How to feed your baby is but one of the aspects of parenting in the early weeks and months. There is also crying, sleeping, diapering, pacifiers, etc. For the most part, as I have mentioned in previous posts, parenting styles can be divided into two categories:

1. Demand Feeding – this approach is most commonly associated with Attachment Feeding and in most cases involves prolonged holding, frequent breastfeeding, rapid response to infant frets and cries, and in many cases co-sleeping at night.
2. Scheduled Feeding – this approach is most commonly associated with a Parent-Directed Feeding and in most cases involves less holding, a regular routine, less frequent but longer times on the breast, a delayed response to frets and cries, and sleeping in a separate bed from the parents.

Up to now I have mainly examined the feeding component. Now I want to shift gears and look at the topic of crying, how parents respond to crying, how it affects the amount of crying, and how it affects the sleep patterns of newborns. The PDF approach claims that sleeping through the night is a skill, and most children can achieve this skill by 12 weeks of age. It goes on to suggest that the attachment parenting approach will delay the development of this skill.

Some Background

Attachment Philosophy

This philosophy, also called “proximal care,” is based on studies in Africa of Kung and Aka infants. These tribal Africans, hold their baby most of the day, breastfeed often, rapidly respond to their cries, and co-sleep at night. They are also noted to have significantly lower amounts of crying when compared to Western infants. From these observations came a book written by J. Liedloff called The Continuum Concept, that advocates an infant-demand approach to infant care.

Cry It Out Philosophy

The Cry It Out (CIO) philosophy, also know as Ferberization, was devloped by Dr. Ferber, who is a sleep expert and the Director of the Center for Pediatric Sleep Disorders at the Children’s Hospital Boston (One of the Harvard hospitals). This is what he has to say about sleep and crying:

• Take steps to prepare the baby to sleep. This includes night-time rituals and day-time activities.
• At bedtime, leave the child in bed and leave the room.
• Return at progressively increasing intervals to comfort the baby (without picking him up). For example, on the first night, some scenarios call for returning first after three minutes, then after five minutes, and thereafter each ten minutes, until the baby is asleep.
• Each subsequent night, return at intervals longer than the night before. For example, the second night may call for returning first after five minutes, then after ten minutes, and thereafter each twelve minutes, until the baby is asleep.

Dr. Ferber believes that children need to learn healthy sleep habits but generally do not have the neuro-developmental capacity to do this before about 3-4 months of age. Thus for the most part he targets this technique for children in the 4-6 month age range. You can read more in his book Solve Your Child’s Sleep Problems.

Ezzo and the Babywise approach basically take the Ferber approach but give a little more credit to the newborns. They feel that newborns can start learning healthy sleep habits in the first weeks of life.

So what to do?

Is there any objective evidence for one approach or the other?

It turns out there is. There was a great study that looks at just this issue, and it was published in a 2006 issue of the journal, Pediatrics. The study is titled, “Infant Crying and Sleeping in London, Copenhagen, and When Parents Adopt a “Proximal” Form of Care.“ Up front, I need to give you a little background so that you can interpret the study for yourself.

In this study there are three groups – London, Copenhagen, and Proximal.

The London Group

This represents a group of parents who believe it is best not too hold your baby all the time and that some crying is normal, perhaps even good for your baby. This group also believes that it is best for babies to learn how to self-soothe, so that they can develop sleep habits that allow them to fall asleep on their own and sleep more easily through the night. This group could easily be compared to the Babywise group here in America.

The Proximal Group

This represents a group that believes babies need to be held and that crying is bad. In an effort to avoid crying and the potential distress it represents, this group holds their babies at least 80% (or more) during the waking hours, and often co-bed with their newborns. This group could easily be compared to the Attachment feeding group here is America.

The Copenhagen Group

This is a parenting philosophy that falls somewhere in the middle. It would best be described as a combination of both but with considerably less daytime holding.

Now this study makes two hypotheses:

1. Infants in the Proximal (Attachment) Group would cry less than the London (Babywise) Group.
2. Infants in the London (Babywise) Group would wake up less during the night at 12 weeks versus the Proximal (Attachment) Group.

These are their findings:

• Crying was indeed less in the Proximal (Attachment) Group. On average the babies in the Proximal group cried about 80 minutes per day, versus 120 minutes per day in the London (Babywise) Group. However, by 12 weeks of age the difference between each group diminished.

• To accomplish this decrease in crying, the Proximal (Attachment) Group had to hold their baby on average 922 minutes per day (or just over 15 hours), versus 412 minutes (just under 7 hours) in the London (Babywise) Group.

• There was no apparent difference in unsoothable crying (ie. colic) between the groups.
• The London Care (Babywise) Infants were less likely to wake at night.
• Most Proximal Care (Attachment) Infants continue to wake their parents at night when 10 months of age.
• The London (Babywise) Group was more likely to terminate breastfeeding.

So there you have it. Again this does not prove that one way is better than the other or that one way is right and one is wrong. It does however provide very useful information for the would-be parent.

1. What is more important for your family… a little less crying each day for a few months – or – a full night of uninterrupted sleep starting around 12 weeks?
2. Are you willing (or able) to hold your baby for 15 to 16 hours per day to get the moderate reduction in daytime crying?
3. Do you consider crying to be part of normal infant development – or – should it be suppressed at all costs?

Next Post

On Becoming Babywise: The Stanford Marshmallow Study

Update

As I am reviewing this post our son is now 10 months old.  We have a much better understanding of the concept of crying now that we have been through the PDF process.  Along the way, we have picked up a few helpful things that we can pass along.

Too young for cry-it-out

We tend to agree with Ferber – the “cry-it-out” philosophy is best held until around 4-6 months of age.  We tried on several occassions to let our son “cry-it-out” in the early weeks and months.  This never worked.  Generally after about 60 minutes of anguish on both our part, and his, we would abort.

Some crying is good

This does not mean though that you should not let your baby cry.  We found that our son’s crying was very predictable.  He almost always cried when we put him down for a daytime nap.  However, it generally did not last more than about 15-20 minutes.  At night his crying was even more predictable – a few minutes of whimpering and then right back to sleep.

What we found to be most helpful with regard to crying is reading Dr. Ferber’s book and really understanding how infant sleep works.  Once we read this book. things got better in a matter of weeks.

One last piece of advice

There is a tendency when you read Babywise to avoid sleep props at all costs.  We were extra vigilant to make sure our son did not grow dependent on rocking or anything else in order to fall asleep.  This is a good idea overall.  However, this does not mean that you should not help your child prepare for sleep.  Just short of 4 months we figured out that listening to Christmas music and holding our son while walking around the living room worked great in this respect.  Once his eyes started getting heavy we would walk into his room and put him in his bed where he would fall asleep on his own.  Once we started preparing him for sleep this way, the 15-20 minutes of crying with naps disappeared.  The trick is figuring out what kind of preparation works and this takes some time and some trial and error.