Sleep Training and Attachment – Is Sleep Training Traumatizing?

In case you aren’t already familiar with me and what I do, you should know that one part of my business focuses on my work as a sleep consultant helping families to sleep train their babies, and another part of my business focuses on my work as a therapist specializing in treating adults who experienced childhood (specifically “developmental”) trauma. The reason it is possible for me to be so passionate about both of those things is because there is no credibility to the idea that sleep training is traumatizing or damages attachment.

All my fellow sleep consultants know and have seen that babies (and children) are capable of learning to be better sleepers, so the whole family can get more rest. My fellow mental health experts know and have seen that getting enough sleep can be a game-changer when it comes to mood, especially during the postpartum period. Improved infant sleep has a positive impact on the whole family’s physical and emotional health. And the research absolutely backs this up.

So in this post I will break down all of the misunderstandings I’ve seen related to sleep training and attachment, and I will explain what people have said the research says and how it actually doesn’t say that, as well as what the research actually does say. This is the longest post I’ve ever written because I think it is so important for overwhelmed, exhausted parents to understand that sleep training is neither selfish nor harmful and that they do not need to continue to suffer!! And if it’s too long for you, feel free to scroll all the way down to my TL:DR summary.

Sleep Training Guilt

A huge area of anxiety for many parents is all this worry they have that they will traumatize their child by sleep training. I have worked with countless moms who struggled with immense guilt for even considering sleep training. I recognize that you might even be feeling guilty right now just because you are reading this post! So let’s address that first:

You are not a bad mom for considering sleep training.

I am deeply committed to changing the narrative that a “good mom” should sacrifice her sleep and sanity in the name of love. Moms should not be guilted into thinking that wanting their baby to sleep better so they can get more rest, or more time with their partner, or more alone time, is selfish. Most important, no mom should ever be guilted into believing that she is harming her baby for “letting them cry” as they learn to fall asleep on their own.

But because I know there are others out there who will “mom shame” anyone who chooses to sleep train, let’s go through everything you need to know to erase any bit of doubt.

Does Sleep Training Cause Trauma?

Let’s start by evaluating the argument made by some that sleep training is “traumatic.”

Stress Versus Trauma

First of all, stress is not the same thing as trauma. Our bodies are designed to cope with stress, and babies and young children need to experience some stress in order to develop healthy “stress response systems” and learn to cope with adversity. The stress response system is also known as “fight or flight” and orchestrates a cascade of hormones, including cortisol. There are actually three different kinds of stress responses: positive, tolerable, and toxic. Note: these terms describe the impact the stress response has on the body, not the stressor itself.

Positive stress responses are a normal and necessary part of development. When babies and children experience brief, mild stressors within an environment of supportive adults, the impact of the stressor is said to be buffered and the hormone levels quickly return to baseline. These experiences are thus able to build resilience and strengthen the child’s ability to respond adaptively to adverse experiences. Examples would be getting a vaccine shot or the first day at daycare.

Tolerable stress responses occur with more severe or longer-lasting stressors. If a child has relationships with supportive adults who help them process and adapt, the brain recovers from the extended period of activation. Examples include losing a loved one or a frightening injury with a period of recovery. Note – because this is important when considering sleep training as a stressor: the supportive adult does not need to be present when the child experiences the stressor (or for the entire duration of a stressful period) in order to buffer the child’s stress response.

Toxic stress responses result from intense, frequent and/or prolonged adversity, such as physical or emotional abuse, chronic neglect, or a parent dealing with substance use or mental illness. In these cases, children do not have a supportive (or consistently) supportive caregiver to buffer their stress. These situations cause such excessive, consistent or prolonged elevations in cortisol that it then damages the brain and body’s ability to respond adaptively to stress, causing both physical and psychological health problems.

From these definitions, sleep training would be considered an example of a relatively brief stressor occurring in the context of supportive caregivers who are lovingly, intentionally guiding the child through the process, and which results in a positive or tolerable stress response, depending on the age and temperament of the child.

Therefore, to argue that sleep training is “traumatic” indicates a fundamental misunderstanding (or ignorance) of what constitutes toxic versus tolerable stress and the fact that sleep training does not occur “in the absence of the buffering protection of a supportive, adult relationship.”

Misinterpreting the Research on cortisol

The claim that sleep training is traumatizing is based on research on stress and trauma.

The problem? People have taken the research on trauma, chronic stress, and toxic stress responses and then unfairly extrapolated these findings to sleep training.

The “Middlemiss” Study

For example, the “Middlemiss” study is often cited by those against sleep training. This clinical trial looked at sleep training and infant and mother cortisol levels, based on three nights of sleep training in a hospital where the infants were put to sleep by nurses. The study concluded that even though the infants were able to fall asleep on their own, they were still experiencing physiological distress, as shown by their elevated cortisol levels.

The problem? A foundational issue is that this was a deeply flawed study whose data and analyses actually fail to support its conclusions. The researchers not only performed the wrong statistical analyses to accurately compare cortisol levels, they also did not report baseline cortisol measurements prior to beginning the study, so there is no way to know if increases in cortisol were due to the sleep training or to the change in environment and caregiver. Even if you barely remember your college statistics class, I think it should make sense to question a study that also used a very small sample size, did not have a control group, and ran its analyses in spite of missing data.

For the sake of argument though, let’s pretend the study had all the data it needed and ran the right analyses and still found a statistically significant elevation in the babies’ cortisol levels after the sleep training program. It. Was. 3. Nights. So all that would prove was that the babies found that very short-term experience to be stressful. It does not prove that sleep training causes a toxic stress response (which is the only kind of stress response that has been shown to damage the developing brain and cause long-term consequences to a child’s learning or behavior, or physical or mental health).

Dr. William Sears

Dr. William Sears, who coined the term “attachment parenting,” is also commonly cited by those against sleep training. In particular, they refer to Sears’ assertion that “excessive crying is harmful,” which he based on his compilation of numerous studies that looked at the impact of cortisol on brain development.

The problem? A foundational issue is that none of the studies were even researching infant sleep training! They were about panicked rats and primates, the crying in infants with colic, children who were victims of physical abuse or exposed to domestic violence, and the neglect experienced by babies in orphanages.

Some of the authors of the studies have actually spoken out against how Dr. Sears has mis-cited their work to promote his own agenda. One author, whose study was about child maltreatment, emphasized that occasional and brief, stressful experiences are not the same as the traumas of abuse and neglect. Another author, whose study was about infant attachment disorders, clarified that “normative, ‘good enough’ parenting” should not be conflated with the impact of parents “in the pathological range of neglect and maltreatment.”

Let’s look at the differences more closely. The stress and crying involved in sleep training – even if it is prolonged crying, even if the crying is going on without a parent’s presence – happens in the context of safe, loving homes. These are parents who are meeting their baby’s needs, making sure their baby is warm and dry and fed before laying them down in their crib. Also, a few nights (or even a few weeks) of crying a few times a day at sleep times is not significant in the context of the overall pattern of affection and connection that exists between parents who regularly snuggle with, sing to, read to, and play with their babies.

In contrast, some of the studies Sears cites refer to babies who lived in Romanian orphanages. Those babies were left alone in their cribs all day, every day for months. No one was checking if they were hungry or wet or cold when they were struggling to fall asleep or even paying attention to them at all. No one sang to them. No one played with them. No one was snuggling them or telling them how much they were loved.

That is an example of profound neglect that goes far beyond tolerable stress levels and had clear, negative impacts on those babies’ development. Those two scenarios, I should think would be obvious, is not even close to the same thing.

Does Sleep Training Damage Attachment?

Beyond the argument that “excess” crying is harmful because too much cortisol hinders brain development, another reason many people consider sleep training to be “traumatizing” is because they believe that it “can compromise secure attachment.”

Attachment Theory

Secure attachment is a term that comes from Attachment Theory – a theory based on many years of research to understand the different kinds of responses babies would have when they were separated from and then reunited with their primary caregiver.

Mary Ainsworth’s research found that babies fell into 3 groups: those with a secure attachment, anxious attachment, or avoidant attachment. Securely attached babies were distressed when their mother left, but when she returned, the baby would seek her attention and was easily comforted. Anxiously attached babies were much more distressed at their mother leaving, and were not easy to comfort even when their mother returned. Babies with an avoidant attachment did not seem bothered by their mother leaving, and avoided contact with her when she returned.

Ainsworth’s research also concluded that securely attached children tend to have parents who are consistently responsive to their needs. Alternatively, insecurely attached children tend to have parents who either did not respond or react to their needs, were dismissive or rejecting of their needs, or were inconsistent in how they responded to their child’s needs.

The key takeaway from Ainsworth’s research that many parenting approaches latched onto is that a secure attachment is built out of a loving, trusting relationship where a caregiver is consistently responsive to a child’s needs. 

A Secure Base

However, a key takeaway from the attachment research that some parenting approaches seem to have missed was the concept of a secure base. Having a secure attachment with a primary caregiver also means that a child grows up trusting that that person is a safe, secure base – from which they can confidently go out and explore the world and gradually grow in their independence.

The reason attachment matters is because a secure attachment in childhood leads to adults who are capable of forming relationships that are made up of a healthy balance of dependence and independence. Whereas an insecure attachment in childhood leads to adults who swing too far in either direction, and are either overly dependent or overly independent.

So, a parent helping a baby or child – or doing for a baby or child – the things they are not capable of doing themselves, builds the child’s trust and security in being dependent. This creates that safe base the child knows they can come back to. Equally important though is a parent teaching a baby or child how to do something they are capable of doing themselves – rather than doing it for them. When this is done from a place of love and confidence in their child’s abilities, it builds the child’s self-confidence and gives them permission to be independent. 

When a child has a secure base, they are able to tolerate discomfort in order to learn and grow and eventually be a healthy, independent adult. Attachment theory does not support the idea that building a secure attachment requires parents to ensure that their child is never uncomfortable or that their child never cries. Let’s dig into this a little more…

Consistently Responding to a Child’s Needs

One of the biggest problems I see with arguments related to sleep training and attachment is a misunderstanding of what it means to “consistently respond to a child’s need.” Of the people who are very anti-sleep training under the flag of promoting secure attachment, many are misconstruing one or more of the following: what is a need, what it means to be responsive, and what it means to respond consistently. 

What Is A Need

Your child does need sleep. Children grow at a faster rate during their first year of life than any other time, and babies’ brains and bodies grow when they are sleeping. Research emphasizes the importance of sleep in the first years of life for healthy cognitive and psychosocial development and shows that sleep deprivation negatively impacts children’s brain development, causing problems with both executive functioning and emotional reactivity.

Your child does not need you to do the work of falling to sleep for them. I know you might not believe me if you’ve never, ever seen your baby go to sleep without being held or rocked or fed to sleep. But even newborns are completely capable of being put down in a separate, safe sleep space wide awake and falling asleep themselves.

Your child also does not need you to prevent them from ever feeling uncomfortable or to immediately do whatever it takes for them to stop feeling uncomfortable. That is actually a recipe for a child who becomes an adult in therapy trying to learn how to regulate and express their emotions in a healthy way, but I won’t sidetrack any further onto that soapbox…

What It Means To Be Responsive

Being responsive doesn’t always mean literally physically or verbally responding. “Responsiveness” is actually referring to the concept of attunement. Attunement is the ability to read another person’s emotional cues and match them with an appropriate emotional response. When a parent is able to calmly observe and connect with their child – even in the face of their child’s very intense emotions – this allows them to identify their child’s need correctly and respond effectively.

Attunement is what builds a secure attachment, not just literally physically responding. For example, if you pick up your baby as soon as they cry and you’re holding or rocking them, but you’re overwhelmed and exhausted and just barely keeping the lid on your frustration, you may not be able to think clearly enough to figure out what your baby needs. Also, just as parents can become stressed from their baby’s lack of calm, babies can also pick up on their parents’ stress, which makes it harder for them to calm and focus on eating or relax into sleep.

So if you are upset enough that you’re struggling to really be present, to patiently observe and tune in to what your baby is communicating, then walking away and leaving your baby in a safe space for a few minutes is probably one of the best things you can do in that moment. It will give you a chance to center yourself, and then come back calm, so you can observe and determine what your baby needs.

And so this is why in discussions of sleep training and and even in more general discussions about what to do if a baby cries the second they are put down but the parent needs to pee or shower or eat, I hate comments about the dangers of “leaving a baby to cry” or “non-responsive care practices” because they are equating basic realities of parenthood with maltreatment.

Sometimes a parent is too dysregulated to effectively co-regulate with their baby. Convincing parents that they can’t even take a moment to themselves to meet their own physical or emotional needs “because their baby will feel abandoned” ignores the reality that this can lead to very anxious, overwhelmed parents and very fussy, difficult-to-soothe babies. Instead of allowing parents to trust their instincts telling them they need a minute to calm down, parents feel pressured to just go through the motions of soothing even if nothing is working. This is not attunement. This is not actually being responsive to what the baby really needs.

Sometimes parental presence is not conducive to going to sleep. Convincing parents that using any sleep training method where you do not immediately go in when the baby cries or you do not stay with the baby while they are crying will “damage their attachment” ignores the reality that overstimulated babies struggle to fall asleep. Instead of allowing parents to trust their instincts telling them that their baby is in the process of settling to sleep and just needs space and a couple more minutes to figure it out, parents feel pressured to go in and pick their baby up or sit in the room even though it is clearly agitating their baby more to do so. This is not attunement. This is not actually being responsive to what the baby really needs.  

A final point I would like to make about what it actually means to be responsive is the difference between “not responding” and “ignoring.” Because another key factor to consider with the crying involved in sleep training is the intention.

When parents sleep train, they are choosing to allow their baby to experience the short-term stress and discomfort that comes with learning a very important, but new, skill. This isn’t the same as a baby in an orphanage or in an abusive situation whose cries get ignored because a caregiver isn’t there or doesn’t care. Repeatedly “leaving a baby to cry” because the parent is unable to or does not want to respond, is neglect. Giving a baby the opportunity to fall asleep independently, even though they may cry as a way to express their discomfort or frustration with having to try something new, is a valid and safe parenting choice.

What It Means To Respond Consistently

Responding consistently does not mean perfectly! Sometimes parents misunderstand. They think their baby is hungry but they are actually overtired or they think they are overtired but they are actually hungry. They try to help their child when they don’t want help, or they give their child space to figure something out when they do actually want help. This is called misattunement.

Misattunements happen all the time, even in healthy families where children have secure attachments. Research by pediatrician Donald Winnicott in the 1950s led to his concept of a “good enough mother.” More recent research affirms this concept, concluding that caregivers only need only “get it right” 50 percent of the time when responding to babies in order to develop a secure attachment.

Edward Tronick’s research also supports the idea that imperfect attunement and secure attachment do go together. He found that even in a healthy parent-child relationship, the parent is truly attuned with the child’s needs only around a third of the time.

Another third of the time, parents misunderstand what is wrong or struggle to figure out what is wrong with their child and so are unable to meet their needs. The child must soothe themselves and figure it out on their own.

The final third of the time – which Tronick believed to be the most important for creating healthy attachment – is when parents repair their misattunements. This means parents are not initially in tune with their children’s needs, but work to become attuned. These times provide a safe experience of distress that gets resolved. This is an example of a positive stress response, which as I discussed earlier, actually helps to build a child’s resilience. 

What Creates an Insecure Attachment?

It honestly takes a lot to create an insecure attachment. Babies and children don’t need anywhere close to perfect parents, as long as their parents keep showing up, keep learning what their child needs and what they don’t, and as long as they are able to apologize and own it when they do make a mistake – when they misunderstand, or when their own emotions cloud their judgment or get in the way of responding well to their child’s emotions. 

A child can still form a secure attachment even when parents don’t respond to their needs sometimes because it’s about the overall pattern of responsiveness, and about repairing when there is misattunement. So even if a parent were to misread a baby’s needs sometimes during sleep training and not respond at times when they should have, this still a small drop in the bucket of the overall relationship.

Anti-sleep-training arguments sometimes claim that we can’t know what will be perceived as traumatizing to any individual child, and so there is an inherent risk of harm in not responding to cries at any age. Yes…and no.

Yes, I’m not going to argue that it is possible that some babies and children would find the sleep training process – regardless of method – to be highly distressing or that they might even feel abandoned by their parents in those specific moments.

But no, the “risk” of this causing a toxic stress response and having lasting effects on a child’s brain or development is not there when this is happening in the context of a safe, loving home because of the bigger picture of the relationship. When the baby wakes up, they are greeted by a happy, nurturing parent who provides them with love and care all day long.

Almost all of my therapy clients have an insecure attachment style. And every single one of them grew up in a home where a hell of lot more was going on than just a few nights or even weeks of potentially feeling unsupported or even “traumatized” by being expected to fall asleep on their own, in their own bed, in their own room. Thankfully, very few grew up in extremely abusive, neglectful environments, but for all of them, their primary caregivers weren’t there for them in the ways that they really needed for their entire childhood. They experienced years and years of misattunements without repair, and that is what creates an insecure attachment. 

Sleep Training and “Attachment Parenting”

The simple truth is that “attachment parenting” is not based on a correct understanding of attachment theory. The term was coined by Dr. Sears in the 80s, partly in response to other parenting methods of previous generations that were a bit more “cold” – children should be seen and not heard, cuddling is coddling, and that sort of thing. So what he gets right is that parents should be emotionally responsive to their child.

But there’s a lot he gets wrong. First, he misses what being “responsive” really means, as I already discussed above. Also, the main practices of attachment parenting, including “breast is best,” bedsharing, and babywearing, all go too far when it comes to creating a secure base. Attachment parenting acts like the parent is the world, rather than the base from which the child goes and explores the world. 

Consequences of “Attachment Parenting”

Attachment parenting can ironically be detrimental to attachment in a few ways. One, Sears’ rhetoric on the harms of crying sometimes instills so much fear in parents that they are going to damage their child that then they aren’t capable of really attuning. These parents are so emotionally dysregulated from all the misinformation and fear mongering and mom shaming, that they are more likely to misread their child’s needs. 

Further, a parent frequently doing things for their child that they are actually capable of doing themselves, can convey a lack of confidence in the child’s abilities and ultimately encourage an over-reliance on the parent. This is one of the hallmarks of an insecure (anxious) attachment.

An anxious attachment also can develop from parents who often engage with their children based on what they as the parent needs to feel comfortable, rather than what the child needs. Instead of building parents’ ability to feel comfortable with giving their child space to express intense emotions and with sitting with their child’s discomfort, attachment parenting pushes parents to soothe their child immediately.

In fact, Sears labels difficult-to-soothe babies “high needs babies,” which only worsens the actual problem, which is “parents with a low tolerance for their baby’s emotions.” Obviously there are actual “high needs” babies, but this isn’t the same thing as what I see the vast majority of the time: parents who believe they are “failing” to keep their baby calm and happy all the time and so they think they must have a “high needs baby.”

Misinterpreting the Bedsharing Research

One of the scariest ways that attachment parenting can actually be harmful to attachment is its promotion of bedsharing. Dr. McKenna (an anthropologist, not a medical doctor, for the record), is an avid bedsharing proponent whose work is cited by Attachment Parenting International. McKenna is known for his philosophy that “babies should never sleep alone” in large part because he claims that almost constant physical touch is essential for promoting attachment and bonding.

The problem? First of all, more recent research found no difference in infant-mother attachment at 18 months among those who bedshared the first 6 months versus those who did not.

But the real problem is that McKenna ignores the plethora of research showing that bed-sharing remains the single greatest risk factor for all sleep-related infant deaths, increasing the risk of deaths from suffocation, strangulation, overlay, and entrapment, and that bed-sharing triples the risk of SIDS (even absent other risk factors like smoking). I don’t know how to mince words on this one, but a parent won’t have any attachment with their baby if they are dead.

Sleep Training Evidence

So the anti-sleep training crowd bases their claims on misinterpretations of the research about trauma and attachment. But what does the research that actually looks at sleep and sleep training have to say about sleep training and attachment?

Why Is Sleep Training Important?

Sleep training is important because poor sleep has a negative impact on the child’s physical well-being… which can negatively impact the parents’ physical and emotional well-being…which can then negatively impact the child’s emotional well-being. Here is what the evidence tells us as far as why quality sleep matters for infants and children:

• Poor sleep negatively impacts children’s brain development and their cognitive, socioemotional, and behavioral functioning.

• Infant sleep problems increase maternal depression.

• Mental illness in a parent negatively impacts the mental, emotional, and social development of infants and children.

• Sleep training reduces symptoms of maternal depression.

How Sleep Training Affects Babies

Now that we’ve established why getting good sleep is important, let’s look at what the research says about using sleep training to improve sleep:

• Sleep training reduces the time it takes to fall asleep, reduces the number of wakings, and increases the total length of sleep times.

• Sleep training improves infants’ mood and behavior.

• There is no long-term harm from sleep training. “No harm” means that they followed up with children who were sleep trained versus those who weren’t, and 5 years later, they found no significant difference in the children’s development or attachment.

Sleep Training vs Not Sleep Training

Arguably this is just semantics, but I think every parent “sleep trains” their baby in some way. But as far as teaching a baby to fall asleep independently or not? Does it matter if families do or don’t sleep train?

Is Sleep Training Necessary?

Whether or not sleep training is “necessary” completely depends on the family! If a baby is naturally easy to get to sleep and stays asleep for long enough stretches for both the baby and parents to be well-rested and in a good mood most of the day, then no, it’s definitely not necessary.

As strongly as I feel that it’s wrong to shame parents for sleep training, I also believe it’s wrong to pressure parents into sleep training or to shame them for continuing to room-share or feed their baby overnight past a certain age. If whatever a family is doing is working well for them, there is no need to change anything.

The problem is that most of the time, parents aren’t sleep training because they feel like they shouldn’t, even though what they are doing is definitely not working and they desperately want more sleep.

When It’s Necessary for the Baby

If a baby is struggling so much with sleep that they aren’t getting enough total hours of sleep in a day or it’s impacting their feeding/weight gain, then sleep training probably is necessary. So if sleep isn’t going great, definitely talk to your pediatrician to make sure your baby is growing and developing well.

When It’s Necessary for the Parent

Sleep training is also probably necessary if one or both parents are so sleep-deprived that it is negatively impacting their physical health, emotional health, and/or their relationship with one another or with their baby.

What makes this hard for parents to notice and take seriously is the expectation I mentioned earlier that a “good mom” should sacrifice her sleep and her sanity in the name of love. It’s gotten to the point that moms wear their sleep deprivation as a badge of honor.

Moms are so busy and exhausted they they believe that a shower is “self-care” and joke about how they haven’t had anything to eat yet today because their baby “wouldn’t let me put them down long enough to even grab a snack.”

If we’ve gotten to the point where moms believe it’s a luxury to meet their BASIC. PHYSICAL. NEEDS. of sleep and personal hygiene and food…. then yes, I do think that’s a sign that sleep training really is necessary for many families.

TL:DR

No, there is no scientific evidence that crying is harmful or that sleep training is traumatizing or damages attachment. People have taken research on cortisol and brain changes from actual trauma, abuse and neglect and unfairly extrapolated those findings onto sleep training. Yes, extreme and chronic stressors that cause toxic stress responses absolutely are harmful. But sleep training is a short-term stressor that causes a tolerable or even positive stress response. The authors of some studies have even come out and criticized those who have used their research to promote an anti-sleep training agenda, and emphasized that occasional, brief stressful experiences like sleep training are not the same as the traumas of abuse and neglect that their research was about. 

Studies that have been conducted to actually evaluate the impact of sleep training have found no difference in development or attachment between sleep trained and non-sleep trained babies, even up to 5 years later.

Studies also show that poor sleep negatively impacts children’s development and brain health. Furthermore, studies show that poor child/infant sleep negatively impacts parent’s sleep and mental health, and studies also show that mental illness in a parent negatively impacts the brain and the development of infants and children. Finally, research shows that sleep training is effective at improving infant sleep and that sleep training can greatly improve symptoms in parents with a mental illness!

So here is the takeaway: convincing parents whose baby or child is not sleeping well – particularly those parents whose mental health is being impacted by their child’s poor sleep – to not sleep train their child because that would negatively impact their development or attachment, is actually more likely to harm the child’s development or attachment than sleep training would, according to the scientific evidence.

I hope this post has given you the confidence you need to let go of any fears and guilt you have about sleep training, so that you can get the rest you need to get your sanity back and truly enjoy parenting!

But if you’re still feeling powerless to improve your baby’s sleep and if you think you might benefit from 1:1 coaching and support with an expert in both infant sleep and maternal mental health, check out my Sleeping Baby, Sane Momma program!