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

Saturday, July 08, 2006

Controlled Crying and Routines

The following Authors are advocates of the Routine. They believe it is very important for a baby to have routine, but many believe this is possibly detrimental to a babies mental and physical health. Their methods often include scheduled feeding (as opposed to demand breastfeeding) and controlled crying methods for sleep 'management'. However this perspective is widely criticised, including by the American Academy of Pediatrics, as it can effect bonding and breastfeeding, and can be associated with a failure to thrive.

'Routine' advocates include;

Gary Ezzo

Gary Ezzo, the co-author of 'On Becoming Babywise' (also by Robert Bucknam M.D), is a pastor with no medical background. According to the website below, "he possesses no expertise in the care of infants ranging from newborn to six months, the approximate age-range covered in his book". His religious based book is criticised by the American Academy of Pediatrics and there is a website that collates the risks of using his method here;

He has two adult daughters who are presently estranged from him.(information from the above website)

(His co-author, Dr. Robert Bucknam, is a pediatrician. Fresh out of residency, he added the foreword to the original self-published Babywise (c. 1993). His foreword recounts how, prior to his pediatric training, he and his wife found guidance for parenting their young children in the Ezzos' earlier, religious version of Babywise).

Tizzie Hall

No qualifications are listed on her website.

Tizzie has a book called 'Save our Sleep'.Tizzie has no children

Gina Ford

Author of the book 'The Contented Baby'. Her website says that after studying Hotels and Catering in Edinburgh, she became a maternity nurse, but no training for this position is listed.

According to Wikipedia she doesn't have any children. (I was told by a GP in the UK that Gina Ford has just had a baby, but I can find nothing to back this up).

Tracey Hogg

RNMH (registered nurse mental handicap) after a three-year course at the Doncaster School of Nursing, England.In 2001 Tracy, with co-author, journalist Melinda Blau, published 'Secrets of the Baby Whisperer: How To Calm, Connect, and Communicate With Your Baby'.

Tracey had two children (this information was not obtained from her website)

Dr Brian Symon

Brian is the author of 'Silent Nights' and is a GP and a lecturer in General Practice at the University of Adelaide, Australia.He has Four children.As a father, he is not able to feel what a mother feels when her child cries. He recommends a method called minimal reassurance, or 'crying down' from birth. He admits on his website that his teachings are not all based in research, but in his experience. "This is not a scientific book, but hopefully a collection of useful hints".Heres a quote from his website; 'During daylight hours I set an upper limit of 45 minutes of crying. The reason for this is that it is too harsh on the parent who is listening to tchild'slds cries. Some children will cry for a couple of hours particularly if they have become overtired. If I ask a mother or father to listen to this crying for hours it becomes distressing and can lead to a loss of confidence. Because of this I allow the baby to be lifted after 45 minutes'.And another; 'Your child's protest is logical, understandable and loud. It tugs at your heart. It needs to be ignored in a way that helps to develop sleep skills".

The following is a media article expressing concern for the Routine followers;

When to let a baby cry: Let the little one be your guide

By Barbara F. Meltz, Globe Staff June 3, 2004. The Boston Globe

Babies cry. That's a fact of life. How much we let them cry, that's a fact of parenting, and it's easily one of the most confusing, emotional, and even divisive issues new parents face. One parent may insist it's a no-brainer: If baby is crying, you do what you can to comfort and console. Another may argue that if you are always at baby's beck and call, life will never get back to "normal."For decades, the advice from respected child development specialists and pediatricians such as best-selling authors William Sears ("The Baby Book") and Penelope Leach ("Your Baby and Child"), as well as a host of organizations such as the American Academy of Pediatrics, Zero to Three National Center for Infants, Toddlers and Families, the Brazelton Touchpoint Institute at Children's Hospital, and Brigham and Women's Hospital, is to respond to a crying baby as quickly as possible, especially a baby under 3 months old but including up to 6 months."Here's what I tell parents," says Sears, a pediatrician in San Clemente, Calif., who is known as the father of attachment parenting, a practice based on a high degree of responsiveness. "When in doubt, put yourself behind the eyes of your baby and ask yourself, `If I were my baby, what would I want my mother or father to do?' "Most of the time, that means parents will -- and in his mind, should -- pick up a crying baby.While this is widely accepted pediatric practice, it is not universal. In some places, it's even controversial.Today in England there's a growing brouhaha over what has come to be known as "controlled crying" -- allowing a baby to cry as a way to manipulate him onto a schedule: If he cries because he's hungry and the clock doesn't say it's time to feed him, let him cry.Leach, a British developmental child psychologist, is so alarmed at the growing popularity of this practice that she has written a position paper this month in the journal for the World Association of Infant Mental Health urging professionals to take a stand against it. The fuel for the movement, she says, is "The New Contented Little Baby Book," by Gina Ford, a maternity nurse, published in 2001. Ford's book is not unlike "On Becoming Babywise," by Gary Ezzo, executive director of Growing Families International, which drew some attention when it was published in 1998.Sears says it would be presumptuous to tell a parent at what moment, exactly, to pick up a crying infant. Pediatrician Constance Keefer of the Brazelton Touchpoints Center at Children's Hospital says that .. "If this [kind of crying] is the way it is for baby day after day, it takes a toll on the body. It creates a state of stress, raising blood pressure and pulse rate. Eventually it compromises oxygen level," she says. The parent of any baby knows that 10 minutes of crying is an eternity. The advice of Indianapolis neonatologist William Engle, a spokesman for the American Academy of Pediatrics, is not to go by the clock but by what the cry sounds like. Sometimes you know within 20 seconds that a baby has lost it; other times, if you leave her for a minute, she'll go back to sleep.How long we let a baby cry may also have consequences that reach into the future."The more we know about brain development, the more we know that when a mother is not responsive, it's linked to [poor] cognitive development and social behavior," says Leach. "The hazard is of a child with too little conviction that he is really loved, as in unconditional love. If you don't respond to him when he cries, he comes to distrust the validity of his own feelings and your willingness to respond to them."Parents who are likely to let a baby cry it out typically do so because they are afraid of spoiling a baby, something Sears calls "nonsense," or as a way to get on a schedule, thinking that if the baby "learns" that this is not feeding time, for instance, eventually he'll stop crying."That's management, not mothering," says Leach in a telephone interview from London.Indeed, Ezzo throughout his book refers to "training" a baby.Ford's book offers feeding and sleeping schedules for newborns that are down to the minute. For instance, for a breast-feeding baby at 6 to 8 weeks, she writes: "Baby should be awake . . . and feeding no later than 7 a.m. . . . Do not feed after 7:45 a.m., as it will put him off his next feed. . . 9 a.m., Settle baby to sleep for no longer than 45 minutes. . ." Efforts to reach her through her British publisher were unsuccessful.Sure, eventually, all parents want children to eat and sleep on a routine, "but it's a matter of self-regulation, not of training or obedience," Leach says. "When it happens will differ from baby to baby. It depends on the maturation of the central nervous system as well as the self-confidence that is gained from warm, sensitive, responsive parenting."Anecdotal evidence suggests that neither Ezzo's nor Ford's book is selling strongly in New England. "Secrets of the Baby Whisperer" by Tracy Hogg is somewhat more popular. Registered nurse and certified lactation consultant Nancy Holtzman, director of postpartum programs at Isis Maternity in Brookline, says Hogg's book is not as rigid as the others, but it worries her nonetheless for its one-size-fits-all approach, especially to nursing. In an interview, Hogg describes her philosophy as "structured routine," but says she would never leave a baby to cry.As someone who comes into daily contact with new mothers, Holtzman says she can understand the appeal of "Baby Whisperer." "Women who are used to being organized and in control want a schedule. Anything less feels uncomfortable to them," she says. "The problem is that young babies are not very predictable. With a 3-week-old, I tell parents to expect every day to be different, but by 3 months, routines develop, predictability happens." A new "normal" emerges.Ideally, those routines happen because parents follow a baby's cues. "Every baby is an individual," says child development specialist Claire Lerner of Zero to Three who also objects to cookie-cutter approaches."What calms one baby upsets another. What bores one overwhelms another. Maybe you've got a baby who is easily frightened by loud noises, so you learn to insulate him when you want him to sleep. Maybe you have a baby who is social. She fusses when you insulate her. So you learn to put her to sleep in a baby carrier in a room full of people."Molly Trudell, who comes to Isis every Wednesday with 7 month-old Annike for a new mom's group, says that in the beginning, she woke her baby every two hours to feed her. "It took a long time to wake her, a long time to feed her, and a longer time to get her back to sleep. It was stupid. I did it for three days."Alanna Harrington, in the same Isis group, says it was her mother-in-law who got her on the right track with baby Julia, now 7 months old. "She kept saying, `Stop waking a sleeping baby.' Finally I did. Looking back now, I realize how ridiculous we were.""Babies are funny that way," says Molly Ducker, whose son Logan is 5 months. "They can figure out their own schedule if you just let them."Contact Barbara F. Meltz at mailto:meltz@globe.com

Another article;

Guilty secret that helps mums sleep at night


There is no doubt that Ford's methods polarise the baby care world. Many midwives hate her theories. Many are also quick to point out that Ford has no children of her own.Last night, one infant-feeding expert even warned that Fords books could lead to a reduction in breast-feeding, now seen almost universally as superior to the bottle.Allison Ewing, an independent midwife based in Glasgow, said: "Ive had some distressing calls from women that it hasnt worked for, possibly because they felt inadequate that they couldnt do what the book said."I dont think Ms Ford has had any children herself and I dont know how shed feel about leaving her own child, born from her own body, to cry. Its a lot easier to leave another baby to cry than yours. Id never recommend anyone to do that. They dont feel comfortable with it, and I would say you shouldnt do controlled crying in a child younger than six months."Another Scottish midwife, who did not want to be named, said: "Babies are not designed to be treated like this. They are not machines and I worry about the consequences."Professor Beth Alder, an expert on infant-feeding based at Napier University in Edinburgh, said the effect of Fords methods on a childs emotional development were unknown because no studies had been done."It would be fascinating to know, but we dont know," she said. "Breast-feeding is most successful if babies are fed on demand. This doesnt fit into a routine very easily, and my concern is that if mothers attempt to feed by routine they may find breast-feeding is difficult. The production of milk comes from suckling on the nipple, and a baby may not suckle frequently enough if it is in a routine."She said overall she would not recommend Ford "in its entirety" but that it contained "elements of good advice".However, Dr Jack Boyle, a chartered psychologist specialising in children, warned that Fords methods could be tantamount to abuse. He said: "Children are different in terms of temperament and intelligence, and hence a child-rearing pattern that suits one will not suit another. Thus the one-size-fits-all school of child-rearing is rejected entirely by mainstream psychologists."In my opinion its a form of abuse to impose a rigid child-rearing practice, because it doesnt take into account a childs own needs."Boyle, who is based in Glasgow, also warned: "[Fords] rules have not been verified. Theyre just made up by her. No one has followed up the babies subjected to those rules to see how they turn out."Ford was not available for comment.This article:

An important statement from the American Academy of Pediatrics;

Babywise advice linked to dehydration, failure to thrive

by Matthew Aney, M.D.

Expectant parents often fear the changes a new baby will bring, especially sleepless nights. What new parent wouldn't want a how-to book that promises their baby will be sleeping through the night by three to eight weeks?One such book, On Becoming Babywise, has raised concern among pediatricians because it outlines an infant feeding program that has been associated with failure to thrive (FTT), poor weight gain, dehydration, breast milk supply failure, and involuntary early weaning. A Forsyth Medical Hospital Review Committee, in Winston-Salem N.C., has listed 11 areas in which the program is inadequately supported by conventional medical practice.The Child Abuse Prevention Council of Orange County, Calif., stated its concern after physicians called them with reports of dehydration, slow growth and development, and FTT associated with the program. And on Feb. 8, AAP District IV passed a resolution asking the Academy to investigate "Babywise," determine the extent of its effects on infant health and alert its members, other organizations and parents of its findings.I have reviewed numerous accounts of low weight gain and FTT associated with "Babywise" and discussed them with several pediatricians and lactation consultants involved.The book's feeding schedule, called Parent Directed Feeding (PDF), consists of feeding newborns at intervals of three to three and one-half hours (described as two and one-half to three hours from the end of the last 30-minute feeding) beginning at birth. Nighttime feedings are eliminated at eight weeks.This advice is in direct opposition to the latest AAP recommendations on newborn feeding (AAP Policy Statement, "Breastfeeding and the Use of Human Milk," Pediatrics, Dec. 1997): "Newborns should be nursed whenever they show signs of hunger, such as increased alertness or activity, mouthing, or rooting. Crying is a late indicator of hunger. Newborns should be nursed approximately eight to 12 times every 24 hours until satiety."Although demand feeding is endorsed by the Academy, WHO, and La Leche League among others, "Babywise" claims that demand feeding may be harmful and outlines a feeding schedule in contrast to it. The book makes numerous medical statements without references or research, despite that many are the antitheses of well-known medical research findings. In 190 pages, only two pediatric journals are referenced with citations dated 1982 and 1986.Many parents are unaware of problems because the book is marketed as medically supported. It is co-authored by pediatrician Robert Bucknam, M.D., who not only states in the book that the "Babywise" principles are "medically sound," but also writes, "'Babywise' has brought a needed reformation to pediatric counsel given to new parents."The book's other author is Gary Ezzo, a pastor with no medical background. Ezzo's company, Growing Families International (GFI), markets the book as "ideally written" for "obstetricians, pediatricians, or health-care providers to distribute to their patients." (GFI promotes the same program under the title "Preparation for Parenting," a virtual duplicate with added religious material).Though "Babywise" does say, "With PDF, a mother feeds her baby when the baby is hungry," it also instructs parents to do otherwise. In a question-and-answer section, parents of a 2-week-old baby, who did not get a full feeding at the last scheduled time and wants to eat again, are instructed that babies learn quickly from the laws of natural consequences. "If your daughter doesn't eat at one feeding, then make her wait until the next one."Unfortunately, the schedule in "Babywise" does not take into account differences among breastfeeding women and babies. According to one report, differences of up to 300 percent in the maximum milk storage capacity of women's breasts mean that, although women have the capability of producing the same amount of milk over a 24-hour period for their infants, some will have to breastfeed far more frequently than others to maintain that supply. Babies must feed when they need to, with intervals and duration determined according to a variety of factors in temperament, environment, and physiological make-up. Averages may fit into a bell-shaped curve, but some babies will require shorter intervals. (Daly S., Hartmann P. "Infant demand and milk supply, Part 2. The short-term control of milk synthesis in lactating women." Journal of Human Lactation; 11; (1):27-37).My review of the low weight gain and FTT accounts associated with "Babywise" revealed several disturbing trends...Pediatricians need to know about "Babywise" and recognize its potential dangers. History taking should include questions to determine if parents are using a feeding schedule, especially before advising formula supplement to breastfeeding mothers or when faced with a low-gaining or possible failure to thrive baby. Lactation consultants also should be instructed to probe this area.Efforts should be made to inform parents of the AAP recommended policies for breastfeeding and the potentially harmful consequences of not following them.Dr. Aney is an American Academy of Pediatrics (AAP) candidate fellow based in Lancaster, Calif.

This article can be read here;

American Academy of Pediatrics Review of Secrets of the Baby Whisperer: How to Calm, Connect, and Communicate with Your Baby by Tracy Hogg and Melinda Blau

Author Tracy Hogg, a British-trained nurse, lactation educator and newborn consultant, works with parents individually as well as organizes and teaches group classes in Los Angeles. Her Secrets of the Baby Whisperer: How to Calm, Connect, and Communicate with Your Baby has been described as a common-sense approach to parenting newborns. In it, she recommends various techniques to help parents understand and soothe their babies. Pediatricians who are familiar with the methods described in this book will be able to help parents distinguishwhat information is pertinent to their own families.Hogg advocates putting babies on a cycle she labels E.A.S.Y., or Eat, Activity, Sleep and Your Time, a schedule fairlyreminiscent of that described in Babywise. Parents are left without a suggested schedule once these naps have been eliminated. Hogg also suggests some feeding techniques that are counter to the AAPs and other specialists recommendations. For example, she advises scheduled rather than demand feeding in the newborn period, earlysupplementation with formula, and only nursing from one breast at each feeding. Such informationmay be confusing and possibly even harmful for patients.The author also classifies babies into five different types to help parents understand and therefore respond totheir infants personality. These categories are: Angel, Textbook, Touchy, Spirited, and Grumpy. For mosttrained practitioners, not to mention many parents, this classification is an oversimplification. Such stereotypesmay even be offensive to parents whose babies who do not fit in one of the 'nicer' groups.That said, her tendency to be authoritative and create oversimplified categories may be welcomed by someparents but, as discussed above, may be potentially misleading or even harmful for others. As with many parenting 'solutions' books, her categories are too narrow to represent the true variation in infant personalities and behaviors.

Jennifer Shu, MD, ChairAAP

Note; I am told that Tracey Hogg has written other books, with so called 'softer' approaches to controlled crying.

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