The Still-Face Paradigm is a three-part interaction sequence used with young infants to examine infant communication and the parent-child dyadic relationship. It starts with a normal phase where caregivers interact with their babies as usual.
Next, during the still-face phase, caregivers keep a neutral, expressionless face, avoiding any smiles, touches, or talk. Finally, in the reunion phase, caregivers return to their normal interactions. Each phase usually lasts about 2 to 3 minutes.
This method has mainly been examined with infants aged 2 to 12 months (1, 2,) but similar effects have been found with toddlers (3).
Several theories have been proposed to explain the still-face effect which sees the baby invariably become distressed and engage in a range of strategies to try and get their mother to respond to them.
Tronick and colleagues theorise that this method disrupts the infant’s expectation of typical interaction and removes the coregulation they rely on to stay emotionally and socially balanced.
Additionally, that the caregiver’s unresponsiveness interferes with the infant’s goal of social engagement and bonding, as well as the back-and-forth (serve and return) dynamic between the infant and caregiver (1, 2, 3).
The still-face effect and parental presence, aka “gentle” sleep training methods, such as “camping out”, “shush-patting,” and similar methods share several similarities:
1. Disruption of typical dyadic interaction expectations: Babies are wired to expect interaction and responsiveness from their parent. During the still-face experiment, the mother suddenly stops interacting, which surprises the baby.
Similarly, during parental presence techniques, the baby expects and asks for comfort, but the parent, though present, does not respond as the child expects. This creates a mismatch between the baby’s expectations and the parent’s responses and is often very distressing for them.
2. Coregulation is withdrawn: In the still-face experiment, the lack of interaction removes the emotional support the baby needs to stay calm and emotionally regulated. This is evident as they become more distressed, often losing postural control of their body. Similarly, during parental presence sleep training, the sensitive and attuned responses the baby relies on for coregulation of their immature nervous system are absent.
3. Interrupted social engagement and lack of attunement: Babies are naturally motivated to connect with their primary caregivers and form a secure attachment. For this to happen, it's crucial that parents respond to their babies' needs in a sensitive and timely manner.
During parental presence sleep training techniques, the baby or toddler’s attempts to get comfort are not met and parents often use various techniques to avoid being affected by their child's attempts to connect. This lack of sensitivity can potentially undermine the baby's sense of connection and security.
Research on the long-term effects of sleep training on social and emotional development is limited and methodologically flawed, often focusing on parents' perspectives (4, 5, 6). In contrast, consistent and responsive interactions are well-established as crucial for creating secure attachment and lifelong social and emotional health (7,8)
Behavioural sleep training methods rely on disrupting the dyadic relationship to produce the desired change. While ruptures are part of the attachment process, intentionally and regularly causing them is different from naturally occurring ruptures followed by repair.
For example, some compare a baby crying in a car seat to gentle sleep training to dismiss concerns about these approaches, despite key differences, such as:
(1) The intention. You are not expecting your baby to “self-settle” when you go on a car ride, and you are not putting them in the car seat or responding differently to teach them this skill.
(2) Response in the moment. When your baby is upset in the car, you probably try different techniques in a genuine attempt to comfort your baby. Whether that is singing to them, talking to them, playing music, giving them a toy, or perhaps even pulling over to soothe them if it is safe to.
(3) Repair. What is the first thing you do when you open the back car door to your crying baby? You probably engage in textbook repair behaviour. Innately, we are aware that a rupture has occurred. Unintentionally, yes, but we know that our baby needs our comfort, that we have not been able to meet their needs optimally, and we seek to repair and restore that connection and trust again.
Applying this nuanced understanding of the relationship between responsiveness, attachment, and social emotional development, it is clear behavioural sleep training techniques are, at the very least, not supportive of optimal development.
Whether they cause harm to an individual or the parent-child relationship is likely dependent on a complex range of genetic and environmental factors that are challenging to disentangle or measure.
What is crucial, however, is that parents (and professionals who support them), are well-informed and do not assume that sleep training is “safe and effective” when the evidence doesn’t stack up in support of that.
-Dr. Jessica Guy, Founder Infant Sleep Scientist
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References:
1.) Tronick, E., Als, H., Adamson, L., Wise, S., & Brazelton, T. B. (1978). The infant's response to entrapment between contradictory messages in face-to-face interaction. Journal of the American Academy of Child Psychiatry, 17(1), 1–13. https://doi.org/10.1016/s0002-7138(09)62273-1
2.) Weinberg, M. K., Beeghly, M., Olson, K. L., & Tronick, E. (2008). A Still-face Paradigm for Young Children: 2½ Year-olds' Reactions to Maternal Unavailability during the Still-face. The journal of developmental processes, 3(1), 4–22.
3.) Tronick, E. (2007). The neurobehavioral and social-emotional development of infants and children. WW Norton & Company.
4.) Kahn, M., Barnett, N., & Gradisar, M. (2023). Implementation of Behavioral Interventions for Infant Sleep Problems in Real-World Settings. The Journal of pediatrics, 255, 137–146.e2. https://doi.org/10.1016/j.jpeds.2022.10.038
5.) Price, A. M., Wake, M., Ukoumunne, O. C., & Hiscock, H. (2012). Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial. Pediatrics, 130(4), 643–651. https://doi.org/10.1542/peds.2011-3467
6.) Pattinson, C. L., Edmed, S. L., Smith, S. S., & Douglas, P. S. (2023). Questioning the effectiveness of behavioral sleep interventions for infants. The Journal of pediatrics, 261, 113335. https://doi.org/10.1016/j.jpeds.2023.01.012
7.) Davidov, M., & Grusec, J. E. (2006). Untangling the Links of Parental Responsiveness to Distress and Warmth to Child Outcomes. Child Development, 77(1), 44–58. https://doi.org/10.1111/j.1467-8624.2006.00855.x
8.) Kochanska, G., Aksan, N., & Carlson, J. J. (2005). Temperament, Relationships, and Young Children's Receptive Cooperation With Their Parents. Developmental Psychology, 41(4), 648–660. https://doi.org/10.1037/0012-1649.41.4.648
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