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.”
"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."
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.
"I have a 3-month-old who I rock at night. He falls asleep very quickly (much quicker than if I leave him in his crib). If he wakes in the middle of the night, we go to him and comfort him. We don't take him out – we just help soothe him. Why make him feel lonely and abandoned? I have no problem losing a little sleep if it means that he feels like we will be there for him."
Once you launch your plan, stick to it. Parents who've been through sleep training agree that consistency is the key. Unless you realize that your child simply isn't physically or emotionally ready and you decide to put the program on hold for a while, follow through with it for a couple of weeks. When your baby wakes you up at 2 a.m., you may be tempted to give in and hold or rock him, but if you do, your hard work will be wasted and you'll have to start over from square one.
This is a very gentle, no-tears/no-cry (or very little cry) method of sleep coaching where you “fade it out” (FIO). With the Fading method, you continue to help your baby fall asleep (by rocking or feeding to sleep, for instance), but over time, you gradually do less and less of the ‘work’ to put your baby to sleep, and your baby does more and more. For instance, if you normally rock your baby completely to sleep, you may shorten the amount of time you rock each night until you are rocking for only a few minutes only as a part of the bedtime routine. This method requires quite a bit of patience on the parent’s part, in some cases, but it’s great for families who want to minimize crying as much as possible.
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.
"By the time your baby is 3 months old and has developed a fairly predictable 24-hour pattern, it becomes more important for you to provide increasingly consistent structure. If you do your best to establish a reasonable and consistent daily routine and keep to it as much as possible, then it is likely that your child will continue to develop good patterns. If instead you allow the times of your child's feedings, playtimes, baths, and other activities to change constantly, chances are his sleep will become irregular as well."
Simply put, sleep training—also called sleep teaching or sleep learning—is the process of helping your infant learn how to fall asleep and stay asleep. It’s also become a pretty controversial topic, with experts and parents speaking for or against various sleep-training techniques. “It’s like talking politics,” says TJ Gold, MD, a pediatrician at Tribeca Pediatrics in New York City. “But there’s no one right way to get your child to sleep through the night. There are a lot of different ways.”
It’s definitions like this that have given the general term “sleep training” a bit of a bad rep. There are certain methods of sleep training, such as “Cry-It-Out” or the Ferber method, that might make some parents wearisome of sleep training as a whole. However, sleep training does not necessarily equal cry it out. There are many different sleep training methods and practices behind sleep training, including gentle sleep training—the most important part of sleep training is finding the method that works best for you and your baby!
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.
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.
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.
"A young child cannot yet understand what is best for him, and he may cry if he does not get what he wants," Ferber writes. "If he wanted to play with a sharp knife, you would not give it to him no matter how hard he cried, and you would not feel guilty or worry about psychological consequences. Poor sleep patterns are also harmful for your child and it is your job to correct them."
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.
As we previously mentioned, introducing healthy sleep habits and routines as early as possible will help significantly during sleep training. If you haven’t already, try to establish a bedtime routine before you start sleep training baby — this will encourage healthy baby sleep patterns. This should be a series of soothing activities that help to calm your baby and prepare them for sleep - things like swaddling, bathing, and rocking usually work well, but every family’s routine will look different.
"When my son was younger, we often 'walked him to sleep' by putting him in a sling. Now that he's older, reading him a book, nursing, and cuddling does it. Also, we stopped fighting the earlier bedtime. Since he sleeps with us, he snuggles down with us, and it's become a habit that when the lights go out and Mommy and Daddy snuggle with him, it's bedtime. We rarely struggle with sleeping unless he's having bad teething pain."
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.
The age of your baby might determine what kind of sleep-training method you choose, though. You could try a gentle shush-pat technique with a five-month-old, but you’ll likely have to leave a one-year-old in the crib as they protest (cry or scream) about the new bedtime arrangement. Don’t attempt a formal sleep-training method before four months, until your baby is able to go longer in between feeds and their circadian rhythm starts to develop. (Many babies this age still feed in the night—contrary to popular thinking, sleep training isn’t synonymous with night weaning.) Dickinson says that many four-month-old babies are biologically able to go through the night without a feed, but that doesn’t mean you shouldn’t respond and feed them if other methods of calming them aren’t working. Since every situation is different, we recommend checking with your doctor before withholding your baby’s night-time feeds.