The History of Sleep Training
Unpacking Sleep Training Culture
Depending on your social circles, sleep training is a given, a tool reluctantly used to improve sleep, or something to strongly oppose. In all the controversy surrounding sleep training safety, efficacy, necessity, and whether or not it’s moral, we rarely stop to consider how the concept got started. Sleep training, however, is a relatively new entirely western idea. It is a concept that emerged from changing values, shifting cultural norms, and the beliefs of prominent physicians in the late 1800s and early 1900s.
Sleep training became popular for a range of reasons I’m going to explore in this post, but the fundamental fact is that it was never based on science or what is good for child development. It was always about white, male physicians using their privilege and platform to spread their own personal ideas about childcare, something primarily done by women. While our understanding of child development, neuroscience, attachment, and sleep have all come a long way since the foundational concepts behind sleep training became popular, the mainstream approach to infant sleep has not.
Throughout much of human history and around the world even today, parents slept near their baby, fed on cue, and nurtured sleep in a responsive way. There was no expectation that babies should sleep through the night or that sleeping through the night was necessary for adults. Sleep was not much of a concern. Most people slept communally, and nighttime parenting was shared. It is only in the last 200 years in western countries that things began to change
Laying the foundation: 1800s and the new Medical Experts
Cultural beliefs in the 1800s laid the foundation for sleep training. Big cultural shifts were happening concerns around disease, the rise of medical “experts”, the industrial revolution, and a shift from a more community focused culture to a more individualistic culture.
I want to take a moment for a note here about medical experts and medicine in general during this time. Doctors received very different training during this time, and medical ideas and expertise were not well developed. Doctors had cultural power, but their practice was not based on evidence and science.
In the early 1800s, people believed that stale, shared air at night spread disease. This was before germ theory. This led to advice never to sleep near your baby for fear of spreading illness. This untrue historical belief started to undermine the wide-spread practice of sleeping near your baby.
People went from assuming that children would sleep when they needed to sleep, to a concern around children getting enough sleep. This cultural shift led to a belief that separate sleep would help babies sleep better.
The medicalization of childbirth and mothering begins in the 1800s. At this time, it was less safe to give birth with a doctor than a midwife. To make up for their poor outcomes, physicians systematically worked to discredit midwives and the intergenerational knowledge sharing that had been the heart of birth and early parenting support throughout human history. Hospital births came with separation of mothers and babies, a decrease in breastfeeding, increase in formula use, and formula seen as the preferred option.
Suddenly the cultural authority figures on feeding, sleep, and infant care actually knew nothing about what was biologically normal. This is the start of the power of “experts” over parent intuition and knowledge. These “experts”, however, were anything but knowledgeable. They popularized many practices that later were proved harmful.
The industrial revolution led to shifts in family structure and living patterns. People moved to cities away from their extended family support systems. This disrupted the intergenerational knowledge sharing, leaving new parents vulnerable to ideas from those seen with cultural authority.
Work patterns changed making it more difficult for children to be integrated into daily work. The values of efficiency, productivity, and independence become stronger. There is more of a focus on time and the clock which lays the foundation for controlling and scheduling infant feeding and sleep. New patterns of life led to a more independent focused culture rather than a communal one where parenting existed within a network of emotionally invested extended family.
Making sleep training concepts popular – late 1800s and early 1900s
In the following works by prominent physicians, you can see the origins of many popular sleep training concepts including night feeds are not necessary, night feeds cause waking, babies should sleep separate from parents, uninterrupted sleep is necessary for babies, you can spoil a baby, and the importance to get them independent as soon as possible. None of these beliefs came from quality research, they were only based on the cultural shifts discussed above.
In 1894 Dr. Luther Emmett Holt published The Care of Feeding and Children. He was an extremely popular medical expert, thought to be the father of pediatrics by some. His work specifically blames night waking on feeding, restricts nursing timings and amounts, and promotes formula for increasing mom’s sleep. He also recommends babies sleep away from parents, have regular sleep times, and first uses the term cry it out. In this quote, he talks about ignoring crying:
“How is an infant to be managed that cries from temper, habit, or to be indulged?”
“[The infant] should simply be allowed to “cry it out.” This often requires an hour, and in extreme cases, two or three hours. A second struggle will seldom last more than ten or fifteen minutes, and a third will rarely be necessary.” P162
Another physician of the time, Dr. Anna Fullerton (1911) wrote that too much holding would spoil babies or turn them into “little tyrants.”
The Children’s Bureau’s Infant Care Pamphlet published in 1914 and again in 1929 draws from Holt’s work and amplifies his beliefs. This pamphlet was widely distributed through government agencies with over 30 million copies distributed in the decades after publication.
Some quotes from the Pamphlet are below:
Parents should “not spoil the baby by picking him up every time he cries. A certain amount of crying is not harmful; it even gives him some exercise.” P. 9
“If a baby is picked up every time he cries, he will soon develop the habit of crying insistently each time he wakes until the mother does pick him up…. This is not a good habit for the baby or the mother. It interferes with the baby’s sleep and with the mother’s work or rest. It teaches the baby that crying will give him control over his parents, whereas a baby should learn that such habitual crying will only cause his parents to ignore him.” P54
In 1928, John Watson published Psychological Care of Infants and Children.
He believed that modern life needs routines and regularities, and babies must be trained to conform to allow for mother’s chores. He recommended separating young children from any emotional attachment so that they could be blank slates molded into what is ideal. He suggested that children should be raised by a rotation of nannies so that they would not get attached. His views were controversial at the time, and yet so many themes from his work around schedules and spoiling babies with too much affection are part of today’s sleep training narrative.
This quote about how to interact with a child is a common one illustrating the relationship he promoted:
“Let your behavior always be objective and kindly firm. Never hug and kiss them, never let them sit in your lap. If you must, kiss them once on the forehead when they say good night. Shake hands with them in the morning. Give them a pat on the head if they have made an extraordinarily good job of a difficult task.” P81-82
Watson was a troubling though influential figure in behavioral psychology. He never finished his research, was fired due to an affair with a student, and turned his experimenting to his own children to their harm. His granddaughter wrote this about him:
"Grandfather's theories infected my mother's life, my life, and the lives of millions. How do you break a legacy? How do you keep from passing a debilitating inheritance down, generation to generation, like a genetic flaw?"- Mary Loretta Hartley, granddaughter to John B. Watson; in memoir of her experiences,
The next influential figure in baby care books was Dr. Benjamin Spock’s Baby and Childcare (1946). While he rejects Watson’s cold parenting style by recommending abundant affection, he does continue promoting strict schedules and the importance of sleeping through the night early on.
These popular sources of parenting information create new cultural expectations around infant behavior and how parents and babies should interact. Over time, these beliefs became treated as fact and the knowledge of developmental norms was pushed aside.
When Modern sleep training culture takes shape – late 1900s and 2000s
The 1980s bring the first books advocating for sleep training as we conceptualize it today. Building off early cultural influences, we see controlled crying and cry it out formally recommended as sleep training strategies.
In 1985, Ferber published Solve Your Child’s Sleep Problems. He advocated for controlled crying, sometimes still referred to as Ferberizing. He advocates that feeds are the cause of night waking and we must break the feeding sleep link. While you may check on your baby for safety reasons, you should leave them to cry for ever increasing intervals.
In 1987, Weissbluth published Healthy Sleep Habits, Healthy Child, which advocates for complete extinction, cry it out. Essentially, you shut the door and return in the morning.
Many books published since then promote some form of cry-based separation sleep training. Cry it out and controlled crying can have fancy names, making it sound gentler.
Ramos and Youngclark (2006) analyzed 40 popular parenting books finding that 61% supported cry it out in some form while only 31% did not and 8% took no position. The majority of sleep advice given today supports some form of cry-based sleep training even though we know now that these goals are not in line with development. Sleep training culture is powerful and it’s difficult to shift the framework on how our society views sleep.
Often, the first response to anything sleep related will be to sleep train – in response to sleep struggles, to prevent sleep struggles, or even simply because it is now an accepted part of parenting.
What you can learn from this sleep training history
We live in a sleep training culture. Over the last 200 years, our values and beliefs have shifted leaving few parents and professionals familiar with biologically normative feeding and sleep patterns. Even modern pediatricians have minimal training on developmentally normal sleep and lactation. Modern life makes these norms difficult to support, and the response by our systems has been to push change on babies rather than develop new ways of supporting families. Parents often feel pressure to sleep train and to get baby sleeping independently through the night as soon as possible. They often do not know that this is not developmentally how babies sleep. The sleep training cultural belief system is so strong that even parents who actively know they don’t agree with sleep training don’t realize how many of their expectations are shaped by it.
Ultimately, sleep training is a product of history that goes against what decades of research on attachment, brain development, and sleep norms tells us about the early years.
If this post leaves you wanting to know more about developmental norms, check out a few of these blog posts:
Developmentally appropriate sleep expectations: birth to age 5
Baby sleep schedules: the difference between schedules and routines
Resources
Some of the sources used to write this post
Tomori, Cecilia (2018) ‘Changing cultures of night time breastfeeding and sleep in the US’, in Social experiences of breastfeeding : building bridges Between research, policy, and practice. Bristol: Policy Press, pp. 115-130.
Integrity Calling (2016) ‘Why Everything Sleep Trainers Tell You Is Rubbish’
http://www.integritycalling.com/blog/why-everything-sleep-trainers-tell-you-is-rubbish
PhD in Parenting (2011) ‘The History of Sleep Training in Germany’
http://www.phdinparenting.com/blog/2011/5/9/the-history-of-sleep-training-in-germany.html
Ramos, Kathleen D. and Youngclark, Davin M. (2006) ‘Parenting advice books about child sleep: cosleeping and crying it out’
https://pubmed.ncbi.nlm.nih.gov/17252893/
Rosier , Jennifer G. and Cassels, Tracy (2020) ‘From “Crying Expands the Lungs” to “You’re Going to Spoil That Baby”: How the Cry-It-Out Method Became Authoritative Knowledge.’
https://journals.sagepub.com/doi/abs/10.1177/0192513X20949891?journalCode=jfia