Surely most of those who read us know Eduard Estivill. He is the author of several works for mothers and fathers who aim to extinguish certain behaviors in children, the best known being his book Go to sleep kid, with whose instructions children stop crying at night in search of their caregivers.
We talk about the 'controlled crying' method, also known as the "Estivill Method", which consists in disabling babies in a controlled way, even if they cry, and that is actually many decades old because it is nothing more than an evolution of the crying method it out '(let your son cry alone in his room, until he stops crying).
Well, after many years writing about it here in Babies and more, I could finally discuss a few days ago with Estivill, talking about his method.
Many years making thousands of babies cry
I have been writing about a lot of things related to babies and parenting for 10 years, and one of the topics that has always surprised me is the crying of babies. For me (and for most, I imagine), the crying of babies is a wake-up call, a cry for help, their way of telling us they need us. For other people, on the other hand, it may be the expression of a whim, or the sign that they have a problem to eradicate.
In the case at hand, that of the nights, there are several professionals who say that babies have something called "childhood insomnia due to incorrect habits", which is really a pathology that does not exist, and that gives name to a most logical event: what babies do at night, waking up a lot of times, bothers us about how our society works, because their awakenings are perfectly normal.
That is, we have created a functioning society that forces us to stay awake during the day and sleep at night, and babies do not work that way. And instead of trying to understand them, put the handbrake and adapt a little to their rhythms, they tell us that the problem is for children, that we should have accustomed them to sleep at night without crying, and that since we have not done so we have to let cry shortly to extinguish their attention demands (which are totally logical).
One of those who say it is the protagonist of this post, Estivill, which in his book presents a table of times that parents should follow, leaving the baby alone, probably crying, so that, in a few days, the baby stop calling us.
The problem? That as I say, we are many parents, and many professionals, who consider it cruel, and not only that: we don't know what consequences it can have for the future Teach a baby that his basic needs can be denied to the point of suppressing them. And the need does not disappear, it is only drowned in the resignation of understanding that that demand is not worthy of attention.
The risk of suffering 'learned helplessness'
There is talk of the possibility of ending up suffering what we know as learned helplessnessIf the child finally discovers that no matter how much he calls the parents, they will ignore him. The learned helplessness is a situation in which the person or child who suffers it assumes that their destiny cannot be altered by what they do; that no matter how much you ask for help, you will not receive it. Learn that it makes no sense to cry, or claim affection, because your needs are not important.
The problem is that Yes they are.
The risk of having an insecure attachment relationship with your caregivers
There is talk of the possibility of having an insecure attachment relationship with parentsIf the child loses control of the responses of his caregivers: this is the feeling, or the feeling, that he does not know how they will act. Because if sometimes he cries and they attend to him, but other times he does and does not attend to him, he no longer knows what to expect, reaching a time when he considers his caregivers necessary, but does not consider them totally fit to be the people who accompany you emotionally.
It's very hard what I'm saying, I know, but it happens. This one-minute video shows it very graphically:
The risk of parental emotional disconnection
And there is also talk of something that has a lot to do with the previous two points: the risk of emotional disconnection from parents towards their baby. We have been talking about the importance of maternal and even paternal bond for years since the beginning of the baby's life. That there is and is empowered, that it becomes solid, that the parents are active and respond to the genuine needs of the baby, from the first moment, and suddenly, when they turn 6 months, someone comes from outside and says that your child should already sleep alone all nightThat what they have done is not right, and that they have to solve it by leaving him alone in his crib for a while, even when he can cry.
A rupture of the aforementioned link that can become bidirectional: the child can lose confidence in the parents, as I just explained, and the parents can break the bond with the children, emotionally disconnecting from them. Because if you can get to cry so you don't need them, a month-old baby will be opening up to the possibility of doing it at other times: leave him alone when he has an emotional explosion in the form of a tantrum; ignore it when they don't like your attitude; force him to eat what they want him to eat, and when they want him to eat, etc.
And this is a problem because the extinction of the need for company at night is done through behavioral methods that act on the acts, but not on the needs. And if this is done with the acts of babies and children, and consequently on their needs, we will not be teaching them to satisfy and overcome them, but simply we will be repressing them, at the risk that later, all that, will go on the other side.
On the other hand? Yes, it is what I have commented on the insecure attachment: children who no longer trust us and who become silent, obedient, and "good" children in external eyes, but with a chaotic emotional world inside, of which they do not speak, nor see the need to do so, considering that not only will not be heard, but that neither deserves to be heard: Thus, he ends up feeling that he is not important, and that his problems are even less so.
And the debate with Estivill?
Sorry I was slow to tell you, but before I told you, I wanted to lay the foundations of where he is, and where I am. He defends that his method is very valid, and that nothing happens to do it, and I argue that it is not so clear that it is not valid, because we do not know to what extent it can harm the baby and his relationship with the parents.
And it all starts last October 31, when TV3 announced an Estivill program on TV with a video:
Sleep bé per viure millor. Dimecres, a la nit, opens "De llit en llit". Amb the @Dr_Estivill. #DeLlitenLllit
A while later, Miri Pris (@MiriPrisCh) left his opinion about it:
The same who said that babies to sleep had to let them cry and not touch them? Well, I don't know ... He doesn't have much credibility.
And Estivill came out in defense of his method by asking that before giving his opinion, be informed, because it does not consist in letting the child cry:
Behavioral methods do not consist of letting you cry, please before giving your opinion inform: //t.co/W9avyileyy. Thank you
To which Miri Pris answered what many of us have already said on other occasions: that in his book he does say clearly that the child is going to cry, and that we leave him the required times before entering the room again:
You say it in your book "Fall asleep, child" many pediatricians criticize his method of letting him cry. Me, as a mother, too.
And Miri added the link to a post I published here, at which point the Twitter notification jumped at me:
//t.co/Bqfd0xjhxX @armando_bastida explains it very well in the link.
Estivill responded by asking for seriousness and science, and not opinions:
But I would appreciate not affirming things that are just opinions. Behavioral methods are endorsed by the scientific and medical community.
And here I entered
I was walking the dog when I read this, and I couldn't shut up. I started a series of tweets (then I repeated them to order them chronologically because as I don't control Twitter a lot they all hung up on the same tweet, and the message was not well understood). Then I put them in the order in which I wrote them.
In the first I replied to his tweet of methods backed by science:
With babies with sleep pathology, maybe yes. The problem is when we are told that thousands of healthy babies must be taught to sleep.
And I continued with my argument with each tweet:
I do not believe that the scientific and medical community considers that thousands and thousands of 'stylized' children had a basic problem.Because if so, we will have to agree that the diagnosis is simply wrong.
In addition: do behavioral therapies have to be applied by parents following a manual? Without a medical diagnosis? Not individualized?
It smells like what it is: pure and hard commercial interest about a consequence of Western society: babies don't understand our schedules.
And then, since he had asked for science, and not opinions, I opened the possibility that it was he himself who would demonstrate with science, and not opinions, that the method is valid and not harmful:
That if there is a well-designed study, conducted by comparing behavioral methods vs. reactive parents to care for the baby, and demonstratesIn the medium and long term there are no differences, no learned helplessness, no insecure attachment, no parents 'disconnected' from their child's crying,
Well, we should consider the possibility that it is not such a terrible method ... I have not found such research to date.
Come on, I left you a summary of what your method really is, and I invited you to show us all that there is science behind what you preach, by asking for a well-done study to prove, comparing babies to those who are The method and babies are treated (they are not allowed to cry at night), that there are no behavioral differences and that does not affect the bond or the relationship between mothers, fathers and children.
And Estivill replied
And he did it in a big way, generating a new tweet so that his answer would reach as many people as possible:
There that study has been conducted at the University of Flinders, Australia and is published in pediatrics.
At last. Finally Estivill gave us the answer to those of us who had been waiting for years, about the science behind the method; about the possible consequences or not consequences. That study that I asked for exists; and is published in Pediatrics.
At first I imagined it would be a fairly old study. Because of course, his method is already a few years old (the book was published in 1995). But no, it's from 2016. What studies have you previously relied on to defend your method? Have you ever studied the damage it can cause? Is there no reliable demonstration that it is not causing any harm to the children of parents who buy their book and follow its method? To those who, after several years of telling them to let them cry, did he tell them that he really didn't say to let them cry?
And obviously I looked for the study. And before reading it, I thought: "It will be an incredible study, with a very large study population and in which babies will be compared to those who have stopped crying with babies who even collect with their parents, given that today there are many babies that start the night in the parents' bed, or that start in their beds and at some point in the night end them. "
And I found this: a study done with only 43 children in total (With this it can already be considered virtually useless scientifically speaking), and with a very questionable design.
So you know what the study says:
To 14 children were applied methods of extinction of their demands (Estivill method); 15 were called "bedtime fading", which consists of leaving the baby awake in the crib and being with him to calm him, and little by little, day by day, remain in his field of vision, or listening (calming him) with a "Shhhh", for example), but less and less time, and increasingly further (it would be a slightly more 'kind' method of extinction); and the remaining 14 children, who were only given information about children's sleep and how they could act at night, were considered the control group.
And what do the conclusions say? Well what Estivill says, that the method is valid because they showed that the children of the first and second groups slept better, with the addition of not having more relationship problems with parents, or worse behavior, than children in the third group.
And so I replied:
The pity is that the sample is only 43 children and that among the groups there is not one of babies sleeping with their parents, for example.
Comparing a group of children who are allowed to cry with a control group that probably does the same will yield magnificent results.
And if you read the study well you realize that it is not clear what the 14 children of the control group did. They say they were given information about the children's dream and, apparently, they were linked to this page where they give advice such as "leave him awake in the crib" or "leave something of yours that he can hug," which are messages that promote lonely night equally.
Thus, when parents receive information that the best thing is for the child to sleep alone, they will most likely end up doing what has been done in the last century: let them cry a little, at times, so that they end up achieving the purpose that the document suggests. Or even attend to the child in his awakenings, but taking longer and longer to attend, as is usually recommended in "popular knowledge."
In other words: we don't know what happened to the control group. We do not know if they were left alone to sleep as suggested by the information they were given, or if they were allowed to cry. We do not know if the parents slept with the babies, or if they all applied that well-known method that consists of making them a little less case, crying, so that they learn to need you less and less, while leaving them with a stuffed animal and a shirt that smells like you (this is also suggested by the information they were given).
So with only 14 children, and many of them probably crying, it's clear that the intervention and control groups could produce very similar results, no?
And then Estivill added more information
In case the study was not enough, he added a consensus document to give more strength to his words:
A part of the consensus document recently made public by the SES //t.co/ma8RW28Gvj
The problem is that it is a consensus document for professionals, with indications for treat children and adolescents with childhood insomnia. That is, children who really have a pathology of sleep, a disorder that prevents them from resting and that negatively affects them during the day both at the level of behavior, as of energy, as of learning ability.
That is why I responded in this way:
A very interesting document for children who DO have insomnia, to be indicated in consultation with personalized strategies, I imagine.
That is, an indication that professionals should apply after studying each case individually to find the best strategy, so that the child or adolescent can rest better and, in general, have better health.
And that's it…
And that's it There was no further debate. Thousands of children have been put to mourn in their rooms (it is said that more than 2 million copies of their book have been sold) without the indications being personalized, with babies most likely healthy and without the evidence that the method Be safe and harmless.
Why Estivill has decided to prove that his method is safe now, with a study of the year 2016, made with 43 children and with a very improved methodological design.
Without going any further, a few days later he published it again, and he was so calm:
Article in @AmerAcadPeds that confirms that behavioral methods are effective and without side effects //t.co/TCJBkOQidj #domir
What do you want me to say. My soul breaks when I discover that not only is there no science behind the method, but when it is finally assumed that there is, or is inconclusive, or is a consensus document for children and adolescents that do have real problems.
From here, let each one draw their own conclusions. I am still waiting for someone to do a well-designed study comparing babies and "stylized" children with babies and children who sleep with their parents at night, without tears, until the day comes when they themselves, and without any problem, they start sleeping alone.
Photos | iStock
In Babies and more | Colecho makes children more insecure and dependent, says Dr. Estivill. What Dr. Estivill should explain (if he were honest), Estivill recommends not letting a baby cry at night: what is the problem if there are only a few days and then they don't remember it?
