Why not to "Cry It Out" : The research on extinction sleep techniques
Amy and Jen take a deep, deep dive into the muddy murky world of "Cry It Out" or "Extinction" sleep techniques. Put on your wellies and join us!
We talk about the research groups and individual studies which have looked at these techniques with our usual critical eye. Attempting to keep our personal feelings out of the objective assessment of the research; nevertheless we still concluded that there is a substantial body of evidence which suggests CIO sleep techniques should not be recommended by health visitors. In the episode we take a closer look at the studies suggesting it is harmless and discuss why these are flawed and why we have come to a different conclusion.
We will also talk about possible alternatives for health visitors who are reaching for some sort of intervention to support parents who feel they are at their 'wits end' in terms of sleep and those suffering with mental illness which may be exacerbated by a lack of sleep.
Hopefully, we leave you with some possible avenues to explore with families as well as getting into the sleep debate in a meaningful way.
As always, we love to hear from you so drop us an email on iamahealthvisitor@gmail.com to chat with us.
Thanks
Amy and Jen
Resources and Further Reading:
Honakar et al 2018
https://scholarworks.iupui.edu/bitstream/handle/1805/18975/Honaker_2018_real.pdf?sequence=1&isAllowed=n
Accessed 30.11.2020
The news furore recently caused by Bilgin & Wolke 2020
https://www.theguardian.com/lifeandstyle/2020/mar/11/leaving-babies-to-cry-does-no-harm-study-finds?CMP=Share_iOSApp_Other
Accessed 30.11.2020
Bilgin & Wolke 2020
https://sovendeboern.dk/wp-content/uploads/2020/06/Bilgin-og-Wolke-2020.pdf
Accessed 30.11.2020Accessed 30.11.2020
Lindsey Hookway 2020 statement - an IBCLC critique and response to the Bilgin & Wolke study.
https://feedsleepbond.com/response-to-bilgin-and-wolke-cry-it-out-study/
Accessed 30.11.2020
Tronnick Still Face Phenomenon Video example:
https://www.youtube.com/watch?v=apzXGEbZht0&list=PLpCQJ8MCxYM7yJXB2vcib0ai-4PZ4TlBL&index=12
Accessed 30.11.2020
Middlemiss et al 2012 - Cortisol and Asynchrony
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.671.2134&rep=rep1&type=pdf
Accessed 30.11.2020
Hiscock et al 2007 - Cluster Randomised Trial of CIO intervention
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2083609/
Price et al 2012 - five year follow up
https://www.researchgate.net/profile/Anna_Price5/publication/230830539_Five-Year_Follow-up_of_Harms_and_Benefits_of_Behavioral_Infant_Sleep_Intervention_Randomized_Trial/links/54d9d57c0cf24647581f8c21/Five-Year-Follow-up-of-Harms-and-Benefits-of-Behavioral-Infant-Sleep-Intervention-Randomized-Trial.pdf
Middlemiss and colleagues - commentaries on Hiscock et al 2007 follow up Price at al 2012
https://pediatrics.aappublications.org/content/130/4/643/tab-e-letters#unethical-and-unscientific-conclusions-ignore-how-infants-are-harmed
Rudzik, Smith & Ball 2018 - Parent's reported infant sleep against actigraphy data:
https://pubmed.ncbi.nlm.nih.gov/30097331/
Douglas & Hill 2013
Review CIO (0-6m) found no improved sleep outcomes.
https://www.pameladouglas.com.au/sites/default/files/pdfs/Douglas_Hill%20JDBP%20%2023_9_13.pdf
Ball et al 2020 - "Sleep, Baby and you"
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237240
A proposed possible alternative to CIO - new, awaiting full validation. Proposes balance between meeting parents sleep needs and infant needs.
Durham Infant Sleep Lab:
https://www.dur.ac.uk/disc/projects/current/slb/
Middlemiss et al 2017
Second proposed alternative - increased total sleep time but no crying. Teaching responsive soothing and cues based methods.
https://static1.squarespace.com/static/5666b428dc5cb462d9f1e05a/t/5905be69725e256add1604d2/1493548654959/Early+Human+development+2017.pdf
We talk about the research groups and individual studies which have looked at these techniques with our usual critical eye. Attempting to keep our personal feelings out of the objective assessment of the research; nevertheless we still concluded that there is a substantial body of evidence which suggests CIO sleep techniques should not be recommended by health visitors. In the episode we take a closer look at the studies suggesting it is harmless and discuss why these are flawed and why we have come to a different conclusion.
We will also talk about possible alternatives for health visitors who are reaching for some sort of intervention to support parents who feel they are at their 'wits end' in terms of sleep and those suffering with mental illness which may be exacerbated by a lack of sleep.
Hopefully, we leave you with some possible avenues to explore with families as well as getting into the sleep debate in a meaningful way.
As always, we love to hear from you so drop us an email on iamahealthvisitor@gmail.com to chat with us.
Thanks
Amy and Jen
Resources and Further Reading:
Honakar et al 2018
https://scholarworks.iupui.edu/bitstream/handle/1805/18975/Honaker_2018_real.pdf?sequence=1&isAllowed=n
Accessed 30.11.2020
The news furore recently caused by Bilgin & Wolke 2020
https://www.theguardian.com/lifeandstyle/2020/mar/11/leaving-babies-to-cry-does-no-harm-study-finds?CMP=Share_iOSApp_Other
Accessed 30.11.2020
Bilgin & Wolke 2020
https://sovendeboern.dk/wp-content/uploads/2020/06/Bilgin-og-Wolke-2020.pdf
Accessed 30.11.2020Accessed 30.11.2020
Lindsey Hookway 2020 statement - an IBCLC critique and response to the Bilgin & Wolke study.
https://feedsleepbond.com/response-to-bilgin-and-wolke-cry-it-out-study/
Accessed 30.11.2020
Tronnick Still Face Phenomenon Video example:
https://www.youtube.com/watch?v=apzXGEbZht0&list=PLpCQJ8MCxYM7yJXB2vcib0ai-4PZ4TlBL&index=12
Accessed 30.11.2020
Middlemiss et al 2012 - Cortisol and Asynchrony
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.671.2134&rep=rep1&type=pdf
Accessed 30.11.2020
Hiscock et al 2007 - Cluster Randomised Trial of CIO intervention
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2083609/
Price et al 2012 - five year follow up
https://www.researchgate.net/profile/Anna_Price5/publication/230830539_Five-Year_Follow-up_of_Harms_and_Benefits_of_Behavioral_Infant_Sleep_Intervention_Randomized_Trial/links/54d9d57c0cf24647581f8c21/Five-Year-Follow-up-of-Harms-and-Benefits-of-Behavioral-Infant-Sleep-Intervention-Randomized-Trial.pdf
Middlemiss and colleagues - commentaries on Hiscock et al 2007 follow up Price at al 2012
https://pediatrics.aappublications.org/content/130/4/643/tab-e-letters#unethical-and-unscientific-conclusions-ignore-how-infants-are-harmed
Rudzik, Smith & Ball 2018 - Parent's reported infant sleep against actigraphy data:
https://pubmed.ncbi.nlm.nih.gov/30097331/
Douglas & Hill 2013
Review CIO (0-6m) found no improved sleep outcomes.
https://www.pameladouglas.com.au/sites/default/files/pdfs/Douglas_Hill%20JDBP%20%2023_9_13.pdf
Ball et al 2020 - "Sleep, Baby and you"
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237240
A proposed possible alternative to CIO - new, awaiting full validation. Proposes balance between meeting parents sleep needs and infant needs.
Durham Infant Sleep Lab:
https://www.dur.ac.uk/disc/projects/current/slb/
Middlemiss et al 2017
Second proposed alternative - increased total sleep time but no crying. Teaching responsive soothing and cues based methods.
https://static1.squarespace.com/static/5666b428dc5cb462d9f1e05a/t/5905be69725e256add1604d2/1493548654959/Early+Human+development+2017.pdf
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