Should You Use Extinction Sleep Training: CIO Isn’t For Everyone
Mommies worldwide will readily agree that raising a newborn, especially your first one, is no easy feat.
At the crux of this arduous endeavor is the problem of finding out the “right” ways to nurture your child and the most effective method for equipping them with essential life skills like how to eat, sleep, sit up, crawl, stand, and walk.
There is no shortage of techniques, and there’s a plethora of conflicting information out there that can quickly add to the already substantial amount of stress that comes with raising a child.
One of the first problems you face with toddlers—getting them to sleep right, is an issue that draws up much controversy and instigates many heated debates in the community on the proper methods to use.
Babies follow atypical feeding and sleeping schedules in their first few months with frequent nighttime wakes for food, other pressing issues, or the hell of it. The period is often the point of most strain for many parents. Plus, even afterward, getting your child’s sleep schedule to stabilize and dealing with all the challenges that managing infant sleep presents is no small task.
The extinction method is a popular sleep training technique that aims to help iron out infant sleep problems and bring respite to both child and parent. However, like with most infant care techniques, there is no shortage of controversy here.
What is Extinction Sleep Training
During the first few weeks after a child is born, the toddler typically feeds around the clock.
Throughout this period, the kid typically wakes every few hours — day and night — for another round of feeding. This process can be extremely exhausting for brand new parents and is often the number one contributor to the never-ending fatigue that characterizes early childcare.
The good news is that this phase typically lasts for only a few months at most. Around the 3-4 month mark, most babies begin to stabilize their circadian rhythm and gain the ability to sleep through the night and fall asleep on their own.
By the six month mark, most babies will ultimately be over this phase and have reasonably regular sleep schedules.
However, even after six months, a small percentage of babies will still have trouble sleeping on their own or staying asleep through the night. This is where sleep training methods like the extinction method can come in handy.
Extinction sleep training (also known as the cry it out method) relies on the premise that the child’s sleep problems stem from them behaviourally adapting to parental soothing and relying on it for sleep onset.
Children who have adapted to this requirement for sleep onset often cry or throw tantrums when deprived of the typical parental soothing. The parents’ response in this situation is to soothe the child, which further reinforces the toddler’s dependency and leads to more nights of troubled sleep.
The cry it out (CIO) method entails training the baby to sleep on their own, allowing cry and fuss until they fall asleep without your help. With this technique, you wean the baby off depending on you for sleep onset by going cold turkey.
With CIO, once you place the baby in the crib, ready for sleep, you leave the room and do not return, even when they cry or fuss (unless absolutely necessary.)
Most babies will adapt to sleeping on their own within the first few days of implementing the technique.
Your baby’s sleep problems may stem from other underlying issues like acid reflux, sore throat, fever, or congestion. Ensure that your kid is fully healthy before embarking on the CIO method to avoid aggravating any pre-existing health problems.
The Arguments for and Against Extinction Sleep Training
The big dilemma with parenthood is figuring out what parents should do or shouldn’t do to train their children correctly.
The same issue applies to get your kid to sleep right. Should you use training methods like CIO to sculpt your baby’s sleep patterns or carry on soothing them every time the fuss? Should you try extinction sleep training?
There are heavy reinforcements to both sides of the argument, some swearing to the efficacy of this method, while others pit it as a potential recipe for disaster.
However, before one even considers the proposed merits and demerits of extinction sleep training, one aspect of the cry it out method—dealing with the constant crying, will already turn off a large percentage of parents.
For many new parents, the idea that you should let your baby cry it out sounds cruel. This criticism is not misplaced. For parents using CIO for the first time, listening to your baby cry out for help is no easy feat, and if you are not strong enough, you may end up in tears yourself.
This facet of the method may be a strong enough deal-breaker for many parents to avoid the sleep training method altogether. While reassuring yourself that the ultimate goal is to help your child develop a crucial life skill that may help, you shouldn’t consider yourself a bad parent if you can or cannot follow through with the technique.
The strongest critics of the CIO method argue that allowing a baby to cry for extended periods without attention may cause some psychological damage to the child.
Proponents of this school of thought often point to one 2012 study conducted by Dr. Wendy Middlemiss of the University of North Texas.
However, this study is far from conclusive. During the research, Dr. Middlemiss observed 25 babies aged 4-10 months using the CIO method for a series of 4 nights. Over the course of the research, the babies reported progressively short spells of cry time before falling asleep, indicating that the sleep training worked.
Nevertheless, according to the researcher, while the cortisol (stress hormone) levels fell in the mothers as the span of the crying time shortened, for the babies, it “remained high” throughout the study.
The problem with this research is two-fold.
First, the study’s scope was minimal as it features a small sample size of only 25 babies, and it had no control group. Consequently, the report does not hold enough weight to serve as a definite judgment on extinction sleep training’s potential risk.
Second, the researcher inferred that the babies’ cortisol levels stayed high throughout the research. However, since there was no control group, there is no telling why the babies had elevated cortisol levels. Environmental factors, like the babies being in an unfamiliar environment, could have played a factor.
Even worse, Dr. Middlemiss’s research report did not contain the measurement of the babies’ baseline cortisol levels. Hence, while the researcher calls the levels measured in the study “high,” there is no telling how high they were or if they were even high in the first place.
In defense of Dr. Middlemiss, the title of her research is Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following the extinction of infant crying responses induced during the transition to sleep.
This title indicates that the study’s focus is on the correlation of cortisol levels between the mother and child during extinction sleep training, not on figuring out if the sleep training method is safe or recommended.
On the other hand, another 2012 study throws some weight behind sleep training methods like CIO. In this randomized trial, the researchers observed a sample size of 326 infants — drawn from a total population sample size of 692 — over 5 years. First, however, the study administered sleep training methods like CIO and Ferber at the 8-10 month age range.
The research showed that babies training using these techniques did not pose any risk of worse psychological health in subsequent years.
The metrics measures for this study include:
- Child-parent relationship
- Child mental health
- Psychosocial functioning
- Stress regulation
- Maternal mental health
Other strong backings behind sleep training methods like CIO are recommendations from the American Academy of Family Physicians (AAFP) and the American Academy of Pediatrics (AAP.)
In a 2012 report in their official journal, researchers from the AAP concluded that sleep training techniques like the Ferber method, or gradual or straight CIO is a practical, healthy, and sometimes necessary entry into babies’ growth and development.
Similarly, in a 2016 study of 43 infants, the AAFP reported that graduated extinction — a less extreme form of the CIO method — is useful for improving sleep onset, improving sleep quality, reducing the frequency of awakenings, and reducing stress in the mother and child.
Should You Use Extinction Sleep Training?
While there is some evidence pointing to the effectiveness of the CIO method, research into its long term effect, although promising, is still limited.
However, since there is no definite research that points to any potentially harmful effects down the road, sleep training methods like CIO still offer some of the best ways to train your child for adequate sleep.
Should you use extinction sleep training? All the available facts point to yes.
Nevertheless, if you consider the extinction method too extreme, there are several other less intensive methods. Less jarring alternatives to CIO include the Ferber method and sleep fading.
Should you use the CIO method for naps?
If you are trying out extinction sleep training, you should apply the technique to every sleep cycle, including naps. However, because naps are considerably shorter than nighttime sleep, you should also allow for a shorter crying period (8-10 minutes) before intervening.
When to Try Extinction Sleep Training
Like most aspects of early development, the evolution of the toddler’s circadian rhythm varies from baby to baby.
However, a general rule of thumb you can follow to figure out when your child is ready for sleep training is to start once the baby can sleep through the night without interruptions for nighttime feeding.
For most babies, this sweet spot will fall around the 4-6 month range. At this time, most toddlers developmentally reach the level where they can handle sleep training.
However, you should also note that there is also such a thing as starting sleep training too late.
Older babies—7 months and up, may have already fully adjusted to the fact that you respond when they fuss. Hence, these toddlers may take much longer and require far more tears to sleep train.
Nevertheless, provided your baby is in good health, sleep training at an older age is still safe. It may take a few extra days and some more endurance on your part, but once they fully get the message that this is the new way, they will adjust.
On the other hand, sleep training babies under four months is an absolute no-no. During their first few months, babies are immature and require an abnormal sleep pattern that allows for constant feeding every few hours, even at night.
Hence, it would be best if you steered clear of implementing any sleep training techniques during this period to avoid impeding their growth during these crucial developmental months.
Before implementing any sleep training methods, you must ensure that your baby does not have any underlying medical or psychological issues. Sleep training is not an appropriate course of action for dealing with medical conditions, psychological trauma, or any of the many forms of sleep disorders that may disrupt sleep.
One critical psychological condition that you should never pair with any form of extinction technique is the conditioned fear of abandonment.
On the medical side of things, conditions like acid reflux or heartburn can disrupt infant sleep and make the baby fuss excessively. However, adding a sleep training method on top of this condition can often make their symptoms worse.
It would be best if you also watched out for sleep disorders like:
- Night terrors and nighttime fears
- Inconsistent sleep schedules
- Circadian rhythm disorders
- Nocturnal headaches
In many cases, treating the underlying condition will fix the baby’s circadian rhythm imbalances, and there will be no need for sleep training altogether.
Sleep Training Your Child with Extinction Sleep Training
Now you are ready to try out extinction sleep training. Here is an easy step by step guide to get you through:
1. Ensure Your Baby is Tired
Before you begin each night of CIO training, you must ensure your baby is ready for sleep. Attempting the cry it out method with a baby that is still fully awake and active is unnecessary torture and a recipe for failure.
Check for signs that the baby is tired and ready for bed. With most babies, these pointers should come at around the same time every night. Familiar cues to watch out for include:
- Rubbing of the eyes
- Sucking of the thumbs
- Getting cranky
- Or pulling the ears
Ensuring that you get started once your baby shows signs of tiredness is paramount to success with the extinction method. Putting your baby in bed when they are not tired enough (or when they are overtired) can lead to problems.
2. Start a Bedtime Routine
Like with adults, a relaxing bedtime routine can help children wind down and set the mood for sleep. A good bedtime routine for your baby should include calming elements like lullabies, a back massage, a bath, or feeding.
3. Place the Baby in the Crib
Once your baby begins to get drowsy, you should transfer them to the crib. While the drowsiness can help them fall asleep more naturally, you must lay them down before they fall asleep, as the goal here is to train them to fall asleep on their own.
After placing the baby down and reassuring it, you can then proceed to leave the room before the fall asleep.
4. Dealing with Protest
Now, this is the toughest aspect of implementing the CIO method. You should expect your baby to adapt to this training without a fight, and you should prepare to deal with some crying and fussing for the first few days of implementing this technique.
The good news is that in most cases, the crying period will get progressively shorter, and by the fourth day, most babies will go to sleep with little to no fuss.
Most babies will cry for around 40 minutes to an hour on the first few nights of CIO
Mentally prepare yourself to deal with the severe spell that is the first few days. You’ve been warned.
One mantra you can use to sure up yourself during this period is to remember that you are doing it for the baby’s good, helping them learn how to fall asleep on their own.
When to Give up
CIO isn’t for everyone. At some point, if the technique isn’t working, you have to call it quits.
In most cases, your baby should adapt fully to extinction training within the first two weeks. If problems persist beyond this point, you should consider quitting the method altogether or visiting your doctor for advice.
Furthermore, you should also factor in your tolerance level when venturing into extinction sleep training.
If CIO is too extreme for you, you should consider trying something less drastic or even quitting sleep training altogether.
If you are incredibly uncomfortable with leaving your baby alone, consider installing a baby monitor with a video feed. Watching the live video from the crib should help appease your worries.
Another thing to watch out for is any potential stressors in your baby’s life, like a new babysitter, a new sibling, a change of apartments, or ailments. Drastic changes to the baby’s life can impede sleep training, and you should put any attempts on hold until the storm passes.
You should also consider stopping CIO training if your baby vomits every night of the preliminary training process. You should also check with your doctor to seek out any potential underlying issues that may be instigating the vomiting episodes.
Extinction Sleep Training vs. Other Sleep Training Methods
The CIO technique is at one extreme when it comes to sleep training methods for babies.
With this technique, you are weaning the baby cold turkey off the reliance for soothing, teaching them to sleep on their own. The good with this method is that it is one of the fastest, and most babies will fully adapt in 3-7 days.
However, on the flip side CIO is also the method that is most likely to place psychological strain on the mother — especially in the first couple of days — as you deal with extended periods of crying and fussing from your toddler.
CIO isn’t for everyone. If you feel that the connotations of extinction sleep training are too much for you to handle, you can try out one of the following milder variants.
These options typically require less crying and fussing but may take longer to achieve the goal.
The Ferber Method
The Ferber method is a more forgiving, graduated version of extinction sleep training. With this technique, you lay the baby down in the crib and leave it like you would with CIO.
However, here, you only allow the baby to cry for a short while. After every few minutes, you can check back in on the infant, soothing them and calming them down for a couple of minutes.
As the training progresses, you should gradually increase the interval with which you enter the room until you reach the 10-15 minute range and maintain this range until the baby gets some shuteye.
With every sleep cycle, you have to repeat this process all over again. By the first seven days of the trial, you should begin to see some progress with your baby’s sleep onset times.
This technique explores an alternative route, focusing instead on bedtime timing. Here, you first have to log your child’s sleep times and figure out their typical bedtime. Then, you should begin moving the time you put them to bed earlier in 15-minutes intervals, until they are going to bed when you want them, and are sleeping through the night.