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.
(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.
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.