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Crying for Comfort: Distressed Babies Need to Be Held
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By
Aletha Solter
Issue 122 January/February 2004
The term “cry it out” refers to the practice
of leaving babies in their cribs without picking them up, and letting
them cry themselves to sleep. A modified version of this approach
is to go to the baby every few minutes to pat her on the back or
reassure her verbally (but not pick the baby up), and to increase
the length of time gradually so that the baby eventually “learns”
to fall asleep alone.
But there is no doubt that repeated lack of responsiveness
to a baby’s cries—even for only five minutes at a time—is
potentially damaging to the baby’s mental health. Babies who
are left to cry it out alone may fail to develop a basic sense of
trust or an understanding of themselves as a causal agent, possibly
leading to feelings of powerlessness, low self-esteem, and chronic
anxiety later in life. The cry-it-out approach undermines the very
basis of secure attachment, which requires prompt responsiveness
and sensitive attunement during the first year after birth.
1 The attachment parenting movement is a healthy reaction
to the harmful promotion of crying it out found in many parenting
books. Attachment parents are aware of the possible emotional damage
from leaving babies to cry alone, so they strive to meet their babies’
needs for physical closeness and responsiveness. However, attachment
parents can overlook the beneficial, healing function of crying,
and believe that their job is not only to respond to, but to stop
all crying. This article describes how parents can further promote
babies’ mental health by learning to recognize stress-release
crying, and implementing what I call the “crying-in-arms”
approach.
History of the Cry-It-Out Approach
The question of whether or not to let a baby cry it
out at night does not arise when a baby sleeps close to his mother.
The history of the cry-it-out approach is therefore linked to the
history of cosleeping. There is sufficient anthropological evidence
to assume that, during prehistoric times, babies slept on their
mothers’ bodies or very near their mothers, and that babies
were never ignored when they cried. Cosleeping is a common practice
in many traditional tribal cultures today. However, where civilizations
became more technologically complex, parents gradually abandoned
the practice of sleeping with their infants and adopted the practice
of separate sleeping arrangements, especially in Europe and North
America.When and why did parents in Western cultures abandon the
natural practice of sleeping with their infants?
During the 13th century in Europe, Catholic priests
first began recommending that mothers stop sleeping with their infants.
It is likely that the primary, perhaps unconscious reason for this
advice was the rise of patriarchy and the fear of too much feminine
influence on infants—especially male infants. However, the
reason the priests gave for this advice was the danger of smothering
the infants, commonly known as “overlaying.” Historians
now believe that most of the infant deaths during the Middle Ages
in Europe were caused by illness or infanticide. When accidental
smothering occurred, it was probably caused by parents who were
under the influence of alcohol.
After the industrial revolution in the 18th century,
the notion of “spoiling” became widespread in industrialized
countries, and mothers were warned not to hold or respond to their
infants too much for fear of creating demanding monsters. If the
home was big enough, parents moved cradles and cribs to a separate
room. With the infants sleeping alone in another room, it was easy
for parents to follow the cry-it-out advice, even if it went against
their gut instincts.
The decline in breastfeeding further contributed to
the separation of mothers and infants. With bottle-feeding from
birth on, the last remaining link to the mother’s body was
removed, resulting in the deplorable, detached methods of child-rearing
that predominated in Western civilizations during the 20th century.
Dr. Luther Emmett Holt, an American pediatrician and
child-rearing expert, was the first person to make the cry-it-out
approach explicit and popular in the US. Over 100 years ago, his
best-selling book, The Care and Feeding of Children, was the child-rearing
bible of the time. The book is structured as a series of questions
and answers. One question is, “How is an infant to be managed
that cries from temper, habit, or to be indulged?” The very
wording of this question reveals Holt’s bias. His answer:
“It should simply be allowed to ‘cry it out.’
This often requires an hour, and, in some cases, two or three hours.
A second struggle will seldom last more than ten or fifteen minutes,
and a third will rarely be necessary.”2 Several generations
were raised according to this advice.
Dr. Benjamin Spock, the medical and parenting guru
of the second half of the 20th century, recommended a similar cry-it-out
approach in his best-selling book, Baby and Childcare. Modified
versions of the cry-it-out approach can be found in many current,
popular parenting books.
The Trend Toward Attachment Parenting
Beginning in the 1960s, there has been a healthy trend
in the opposite direction, commonly known as “attachment parenting.”
This approach recognizes the infant as a vulnerable, feeling human
being who needs sensitive attunement, prompt responsiveness, and
nurturing. Proponents claim that the need for physical closeness
is paramount, and that babies should never be left to cry it out
alone. They advise parents to respond promptly to crying and to
soothe babies, generally by rocking or nursing. Attachment parenting
is the exact opposite of the cry-it-out approach.
Several factors have contributed to the growth of
attachment parenting. One of the original influences came from British
psychoanalyst John Bowlby, who coined the term “attachment”
in the 1950s to refer to a child’s bond with her mother.3
Thanks to Bowlby&rs quo;s work, people became aware of the potential
damage to a child that can result from a prolonged separation from
his mother.
Researchers in the field of attachment have discovered
that it is impossible to spoil babies by responding to their cries.
On the contrary, prompt responsiveness leads to a solid foundation
of trust and a secure attachment in the infants by one year of age.
Infants whose parents delay in responding to their cries become
demanding and clingy by one year of age, and are described as being
“insecurely attached.”4
One influence on the growth of attachment parenting
has been the gradual return to breastfeeding. Organizations such
as La Leche League have encouraged mothers to trust their own bodies
to produce the perfect food for their infants. A revival of the
age-old practice of cosleeping is another important aspect of attachment
parenting.
Further support for attachment parenting has come
from research in stress physiology. Cortisol levels are a reliable
measure of stress, and can easily be measured from a sample of saliva.
Researchers have found that even brief separations of human infants
from their mothers can affect the infants’ cortisol levels.
In one study, nine-month-old infants who were briefly separated
from their mothers and left alone in an experimental situation experienced
an increase in cortisol levels, indicating a physiological stress
response. However, when the babies were left with a substitute caregiver
who was warm and attentive, their cortisol levels did not increase
as much.5 The researchers concluded that it is quite stressful for
infants to be left alone.
The Recognition of Stress-Release Crying
While the attachment parenting approach is a healthy
trend in the right direction, it is possible that, in an effort
to counteract the harm caused by the cry-it-out approach, parents
may overlook an important function of crying. In our eagerness to
persist in soothing and hushing our babies, we may be missing opportunities
to help them release stress and heal from trauma. Although it is
stressful for babies to cry alone, there is no evidence that crying
in a parent’s arms is harmful, once all immediate needs are
met. On the contrary, crying in arms can be beneficial for babies
who have an accumulation of stress.
Many psychotherapists recognize the therapeutic value
of crying and encourage their clients to cry. There is a current
trend toward deep-feeling therapies (sometimes known as “regression
therapy,” “primal therapy,” or “emotional
release therapy”) in which therapists encourage clients to
relive early childhood traumatic experiences, and to cry and rage.6–8
The therapists assume that people who did not feel safe enough to
cry as children can “catch up” on their crying later
in life and heal themselves from the effects of early traumatic
experiences.
Our culture tends to block and suppress the healthy
expression of deep emotions. Some adults remember being punished,
threatened, or even abused when they cried as children. Others remember
their parents using kinder methods to stop them from crying, perhaps
through food or other distractions. This early repression of crying
could be one factor leading to the use of chemical agents later
in life to repress painful emotions. The goal of deep-feeling therapy
is to help adults overcome the inhibition against crying, thereby
allowing them to cry as much as needed in a supportive environment
with an attentive, empathic listener.
Researchers have measured physiological changes in
adults following therapy sessions in which they cried hard. The
results showed lower blood pressure and body temperature, slower
heart rate, and more synchronized brain-wave patterns. This state
of physiological relaxation was greater following crying than following
physical exercise for an equivalent period of time.9 Biochemical
studies have discovered greater concentrations of stress hormones
in emotionally induced tears than in irritant-induced tears, leading
to the theory that one purpose of crying is to rid the body of excessive
amounts of these hormones.10 It is obvious that, when we cry, something
important happens.
A growing number of psychologists believe that the
healing function of crying begins at birth, and that stress-release
crying early in life will help prevent emotional and behavioral
problems later on.11–14 However, babies should never be left
to cry alone. This healing process will be effective only if babies
are allowed to cry in the safety and comfort of a parent’s
loving arms. When toddlers and older children cry or have temper
tantrums, it is still important to stay close and be attentive,
even when holding may not always be appropriate.
The stress-release function of crying in restoring
emotional health is comparable to the beneficial function of fever
in fighting an infection and restoring physical health. Wise doctors
know that it is often best to let a fever run its course rather
than use drugs to cut it artificially short.15 Stress-release crying
and fever both help children (and adults) regain homeostasis. There
is no easy shortcut to emotional or physical health.
Sources of Stress for Infants
What kind of stress or trauma do babies experience?
The emerging field of prenatal and perinatal psychology has taught
us that, if the pregnant mother is anxious or depressed, babies
can be stressed even before birth.16–18 Furthermore, the birth
process itself can be frightening and painful for infants, especially
when medical interventions are used. In the absence of emotional
healing, early trauma can have a lifelong impact. Studies have shown
that complications at birth correlate with later susceptibility
to psychological problems, including schizophrenia, drug abuse,
depression, suicide, and violence.19–25
There is evidence that prenatal and perinatal events
are major causes of extensive crying in infants (commonly referred
to as “colic”), and that “high-need” babies
are often those who have experienced early stress or trauma. Researchers
have found that babies whose mothers were extremely stressed during
pregnancy, or whose mothers experienced a difficult delivery, cried
more and awakened more frequently at night than babies who did not
have these traumatic experiences.26–30 It is possible that
the crying we see in these stressed infants represents their attempt
to heal themselves and regain homeostasis. Sheila Kitzinger mentions
the need for babies to cry in arms following a stressful pregnancy,31
while William Emerson emphasizes the healing effects of crying following
both prenatal and birth trauma.32
After birth, overstimulation is a possible stressor
to keep in mind, especially for infants born prematurely,33 or those
who are highly sensitive by nature.34 During the first few months,
it is typical for babies to have a crying spell at the end of a
stimulating day, even though all of their immediate needs are met.
T. Berry Brazelton calls this time of day the “fussy period,”
and claims that babies need to “blow off steam” because
of information overload to their immature nervous systems.35 This
kind of crying peaks at about six weeks of age, then declines.
Stress can also result from the inevitable frustrations that arise
as babies strive to accomplish new skills, such as grasping, crawling,
or walking. These frustrations build up and find an outlet in crying
spells, providing further fuel for the end-of-the-day “fussy
periods.” Researchers have found that babies tend to cry more
frequently for a few days or weeks before attaining these developmental
milestones, presumably because of high frustration levels.36
Other sources of stress include jealous siblings,
stressed or anxious parents, or frightening events. In addition
to these daily stresses, some babies experience major traumas, such
as hospitalization, surgery, parental divorce, or the illness or
death of a parent. All of these traumas increase the need for stress-release
crying. While it is important to minimize stress, frustration, and
overstimulation in babies’ lives, it is also helpful to remember
that crying in arms is a healthy release for babies whose current
needs are met, but who are suffering from the effects of stress
or trauma.
Implementing the Crying-In-Arms Approach
I recommend seeking the advice of a health professional
for babies who cry a lot for unknown reasons, or for those whose
crying suddenly increases or has an unusual sound. Sometimes there
is a medical condition that requires prompt attention. Some crying
is the result of allergies or food sensitivities. It is definitely
worth checking into all possible causes for crying and searching
for remedies. However, if there is no medical reason for the crying,
it is likely that your baby simply needs to release stress.
To implement the crying-in-arms approach, the first
thing to do when your baby cries is to look for all possible needs.
When all immediate needs are filled and your baby is still crying,
even though you are holding her lovingly in your arms, a helpful
response is to continue holding her while trying to relax. This
is not the time to continue searching frantically for one remedy
after another to stop the crying. Take your baby to a peaceful room
and hold her calmly in a position that is comfortable for both of
you. Look into her eyes and talk to her gently and reassuringly
while expressing the deep love you have for her. Try to surrender
to her need to release stress through crying, and listen respectfully
to what she is “telling” you.37, 38 Your baby will probably
welcome the opportunity to have a good cry.
If you have had the good fortune to cry without distractions
in the arms of someone who loves you, it helps to remember the wonderful
feelings of relief, relaxation, and connection that follow such
an experience. Don’t worry if your baby closes her eyes while
crying. She will peek at you from time to time to make sure you
are still emotionally attuned and paying attention. After she has
finished crying, you will find yourself holding a relaxed little
person who will probably fall asleep peacefully in your arms, sleep
soundly, and then awaken, bright and alert.
The success of the crying-in-arms approach lies in
correctly interpreting your baby’s cues. Obviously, you don’t
want to overlook legitimate needs by assuming that your baby “just
needs to have a good cry.” On the other hand, it is not helpful
to assume that all fussiness indicates an immediate need that you
can “fix,” because you will eventually fail. For some
crying there is no immediate remedy, and it is not your fault. Once
you begin to view crying in this way, you will learn to read your
babies’ cues more accurately, to recognize the need for stress-release
crying, and to relax when it occurs. In my consultation practice,
I have found that this approach helps prevent parents from feeling
anxious, angry, guilty, or helpless when their baby cries. It can
even help prevent child abuse.
It is important to emphasize that the crying-in-arms
approach is totally different from the cry-it-out approach: Your
baby is with you at all times, so he will not experience any stress
from separation. If you feel that you cannot respond compassionately
to your baby’s crying, try to find someone else to hold him
rather than leaving him to cry alone. Your baby will not cry indefinitely.
After the crying has run its course, your baby will probably fall
asleep peacefully, or become calm and alert.
Advantages of the Crying-In-Arms Approach
There are numerous advantages to allowing your baby
to release stress by crying in your arms. First, you will help him
heal from trauma, thereby avoiding the possible lifelong impact
of prenatal or birth trauma. He will also heal regularly from the
minor upsets of everyday life. Releasing pent-up stress from daily
overstimulation or frustrations will allow him to have a longer
attention span and greater confidence in learning new skills. He
will probably also be more relaxed, and less whiny or demanding.
Your baby will also sleep better. Many parents who
start using the crying-in-arms approach with older babies are delighted
to find that their babies begin to sleep through the night, sometimes
after months of frequent night wakings. The parents accomplish this
shift while honoring their babies’ attachment needs, without
ever leaving their babies to cry alone.
Another advantage of this approach is that toddlers
who have cried enough as infants (while being held), and who continue
to be supported emotionally as they grow older, are calm and gentle.
They do not hit or bite other children. Toddlers who do not have
opportunities to cry freely can become aggressive, hyperactive,
obnoxious, or easily frustrated. These disagreeable behaviors are
often caused by an accumulation of pent-up stress, or the impact
of early trauma that has had no healthy outlet.
Most important, by practicing the crying-in-arms approach
you will enhance your emotional connection with your baby. She will
learn that you are able to listen and accept her entire range of
emotions, and that nothing can damage the loving bond between you.
If you continue to be an empathic listener, your child will grow
up with a feeling of being loved unconditionally, which will lead
to high self-esteem.
Finally, you will be rewarded with children who continue
to express their emotions and bring their problems to you throughout
childhood and adolescence, because they will trust in your ability
to listen. There is nothing more touching than a teenager who can
say to his mother or father: “I need to cry. Will you hold
me?”
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