Definition of sleep training and cry it out sleep training with regards to ‘Study of guidance and practice in relation to child sleep and sleep training in Denmark, Greenland and the Faroe Islands’

For the purpose of the study, we have defined criteria for the overall concept of ‘sleep training’ (søvntræning) and used the terms ‘sleep training’ (søvntræning) and ‘cry it out sleep training’ (cry it out -søvntræning), which has its own narrower definition, when used in relation to certain aspects of the study.

Below we will list the criteria for all three.

We have defined the overall concept of ‘sleeptraining’ as:

  • Advice that the child is allowed to fuss, be upset, be sad or cry, and the parents should ignore this and continue putting the child to sleep.
    (Example: The child cries terribly when the parent puts them in the crib for a nap and the parent continues with the singing, patting and shushing – as opposed to picking up the child, comforting the child and putting it down again when calm and ready to be put down without fussing or crying)
  • Advice to leave a child that has been put to bed, even if the child fusses, is upset or is crying
    (Example: Putting the child in the cot, saying goodnight and leaving, even though the child is crying and calling  – as opposed to staying with the child and offering comfort and calming contact)
  • Advice to delay or minimize the response when putting the child to bed, understood as deliberately waiting to respond to the signals of the child and/or giving the child less reaction than warranted by the signals of the child.
    (Example: Letting the child cry  for a short while and then shushing the child – as opposed to reacting immediately to the crying and offering physical contact and comfort)
  • Advice to reject or ignore verbal and nonverbal contact, even though the child is actively trying to establish contact with the parent, when putting the child to bed.
    (Example: Putting the child to bed and sitting next to the bed with no reaction when the child talks to the parent, attempts to obtain eye contact or reaches out for physical contact – as opposed to responding to the attempts to obtain contact)
  • Advice to leave the child as a ‘consequence’, to get the child to follow a certain request when putting the child to bed.
    (Example: Leaving the child while telling the child, that if the child does not lie down and go to sleep, the parent will leave) 

When preparing the parental questionnaire, we had to present and use a less nuanced set of criteria, to identify cases of sleep training and cry it out sleep training respectively.

As a result, the questionnaire has identified fewer cases of sleep training and cry it out sleep training, than if we had used the complete and nuanced definition.

This is in line with our conservative attitude towards all assessments throughout the study.

Definition of sleep training and cry it out sleep training with regard to the parental questionnaire and the enquiries to the public health visitors.

When preparing the parental questionnaire, we had to advance and use a less nuanced set of criteria, to identify cases of sleep training and cry it out sleep training respectively.

‘Sleep training’ is defined as advice that tells the parents to leave the child after putting the child to bed, when the child is unhappy, fussing, complaining, calling out or otherwise signaling the need or wish for contact – this includes crying.

‘Cry it out sleep training’ (CIO) is defined as advice that tells the parents to leave the child after putting the child to bed, when the child is crying or screaming. The crying or screaming is to be ignored completely. The parents can either ignore the child for a shorter or longer time before intervening or ignore it altogether.

Using the criteria stated above, the cases of cry it out are included in the sleep training cases, while the numbers for cry it out-sleep training are for cases of leaving AND ignoring a crying or screaming child only. Our questionnaire only looked at these two versions of sleep training.

Should the questionnaire have captured all versions of sleep training, as described in our definition of the concept of sleep training, it would have needed many additional questions, resulting in a considerable risk of respondents leaving the questionnaire incomplete.

The criteria have also been adjusted for the purpose of comparing the results of the questionnaire with the issued requests for access to documents and inquiries, in order to uncover the municipalities’ guidance in, recommendation of, and knowledge about sleep training