Home > Babies and Breathing > Babies and Breathing – Cry It Out Method and Waterboarding (Part 2)

Babies and Breathing – Cry It Out Method and Waterboarding (Part 2)

Part one of the series talked about four important changes that happens in respiration.  Part two will continue to scientifically build upon the consequences for using the “cry-it-out” method.

An important concept to once again remember is that anatomical development precedes  functional development.  Babies are not fully functional at birth.  They all have their eyes, ears, hands and feet, heart thumping, etc.  however they are still growing – not in the mother’s womb but out in the real world as “immature” human beings.  People tend to associate the word “immature” with psychological aspects but in this case this applies to anatomic, physical immaturity.  Not being mature is not good or bad but frankly this just tells us that the child is not ready for certain tasks.  For example, a baby sits before he/she can crawl.  This is due to continued  development of bodily coordination which matures throughout life.

Let’s look at the growth chart below.

CDC Growth Chart from birth to 24 months: Length for age and Weight for age percentiles

(The PDF file of the CDC Growth Chart from Birth to 24 Months old can be downloaded here.)  As one can see, the rate of growth from newborn through the first 6 months of life is astonishing. The most rapid rate of growth occurs during this period. The weight of the baby is doubled and the baby grows in average an inch per month. The metabolic rate of the newborn is very high and nutrition among many other factors can influence the growth of the child.   Naturally, respiration plays a very important role in this.  It is vital for a child from birth to at least 6 months of age to have adequate oxygen in their system.  Oxygen is important for the production of ATP – energy needed for cells to survive among other things.  ATP provides the energy that organs use to function.  ATP can be compared to the fuel that powers automobiles.  Without fuel, no matter how expensive the car, it is reduced to being a nice piece of metal.  The human body, especially babies need this oxygen to keep up with their amazing growth.  The human brain is the most sensitive organ to oxygen deprivation and will be the first to be effected without it.  Brain damage can occur.

All cells, especially brain cells need oxygen to survive.

With this observation it is to the benefit of the child to calm him/her down from crying so that the child can obtain optimal levels of respiration.

Parents who are contemplating the “Cry it Out” (CIO) a.k.a. Ferberization method by Dr. Richard Ferber should consult their pediatrician before attempting this. There are differences of opinion even amongst pediatricians.  However they will determine whether it is safe for your baby to use this method of sleep training.  Ultimately the parent should be the one who will decide for they will have the best interest for their child and in most cases for the sake of sanity.

The CIO method has worked for some parents and not for others. There is no one key for a successful sleep training for babies. At the very least, the CIO method should not be employed until there is sufficient freedom of airway patency during crying.  Implementing the Ferber method before a certain degree of maturity in the airways can physiologically lead to hypoxia – lower oxygen levels in the tissues.   CIO should also not be performed on babies who are sick or recovering from one.

There are some who observe that breathing is not only solely through the mouth but at the same time with the nose – thus the term oro-nasal breathing. This is true. However when crying is initiated, tears fall and some are drained into the nasal cavity further increasing airway resistance. Since the baby is normally lying down with their face up when the CIO method is initiated, tears and saliva will eventually flow into the airway tract further increasing respiratory distress and thus cause coughing. Some parents will even exhibit vomiting from the babies during prolonged measures. This is never a good sign and CIO must be stopped immediately. (There are those people who push for continuance of the CIO method despite vomiting. Vomiting at this age is not a learned reaction nor should it be interpreted as one.)

As reiterated in a previous article Children and Mouthbreathing, it takes a great effort for babies younger than 6 months to breathe through their mouth due to anatomic reasons.  Since airway resistance is further increased during CIO, breathing will be very labored and difficult.  There was a case study in the Journal of American Medical Association where a child was having severe respiratory difficulties during her cold and was exacerbated when saline drops were entered through her nose.

Does this sound like waterboarding?  The principle of waterboarding is essentially to make the person feel as though he/she is drowning to the point of death.  The thought of comparing CIO with waterboarding is appalling.  However the provocative statement was made in order to emphasize that babies that undergo CIO too early in life can compare to the traumatic experience of those who are in severe respiratory distress.

At the very least, the CIO method should never be implemented before 6 months of age.  The growth chart represents the average (standard deviation) of all babies.  For parents of premature babies, CIO should even be implemented at later months.  What should serve as a guideline is knowing your baby’s sizes (height, weight, head circumference) and comparing it the average percentile.  All babies development at a different rate.  Some crawl earlier than others.  This is a normal thing.   The most important sign is the mother’s gut feeling.  She will know whether this is the right method for her baby or not.

  1. April 16, 2013 at 2:59 pm

    Whats your view on Carseats? Many babies including ours cry when put in a car seat. Most of our trips take longer than 15 minutes, by the logic in this article we are damaging our baby when we put them in a car seat.

  2. April 17, 2013 at 10:39 am

    Thank you for your comment. I would like to clarify that the act of crying itself does not equate to brain damage. It is the deprivation of oxygen to a certain degree which can cause such a damage. That “certain degree” may be defined when the baby turns blue and the baby starts to be less responsive and less active. If deprivation of oxygen occurs, the human body is resilient and the damage is small and usually nothing to worry about.

    [Off Topic : Many times parents rush their baby to the hospital because the baby is crying so hard. On the other hand, doctors welcome such response because it indicates that the baby is still stable versus a baby who is lethargic and unresponsive – a more grave condition requiring immediate action..]

    I wanted to emphasize that the act of crying has different effects in a baby who is 1 month versus 1 year old. The reason stems that a 1 year old baby has a more mature lung and is able to breathe easier through the mouth when the nose airways are compromised. Parents who do implement the CIO method sometimes allow the baby to cry to the point of vomiting which is not the true intended technique of the CIO method. A 1 month old baby who is crying has increased stress vs a 1 year old because of physiological and anatomical immaturity. Many times the baby is left alone to cry while the mother or father is in the other room and check back within a certain time interval.

    Going back to the carseat question, babies do cry in carseats but the difference between that and the CIO method is that the parent is with the child at all times and can directly monitor the child for any changes in crying pattern. Parents know the differences in crying whether their child is meaning to want something or crying because he/she is actually in pain or suffering. Parents should investigate why the baby is crying. I am a firm believer that all babies cry for a reason. While you can condition a baby not to cry, it is not a good method in my opinion.

    For example there was an orphanage that has a quiet room filled with babies. The reason for this remarkable finding was that the babies learned not to cry in order to get more attention and food from the care providers who gave more to babies who are “nice” and quiet.

    In hindsight, it was not my intention to focus the reader on “brain damage” which is an extreme case.. but moreover babies are functionally immature during their first year and especially the first few months of life. Caution should be taken when methods like the CIO method is used.

    Once again thank you for your comment and I hope this clears up your question.

  3. April 17, 2013 at 8:42 pm

    Great article. My husband and I never used CIO many family, friends, coworkers etc insisting it was the only way . We are attachment parents proud of it, and as a result our daughter is thriving. She is in excellent health, reading sentences at age 3 , counting to 40 in English, to 20 in Spanish, is active and happy. I appreciate your blog and the info you are sharing. Jessica left a snarky comment and is a dumb ass. Good for you for taking the highroad in response.

    • April 17, 2013 at 11:36 pm

      Thank you for the encouragement. My son is almost three too and while I do admit of some shortfalls in our quest for a happy baby as there are ups and downs, Many times I have realized time and time again, it is us the parents who need education in how to see things through a child and try not to put them in our shoes as we often do. Communication is key. It is indeed wonderful to see your daughter thriving in love with positive reinforcement. Looking forward to read your experience and tips someday!

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