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.
In the first several weeks of life, babies are hungry at night, leading to an apparent reversal of day and night and erratic sleep patterns. Fortunately, this usually resolves by about 3 weeks of age, after which your child settles into a three- or four-hour cycle, typically following a pattern of waking, feeding and sleeping. At this point, exposing your baby to natural light during the day can help encourage longer periods of daytime wakefulness and more sleep at night.
For my wife and me, those early days passed in a blur. Nights seemed endless, and no government ordinance was about to come along to shorten our shifts. When he was around 3 months old, our son started sleeping for longer periods and our relief was profound. But after about a month, the baby started waking up at night again. After one nightly waking became two, then three and four, I realized it was time to sleep train our son.
There is no right or wrong method of sleep training; it all comes down to your unique baby and your unique parenting style. What works well for some babies does not work well for others, so do not be surprised if the techniques your friends or family members recommend don’t work the same way for your baby. The bottom line is to choose a technique that you feel comfortable with, and that you think will work well with your baby’s temperament.
Also on the far end of the cry it out spectrum is the Baby Wise approach by pediatrician Robert Bucknam and co-author Gary Ezzo. In their book On Becoming Baby Wise, they advise against feeding babies on demand around the clock and instead advocate a parent-led feeding, wake, and sleep schedule. Their method involves following a strict nap and sleep schedule and putting your baby down awake so she can learn to soothe herself to sleep. This means there will be some crying, especially at first, as your baby adjusts to your schedule.
Pantley offers a gentle and gradual approach to all aspects of sleep, customized to your baby's needs. She recommends rocking and feeding your baby to the point of drowsiness before putting him down – and responding immediately if he cries. Parents are urged to keep sleep logs, nap logs, and night-waking logs. Pantley also describes a six-phase process for teaching a child to sleep in a crib.
“The biggest reason why the solutions that work for one parent don’t work for another is simple. They’re not dealing with the same baby...sleep is a complicated issue and there’s very rarely one single thing that can remedy the situation overnight. A professional sleep consultant has the experience and training to recognize which problems result in specific symptoms, and can work with you to develop a personalized plan for your child that addresses those individual issues."
"My 5-month-old was waking every two hours at night. I was so tired I wanted to die. I finally caved in, put in earplugs, and let him cry it out – which he did, all night! But then, something amazing happened the next night: He slept a full 12 hours and awoke rosy and cheerful. It's been that way ever since, and he's even a better napper now. I know that it is hard to listen to your precious little one cry, but a sleep-deprived, miserable mom and baby is a terrible thing too."
Proponents of these sleep training methods say it's okay for your child to cry when you put him to bed and leave the room, although they don't advocate letting a baby cry indefinitely. Typically, these methods suggest putting your baby to bed when he's still awake and allowing short periods of crying punctuated by comforting (but not picking up) your child.
Typically, formula-fed infants who are growing well no longer need to feed at night by 6 months. Breastfed infants may continue a little bit longer, but typically no longer feed at night by 9 months. If your baby has been falling asleep independently at bedtime for a month but still waking to feed, you may want to consider weaning at night. Be aware that if you are breastfeeding, this may lead to a reduction in milk supply.
Prepare yourself for a few difficult nights. Hearing your baby cry can be excruciating, as every parent knows. During the waiting periods, set a timer and go to a different part of the house, or turn on some music, so you don't have to hear every whimper. As one BabyCenter parent says, "The first week could be rough. Try to relax and know that when it's all over, everyone in your household is going to sleep more easily and happily."
Not to be confused with the bedtime-routine fading technique described above, bedtime-hour fading involves putting your baby into the crib at the time they usually end up dozing off, and making that their new bedtime for a couple of nights, and then gradually moving it to an earlier time. For example, say you always put your baby down at for the night at 7:30 p.m., but they tend to fuss or cry in the crib for 20 minutes or more, until they finally nod off around eight. This means 7:50 to 8 p.m. is actually their “natural bedtime,” even though you’d like it to be earlier. To figure out when your baby naturally falls asleep, keep a diary for a few nights to track when they finally settle for the night. (Using a video monitor can help with this.) A few nights later, move the whole routine 15 minutes earlier. Continue moving the bedtime earlier by 15 minutes each night (if needed) until your baby has shifted their old habits to nod off at the desired time instead of the later one.