Sleep Training

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Baby Sleeping at Night

Photo By Seth Baur

“Are they sleeping thru the night?”

This is the age old question that is asked of new parents by family, friends, and healthcare providers alike.  Up to 45% of mothers reported infant sleep problems over the age of 6 months.   So what can you do about it?   This is usually when the conversation turns to sleep training.  How do you do it?  Will it work?  Is it ok to put my child (and myself) thru it?  Will it do any long term damage to let them “cry it out”?

Sleep training has a lot of different names:  “gradual extinction”, “controlled comforting”, “adult fading” aka “camping out”, “crying it out”, and the “Ferber method” or “Ferberizing” just to name a few.  Although, all with different names they share similar themes, which is gradually teaching a child to put themselves to sleep without needing a parent to be there or do something (rock, nurse, sleep in bed with).

That being said, sleep training doesn’t HAVE to be done.  If your child doesn’t sleep thru the night and you have to go in and do whatever you do to get them back to sleep … that is ok.  There are no studies that show that NOT sleep training will do any harm (and on the flip side, if you DO sleep train, this will NOT cause harm either).  Most kids will eventually “get it” and be able to sleep without the training method, but obviously, it can take much longer.  An Australian study entitled, “Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep Intervention:  Randomized Trial” found that sleep training had no long-lasting effects (either good or bad) in children or their parents.   Therefore, deciding to sleep train is a personal decision based on each family and their wants/needs.

The American Academy of Sleep Medicine classified behavioral techniques as “standard” practice for managing infant sleep issues.  And for the purpose of this blog, I am going to discuss the Ferber method, based off of Dr. Richard Ferber’s book “Solve Your Child’s Sleep Problems”.  It is my favorite and the one I’m most familiar with as I have recommended it to countless parents, friends, and used it with my own two children.   Ferber says you can sleep train starting as early as 4 months of age.  That being said, I do think that 4 months is too young.  My personal opinion is “around” 6 months of age would be the earliest age to sleep train.

The main idea behind the Ferber method is that infants and children who have trouble sleeping thru the night, have usually created a nighttime association with going to sleep that they then NEED in order to fall asleep.  An example of this is the parent who has to rock their 9 month old to sleep every night.  They read a book, cuddle, and rock until the baby is asleep and then carefully, treating the child like a live bomb, put the child in the crib and tip toe out of the room like a ninja.  The child then wakes hours later and won’t go back to sleep until the parent comes in and rocks them to sleep again (as it happened in the beginning of the night).   This baby has a sleep association with rocking.  They learn that in order to fall asleep, they need that parent to rock them.  So, when the baby wakes later on in the night (and this can happen up to every 90 minutes based on their natural sleep cycle), they panic when they find themselves not as they remember falling asleep (being rocked), and cry out to get the parent back to the room to help them fall asleep as they remember.  THIS MAKES SENSE.  Ferber uses this example and it’s genius:  If you were to fall asleep with your pillow under your head, but then wake up in the middle of the night to find that your pillow is gone, wouldn’t you freak out?  What happened to my pillow?  Did someone come in and take my pillow while I was sleeping?  And you probably would have trouble falling asleep until you figured out what on earth happened to your pillow and got it back.  It’s the same concept with a baby.    So rule #1– put the child down drowsy, but awake.  If you put the baby to bed while they’re awake, it makes it hard for them to associate anything with falling asleep.

Now this also leads into the topic of bedtime routine.  This is very important.  Rule #2 – Children NEED routine and boundaries.  This will help their little minds realize that it’s getting close to bedtime and they will need to go to sleep.  So a good bedtime routine could be bath, jammies, a book or two, some cuddles and some rocking (as long as not rocking to sleep), and then a little statement like “night, night, time for bed!”  The child then goes into the crib and falls asleep.  Sounds good right?  Well it won’t exactly go like that the first few nights of sleep training – but you will eventually get there!

Once you’ve decided that you want to sleep train, choose a time that works best for your family.  Doing it around the time of an illness, vacation, or busy time of year may not be the best time.  In a typical family with both parents working full time, Monday thru Thursday night may not be the best time.  Start on a Friday if possible and then at least you have the weekend to muddle thru it.  Once you’ve decided to start the sleep training process, make sure you set up your bedtime routine, and then put the baby in his crib AWAKE.  If he goes right to sleep without problems, great!  If he starts crying –  stay strong, tell him it’s time for sleep, put him in his crib, and walk away.  This is the hardest part emotionally.  Turning your back on your child when they are crying will pull at your heartstrings.  But I promise, if you stick to this method, it will get better!  Then you start a timer.  The first night the timer intervals are 3 minutes, 5 minutes, 10 minutes, and then every 10 minutes until he falls asleep on his own.  So, after 3 minutes, if he is still up and crying, go back into the room.   But this is the important part – Rule #3 – when you go back into the room, DO NOT PICK UP THE BABY.  You can go in and tell him, “everything is fine, mommy (or daddy) is here, but it’s time for sleep and you need to go to bed.”  You can rub his back a little bit, talk a little bit, but keep it simple and quick.  Then you will leave the room.  Again, this is going to be tough.  But be strong.  It will work.  Wait 5 minutes and repeat the same thing you did when you initially went in.  And to drive home the point, may I repeat, DO NOT PICK UP THE BABY.  Wait 10 minutes, and then do 10-minute intervals for the rest of the night til he figures it out, gives up, and goes to sleep.  If he falls asleep but then wakes up a few hours later in the middle of the night, you start the intervals all over again – 3 minutes, 5 minutes, 10 minutes.   Each day will bring longer and longer intervals.  Day 2 of sleep training is intervals of 5, 10, 12, 12 minutes, Day 3 is 10, 12, 15, 15 minutes, Day 4 is 12, 15, 17, 17 minutes, Day 5 is 15, 17, 20, 20 minutes, Day 6 is 17, 20, 25, 25 minutes, Day 7 is 20, 25, 30, 30 minutes.

I love this method because of the message that it’s sending to the child.  Mom (or dad) are here, and we will come in and reassure you that we haven’t abandoned you, but we are still going to leave and you are still going to have to figure this out on your own, without us.  The intervals are way better than what a lot of people imagine the “cry it out” method to be – just letting your kid cry alone in their room for hours on end without comforting them.  Now that being said, some parents may end up doing the intervals for a few hours, but most kids figure it out after a handful of times.  Kids are smart, and when they see a trend/routine happening, they accept it.  The most important reason why I love this method is because it works.  If parents stay consistent and don’t give in, most kids will go thru 2-4 bad nights, and then will successfully sleep thru the night.  For some, it can take up to a week (but this is rare).

Now this may not be a forever fix.  Your child may get sick and need you in the middle of the night for a few nights and then when they are better, the old, bad habits start up again.  This is fine.  Sometimes you have to re-train in the future based on what’s going on.  But most kids who have to be “re-trained” will “get it” a lot sooner than the first time.

I strongly encourage buying Ferber’s book to read about special situations as well – using the method in toddlers and older children, mulitples, co-sleeping, nap times, special considerations when nursing, and when it’s not ok to sleep train (i.e. younger than 4 months of age, certain medical conditions).   He also describes countless amounts of examples and their outcomes.

More than anything, I love this method because I believe it abides by a good general rule that is a common vein in parenting.  Limit setting but in a loving manner.  In fact, the authors of the Australian study said it best, “…teaching parents to regulate their children’s sleep behavior is a form of limit setting that, combined with parental warmth, constitutes the optimal, authoritative, parenting style for child outcomes.”

So good luck, be strong, and happy sleeping!!!

References:

  1. Price, Anna et al.  (October 2012).  Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep Intervention:  Randomized Trial.  Pediatrics, 130(4), 643-651.  doi:  10.1542/peds.2011-3467
  2. Richard Ferber, MD.  (May 23, 2006).  Solve Your Child’s Sleep Problems.  New York.  Simon & Schuster.