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CHILD CARING

When to let a baby cry: Let the little one be your guide

Babies cry. That's a fact of life. How much we let them cry, that's a fact of parenting, and it's easily one of the most confusing, emotional, and even divisive issues new parents face. One parent may insist it's a no-brainer: If baby is crying, you do what you can to comfort and console. Another may argue that if you are always at baby's beck and call, life will never get back to "normal."

For decades, the advice from respected child development specialists and pediatricians such as best-selling authors William Sears ("The Baby Book") and Penelope Leach ("Your Baby and Child"), as well as a host of organizations such as the American Academy of Pediatrics, Zero to Three National Center for Infants, Toddlers and Families, the Brazelton Touchpoint Institute at Children's Hospital, and Brigham and Women's Hospital, is to respond to a crying baby as quickly as possible, especially a baby under 3 months old but including up to 6 months.

"Here's what I tell parents," says Sears, a pediatrician in San Clemente, Calif., who is known as the father of attachment parenting, a practice based on a high degree of responsiveness. "When in doubt, put yourself behind the eyes of your baby and ask yourself, `If I were my baby, what would I want my mother or father to do?' "

Most of the time, that means parents will -- and in his mind, should -- pick up a crying baby.

While this is widely accepted pediatric practice, it is not universal. In some places, it's even controversial.

Today in England there's a growing brouhaha over what has come to be known as "controlled crying" -- allowing a baby to cry as a way to manipulate him onto a schedule: If he cries because he's hungry and the clock doesn't say it's time to feed him, let him cry.

Leach, a British developmental child psychologist, is so alarmed at the growing popularity of this practice that she has written a position paper this month in the journal for the World Association of Infant Mental Health urging professionals to take a stand against it. The fuel for the movement, she says, is "The New Contented Little Baby Book," by Gina Ford, a maternity nurse, published in 2001. Ford's book is not unlike "On Becoming Babywise," by Gary Ezzo, executive director of Growing Families International, which drew some attention when it was published in 1998.

Sears says it would be presumptuous to tell a parent at what moment, exactly, to pick up a crying infant. Pediatrician Constance Keefer of the Brazelton Touchpoints Center at Children's Hospital says that except for a rare exception, it should not take more than 10 minutes, preferably not even close to that for a baby 3 months or younger.

"If this [kind of crying] is the way it is for baby day after day, it takes a toll on the body. It creates a state of stress, raising blood pressure and pulse rate. Eventually it compromises oxygen level," she says.

The parent of any baby knows that 10 minutes of crying is an eternity. The advice of Indianapolis neonatologist William Engle, a spokesman for the American Academy of Pediatrics, is not to go by the clock but by what the cry sounds like. Sometimes you know within 20 seconds that a baby has lost it; other times, if you leave her for a minute, she'll go back to sleep.

How long we let a baby cry may also have consequences that reach into the future.

"The more we know about brain development, the more we know that when a mother is not responsive, it's linked to [poor] cognitive development and social behavior," says Leach. "The hazard is of a child with too little conviction that he is really loved, as in unconditional love. If you don't respond to him when he cries, he comes to distrust the validity of his own feelings and your willingness to respond to them."

Parents who are likely to let a baby cry it out typically do so because they are afraid of spoiling a baby, something Sears calls "nonsense," or as a way to get on a schedule, thinking that if the baby "learns" that this is not feeding time, for instance, eventually he'll stop crying.

"That's management, not mothering," says Leach in a telephone interview from London.

Indeed, Ezzo throughout his book refers to "training" a baby.

Ford's book offers feeding and sleeping schedules for newborns that are down to the minute. For instance, for a breast-feeding baby at 6 to 8 weeks, she writes: "Baby should be awake . . . and feeding no later than 7 a.m. . . . Do not feed after 7:45 a.m., as it will put him off his next feed. . . 9 a.m., Settle baby to sleep for no longer than 45 minutes. . ." Efforts to reach her through her British publisher were unsuccessful.

Sure, eventually, all parents want children to eat and sleep on a routine, "but it's a matter of self-regulation, not of training or obedience," Leach says. "When it happens will differ from baby to baby. It depends on the maturation of the central nervous system as well as the self-confidence that is gained from warm, sensitive, responsive parenting."

Anecdotal evidence suggests that neither Ezzo's nor Ford's book is selling strongly in New England. "Secrets of the Baby Whisperer" by Tracy Hogg is somewhat more popular. Registered nurse and certified lactation consultant Nancy Holtzman, director of postpartum programs at Isis Maternity in Brookline, says Hogg's book is not as rigid as the others, but it worries her nonetheless for its one-size-fits-all approach, especially to nursing. In an interview, Hogg describes her philosophy as "structured routine," but says she would never leave a baby to cry.

As someone who comes into daily contact with new mothers, Holtzman says she can understand the appeal of "Baby Whisperer." "Women who are used to being organized and in control want a schedule. Anything less feels uncomfortable to them," she says. "The problem is that young babies are not very predictable. With a 3-week-old, I tell parents to expect every day to be different, but by 3 months, routines develop, predictability happens." A new "normal" emerges.

Ideally, those routines happen because parents follow a baby's cues. "Every baby is an individual," says child development specialist Claire Lerner of Zero to Three who also objects to cookie-cutter approaches.

"What calms one baby upsets another. What bores one overwhelms another. Maybe you've got a baby who is easily frightened by loud noises, so you learn to insulate him when you want him to sleep. Maybe you have a baby who is social. She fusses when you insulate her. So you learn to put her to sleep in a baby carrier in a room full of people."

Molly Trudell, who comes to Isis every Wednesday with 7 month-old Annike for a new mom's group, says that in the beginning, she woke her baby every two hours to feed her. "It took a long time to wake her, a long time to feed her, and a longer time to get her back to sleep. It was stupid. I did it for three days."

Alanna Harrington, in the same Isis group, says it was her mother-in-law who got her on the right track with baby Julia, now 7 months old. "She kept saying, `Stop waking a sleeping baby.' Finally I did. Looking back now, I realize how ridiculous we were."

"Babies are funny that way," says Molly Ducker, whose son Logan is 5 months. "They can figure out their own schedule if you just let them."

Contact Barbara F. Meltz at meltz@globe.com

for crying out loud
In a normally developing baby, crying begins to decrease at about 3 months.
Don’t ascribe adult motives to your baby’s crying. Her cries are a signal to basic needs: “I’m hungry or tired, hot or cold, overstimulated.” She doesn’t cry because she doesn’t like you, wants to “get” you, or thinks you aren’t doing a good job.
Trial and error brings your baby comfort; it also gives you a window into what he likes and dislikes. For instance, music is often a source of comfort, though finding the right music may take a while. Try Latin music; researchers say babies tend to like a good beat.
There’s no magic formula for how much a typical baby cries but there is often a predictable pattern as to when he cries.
Some babies cry for only 30 minutes a day, others for up to a third of their time awake. Researchers say neither predicts temperament.
Consult your pediatrician about any uncertainty, if prolonged crying is putting you over the edge, or if cries are sudden, sharp, and high-pitched. Those are typically cries of pain.
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