The final set of recommendations for sleep-training methods that I'll summarize in this series of posts about specific techniques is kind of hard to paraphrase in some pithy heading. It's not really a method per se, but a general philosophy or approach, I guess you'd call it. What I've labeled here as "sleep routines and scheduling" encompasses a bunch of general pointers for making kids more amenable to sleeping longer and better. This approach to sleep training involves creating good sleep habits from a very young age. It generally focuses on putting babies on sleeping and feeding schedules that promote children’s capacity to sleep through the night and nap regularly. Perhaps the best-known manual for this approach is Weissbluth’s Healthy Sleep Habits, Happy Child. But in truth, most grandmothers with lots of experience child rearing have given the same advice for decades, probably centuries. 

The rationale for this approach is that babies and toddlers have natural, neurologically-based sleep rhythms that should be respected. It is the parents’ job to structure the child’s day and night such that sleep is optimized. The goal is to get babies and toddlers to sleep for age-appropriate durations throughout the day and night by watching the baby’s cues and following a handful of tips. There are about five main tips that can help children fall into healthy sleep habits.  Some may be counterintuitive, but they are generally all “tried and true” techniques.

(1)    Sleep begets sleep. The more a child naps during the day, the more likely it is that she will sleep longer and wake less frequently during the night.
(2)    If a child is waking up frequently during the night or waking up far too early, put the child to sleep earlier in the night (rather than the more intuitive later bedtime).
(3)    Do not allow babies younger than 4 months or so to stay awake for more than 1-2 hours at a time during the day.
(4)    Watch for tell-tale signs of fatigue and put your baby down for a nap or for bedtime as soon as you see these signs. The sleepy signs include the baby rubbing her eyes, yawning, batting her ears, whining or fussing, and so on.
(5)    Use the same bedtime routine every night (often including bath, bottle, breastfeeding, stories, rocking, and so on).

Another tip comes from a number of online sources, the origins of which are difficult to pinpoint. I came upon it on the parenting advice blog, AskMoxie. It’s called the 2-3-4 nap rule and an astonishing number of babies between the ages of about 6 and 18 months end up conforming to this rule eventually. Keeping it in mind was enormously helpful for scheduling our boys’ naps. The idea is that 2 hours after the baby wakes up in the morning, put him down for his first nap (whether you see the signs of fatigue or not). Then, 3 hours after he wakes from that first nap, put him down for his second nap. Then, 4 hours after he wakes from that second nap, put him down for the night. So, for babies who sleep during the night from approximately 7 PM until 7 AM (hahahahahahah!  Most of you wouln't be reading this silly blog if your kids were sleeping through on that schedule, but let's dare to dream, shall we?) the sleep and wake periods fall out roughly as follows:

7:00 AM – Wake for the day
9:00 AM – First nap
10:00 AM – Wake from first nap
1:00 PM – Second nap
3:00 PM – Wake from second nap
7:00 PM – Bedtime

Generally, after the child is around 12-18 months, she drops the first morning nap and the afternoon nap can get a little longer and perhaps start a little earlier.

There are a whole lot more tips and tricks for maximizing children's nap times and helping them sleep better during the night that can be categorized under this general rubric of sleep routines and schedules.  What are/were your favourite tips? What seemed to work for EVERYONE else's kids but never worked for your little one? What do you wish you were told about children's sleep schedules and routines that you know now?  

In Part I and Part II of this series, we discussed some of the more gentle approaches to sleep training; those that attempt to minimize or altogether avoid any crying of distress. There have been some great comments about the parts that did and didn't work for various readers. With this last post about this set of techniques, I just wanted to pull together a summary of some of the advantages and possible disadvantages of these methods; most of them have been mentioned by other readers as well, with some great examples to boot.

So, starting with some of the pros: First and foremost, many parents report experiencing less emotional distress, and less guilt in particular, when implementing these methods as compared to the extinction methods. Parents feel like they're being sensitive to their baby's needs and protecting them from undue stress and turmoil. Second, for parents with a great deal of patience and support, these methods do prove to be effective. For some kids, these gentle methods are just as effective as the more cut-and-dry CIO or Ferberizing. Third, the more gentle methods may be more likely to be consistently implemented since they cause less distress for the whole family. This is hugely important because, as we've discussed several times before, consistency may be one of the most important factors responsible for successful sleep training.

But of course there are some limitations or cons to these approaches as well: First, almost all the sleep experts agree that these methods require a lot more time, commitment and patience on the part of the parent than the more “quick fixes” of extinction or gradual extinction. As a result, severely sleep-deprived parents may give up sooner than it actually takes to get the promised results. Second, these methods often require a great deal of the mother’s own loving attention and time; resources that the mother is usually sorely lacking by the time she has decided to sleep-train her child. The father, although encouraged to participate in some of these approaches, is still regarded as more of a support figure.  Finally, a great number of parents report that many of these methods end up encouraging more dependence on the parent during bedtime and naps, rather than discouraging that dependence. Because there is a lot more demand for the parent to actually be present during sleep transitions, albeit less so over days and weeks, some children begin to feel more frustrated, rather than less, at their mother’s unwillingness to soothe them in a consistent manner.

As with all the methods we've discussed, a whole lot will depend on the emotional resources of the parents and the temperament of the child. And last thoughts or considerations that you'd like to add to this list before we move on?

BTW, I know I said that I'd let you in on the plans for the blog last week and I never got to it. In part, it's because I'm talking to some folks that will be able to let me know what will be possible and impossible for me to manage on this site in terms of some capacities I'd like to build onto the blog (mostly to do with adding chat functions, video presentations, discussion forums and the like). Before I start sharing all my high hopes, I want to make sure I can deliver, so stay tuned!

As some of the commenters mentioned on the first part of this series on "no cry" sleeping-training techniques, there are lots of other approaches that I haven't yet described. I'll finish off these descriptions in this post and throw out a few pros and cons in the last part.

Elizabeth Pantley’s “No-cry” solutions are perhaps some of the best-known approaches geared towards minimizing children’s distress. Her approach is meant as an alternative to the cry-it-out methods. In addition to her other common-sense suggestions, including creating a relaxing atmosphere (e.g., dim lighting), providing a bedtime ritual and so on, Pantley offers a number of additional tips. Hers is not a sleep-training method per se, but more like a set of helpful soothing strategies. Her suggestions are aimed at transitioning children’s bedtime and napping habits very gradually. For example, if a parent wants to stop nursing her baby to sleep, Pantley suggests substituting the nursing for gentle rocking, then the rocking for patting in the crib and then finally moving towards putting the child down on her own and seeing if she’ll self-soothe without the parent’s help. Other examples of such techniques include a form of “gradual extinction” but at a much slower pace than Ferber’s approach. To get a child to fall asleep on his own, in his crib, one gentle method might be to sit close to the child with a hand on her belly at first and stay that way until she falls asleep. The next night, the parent might move the chair back a meter or so and not touch the child. The next night, the parent may inch the chair back even further until eventually the parent is outside the child’s room and the child can fall asleep on her own. 

Another very popular “gentle” sleep-training method comes from Hogg’s The Baby Whisperer Solves All Your Problems. This technique, often referred to as the “shush/pat” method is meant to be a soothing, gradual way to help your child learn to fall asleep on his own. The basic steps are as follows:
(1)    Make the room in which the baby will be sleeping as dark as possible.
(2)    Swaddle the baby and lay him on his side in his crib so that you have access to his back (if the baby is old enough to sleep on his stomach, then you can lay him that way instead).
(3)    Pat the baby on the back slowly and rhythmically while making a shushing sound just over his ear (not directly into it). A loud shushing sound is meant to emulate the sounds that the baby was exposed to in the womb.
(4)    If the baby starts crying and is inconsolable with the shushing and patting, pick him up and continue the shushing and patting.
(5)    When he calms down completely, lay him back down in the crib and continue the shushing and patting for a few minutes until he starts becoming very sleepy, then slow down the process.
(6)    Don’t stop touching him and shushing him until he’s deeply asleep.
(7)    Once you’ve done this for several days or weeks, the idea is that your baby will get used to falling asleep faster and faster without being picked up and will eventually not need your support at all.

I've heard some magical, miraculous stories of how well these methods have worked and pure all-out horror tales. Again, it must have a lot to do with individual babies' needs and temperaments and the personalities and philosophies of the parents. Has anyone tried either of these approaches specifically? For better or worst?

We've talked about Ferberizing or gradual extinction methods, now let's go to the other side of the spectrum and discuss some of the techniques that attempt to avoid any distress or crying on the part of the baby. The following excerpt is from our book and summarizes some of these approaches and their general aims:

"There are a set of methods that are often referred to as “No-cry” solutions, from Pantley’s popular book by the same name, The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night. The methods under the rubric of “attachment parenting” would also be classified as gentle methods, including manuals such as Sears’ Nighttime Parenting and McKenna’s Sleeping with your Baby: A Parent’s Guide to Co-Sleeping.  What these approaches have in common is a commitment to minimizing or altogether eliminating any distress at all by the baby when she is falling asleep for naps or bedtime.  The Sears and McKenna approaches are particularly focused on encouraging co-sleeping practices. The former author is well-recognized for encouraging parents to accept the natural, often difficult sleep patterns that many babies and toddlers fall into in the first 2 years of life. Sears stresses that parents can’t “force” their children to sleep longer stretches. Sears and other attachment parenting gurus suggest that sleep training itself is not a healthy, productive way to promote healthy sleep habits. Instead, parents should learn to structure their lives such that their own sleep is maximized; but to be realistic about this structure and understand that sleep deprivation in the first few years of parenting is simply a part of parenting. 

Proponents of gentle or no-cry methods of putting your child to sleep argue that babies and toddlers have been kept as close as possible to their mother’s bodies for centuries and across many different cultures. Practices such as co-sleeping and “wearing” your baby are critical practices that promote a healthy bond between the mother and child, a bond necessary for the optimal development of the child. These authors go on to argue that mothers who systematically ignore their babies’ cries during the night are fostering deep anxieties and insecurities in their children that will leave emotional scars for life. Some of the most common sleep strategies that are often touted as “attachment” oriented include:
(1)    Sleep with your child in the same bed (co-sleep).
(2)    “Wear” your baby (in a sling or other type of baby carrier) for as long as possible throughout the day and at night if necessary.
(3)    Nurse on demand and particularly before naptimes and bedtimes to help the baby fall asleep peacefully. 
(4)    Fathers can bounce, rock or cuddle the baby into a deep sleep.
(5)    If you leave the baby alone in a crib or bassinet, leave behind an article of clothing or cloth with the baby that has the mother’s scent on it.
(6)    Respond as quickly as possible to your child’s cries at bedtime and throughout the night (in other words, try to not let your child cry for any length of time before falling asleep or upon waking during the night).

Pantley’s “No-cry” solutions are also geared towards minimizing children’s distress. Her approach is meant as an alternative to the cry-it-out methods. In addition to her other common-sense suggestions, including creating a relaxing atmosphere (e.g., dim lighting), providing a bedtime ritual and so on, Pantley offers a number of additional tips. Hers is not a sleep-training method per se, but more like a set of helpful soothing strategies. Her suggestions are aimed at transitioning children’s bedtime and napping habits very gradually. For example, if a parent wants to stop nursing her baby to sleep, Pantley suggests substituting the nursing for gentle rocking, then the rocking for patting in the crib and then finally moving towards putting the child down on her own and seeing if she’ll self-soothe without the parent’s help. Other examples of such techniques include a form of “gradual extinction” but at a much slower pace than Ferber’s approach. To get a child to fall asleep on his own, in his crib, one gentle method might be to sit close to the child with a hand on her belly at first and stay that way until she falls asleep. The next night, the parent might move the chair back a meter or so and not touch the child. The next night, the parent may inch the chair back even further until eventually the parent is outside the child’s room and the child can fall asleep on her own."

For those of your who have tried one or a set of these methods, how did it go for you? What were some of the challenges you faced? At what age did is seem to work or not work for your family?  Why would you recommend these types of methods or why would you advise others to steer clear of them? Remember, I firmly believe that different strategies will work for different children, depending on a whole host of factors. So it would be particularly useful for parents still considering the many options of sleep-training methods to hear from parents about their own philosophies, their child's temperament, their child's age and all the other issues that may need to be considered to make gentle or "no cry" methods work.

As I mentioned in the first part of these posts on "ferberizing" or "gradual extinction," I'm not recommending this sleep-training method over any others. Instead, I think it's important for parents to understand their options and make their own choices based on whatever set of issues are important to them. Despite the heft of the book that describes Ferber's method, it isn't very complex. You can see from the comments on the last post that this technique has worked miracles for some families and has drained the life-blood from others. Thanks to all the parents that pitched in with their experiences. I think this kind of dialogue can be a fantastic resource for parents who are considering whether this is the sleep training method they want to try with their own child. Also, I wanted to thank you all for being so awesomely civil and supportive and generally non-judgmental. In my efforts to find other sites that provide forums that consider these sleep-training issues, I happened upon a few that were SCARY in terms of the venomous name-calling and downright nastiness. I am well aware that this topic can bring out our most judge-y sides, so I really appreciate the tone of everyone's comments.

With today's post I just wanted to add a few additional, more general considerations that you might want to think about if you're trying to decide whether this is the sleep-training method for your family. Some reasons to recommend Ferberizing first: Most importantly, unlike full-blown cry-it-out methods, parents can feel like they are reassuring their child as the child is trying to learn the ropes of falling asleep on his own. Because parents can start by checking on their child even after two or so minutes, increasing the duration from there, this approach often feels much more gentle than leaving the baby alone to cry himself to sleep. In fact, this method is probably meant to reassure the parent as much, or more than, the child during this difficult training process. Second, Ferber has a reasonable amount of empirical evidence to back up his claims that the method actually does work, and works for many children, if implemented correctly. Third, if you read the second edition of Ferber’s book, How to Solve your Child’s Sleep Problems, the author gives extensive information on how to first diagnose the barriers to getting your child to sleep on his own. As a result, you can tailor the gradual extinction method to match the needs of your own child.

And now some important downsides to think about: There are some good reasons to be cautious about this sleep-training technique. First, it does require the parent to ignore (or at least refrain from responding to) her baby’s cries. Although there’s a chance to return to the child at regular intervals, hearing the distressed cries of their young child just seems unbearable to some parents. As a result, many parents find it difficult to keep to a consistent schedule that maintains an ever-increasing duration between visits to the baby’s crib. Without this consistency, the method is likely to fail, and many parents will then give up, sometimes after just one or two days. Second, like all methods, it doesn’t work for all babies. For some babies, the repeated visits from the parent serve to increase frustration and result in escalations in crying. These may lead to uncontrollable sobbing and even throwing up. For those perhaps more sensitive children, implementing this method consistently won’t decrease the length of crying before sleep. Related, the distinction Moxie makes about tension increasers vs tension decreasers may be important to consider here. If your kid needs to cry to diminish some level of tension in his system before he can fall asleep, this method is probably suitable for him. If, on the other hand, your child tends to increase in tension as he cries and cannot, for love or money, ever bring himself down from those levels of arousal, then this method may not suit him. Finally, the age of your child might be really important to think about. This method may work best for children younger than about 16 months. As we've talked about frequently on this blog, after children hit the 18-month stage transition, they “wake-up” socially, separation distress peaks again, their language skills become sophisticated and they are emotionally much more complex than ever before. As a result, they may not “fall for” the Ferberizing method in the same way that younger children do (although Ferber does provide some interesting extensions to his method for older kids). Given their increased working memory capacity, older children may realize that, no matter what, mom will return eventually, especially if they stay awake and cry. So, the usefulness of this method may be limited to the first year and a half of life.

What other factors do you think influences how appropriate this method is for children? 

OH! And tune in next week: I want to tell you about some of my plans for this blog and maybe start a discussion about how to improve this space in the next couple of weeks. I'm actually quite excited about this new stage (Um… yeah, so obviuosly I'm sticking around. Yeah!)

You guys know by now that I'm not keen on giving specific advice about what KIND of sleep-training method you should use. I've written over and over again that the method you choose does and/or SHOULD depend on so many factors: your parenting style, your child's temperament, your child's age, your cultural background, the social support you have, your work situation, your tolerance for sleep deprivation, your own and your child's emotional well-being, and so on. There are a few key points you need to keep in mind about sleep-training (the most critical of which, from my perspective, is the developmental stage… as if you needed me to tell you that AGAIN), but otherwise, most popular methods are going to give you reasonable results. I have been diligently doing the avoidance dance on the question: "But what do you REALLY think is the best method?" Because I REALLY don't think there is one. Having said that, there's no reason why we shouldn't talk a little about the actual advice out there from the "sleep gurus." So, to address several of your emails that have asked me to explain some of the top sleep-training techniques, I'm going to do a series of posts about the ones that are probably best known.

Let's start with Ferberizing, just because the question of "what is ferberizing and why should/shouldn't I use the method with my child" is probably the most common one I've received. I'll split this into parts: I'll first describe WHAT it is and then follow up with some pros and cons (much of this material is taken out of different parts of the book, so if you've read it, this will sound familiar). PLEASE feel free to throw your voice into a discussion about these methods. It's so important for parents to have multiple perspectives on success and failure stories with different methods. I think that's really the best way for you to figure out what might work best for your own unique family.

Contrary to misinterpretations and media-hype, Richard Ferber is not an advocate of the cry-it-out approach, although his name is most commonly associated with it.“Ferberizing” or "gradual extinction" is a deceptively simple method that uses basic behavioral principles to help babies gradually take on the task of putting themselves to sleep. It was actually developed as an ALTERNATIVE to the full-blown cry-it-out technique. Instead of allowing the baby to cry for however long it takes until he falls asleep on his own, Ferber advocates a gradual weaning of parental support.

The rationale for Ferber’s approach goes something like this: From around the age of 6 months, most children no longer need to wake up in the middle of the night to be fed (they can get all the nutrition they need during the day). So, at around this early age, you can begin teaching your child to put herself to sleep. Up to around this young age, if you’re like many parents, you’ve been rocking, gliding, nursing, singing and/or bouncing your infant for extended periods of time before she falls deeply asleep in your arms. Then, when your child finally drops off into a deep sleep, you ever-so gently lay her in her crib, taking great care to move your hands slowly from under her head and stealthily back out of the nursery. As you gingerly inch the door closed…your baby suddenly jolts from her slumber with a wail that could wake the dead. And then she is inconsolable and unable to go back to sleep. So… you start the process of rocking, gliding, nursing and bouncing all over again. The same thing happens 2 hours later when she wakes in the night, and an hour after that, and an hour after that. The problem, says Ferber, is that your baby has built up very particular sleep associations that include mother’s presence, lots of cuddling and lots of movement. All of these conditions are unavailable to the baby when she wakes or partially wakes in the middle of the night. Of course, she calls out for you so that you can yet again help her fall asleep with the props she’s grown used to. In essence, those children who fall asleep in one context (for example, on mama’s breast) and wake up in another (for example, alone in a crib) will start crying because they’re confused and scared and can’t bring back the context that put them to sleep in the first place. Ferber suggests imagining what it would feel like to go to sleep in your bed and wake up in the garage: disturbing to say the least. So the goal of Ferber’s method is for the parent to gradually transfer her extensive arsenal of sleep supports to the child herself.

 “Ferberizing” is a very simple method. It is SO not rocket science (so much so that I find it rather funny that it's become a verb and so many people find it controversial):
1.    Put your child in his/her crib sleepy, but still awake.
2.    Say your comforting good-nights and then leave the room.
3.    The child will usually begin to cry at this point if she is not used to being left alone to soothe herself.
4.    After an initial, short, predetermined duration (for example, after 3 minutes), return to the child. Pat the child, say soothing words, stroke her back or belly, but do not pick her up. Stay in the room for only 1 – 2 minutes and then promptly leave again.
5.    Increase the period of time that you leave the child to fuss or cry before you return to soothe her, always without picking her up (for example, return after 5 minutes, then 7 minutes, then 10 minutes and so on). Each time, leave the room after 1 – 2 minutes of soothing.
6.    Incrementally increase the duration of time you stay out of the room while your child attempts to put herself to sleep (or, as is often the case for the first day or two, cries her little head off). Eventually, she will fall asleep on her own.
After about a week or two, Ferber says that most babies will learn to soothe themselves both at bedtime and when they wake up during the night.

There are some pointers to maximizing the liklihood that this method will work for your child (we'll get to those next). And there are some caveats that I think should be made as well (in terms of ages, developmental stage, and temperament). We'll get to those in the third part. 

So, tell us: Have you tried this method? At what age? Did it work? If it did, what did you do to make it successful? If not, why do you think it wasn't for your family? Do you think Ferber is the spawn of the devil or should he be sainted?