In clinic, I help parents with their children’s sleep problems. But in my own home, I found it challenging to apply the techniques I recommended to others. What seems obvious in a brightly-lit exam room is harder to follow at 2 a.m. Like many pediatricians do with their own children, I elected to try extinction sleep training, which involves letting a child cry in order to learn to soothe himself to sleep on his own. Night one was relatively easy, but night two left my wife in tears and me feeling like a heel. Things improved on night three, and our son scarcely cried on night four. By the end of the week, he was sleeping through the night again.
Crying isn't the goal of this sleep training method, but advocates say it's often an inevitable side effect as your baby adjusts to sleeping on his own. They say the short-term pain of a few tears is far outweighed by the long-term advantages: A child who goes to sleep easily and happily on his own, and parents who can count on a good night's rest.
I have a 5 month old girl who has been inconsolable when it’s has come to going to sleep, whether it be nap time or bedtime. Up until 6 weeks ago she was very good at self soothing, where I’d put her down drowsy/almost asleep, put on some soothing music and she’d toss and turn for a few minutes and fall asleep. Initially I thought it was the famous 4 month sleep regression but now it’s starting to get out of hand. Just to note, she used to sleep about 30-45 minutes and occasionally longer. She seemed happy and content when she woke so I assumed she had had enough rest, although I would’ve preferred longer naps. Also to note, She currently sleeps anything up to 8 hours at night and wakes for a feed around 3-5am.
With the fading technique, continue with whatever method you were using to help your baby fall asleep (such as rocking or nursing), but decrease the amount of time you spend doing it until, in theory, you don’t have to do it at all. This is a great technique for minimizing crying, but unfortunately, many parents find it difficult to sustain. “There has to be an end in sight,” explains Mitelman. “For example, we’ll meet this need for five to seven days and then we’ll pull back a little bit.” But if you’re willing to stick to the plan and get your baby to the end goal of going to bed without your assistance, Mitelman says it’s worth a try. “Whichever way the child can get to sleep independently is fine because that’s the key ingredient to sleeping through the night.”
Exhausted parents may be eager to get training underway—so how do you know when to start sleep training? “Most infants are ready for some sort of sleep training at 4 to 6 months,” says Lauren Kupersmith, MD, a clinical instructor at the department of pediatrics at NYU Langone Medical Center. “While some pediatricians adhere to the guidelines that infants are ready to be sleep trained when they achieve a particular weight, I feel it’s much more appropriate to wait until they are developmentally ready to self-soothe, at about 4 months old.”
"I have a 6-month-old who has refused to sleep longer than 30 to 90 minutes day or night since he was born! I've tried everything out there except CIO. He's strictly breastfed and relies on that or rocking to get to sleep. He doesn't know how to soothe himself to sleep, and he naps for only 15 minutes. I'm severely sleep deprived. I don't have the heart for CIO, but I think I'll try the revised method where you pat him down and reassure him lovingly while allowing him the opportunity to comfort himself. He's been co-sleeping since day one, and it's going to be tough, but I'm at my wits' end and cannot function."
Some experts suggest techniques that are slightly different than these methods. Perhaps the best known is pediatrician Harvey Karp, author of The Happiest Baby on the Block. His method suggests a very specific routine involving the so-called five S's: swaddling, the side or stomach position (for calming your baby, not for sleeping), shushing, swinging, and sucking.
"My 4-and-a-half-month-old will only sleep through the night if we do everything the experts say not to do. She must be nursed to sleep unless we want to see her turn purple and cry for 45 minutes or more. She's like a wind-up doll when she starts and never settles until she's comforted, and she's been that way from the beginning. It really became a matter of, "Do we want to sleep, or do we want to do what the books say?" If she's comforted and put down sleeping, she sleeps eight to 10 hours. To all you parents out there who have a baby like mine, do not despair – just do what works for you."
Healthy sleep is so important for your baby AND you! If your baby isn’t sleeping, chances are you aren’t either. Sleep deprivation in children has been linked to obesity, behavioral problems, learning issues, and more later on in life. Sleep deprivation in adults can lead to similar issues, and has even been shown to play a role in Postpartum Anxiety and even depression in parents. Teaching and establishing healthy sleep habits right from the start will make sleep training easier and, more importantly, help keep you and your baby well-rested!
A consistent bedtime routine is the cornerstone of good sleep for children. It should also be a time for parents and babies to bond. Bedtime routines need not be complex. Bathe your child (if you like), change her into pajamas, read her a story, sing a song and feed or soothe her, then put her in her crib. The key is consistency — performing the same activities, in the same sequence, at the same time each evening.
Finding the ideal bedtime can be tricky in the first few months of life. Infants who take a late afternoon nap (say, 4 to 6 p.m.) may go to bed as late as 9 or 10 p.m. A good rule of thumb is that your baby will probably sleep three to four hours after his last nap ends, but you may need to experiment, adjusting your baby’s nap and bedtime schedule to figure out what works best.
If your baby is growing poorly or is difficult to console, you should talk to your child’s pediatrician to ensure that your child’s sleeping difficulties have no medical cause. Likewise, if you are struggling with depression, it is critical to discuss this with your child’s pediatrician as well as your own physician. Poor sleep can prolong postpartum depression in mothers.