No one likes to talk about sudden infant death syndrome (SIDS); it is a terrifying topic. SIDS is defined as the sudden death of an infant, which remains unexplained after a thorough investigation. These deaths occur in the first year of life, with the highest risk occurring between 2 and 6 months of age. Fortunately, these deaths are becoming less common, thanks in large part to the early ’90s Back to Sleep campaign, which urged parents to place infants to sleep on their backs. Suffocation is also a major risk for infants if they do not sleep in a safe sleeping environment.
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.”
There are various schools of thought on sleep training. Some sleep-training methods fall under the umbrella of “gentle sleep training,” which generally means you’re still going to pick up, rock and soothe baby if she cries. Other methods, often under the “extinction” label, advise parents to let baby self-soothe for the entire night and not open the door until morning. Neither of these methods are right or wrong—it all depends on what works best for you and your family.
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.
Honestly, in our personalized consultations, we try to avoid this method as much as possible. If you are going to use cry it out, we recommend your baby is at least 6 months old, but preferably 10 months or older, when we expect almost all babies to be able to get through the night without a feeding. It is not for the faint at heart. We find that laying a foundation in the beginning with other strategies and techniques can reduce crying even if this method is used in the end, however.
One common misconception about sleep training babies (also called sleep coaching) is that there’s only one way to do it. But this could not be further from the truth! In reality, there are a number of ways many parents can work to help their babies develop healthy sleep habits and stop waking up in the middle of the night or taking short naps. Some methods involve crying, but others involve little to no tears and are very gentle.
“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."
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As your baby gets older and their sleep needs change, make sure that you’re adjusting wake times, naps and bedtimes accordingly to help them continue to easily fall asleep and stay asleep. Some parents think of sleep training as a “one-and-done” endeavour: You endure a lot of crying for a few days and your prize is a perfect sleeper. But it’s really a lifestyle change—once your child has the skills to fall asleep, they’ll still need routines, consistency and help adapting when life throws curveballs, like starting daycare, the arrival of a new sibling or going on a trip (where they may have to sleep in a different space or crib). Colds and illnesses, as well as time changes, can also throw a wrench in your perfect schedule. The trick here is to get back on track as soon as possible. If you start allowing or enabling the old, bad habits and sleep associations, it will take longer to return to the regular routine.
"My first daughter was sleeping through the night (10 p.m. to 9 a.m.) by 6 months. We had a complete bedtime routine: a bath, a book, a bottle, then to bed, a little music in the crib, and asleep in 10 minutes. It was wonderful, but that scenario didn't work for my second daughter and hasn't worked for my son, so I've tried different things for each of them. Sometimes a plan doesn't work. Listen to your baby – he or she will tell you what you need to know."
This sleep training technique usually involves quite a bit of crying on your baby’s part for the first couple of nights but some say it tends to be less crying, overall, since sleep training is ‘done’ faster (for many, but not all, people). The way it works is simple – you do your bedtime routine, put your baby to bed awake, and then leave the room without returning for checks. If your baby cries, you are not supposed to go in to check on her; instead, you let her ‘cry it out’ on her own. The thinking here is that if you allow your baby to cry for a period of time, but then go in and ‘rescue’ her, you have all but guaranteed that she will cry for that amount of time the next night because she will expect you to come and “rescue” her again.
This is another gentler technique. The PUPD method works just the way it sounds: when it’s time to sleep, and your baby is fussing or crying in his crib or bassinet, you pick him up and comfort him until he’s calm and drowsy. Then, you put him back in his crib to sleep, repeating this cycle until your baby is finally asleep. PUPD is another method that requires quite a bit of patience, depending on your baby, and it won’t work for every baby; some babies find being picked up and put down so often over-stimulating, and they gradually become frustrated and worked up, instead of relaxed.
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.
Nicole Johnson is the founder and lead sleep consultant of The Baby Sleep Site®. Since she began in 2008, and with the help of her team of sleep consultants, she has helped over 40,000 families improve their sleep. She has also held a position on the board of the International Association of Child Sleep Consultants (IACSC) since 2015. Millions of visitors land on The Baby Sleep Site each year, and Nicole and her team are here to find solutions for your family’s sleep problems that will match your baby's temperament and your parenting style.
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.”
It’s difficult if not impossible to sleep train if you share a bed with your child. There’s good evidence that bed sharing is associated with sleep difficulties in infancy and beyond. One survey of more than 50,000 Norwegian families showed that bed sharing was associated with more frequent night awakenings at both 6 and 18 months. Switching your child to sleeping independently for a week or so prior to sleep training can be helpful as you can soothe your child to sleep in the new sleeping environment first.
The idea behind extinction (or full extinction to differentiate it from graduated extinction) is that you want to extinguish the behaviour (crying) by not responding to it. As with the check-and-console method, go through your bedtime routine, put them in their crib awake, say good night and walk out. This is certainly the most controversial sleep-training method, and even experts disagree on what you should do next—it all depends on what stage your baby is at developmentally, as well as what works for the parents.