CIO: should we do it, or no?

CIO, or Cry It Out, can be a tough topic to discuss among parents. It’s often met with extreme feelings, no matter if you’re a proponent or not. I’ve noticed that occasionally folks may not truly understand what it is when it comes up in discussion, and what it entails.
Is it CIO if you let your baby whimper for a couple minutes after waking, knowing they’ll drift back to sleep? No.
Is it CIO if your baby cries hysterically before falling asleep, even though you’re holding her and rocking her? Nope.
Is it CIO if you let your baby cry for gradually longer periods of time before responding? Yeah… it might be.
Is it CIO if you let your baby cry until they fall asleep? Yes.

CIO, when done the way it’s ‘supposed’ to be done, according to the books, is a graduated extinction method. Let’s break down what graduated extinction means:

Extinction is a term used to describe the removal, or discontinuation, of reinforcement for a specific behavior. If you say you are now ignoring a behavior in order to get it to stop, you may be using extinction. Though, keep in mind, ignoring means you are removing your attention, and this will only work if the function of the behavior is attention. I talk about functions of behavior here.

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One of the reasons behavior analysts, or behaviorists, are spoken badly about is because people incorrectly assume we only look at the behavior of a child. Well, sure… we rely heavily on what the behavior is: what it looks like, when it happens, what happens before and after… because behavior is communication. The child’s behavior is communicating something to us, and understanding it is a window into what the child is trying to tell us. But the very first step in trying to change, reduce, or increase a behavior is knowing what the function is. It’s knowing WHY that behavior is happening. This is where we investigate the underlying causes: is the child in need of something? Does she want your attention? Is she telling us she doesn’t like something or doesn’t want to be in a particular situation? Of course, this is where the feelings of a child come into play, and those feelings are not ignored or pushed aside. If a child feels neglected, or needs a hug or reassurance, then that child will engage in some behavior to get that attention.

If that behavior is inappropriate, then we want to teach the child more appropriate ways of getting the kind of attention being sought.
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So back to extinction, and graduated extinction. Proponents of certain sleep training methods that recommend graduated extinction are teaching parents to slowly stop responding to their baby’s crying behavior. Over time, the baby learns that this behavior does not produce the wanted response, or any response, which means the behavior is no longer being reinforced. The crying behavior then decreases. Does it work? Yes. This method works. Behavior analysis is a science of behavior, and when using these procedures accurately they can be very effective.

BUT.

Who is this benefitting, and is it normal? Just because something works, or is effective, does that make it responsible or ethical? Of course not.

Sleep varies for everyone, whether they are a baby, a child, or an adult. There are averages, yes. And folks can definitely suffer from sleep problems and difficulties. But it’s generally known that everyone wakes occasionally during the night, including babies and adults.

It is normal, however, for babies to wake more frequently and need her primary caregiver to get back to sleep.

It is normal for babies, especially babies who are nursing, to wake every 2-3 hours to nurse. The time between feedings will gradually increase as the baby grows. But the baby may also wake due to other reasons, such as pain from teething, or discomfort from something else (too hot, too chilly, pajamas are uncomfortable, they heard a noise and became scared, etc.).

Babies do not have the abilities older children and adults have when these things occur. They cannot get up and turn on a light. They cannot change themselves or adjust their pajamas. They cannot get up and get a drink. They have limited means of seeking the comfort they need to fall back asleep.

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Clare has slept with us since she was just a couple weeks old, when we discovered that bedsharing was the best way for all of us to sleep. My husband and I became very aware of her movements and wakings over time. We would respond immediately when we knew she was awake, whether it was to nurse or cuddle. Sometimes she would stay awake for longer than we wanted, sometimes she would cry if there was something else going on (teething, sick, or even a bad dream), but mostly she would easily fall back asleep without crying. Even now, at 3 years old, we know immediately when she has woken up and needs to use the bathroom.
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Since babies have a limited means of seeking comfort on their own, they rely heavily on their caregiver to provide comfort. They rely on behaviors they are capable of doing to try and seek the comfort they need. They can open their eyes, fuss, move around, and cry. These behaviors alert the parent, and the parent responds. Usually, at night, a parent may not realize the baby is awake until the baby begins to cry. Crying results in the parent responding, giving attention, and the need being fulfilled. The parent’s behavior of responding increases the future occurrence of the baby crying when needing something. THIS IS OK, as the baby is learning that when he needs something he has a means of gaining the attention of his parent and the need is fulfilled. This builds trust; the baby trusts that his needs will be fulfilled by his caregiver.

If the parent stops responding to the crying behavior, the behavior will begin to decrease and eventually stop altogether. However, this usually means that the parent is also not responding to any other cues the baby is exhibiting (such as opening eyes, fussing, moving around…crying is generally the last resort). When crying is not responded to, this leaves the baby with no other means of communicating his need.

The baby will become tired and fall back asleep. Over time, when/if the baby wakes, he will not cry because crying did not produce the wanted result in the past. Someone has recently told me that this suggests babies cry to manipulate parents…that babies choose to cry to gain parents’ attention and that what I’ve explained is just not true.

Let’s get a couple things straight: everyone’s behavior is manipulated all the time by people and things in their environment.

This is not a bad or good thing, it just is. It’s science.

Babies do not actively ‘manipulate’ their parents in the negative sense of the word; they simply engage in the behavior they are capable of, and that behavior is either reinforced or not by the caregiver… which may or may not increase the future occurrence of that behavior. While we all have free will, and can choose or not choose to engage in a behavior, it’s also science that we generally are going to engage in behaviors that have been reinforced in the past. So, no, a baby is not actively ‘choosing’ to cry, however, since that behavior has gained the attention of the caregiver in the past, it has been reinforced, which means the baby is more likely to engage in that behavior in the future when needing something.

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Self soothing: young babies do not soothe themselves. Sure, they receive comfort from suckling, whether on a pacifier, their thumb, a bottle, or by nursing. But accessing these items is not something they can do on their own. Babies cannot regulate their emotions, the ability to do this develops over time… Years, actually. They rely on their caregivers to help them regulate not only their emotions, but also their breathing and heart rate. Holding your baby close to you allows her body to mimic your breathing and heart rate, which helps her to calm down.

The idea that babies can learn to self-soothe if left alone is misleading. Babies will become tired from crying or fussing. They will learn that their cries do not produce a response if no response is given. They will eventually fall asleep on their own. They will also tend to fall asleep and not fuss when they wake during the nights from then on. This is not because they are self-soothing, it’s because they have learned to associate things such as a dark room, their crib, etc as cues that a caregiver is unavailable. They have learned that crying or engaging in other behavior does not produce the wanted response.
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Some have called the act of responding to a baby crying at night as a ‘coercive behavior trap.’ First, a ‘coercive behavior trap’ is a terrible way to explain what I think was trying to be explained, which is the cycle of reinforcement going on (reinforcement or punishment is happening all the time… no matter what we’re doing…). In this case, they are saying, or trying to say, that parents responding to a baby crying reinforces the future occurrence of the baby crying (they cry to get our attention…normal, expected…and we respond, as we should). The baby learns that crying will result in the parent responding (again, this is normal and we should respond). On the other hand, the parent is also being reinforced because when they respond to the baby’s cries, the crying stops (which is relieving to the parent). In this way, the baby and the parent are both being reinforced (not rewarded…reinforced). Folks who promote CIO have taken this basic behavioral premise and basically said, ‘OK, so parents, if you slowly stop responding to the crying, the baby will stop crying.’  What they don’t take into account are other very important behavioral premises: that when you’re trying to decrease a behavior you first need to understand the function of the behavior – (what the baby is attempting to get, what she needs). Then you work with the individual to teach more appropriate behavior that will allow them to gain the thing they were trying to gain. In this case, babies don’t have many other behaviors in their repertoire, and crying is actually the last resort attempt to gaining attention to fulfill a need (need for love, comfort, attention, food, etc). So when parents stop responding to the crying, the baby learns that crying does not have the wanted results, and they stop. This is awful, because babies are then left with no replacement behavior for gaining the parents’ attention.

I am not an advocate of CIO or ‘graduated extinction’ for getting babies to sleep, and firmly believe that the natural development of the infant/child should be respected.

But if you choose to do it, at least know what’s happening when you do.

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