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.
• DIY methods work. Don’t love the rigidity of a particular method? Modify it to suit your own family’s circumstances. Sometimes, a sleep coach can be helpful to come up with modifications that won’t affect the goal of getting baby to sleep through the night, but it’s fine to mix and match until you find a strategy you’re comfortable with. “I don’t think I’ve ever loved and loathed anything as much as I do sleep training. We did it with my son because he was still waking up every three hours at 3.5 months old, and I felt it was more out of habit,” says Margaret, a mom of one. “My husband and I decided that we valued teaching him self-soothing and that in the long run it was worth some short-term effort. I did a ton of research and came up with our own plan—similar to Ferber, but our time limits of letting him fuss weren’t as rigid. It worked, and he’s been a solid sleeper since.”
Sleep experts who support the cry it out approach (as well as most pediatricians) disagree. They say it isn't traumatic for babies to cry alone for short periods of time with frequent check-ins by Mom or Dad – and the end result is a well-rested, happier child. They say no tears sleep strategies may cause babies to be overly dependent on comfort from a parent at bedtime, making it harder for them to learn to soothe themselves to sleep.
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.
Sears emphasizes a nurturing, child-centered approach to sleep and warns parents to be wary of one-size-fits-all sleep training. He recommends patiently helping your baby learn to sleep in his own time. He encourages co-sleeping, rocking and nursing your baby to sleep, and other forms of physical closeness to create positive sleep associations now and healthy sleep habits down the road.
There are many different sleep training methods to choose from, but the most common methods are one of or a variation of one the five we've explained below. You might find that one of these methods sounds like it would be a perfect match for you, OR you might find aspects from each plan that you like. Just like Melissa said, don't feel like you need to stick to a certain method 100%. Make the plan work for you!
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Though many of the parents I see in clinic have put up with terrible sleep for years, sleep training is a safe and effective tool to help babies learn to soothe themselves at night. For this guide, I reviewed the literature on infant sleep. As director of the Pediatric Sleep Center at Yale University, I have extensive experience helping families to address sleep problems. I have also written a book on the topic, which was inspired by sleepless nights with my own children.
"My daughter woke every hour on the hour in her crib. I tried every other method available. Finally, at 7 months, we let her cry it out. It took three to four weeks to complete the sleep training and even though it was the hardest thing I've had to do thus far, it was so worth it. She now sleeps about 10 hours a night and loves her crib. We're both happier and have more energy to play."
"As a last resort, I broke down and gave Ferber a try. It's been two and a half weeks, and I see no real improvement. My daughter goes down faster at night, but the crying breaks my heart. I miss snuggling with her. She still wakes up every 30 to 90 minutes after her first two-hour stretch. She shrieks when it's time for a nap. I broke down and nursed her to sleep for her afternoon nap because I couldn't stand to see her so exhausted."
All sleep-training methods have pros and cons, says Vanessa Vance, a child-sleep consultant in Austin, Texas, so it’s important to suss out which one is best for you. “When I work with a family, we discuss what their needs and goals are. Some families may not want any crying, so a gradual approach may work best,” she says. Here, an overview of some of the most popular sleep-training methods:
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.
It’s okay if you’re not ready. You aren’t missing out on sleep training if you skip it at 4 months: You truly can start sleep training at any age, even in the toddler years, although experts say it’s smart to be aware of developmental milestones and adjust baby’s sleep schedule accordingly. For example, the week baby learns to walk may be tough to implement a sleep-training schedule, and even a sleep-trained baby may see a regression simply because he’s going through such a developmental shift.
While you may have read up on various sleep training methods while pregnant or in the early weeks of baby’s life, it’s a good idea to speak with your pediatrician before you start. For example, if your child is gaining weight slowly or was a preemie, he may not be ready to drop a nighttime feeding and may need a sleep-training schedule that’s adapted to a few middle-of-the-night wake-ups.
"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."
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.
On the advice of a sleep consultant, Welk and her husband took away Greyson’s pacifier, moved his bottle to before his bath (so he wouldn’t associate feeding with going to sleep) and chose to start with a very gentle method (because he was only four months old at the time). Greyson’s dad put him in the crib and stood next to him, patting him until he fell asleep, for about a week. That went well, and then they started leaving him immediately after putting him in the crib without patting him fully to sleep. “For about a month, he would cry or fuss every night for 10 to 15 minutes before falling asleep,” recalls Welk. It was hard to hear her baby cry, but she feels confident that it was for the greater good because they were both well rested and happy during the day. Now, Greyson is 11 months old and a champ sleeper, having weaned himself from night feeds at seven months.