Category Archives: Sleep Training Methods to the Madness

Sleep routines and scheduling Part I: Some general recommendations

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?  

Gentle or “no-cry” sleep training methods Part III: Some pros and cons

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!

Gentle or “no-cry” sleep training methods Part II: Some more popular methods

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?

Gentle or “no-cry” sleep training methods Part I

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.

Ferberizing demystified Part II: Some pros and cons to consider

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!)

A bunch of readers’ questions: Ferberizing demystified Part I

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?

When the all-night snack bar is closing: Some strategies for night-weaning

Several readers out there are considering night-weaning, with the potential that this may make it easier to sleep-train their babies. I want to emphasize that night-weaning is NOT necessary for sleep-training, but your child may get the sleep lesson faster if he isn't SOMETIMES fed and SOMETIMES not. I wouldn't recommend night-weaning until your baby is eating solids during the day. So, probably not before 4 months and I'm more inclined to suggest 6 months or so. This is mainly because most babies' tummies before 4-6 months are still quite small and they need the round-the-clock feeding to continue to thrive. OK, let's talk about some strategies that might help.

The first consideration is if the mother is breast- or bottle-feeding at night. If you are bottle-feeding (either expressed breastmilk or formula) during the night, then there's a handy little trick that works for a lot of us. Oh… and if you're NOT bottle-feeding and you're dying a slow and painful death from sleep deprivation, you might want to consider handing your partner the bottle and showing him/her the way to the baby's room at 3 am — pump or mix up some formula and away he/she goes (and 3 or more hours of uninterrupted sleep could be yours). Ahem… I digress.  If you ARE bottle-feeding at night or you COULD be (in other words, if your baby DOES take a bottle and you CAN pump or are OK with formula), try this "graduated weaning process":

1. Plan on about 10 days for this process to work.

2. On the first night, prepare the bottle with one less ounce of milk than usual, and replace this ounce with water. This way, your baby is getting the same amount of liquid, but one less ounce of milk. (For example, if your baby usually gets 6 ounces of milk, put 5 ounces of milk and one ounce of water in the bottle instead).

3. Feed baby this amount every time she wakes up in the night, for the next 2 or so nights. Guaranteed, the child will not notice this first stage. Soothe baby back to sleep

4. On the third day, take out another ounce of milk and replace with another ounce of water (so now you have 2 ounces of water and the rest milk). Soothe baby back to sleep.

5. Repeat steps 3 and 4 until the baby starts with the HATE. In other words, continue to replace more and more milk with water. At some point in this gradual process, most babies start noticing and protest. Some protest A LOT. Others, remarkably, very little. Most kids will take a few sips of the now water-with-a-tiny-drop-of-milk and give up, but many will finish the water. Soothe back to sleep.

6. Usually, by the time the baby does start to notice (around the 10-day mark), you will be giving her almost NO milk and you will have been doing this for several days. That means, the child hasn't been getting much nutrition at all from these night feedings for days now.

7. Continue to give the baby water every time she wakes up. Or at this point you can substitute with a soother/pacifier if she takes one and if you're into that sort of thing. 

8. At the same time you're doing this gradual weaning, you should be trying to up the baby's caloric intake during the day. This can be through nursing, formula-feeding or solids.

9. That's it. At the point that your baby is waking up and only getting water from the bottle, your baby is night-weaned. If he's going back to sleep with your help after the water, then he is no longer getting hungry. The whole point of this process is to get to a place — GRADUALLY — where you know that the baby no longer NEEDS the nutrition that he usually got at night. He will compensate during the day.

This is a slow, gentle process by which the baby's body becomes gradually accustomed to getting fed only during the day. At night, the same hunger pangs need not arise anymore. For me, this process was critical to go through before I started sleep-training so that I could ensure that when my boys did wake up at night during the sleep-training phase, they weren't hungry (and I wasn't filled with doubts/guilt as to whether they really needed the food or not). 

Night-weaning is quite a different ball game if you're exclusively nursing during the night. In this case, transitioning usually requires a whole lot of support from your partner, if you have one (and if you don't, I would enlist the help of family or a close friend; otherwise, this can be a very painful process for one person alone… not impossible, but HARD).

Your partner needs to start doing more night soothing during times when the child is used to being nursed. Also, because it's very, VERY hard to just offer the breast for a couple of sucks and then take it away, it's harder to GRADUALLY decrease the amount of milk the child receives. So, sometimes, this is a more hard and fast weaning process. Many mothers report that cutting off the night feedings entirely was much easier than trying to cut them down to just one or two. Mostly because the baby doesn't get the idea that sometimes you're allowed to nurse at night and sometimes you're not. So, when the baby does wake up, the partner starts to soothe. As usual, it always depends on your child, but the partner's soothing could involve back- rubbing or cuddling in bed (especially if you co-sleep) or in the crib or, more likely, the process will involve being out of the bed, rocking and/or bouncing the child.  The first few days are going to be the hardest. Sometimes, mom needs to be out of the room every time the baby wakes up and wants to be nursed. If the child is old enough to understand words and some more complex ideas, saying things like this might help:  "boobie is empty now and needs to make more milk and will be ready in the morning", "you can have it when you see the sun", or "boob is sleeping".  In the morning, you'll need to be prepared to nurse for a long time.  The soother is a big help here, again, if your baby takes one and you're into giving her one.  Singing also has helped many women.  Instead of nursing to sleep, some kids quickly switch to being sung to sleep, some favourite songs help, but introducing some new lullabies can be helpful too. Some kids adopt new soothing behaviours like belly-rubbing (the baby's or yours), playing with mommy's hair, sucking their thumb, and so on. You can also try to introduce new items to soothe with like lovies, stuffed animals, blankies, etc.  Lots of love, affection, cuddling and discussion of what is going on (even if it's a wee lie) can help the older ones especially. Also, keep in mind that SOME kids are not big cuddlers and don't NEED the tight shmushing  to compensate — we as mothers often try to pull our kids physically closer during these times when they might feel best with a little space of their own. So, keep an eye out for these signals and try not to take it personally (HA!) when your child pushes you away a bit and starts to self-soothe instead.

This is a tough transition. For both the baby and the mother. Be kind to yourself. Cut yourself some slack. Try to ease the guilt you might feel with lots of playtime and cuddling during the day. 

Anyone been through night-weaning and have some extra pointers? Words of encouragement? Horror stories? Anyone want some support while thinking about starting this transition?

Going down at bedtime easily, but waking up frequently

Thanks for all your feedback on the last post!  I really appreciate
your input and it has rejuvenated me. Maybe I'll just put up a "needy,
insecure" post every month or so and get my fix for your collective
voices… For what it's worth, I completely understand the tendency to
lurk (I was one of you for a long, long time) and I really am cool with
it. Having said that, it's always great to read your feedback, positive
or negative, and not JUST because I'm needy and insecure. It also gives
me fodder for more material to blog about.

So today's post is
going to try to address some of the questions in the comments section
about what to do about multiple wakings. For some people, this doesn't
seem to be under the same category as "sleep training" per se because
the child has no problem falling asleep at bedtime, but he or she DOES
end up waking up multiple times and then can't go back to sleep without

First off, I have to say that this is indeed part
of the whole "sleep training" area. As many of you know (whether by
research or by just plain observing your infants), children cycle
through light and heavy sleep throughout the night, waking many times.
What they're actually cycling through is REM sleep (Rapid Eye Movement:
the light sleep during which we dream) and non-REM sleep (of which
there is the light, medium and heavy variety). They go through many
more cycles than adults do and they need lots of that heavy sleep to
function properly. So, the trick to decreasing the night wakings isn't actually about decreasing them at all
but, rather, we need to teach them to put THEMSELVES back to sleep when
they wake up (as adults, we also put ourselves back to sleep in the
middle of the night, sometimes several times per night, mostly

Part of the reason that many kids don't have a
problem falling asleep in the first place is that we usually provide
them with lots of loving help. Most parents I've talked to have very
little problem with spending some reasonable amount of time rocking,
bouncing, singing and shushing their babies to sleep at bedtime
(provided it's not a 3-hour marathon). It's one of the nicest parts of
early parenthood for some of us. The problem with it, however, and this
is really a tough one to swallow, is that we are teaching our babies to
fall asleep with these "props." Richard Ferber talks a lot about these
cues (btw, he really is not the evil CIO guy that many make him out to
be; the newer edition of his book
is very well-researched, well-written and has some great information
about sleep patterns, biological rhythms and empirically-based
strategies that really work to deal with nightmares, night terrors,
etc.). Elizabeth Pantly
also does a good job of explaining sleep cycles and the importance of
teaching children to put themselves back to sleep. So, one of the first
"causes" of multiple wakings is the child's lack of experience and
ability to put himself back to sleep. What we try to do when we sleep
train is provide the child with appropriate "tools" to fall back asleep
when he wakes up (for example, we use pacifiers, blankies, teddies,
white noise, music, or in many cases, nothing at all except a dark room
with appropriate temperature and a peaceful environment).

course, some children fall asleep on their own easily at bedtime
because they're simply exhausted and their body is drifting into a
natural sleep cycle that they just roll with. However, in the middle of
the night when they reach the light sleep part of the cycle, they may
startle awake and have no clue what to do with themselves. The natural
instinct is to holler for mom or dad to help him out.

So… what
can we do about these night wakings? Mostly: Teach the child to go to
sleep initially by himself. That doesn't mean you have to cut out the
rocking or singing or cuddle time altogether. Just don't put them into
a deep sleep through those methods. And then use your favourite (UGH)
sleep-training approach for every opportunity that the child needs to
fall asleep (bedtime, night wakings, naptimes). That means using the same "gentle" or "graduated CIO" or
"no-cry" or whatever method every single time the child wakes up. Use
those methods until the child learns to put herself to sleep during all
appropriate times. A child needs many, many repetitions to learn a new
skill. So, if most of the time you're doing a pat/shush/pick up/put
down method of gradually teaching your child to soothe himself to sleep
and then other times you let him cry for a few min and yet other times
you nurse him to sleep, he just won't be able to "get" it quickly. The real problem for most of us is that at 8 pm, we can pull off almost any elaborate training method, but at 3 am?! Then AGAIN at 4 am?! And 5 am?! The probability of consistently teaching ANYTHING at those hours with that little sleep starts to seriously decline. 

And all of this gets SIGNIFICANTLY more difficult if the child hasn't been night-weaned. Because when the child wakes up, he's usually fed. And whether that entails a breast or bottle, it requires a parent to do the feeding which, at least for the first stage of infancy, usually soothes the child back to sleep. So, it's very hard for a baby to learn to put herself back to sleep when most of the time a parent gives her milk and that works beautifully to ease her back to dreamland. THIS IS ALL GREAT. No problem whatsoever if everyone in the family is happy. And for the first few months, the multiple wakings are usually expected and tolerated to some degree. HOWEVER, 2 major things start to happen:

1. After the fourth, fifth or sixth month, many of us start to lose our minds from the sleep deprivation. I'm not talking about being a little groggy, a little tired, a tad slow. I'm talking seriously brain dead, dangerously impaired, potentially depressed, perhaps bordering on psychotic, and definitely less fit to parent. Even the most well-intentioned mother may lose it by the 6th month of 4-6 night wakings.

2. Around the 4-month mark, most babies do NOT fall asleep immediately after being fed. OH THE INDIGNITY!  Not only is the child waking up 5 times per night, but the regular routine of nursing or giving him a bottle isn't working to calm him back to sleep anymore. Now there's more bouncing, rocking, shushing, patting, and pleading which can last SO VERY LONG. And seem even longer at 3, 4 and 5 am.

That's why I generally recommend that parents try to night-wean before attempting to sleep-train. Because if the parent is going in sometimes with a bottle or boob and other times trying to use some sleep training technique, it makes it MUCH harder for the child to learn what the deal is. It's not impossible, but it IS harder. I want to be clear: This is NOT a recommendation to night-wean at any particular age. It's a rather straightforward consideration: if feeding your baby throughout the night is more important to you than your ability to sleep through the night, then DON'T night wean. If you are desperate to sleep-train and you want to make the transition as easy as possible, then night-weaning will probably help reach that goal.

So… now that I lost and just re-wrote half of this post (STUPID Typepad… *&&#^#%#%!!), I've lost steam and I'll get to some night-weaning methods in another post soon.

Some thoughts about sleep-training methods

If you've been following this blog or have read our book, you know that I am extremely agnostic about what sleep-training technique works best. I simply don't think there is one best method. I've tried to convey my belief that the age and stage you choose to teach your young child to sleep is just as important as the method you use. Perhaps more important. But deciding on what method to use is indeed a critical decision as well—a very personal and powerfully emotional decision at that. I wonder if my responses to some of the questions I've posted feel somewhat unsatisfying to you. I can see why they may, given that I don't think I can offer you a step-by-step guide to changing your baby or toddler's sleep habits. Actually, I probably COULD provide that kind of specific advice, but it would mean that we'd have to go out for a long lunch and talk about your personal situation at length (maybe dinner and a bottle of wine would be more appropriate).

I think the method you choose will and should have everything to do with your parenting philosophy, the way you were parented yourself, your cultural background, whether you have to work outside the home, whether you have support from family and friends, the extent to which your partner is involved with co-parenting, whether you have a partner at all, not to mention your child's temperament and his or her already-established sleeping patterns. It's complex, isn't it? I think if I offered you a 2-paragraph summary of what you should do with your child to change his sleep schedule based on one email, I would be hugely underestimating all these other complexities that should go into your decision. But I think hearing from a whole bunch of parents going through similar struggles and hearing what worked and didn't for them (and why) is really helpful.

Ideally, there should be strong empirical support for at least one of the many methods out there but, in fact, this area of research is rather dismal. I'll point you again to the recent review of the most popular sleep-training methods conducted by the American Academy of Sleep Medicine (published in 2006 in the journal, Sleep). The review concluded that no sleep-training method is superior to any other, in terms of effectiveness. From a scientific perspective, there’s no one best way to do it. (I only make one exception to my general rule of being open-minded to any approach out there: I abhor Ezzo. I know some people swear by him. But he has contributed to some serious damage and that's why you won't see any links to his books and material here).

Despite raging debates, most authors of sleep-training books share the goal of providing children with warm, relaxing rituals that will make it easy for children to want to go to sleep. Most think bedtime should be a time for parents and children to feel close and secure with one another. Almost all the sleep-training manuals out there advise parents to first and foremost set up regular bedtime rituals that will reliably signal the baby or toddler that it is time to go to sleep. Most of these rituals include some variation of feeding the baby (either nursing or bottle-feeding), giving a warm, soothing bath, perhaps reading a bedtime story or two, singing or playing lullabies, and then finally putting the child down in his or her crib (or family bed). The methods begin to diverge at this point.

So, although I'm not going to be telling you what to do as much as WHEN to do it (and why), I'm interested in YOUR perspectives and also your questions about the methods that are out there. I'd really like to hear from you and I'd like other parents who read this blog to hear from each other:

1. Is there something you want to know about a particular sleep-training technique? I can't promise to know everything about all the approaches out there, but if I have the information, I'll share it with you.
2. What are you trying right now, with varying degrees of success or failure?
3. What method would you recommend to only your worst enemy?
4. Do you even believe in ONE AND ONLY ONE method for sleep training?

The “how” is up to you

If you listen to our radio interviews or read the published reviews (listed on the right sidebar), you'll get a sense of how frustrated some people get when they can't nail me down on the question: What do you REALLY believe is the best METHOD to sleep train a child?

Generally, I don't think any one method is objectively any better than another (with maybe one rather evil exception which I won't mention here because I don't want to give any fundamentalist charlatans the publicity). I think the METHOD you choose to sleep train your child should have everything to do with your own parenting philosophy, your cultural background, the way you were parented yourself, the temperament of your child, your family composition (single, married, grandparents within shouting distance, etc.), and so on. What may work beautifully and miraculously for one family may be disastrous for another. There are people in some cultures who would be horrified by the idea of leaving a small child alone in their own room to sleep while other cultures have disdain for co-sleeping families. Bottom line for me: Do what's right for your own family.

Also? There is no one method that's been empirically proven to be any better than another.  A review of 52 treatment studies conducted by the American Academy of Sleep Medicine (published in the journal Sleep) concluded that out of the top 5 types of sleep-training techniques (ranging from "cry-it-out" methods, to Ferberizing, to more "gentle" methods), all were equally effective.

So… no, I don't think cry-it-out methods are the work of the devil, nor do I think co-sleeping will lead to children becoming clingy, spoiled brats and who can blame the mother who relishes the hour-long rocking sessions that ease her baby gradually toward a good night's sleep? Whatever works for you and your child is just fine by me. But when it STOPS working for you, and you want to make a change, then pick the sleep-training method with which you feel most comfortable.  Our main point: try to apply that method at the right developmental window.