How do you know when good advice is no longer useful? For Sleep Series week 2, we’re examining some controversial opinions around kids and sleep.

In this post, we’re covering swaddling and crying it out.

All Safe and Snug

Swaddling is the practice of wrapping your newborn in a light, breathable blanket when they sleep. This helps newborns feel safe and comfortable, mimicking the snugness of the womb. The wrapping prevents your baby’s limbs from moving when startled (moro reflex), all while keeping them warm until they can regulate their body temperature. Because swaddling encourages uninterrupted sleep, it helps establish healthy sleep patterns and promotes growth for your little one.

Despite all the benefits, swaddling does have some setbacks. For one, some parents struggle swaddling their babies correctly. This can lead to:

• Hip joint issues when swaddled too tightly around the hips
• Difficulties breathing when wrapped too tightly around the chest
• Increased risk of suffocation or choking if swaddled too loosely
• Overheating if wrapped too tightly or with heavy or thick blankets
• Less feedings and inefficient suckling, preventing appropriate weight gain
• Limited flexibility and movement affecting mobility

The trick to swaddling is to find the right amount of tautness that is not overly restricting for your baby. That sometimes means allowing them to have access to their hands, as well as letting their legs fall into a natural “frog style” position. Yeah, no pressure at all trying to figure out this baby origami.

Do you have to swaddle your baby?

No. Although it can be helpful for your newborn in the first 3 months, it is not necessary to wrap your newborn up in a sweet little bundle. If, however, you choose to swaddle your baby, make sure you do it correctly. Before leaving the hospital, learn from skilled nurses/caregivers and practice on your newborn until you feel comfortable doing it on your own. There are also many video tutorials on YouTube should you need a refresher. Swaddle sacks that use wraps or light compression fabrics are also good alternatives. Remember that babies do NOT need to be swaddled all day, only when fussy or during sleep.

What about weighted swaddles?

Weighted swaddle sacks are designed to help calm your baby by imitating a sensation of a hand placed on them. That feeling of security translates to them sleeping longer. Use them with caution as they pose an increased risk of overheating or trouble breathing. Also, while we’re on the topic, ABSOLUTELY NO WEIGHTED BLANKETS for infants under 12 months of age. Most commercial weighted blankets are too heavy for infants.

What about a sleep suit?

You may have seen the Merlin Magic Sleep Suit. If you don’t know, it looks like a ski suit for babies. Developed by a pediatric PT mom, it offers a safe and secure option for transitioning your baby out of swaddling to independent sleep. The suit allows for free movement of your baby’s limbs but still gives the snugness. Although the suit is fairly safe, you must frequently monitor your infant’s body temperature to avoid overheating.

Stop swaddling when your infant begins to roll over, usually around 3-4 months of age (or sooner). The chance of SIDS (sudden infant death syndrome) increases if a swaddled baby rolls onto their side or belly and cannot use their limbs to adjust and breathe. Additionally, if your child is fussy, isn’t soothed by it, or continuously breaks out of their swaddle, that’s a good sign to stop.

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Just Cry It Out

The Cry-It-Out method (CIO for short) or “controlled crying” refers to any technique that involves letting your baby cry for a period of time as they learn to fall asleep on their own. Learning to self-soothe can lead to solid and more independent sleep skills over time.

There are several forms of extinction sleep training, such as:

• Ferber’s Method. The most well-known of all the CIOs, Ferber uses a graduated extinction model where parents put their baby to bed when then they’re drowsy starting around 6 months of age. It involves checking on and briefly comforting your infant at predetermined intervals when they cry. The time between each check-in gradually increases until they fall asleep.
• Weissbluth’s Method. This uses a full extinction approach, meaning that you let your baby cry until they stop or fall asleep without parental interference, starting when they’re 4 months old.
• Murkoff’s Method. This strategy says to begin sleep training techniques around 4 months (or at 11 lbs), when the child no longer requires night feeds. Once they reach 6 months, it is appropriate to let them cry it out until they sleep.
• Bucknam and Ezzo’s Method. This method believes that babies 7-9 weeks old can sleep up to 8 hours a night so long that there’s an establishment of a specific day/night sleep pattern when your baby is a month old (eat-wake-sleep). This also allows for your infant to cry 15-20 minutes before sleep to self-soothe.
• Hogg and Blau’s Method. This technique starts around 6 weeks old (or at 10 lbs) and believes in cluster and dream feeds. When it comes to CIO, parents are permitted to respond to their baby’s cries, but encouraged to leave immediately after they settle.
• Giordano and Abidin’s Method. This approach allows your baby to cry for 3-5 minutes before responding, beginning around 8 weeks of age. Unlike the Hogg and Blau’s method, this technique encourages parents feeding babies every 3 hours during the day instead of night feeds.

However, cry it out also isn’t without a bit of controversy. Critics of CIO feel that these methods teach littles ones that their cries will be ignored. A key part of CIO is being able to determine what their cries really mean. They may whimper because they want you around or it could be because they are uncomfortable or not feeling well. You know your child best and should have the best idea of how your baby communicates their needs.

How long should you let your baby cry it out?

The truth is that there is no solid, straight answer. You may be by the book and strictly follow what each method suggests, or you may want to go with your gut when you hear your infant in distress. The best advice would be for you and your spouse to have a clear game plan before you begin sleep training. Together, decide when you want to start, what method you’ll follow (can be one or a mix of many), and what would warrant a check-in at night (for example, crying for more than 10 mins or the volume/type of cry).

It’s also worth noting that certain situations (like sickness, teething, temperature regulation, ear infection, etc.) may cause extended bouts of crying, serving as your baby’s signal for help. In these cases, address the issue or stop CIO until they feel better. Remember that the goal of CIO is for an infant to fall asleep without any assistance from their parents.

Can cry-it-out methods negatively affect your infant’s development?

No. Need proof? A 2016 study investigated the emotional effects of letting babies cry. The study specifically looked at sleep training methods that involved graduated extinction where parents respond to cries at set intervals. Scientists measured the babies’ cortisol (aka stress hormone) levels through their saliva. A year later, these babies were evaluated for emotional/behavioral problems and attachment issues. The results indicate that there is no significant difference in these areas between the test and control baby groups. In other words, there is no long-lasting emotional trauma in babies when using gradual CIO methods.

As for sleep, the same study revealed that the CIO babies fell asleep faster, had less stress, and were more likely to sleep through the night than the babies in the control group.

Another study conducted in 2012 examined the long-term effects of sleep training and produced similar outcomes, determining that such methods had no negative outcomes with no difference between test and control groups.

Do you have to do CIO method to get your baby to sleep?

No. In fact, a 2009 study showed that babies become more securely attached with their parents when nighttime interactions are positive, such as picking up and soothing them when they wake up crying. 

Other alternatives are:

• Stay in the Room – staying right next to the crib and providing comfort when they cry
• Leave and Check – leaving the room and checking in on them at regular intervals
• No Tears – establishing the foundations of sleep hygiene (such as bedtime, sleep environment, routine, and what noises to respond to); may also include co-sleeping, room sharing, or faded bedtimes

If you are interested in trying a CIO method, know that every approach is different and results may vary from kid to kid. Each approach depends on age, your parenting style, and your sleep expectations.

In truth, sleep isn’t so cut and dry. Like all parenting, take it all with a grain of salt and little patience. Some kids are great sleepers while others need a little extra attention throughout the night. Regardless of what sleep tactic you use, your little one may still wake up in the middle of the night every now and then. Factors like brain growth, your child’s temperament, culture, and sleep regressions within the first year can affect their slumber.

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On Thursday, we’re wrapping up the Sleep Series and covering melatonin and co-sleeping.

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