Several of you have written to me about teething and how it can mess with any hopes of sleep training (or how teething has disrupted already healthy established sleep patterns). Here's one example of the emails about this topic:

Before I had kids of my own, I was convinced that one the most serious design flaws ever to emerge from our evolutionary history was being born without teeth. Why on earth would babies be born with sweet, gummy mouths and then have to painstakingly grow each and every tooth, one by one, in excruciating anguish?! Why don't infants just pop out with a full set of pearly whites? Then I started nursing my twin boys and it all became soooooooooo clear. Actually, my "aha" moment came when my peacefully-nursing 8-month old clamped down on my boob so hard that he left some serious marks. Yeah. I get it now.

Teething is a funny thing when you start talking to parents about it. There is no doubt that it's one of the most common reasons for sleep setbacks and disruptions and it certainly can mess with any sleep- training plans. There is a fascinating amount of variation among babies in terms of how much pain they actually experience during teething episodes. You talk to some parents and teething is the #1 most under-appreciated parenting (and infant) challenge they have ever experienced. They talk about watching their children's pain with such horror and pain themselves. Other parents? They can't see what the big deal is; they didn't even notice when Johnny got his last 10 or so teeth. Although I'm no physician and this is most definitely not my area of expertise (I'm happy to hear from anyone that knows more about this), I haven't come across any good research on what might cause this huge difference among children's teething experiences. Some pediatricians have had the gall to suggest to me that teething doesn’t actually cause pain, it just “seems” like that to us; some tell us that often parents attribute "bad moods" to teething in general (I can't tell you how hard I wanted to deck my ped when he offered this nugget of insight while my 4-month old was gnawing on his fist, sobbing and screeching all the while. And I can't tell you how righteous I felt when the poor boy cut his first tooth 2 days later, "way before kids get their first teeth"). Most parents, however, have had the heartbreaking feeling of watching a young infant or child wail through a teething episode, rubbing their gums like mad and biting on anything that passes their way. 

Teething can disrupt sleep for the obvious reason: pain is difficult to sleep through. But teething is also often accompanied by a runny nose, fever, congestion, coughing from all the drool that gets stuck in the back of the throat, and rashes around the mouth or anal area; all very difficult symptoms to fall asleep and stay asleep with!  Teething episodes can last as short as one day to as long as many weeks.  Diagnosing the problem can be critical for your sanity and, importantly, for helping your child through this difficult period by providing pain relief and emotional support.

But you all probably know that. How can you sleep-train through these episodes? Should you? Is it better to wait it out with the potential of getting into a dicey stage transition after the teething subsides? All I can offer are some of my thoughts, no real answers here:

• Sometimes, children with well-established sleep habits can and do put themselves to sleep right after bursts of pain. From my experience and other moms I know, teething often happens in
  bursts, so the pain doesn't last for hours at one time (although the
  bouts may come one after another for hours).The skill to put oneself to sleep can be a blessing for these kids, because they escape the post-pain anxiety that often comes AFTER the pain recedes. In other words, sometimes kids continue to cry even after the major bout of pain has subsided because they're afraid of the impact of the next bout. If they can put themselves to sleep quickly, they might be able to avoid this extra distress.
• If you do want to sleep-train during a teething period because EVERY month is a teething period or the child has a cold or you're traveling or… SOMETHING, then you might want to avoid any sleep-training method that requires prolonged stretches of letting the child cry. Gentle sleep-training methods that encourage you to help the child fall asleep gradually on her own without crying will help you read your child's signals better. In contrast, if you use a cry-it-out method, it will be very difficult for you to distinguish between when the child needs you to help him deal with intense physical pain vs when she is simply crying because she wants you present and/or she doesn't want to go to sleep.
• Obviously, pain medication can be a huge help if you ARE sleep training during teething episodes.
• If you're in a good developmental window for sleep training and the only obstacle you're facing is teething, there is no harm in trying to implement your favourite sleep-training method and just see how it goes. If after 3 or so days nothing is improving and you're finding it confusing to read your child's signals of distress, quit and try again next week. Teething bouts ebb and flow and some weeks they are less intense than others (at least for some children; some others never seem to feel relief until all their teeth have come in).

This is a really, really common problem and I hate when I can't give straightforward advice based on data. But I thought it might be good to just put this issue out there since so many of you are dealing with it and perhaps others can help with some suggestions that have worked for them. Alternatively, remember that development IS like a pendulum and if you miss the next opportune window for sleep-training, another one is coming eventually (little comfort, I know, for a desperately sleep-deprived parent RIGHT NOW).

Words of wisdom or commisseration?