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

Sunday, November 12, 2006

Medical news today - study

Pick Up Your Baby For Crying Out Loud
Main Category: Pediatrics News
Article Date: 01 Nov 2006 - 2:00am (PST)

Parents should listen to their instincts and pick up their newborn babies when they cry, Queensland University of Technology researcher Professor Karen Thorpe said.

A joint study with QUT and the Riverton Early Parenting Centre has found many parents of infants up to 12 weeks, were uncertain about how best to settle their crying baby and whether or not it was "right" to pick them up.

"A lot of parents are unsure if they should pick up their baby when their baby cries," Professor Thorpe from QUT's Faculty of Education said.

"The answer is: you should. Babies in the first 12 weeks of their life need highly responsive parents. They want and need a parent that is responsive to their cries."

Professor Thorpe said the study was initiated by concerns by clinical nurses from the Riverton centre that parents were choosing to ignore their crying newborn for fear it would "spoil" their baby to pick them up.

Riverton clinical nurse and co-researcher Claire Halle said parents felt picking up their crying baby would create "bad habits" which would impact negatively on their child's behaviour in the future.

"Parent's felt torn between what they thought and what they felt was the right thing to do, and this uncertainty seemed to heighten their stress levels," Ms Halle said.

The study found about 20 per cent of first time parents and 30 per cent of experienced parents admitted they were uncertain about picking up their crying baby. It also revealed that almost 25 per cent of first time parents and just over 10 per cent of experienced parents believed picking up a crying baby would spoil them.

"One parent said 'I feel guilty for not picking him up when he cries'," Ms Halle said. "Another said 'frequent and sudden changes in baby's behaviour make it hard to judge; too much attention may spoil them'."

But Professor Thorpe said in the first three month's of a baby's life, having responsive parents was very important to the child's emotional and neurological development.

She said the study highlighted there was a problem because parents were getting mixed messages about how best to settle their newborn baby.

"We need to ensure nurses, educators and health professionals are providing parents with consistent and appropriate guidelines for caring for their baby," Professor Thorpe said.

"It is also important for parents to have the confidence to trust their instincts when it comes to caring for their baby."


The study, funded by the Royal Children's Hospital Foundation, is a joint collaboration between Dr Toni Dowd from QUT's School of Nursing, Professor Karen Thorpe and the Settling Team at the Riverton Early Parenting Centre.

The study was a unique experience for clinical nurses to work as co-researchers and demonstrated the value of engaging clinical staff, academics and parents in research.

Contact: Sandra Hutchinson
Queensland University of Technology

Saturday, November 11, 2006

Disembodied from the beginning

This is a fantastic essay! It is by a nursing student; Kathryn. Email me if you would like the references.

Disembodied from the beginning: the practice of controlled crying

In recent decades, nursing has moved away from biomedical theories in favour of theories that value individual experience (Madjar 1997, p. 55; Koernig Blais et al. 2006). Nurses are now expected to listen to patients and respect their experiences as embodied people (Erickson, Tomlin & Swain 1983, p. 46; Lawler 1991, p. 29), not separate the physical, emotional, social and spiritual aspects of self and treat people as just a body with a problem to be fixed. But what of those who have a voice that is misunderstood, or worse, ignored, whose attempts to communicate their most basic needs go unheeded? In western societies, babies, perhaps our most vulnerable and powerless members of society, are disembodied, and this is not simply condoned by the medical and nursing professions, but actively promoted by many.
This paper explains how controlled crying disembodies babies. It briefly reviews embodiment research specific to infants, explores the history and theories behind controlled crying and examines the societal factors that lead parents, particularly mothers, to adopt the practice. The implications of controlled crying for the infant are discussed, and the idea that it is as harmless as many doctors and nurses who promote it believe is challenged. The paper explains how embodiment theories specific to pain and illness apply to healthy infants, and concludes with implications for nursing practice. Not included is a detailed discussion of the effectiveness of controlled crying programmes. Knowledge of this is important in understanding why controlled crying is promoted by many and is in such wide use. The benefits for families when controlled crying is effective, particularly for mothers with post natal depression, is well researched, from Dr Ferber (1985) who pioneered the method, through to more recent studies (Pearce & Bidder 1999; Hiscock & Wake 2002; Hawkins-Walsh 2003; Skuladottir & Thome 2003; Hall et al. 2006), but is outside of the scope of this paper. Also omitted is a discussion of alternative settling methods and sleeping practices (McKay 2001; Pantley, 2002; Buckley 2005; Buckley 2006).

Early modern embodiment theorists include Sartre (c1960 cited in Lawler 1991, p. 57) who wrote about the body as being socially constructed, Merleau-Ponty (1962 cited in Madjar 1997, p. 55; Lawler 1991, p. 58; Marriner-Tomey & Alligood 2006, p. 172) who argued that the body is central in developing ones identity, and Heidegger (1962 cited in Madjar 1997, p. 55; Marriner-Tomey & Alligood 2006, p. 172) who wrote about existentialism and caring. These theories formed a basis for later embodiment and holistic nursing theorists such as Neumann (1989) Lawler (1991) and Madjar (1997), but most of these theories are concerned with illness and health in adults. There has been little written about infants and embodiment, perhaps because their communication skills are limited and it’s difficult to understand an infants’ lived experience. What little embodiment research specific to infants has been reported includes studies of the birth experience (Goldberg 2002), the mother/baby dyad (Bartlett 2000; Dykes 2005) and cultural embodiment and early experience (Rydstrom 2001), which are not very relevant in a discussion about controlled crying in western societies. This paper therefore focuses on how general embodiment theories illustrate the disembodiment of infants in the practice of controlled crying.

Over the past 150 years scientific approaches and ‘experts’ have taken over from maternal instincts and started telling parents how to raise children (Buckley 2005, p. 258; Kitzinger 2006). In the 1870’s parents were told that babies cry for exercise, that it is beneficial and should be ignored (Smiles 1871 cited in Kissinger 2006, p. 77). In the 1940’s the ‘rules’ dictated that every baby should sleep for 19 hours a day, be placed alone in its cot after the six o’clock feed and left to cry it out (Medley 1943 cited in Kissinger 2006, p. 77). Even quite recently parents have been told to ignore babies who vomit in ‘temper’ (Pearce & Bidder 1999, p. 45), or to manipulate parents (Ferber 1985, p. 70). These practices disembodied babies by treating them as a malfunctioning body, which was in accordance with the view of nursing and medicine at the time (Madjar 1997). This medicalisation or ‘scientising’ of nursing has been criticized as objectification, and care and comfort do not fit well with objectification (Lawler 1991, p. 30). In this context, controlled crying, where a baby is left for increasing periods of time to cry but returned to at specified intervals, was seen as a kinder option (Ferber 1985, p. 15). Controlled crying is based on behaviourism, which is a school of psychology that only observes measurable responses, with no regards for emotions or ideas, and has been criticized by many (Block 2001). Behaviourism is in direct opposition to theories of embodiment, which view the person as a whole- ideas and emotions experienced seen as integral to the development of ones personal identity (Madjar 1997, p. 55; Lawler 1991, p. 29). Prompt response to the cries of a baby also recognizes that the body is a means of expression (Lawler 1991, p. 29). Communicating with the infant and treating it as an individual with unique needs, rather than adhering to a controlled crying program designed to be applied to all infants, respects that there is a ‘uniqueness in how people experience their own bodies for themselves…’ (Madjar 1997, p. 55).

A central theme in embodiment is understanding ones lived experience, that a person is not just a physical body but exists in a social and cultural context (Madjar 1997, p. 55). In a similar way to how culture is a major determinant of health (McMurray 2003, p. 23), the way babies are raised and how we view the role of parents and children is highly influenced by the culture that one lives in. When mothers follow their natural instincts, treat their babies as embodied people, and attend to their basic needs, children are likely to grow up with strong attachment and be secure, independent adults (Buckley 2005, p. 242). In western societies however, many mothers have never even held a baby before they hold their own, and most feel insecure about their ability to parent (Spencer 2003; Buckley 2005, p. 241). We have a history of being bombarded by advice by ‘experts’, whose books for parents are so prescriptive that parents feel guilty if the are not following the ‘rules’ (Kitzinger 2006), and the media portrays a good baby as one who is controlled and disciplined from birth to sleep a lot and rarely cry (Kitzinger 2006). Parents are under so much pressure to have a ‘good’ baby- a baby who does not sleep through the night is labeled a ‘bad’ baby, and the implication is that the parents, usually the mother, is responsible (Ferber 1985, p. 20; Kirschner 2006). In western societies there is a high value placed on self control and independence (Wilson 1993; Buckley 2005, p. 242) and controlled crying is seen as a way to enable babies to improve their self control and foster independence by developing self settling abilities. Ironically the reverse is true- babies who are taught to self settle through controlled crying are more likely to exhibit ‘clingy’ behaviour later in childhood, and be less secure and independent adults (Houlahan 2006; Buckley 2006).

Other adverse effects of controlled crying on the infant are also significant and lifelong. Psychoneuroimmunologists have found that under stress the adrenal cortex releases cortisol, which causes an inhibition in the formation of antibodies (Rapee 2001, p. 51), and, in chronic stress situations such as controlled crying, results in long term immunological impairment (Buckley 2006). Early adverse experiences can interfere with establishment of social bonds and the regulation of emotional behavior later in life (Wismer Fries 2005). Experiments on infant rats have even found that early maternal inattention adversely effects the development of the limbic system, the vermis and the hippocampus, which, for humans, has lifelong effects on sexual arousal and the ability to love, and results in an increased risk of developing borderline personality disorder (Teicher et. al. 2001, p. 157). These negative effects show that viewing and treating a person from a purely scientific perspective and completely disregarding the holistic, embodied nature of an infant, can have lifelong effects on the formation of a positive personal identity.
Madjar writes that in health, embodiment is taken for granted, that it is only when the body is malfunctioning that we become aware of our bodies (Madjar 1997, p. 55). This, however, is different for infants- even in health they are disembodied by practices that ignore their needs. Although there is no way of knowing for sure, it has been suggested that when left alone to cry, babies feel threatened and abandoned (Buckley 2005, p. 265; Buckley 2006) and experience feelings of terror and hopelessness (Leidloff 1977 cited in Pantley 2005, p. 10). This could be seen to be a type of mental pain, a term that has also been used to describe the pain felt by people with a mental illness (Baker 1996, p. 25). Madjar (1997, p. 62) writes ‘Pain has the capacity to enter the very fabric of one’s body and destroy the familiar, taken-for-granted being in the world.’

There is also a ‘trend towards an increasing pathologization of…personality and behavioural ‘difference’’ in children (Kirschner 2006). In this way, the child is seen as an object, and disembodied. The behaviour, in this case crying, is viewed as an illness- a problem to be fixed. For centuries, philosophers and theorists have maintained that the mind and body are interconnected (Lawler 1991; Madjar 1997; Erikson, Tomlin & Swain 2002). Lawler (1991, p. 55) has even suggested that Descartes’ work, which has long been attributed to the so called ‘Cartesian dualism’, or mind-body split (Montgomery et al. 1988, p. 64; Madjar 1997, p. 56; Tomey & Alligood 2006, p. 172, Benner 2000) has been misunderstood, and that he too, recognized the interdependence of the mind and the body. If the infant is respected as an embodied individual, and if the mind-body interconnectedness holds true, then the cause of the crying when left alone is simple to understand. It follows that what the inner self experiences will be expressed bodily- in this case expressing feelings of abandonment, hopelessness and terror (Leidloff, 1977 cited in Pantley 2005, p. 10; Buckley 2005, p. 265; Buckley 2006) through one of the few ways infants have of communicating- crying. With the controlled crying method, however, crying is seen as a symptom of disease- and the symptom is treated without examining the underlying cause. Although embodiment theorists have claimed that during illness the mind and body are ‘emotionally, intellectually and practically inseparable’ (Lawler, 1991, p. 155), it is very common for people to feel as if their symptoms are being treated at the expense of their emotional self (Fassett & Gallagher 1998). Many parallels can be drawn from the illness experience, and that of a baby- the main difference is that although the baby is treated as ill, by crying when left alone and having disturbed sleep patterns it is displaying what proponents both for and against controlled crying agree are actually very common behaviours (Ferber 1985, p. 20; Skuladottir & Thome 2003, p. 376; Pantly 2005, p. 32).

To empower parents to make informed choices with which they feel comfortable, the medical and nursing professions must present parents with a balanced view of the advantages and implications of controlled crying, and make gentler options more acceptable. While the government provides information on a variety of gentle settling methods, and acknowledge that babies and children can be adversely affected by controlled crying (Parenting SA 2003), many doctors and nurses still promote controlled crying (Buckley 2005, p. 264, Houlahan 2006), and some sleep schools still use controlled crying (Cooke, 2003, p. 159; Houlahan 2006). Infants with severe sleep problems are at an increased risk of child abuse (Skuladottir & Thome 2003, p. 378), and controlled crying is certainly preferable to shaking or hitting a baby out of frustration (Buckley, 2005, p. 266). Nurses should, however, weigh this and other advantages of controlled crying against its potential long term effects before they suggest it to parents, and it should only be used as a method for improving infants sleep patterns when gentler approaches have failed. The experiences that each of us has, from birth to death, contribute to the uniqueness of our personalities (Madjar 1997, p. 55; Lawler 2001, p. 29). By choosing to communicate with and promptly respond to our babies we show a respect for their fundamental needs of human affection, touch, warmth and love. A shift away from treating them as objects of control is a positive move towards treating them as embodied humans.

Independence Learnt?

This article is from Natural Parenting Magazine, and highlights the concerns people have about controlled crying.

Independence Learnt? Issue 3 Winter 2003, Natural Parenting Magazine, Editorials (Free Access) by Susan Stark

A Baby Needs to Have Needs
It is a natural, appropriate and desirable part of development for a baby to be dependent. A baby needs to have needs. A baby who is forced into independence (to become a self soother) before his time misses the needs stage. A baby needs first to learn to bond to people before things. If a baby can’t have needs, who can? If the parents can’t fill those needs, who will? Later in life you may be very distressed to see who or what will be used to fill needs that went unmet in infancy.
Sears, W and Sears, M (1993) The Baby Book; Little Brown and Company; New York; p.314.
A common point of discussion in parenting groups all over the country is sleep. From day one baby’s ability to sleep well is often a measure used by many to indicate a parent’s competency and how ‘good’ or ‘difficult’ the baby is. Parents may feel distressed at their baby’s wakefulness and often feel pressure to have baby sleeping independently through the night at a very early age. Exhausted parents seek advice and support from those around them and may be encouraged to try methods such as controlled crying.
Controlled crying, a well known method of issuing limited comfort to a child in an attempt to get a child to sleep independent of their parents, is frequently explained to parents as a solution to all their night time worries. The appeal of getting quick results and the pressure to ‘perform’ as a parent means thousands of babies across the country are subjected to this method of invoking sleep.
What parents aren’t told however is that controlled crying while it may engender a short term solution comes at a price.
Methods such as controlled crying are devised on the notion that babies can be taught to be independent and that the sooner this training begins the more mature and competent sleeper the baby will be. Independence however is not a skill to be learnt by a child but rather a natural progression that will occur at developmentally appropriate times throughout a child’s life. Independence is best nurtured in the loving arms of an attentive parent.
William and Martha Sears in the Baby Book (1993) warn parents to “watch out for short cuts, especially in nighttime parenting.” They state that methods such as “leaving babies alone or setting them up to devise their own methods – rather than allowing babies to rely on their mother or father, ignores a basic principle of infant development: a need that is filled in early infancy goes away; a need that is not filled never completely goes away but recurs later in “diseases of detachment” such as aggression, anger, distancing, withdrawal and discipline problems” (1993:314).
Methods such as controlled crying assumes that a baby is waking because they are being manipulative and picking them up or allowing them to sleep in the family bed, will only spoil them. How many new parents are told they are making a ‘rod for their own back’ by merely following their natural desire to comfort their child? Nature intended babies to be highly dependent on their parents and gave them the ability to cry in order to communicate their needs. It is the only mechanism at their disposal. To ignore these cries for help goes against the natural instincts of a parent to comfort and console their child. The bond of trust is broken when our baby’s cries for help go unheard. Babies learn that they are helpless to change their situation. Parents learn detachment and distance from their child.
So where does this leave an exhausted and frustrated parent needing a much desired good nights sleep? My son Harrison has shared our family bed since the night he was born. He snuggles happily on our king size mattress on the floor and often asks to go to bed. He does not fear sleep time nor does he cry on waking. We have never paced the floor at night with a crying baby nor have we ever left our bed to meet Harrison’s night time needs. But rather we have enjoyed a very precious closeness with our child and treasure the special memories of waking up beside him. That is not to say however, that there is never a stray kick to the ribs or struggle over the blankets.
While co-sleeping works well for our family, it is not the solution for everyone. Every family is made up of a unique set of individuals with varying needs and expectations. Parents feeling challenged by night time parenting need our encouragement and support. Sometimes all that is needed is an understanding of a baby’s natural sleep cycle and a reassurance that this time is so short and will pass. What is perceived as a problem may be a natural developmental progression that is necessary for a child to reach a final stage of maturity in regards to their sleep. Variations on co-sleeping such as having a baby in their own bed in your room, or baby starting out in her cot and then joining the family bed later, will be workable solutions for some families.
Parents often fear creating a situation whereby their child will continue to be highly dependent upon them to achieve sleep. We can be reassured that in most traditional cultures the custom of sharing sleep is a natural unquestioned part of parenting that has been practiced for thousands of years. Westernised ‘experts’ have labeled the practice as harmful and encourage people to distrust their natural desire to stay close to and comfort their child. It is important to remember the bigger picture and know that the investments made in a baby’s early years will pay off three fold in years to come.
Babies are not a commodity that will fit conveniently into our existing lifestyle. They require constant nurturing and attention. New parents need to be supported in this challenging and at times difficult role so that the vital bond of trust with their baby is honoured and preserved. One of the most precious gifts you can give your baby is a sense of security and belonging and a belief in his ability to meet his own needs. These intimate memories are greater than anything money can buy and will serve your child a life time.
Useful Books:
Sears, W and Sears, M (1993) The Baby Book; Little Brown and Company; New York.
McKay P. (2002) 100 Ways to Calm the Crying; Lothian Books; Melbourne.
Issue 3 Winter 2003, Editorials, Free Access.[pointer]=3&tx_ttnews[tt_news]=30&tx_ttnews[backPid]=229&cHash=280d2744a6

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