Sleep Training: A Perspective by Dr. Nicole Glynn
Sleep is something that everyone needs. It is essential to restoring our bodies. Why then can it be so difficult to get children to sleep well?
Most parents worry about their child’s quality and quantity of sleep at some point and many get roped into elaborate bedtime routines that seem like they can take as long as the sleep itself. What I as a parent have found both among the families I work with and with my own kids is that some children are just genetically great sleepers. Now of course it isn’t all genetics. The habits parents instill are also really important.
I’d like to share some personal background. My first daughter slept through the night on her own starting at around 8 weeks old, and I smugly thought I must have this sleep training thing down! Fast forward to my second daughter who literally needed to be held, day and night, for the first 3 months of her life. Finally, once she made it through the “4th trimester,” I was able to have her sleeping in her bassinet and soon after started putting her down drowsy but awake, letting her drift off to sleep on her own. However, I needed to feed her through the night because her weight gain was inadequate, so we were still up nights. Finally, when she turned one year I felt comfortable weaning her from her night feeds (she was extremely late to take to solids) and I embarked on some serious sleep training. After 2 weeks of doing gradual extinction (or modified cry it out) I finally got her sleeping all night!
Is Your Baby Ready For Sleep Training?
Sleep training is one option many parents choose to teach their infant how to transition into a sleep state. Many babies must learn how to do this – for them it doesn’t happen by itself. However, the idea of sleep training scares a lot of parents because they’ve heard it involves crying and they are unsure what it really means in practice. Do I have to leave my baby crying for extended periods? Will I have to walk out of the room and not go back in? Won’t that have lasting consequences? Some parents have even heard that crying caused by sleep training causes cortisol surges that irreversibly change children’s brains. (Talk to us about this.)
When babies are young (less than 4 or 5 months), at GetzWell Pediatrics in general we don’t believe they are ready for formal sleep training. That said, you can start practicing good sleep habits at a young age: putting baby in their own safe sleeping space on their back, lying them down drowsy but awake so they can begin to transition themselves to sleep, trying not to feed or rock them all the way to sleep. And, some babies will sleep through the night on their own like my first daughter did! Speak to us if you have questions about whether your child seems ready to sleep train.
Sleep Training Methods
But parents don’t have to sleep train. Some families don’t want to do this or are uncomfortable with it. They’d rather co-sleep and maintain a “family bed.” In many cultures families share one bed for a very long time. If co-sleeping (please ask us about the safest way to co-sleep with an infant) is what you WANT to do and not what you are stuck doing or feel you must do, then we support it. However, if you want to help your baby/child learn to fall and stay asleep on their own then it can take some work, and it’s best done, in most cases, between 5 and 8 months of life. There are many methods to choose from and none is necessarily superior to another. Of note, the gentler methods involving less crying tend to take longer and require more patience. Here are some brief descriptions a few:
- Ferber or gradual extinction method: You put baby down and let them fuss/cry checking on them at set intervals, gradually lengthening those intervals.
- Cry it out/extinction method: After the bedtime routine, you put your child down drowsy but awake and do not return for check-ins.
- Fading: You continue to help your baby transition to sleep (by rocking or feeding, etc), but gradually decrease the amount of work you are doing. For example, if you rock your child to sleep then you will gradually shorten the duration.
- The chair method/sleep lady shuffle: this involves gradually withdrawing your presence. You start by sitting right next to your child as they fall asleep. Then over the course of days/weeks you slowly move further away until you are eventually no longer in the room. I have used this several times with my older child during periods of separation anxiety.
- Pick up/put down: if baby is crying after putting them in the crib, then you pick them up immediately and calm them until drowsy again and put them down again. I have heard parents may pick up and put down close to 100 times so it requires a lot of patience. Furthermore, not every child will respond to this as some are more stimulated the more interaction they have with their parents.
There is no one right way to sleep train and some families will decide they don’t want to sleep train at all. Every child is unique and what works well for some babies does not for others. The bottom line is to choose a technique that YOU feel comfortable with and that you think will work well with your baby’s temperament. Then stick with it. Don’t begin a sleep training program without having adequate preparation (we can help with that!) or if you feel ambivalent – little ones can sense that and will not respond well.
There are many resources to guide you and we can direct you to them. Give us a call at our office in San Francisco for more information on sleep training. We love supporting families!