoned.
The Sunday Times Britain, Children 'should sleep with parents until they're five', by Sian Griffiths, May 14, 2006,,2087-2179265,00.html

Locations of visitors to this page