by Warren P. Silberstein, M.D.
First the good news: There is help for parents whose children don't sleep through the night. The best approach is to try to prevent sleeping problems early on, since the older a child gets, the harder it may become to change sleep habits. With that in mind, we'll start our discussion with the approach and pitfalls to developing good sleep habits in infants.
Now the bad news: If your child is already giving you sleepless nights, there is help available, and there is more to it than just letting your child cry, but there will be some crying involved, and you may find that difficult. If it were easy, you probably would have been well on your way to having a child with good sleep habits already.
Before we begin, let me clarify that this advice is aimed at those parents who are looking for advice to get their child to sleep through the night. There is no rule that says your child must sleep through the night or sleep in his own bed. In giving this advice I am not saying or implying that parents who choose a different approach are doing something wrong, or that their approach may be harmful to their child. There are many societies where it is a common practice for the children to sleep in the same bed as their parents. The Family Bed (also known as co-sleeping) has gained some popularity in the United States as well. This approach has stirred up some considerably emotional debate with some proponents suggesting that allowing children to cry is cruel and leads to later emotional disturbance, while some who find the approach objectionable consider it strange and unwholesome, or feel it will result in poor sleep habits. It is an approach I do not personally advocate, but if it suits a family, I have no objection. On the other hand, there may be a risk of suffocating an infant by overlying in a family bed.
Some infants may begin to sleep long stretches as early as 1 month of age. Most infants start to sleep a 6 to 8 hour stretch between 2 and 3 months. Initially it may not coincide with the parents usual nighttime sleep hours, but eventually it moves to the night without any intervention. It is very common for infants to fall asleep at the breast or during a feeding because they are satisfied and soothed by the warmth and comfort of their mother's arms and body.
If a young infant spends a lot of time crying and sleeps poorly he should be checked by his pediatrician to be sure he isn't ill. Infants who have many episodes of crying may have colic. Such infants may require a great deal of soothing, but this stage rarely extends beyond 3 to 4 months. If your infant cries a great deal you might consider putting a ticking clock in his room to simulate the rhythmic sound of your heart beat since he spent 9 months in the womb hearing and feeling that rhythm. You might add some white noise to the room to block out other stimulation. White noise can be as simple as a radio tuned to no station so there is only static. Or you can get a white noise generator that provides a variety of soothing sounds. There is also a device known as the "Sleep Tight" device [information no longer available on-line] which can help babies sleep by simulating the movement and sound of a car. Nature's Cradle by Infant Advantage also lulls a baby to sleep with sound and motion.
By 4 months of age, most infants should be able to sleep through the night without feedings. Since infants derive such great comfort from feeding, it should come as no surprise that a feeding can soothe a crying infant even if he isn't hungry. Some infants become dependent on having feedings to soothe themselves and put themselves to sleep. Often they take just a few sips from the bottle or a few sucks at the breast and they are right back to sleep. But if they aren't offered the feeding, they are wide awake and screaming. Why risk letting the baby get hysterical when it's so easy just to feed him and then get back to bed yourself?! Of course there is the problem that babies who go to sleep with bottles in their mouths may develop cavities in their teeth (bottle rot, nursing bottle carries). Aside from that, if your baby is old enough to sleep through the night and really isn't taking a full feeding, then he is using the bottle to put himself to sleep. Unfortunately, he may continue to demand a feeding every time he becomes slightly awake in order to put himself back to sleep. This is known as Trained Night Feeding.
Sleep is a necessity, but how we go to sleep is a learned behavior. If you want your child to sleep in his own bed or crib without feeding or other interventions you have to teach him to put himself to sleep. Normal sleep is punctuated by many periods of arousal. Adults look at the clock and groan and go back to sleep. A baby who hasn't learned to put himself to sleep will awaken and demand whatever intervention he has learned to use to put himself back to sleep.
Between 6 and 8 months, most infants start to develop separation anxiety. That means they become unhappy or even distressed if their parent (usually mother) isn't within sight. Separation anxiety will add significantly to the difficulty of getting a baby back to sleep in his own crib. For that reason, I recommend getting infants used to going to sleep in their own cribs by 4 months of age. By that, I mean, put the baby into the crib awake but drowsy and help him fall asleep in his crib. This can be done by talking to him or singing to him or gently stroking him as he falls off to sleep with the idea that you will gradually diminish the time spent doing this. If an infant doesn't fall asleep in his crib, all he knows about his crib is that it's a place where he wakes up alone and terrified without any idea how he got there or that you want him there. It may seem foolish to put a child into his crib awake and risk crying when you could just as easily put him in asleep and be done with it like you did in early infancy, but it's a lot easier to encourage a child to develop good sleep habits at 9 PM or 11 PM then it is at 2 AM or 4 AM. If he awakens during the night, you should avoid taking him out of the crib. Try to comfort him in the crib by talking to him and gently stroking him. If you must take your baby out of the crib, comfort him sufficiently to be able to put him back into the crib, but put him back into the crib while he is still awake.
Suppose your infant doesn't agree with my advice and can't fall asleep easily. Suppose he keeps waking and crying. Or suppose you have an older infant who never learned to put himself to sleep. Then what? Chances are you've already resorted to a number of methods to try to calm your screaming child and get him off to bed quickly. Naturally, you chose an intervention that got you back to sleep as quickly as possible, but the price you pay for your choice is that your child still demands the same intervention. My first piece of advice on that subject is "Don't resort to any method to get your child to sleep that you're not willing to continue for a long, long time!" Your child comes to depend on any technique you use regularly to get your him to sleep and can't get to sleep without it. Whether you take him into your bed, feed him, walk with him, rock him, or whatever else, he has learned to depend on that specific intervention to put himself to sleep. He considers it his right and he will continue to demand it.
Whatever it is you're doing to get your child back to sleep, you have to wean him from it. If you're giving him bottles, cut down the amount and water down the contents until you're just giving him a little water. Then it's time for cold turkey. If he's coming into your bed, switch to comforting him in his bed. If you're comforting him or walking with him, gradually decrease the time spent with these interventions. You will eventually end up putting him into bed awake resulting in protests. You may go back briefly to comfort him and check on him, but you have to make it clear that he is going to stay in his own bed. In fact you must go back to check on him periodically so that you will be satisfied that your child is okay and so he will know his cries aren't being ignored. Only by knowing that you are there for him and that you intend for him to stay in his bed can your child learn to sleep in his bed peacefully.
Naturally a child screams for what he believes is rightfully his. Children's cries weren't meant to be ignored. If a child's cry didn't tear at his mother's heart the human species wouldn't have survived. But children are not always capable of distinguishing between what they truly need and what they want. You, as the parent, have to make that distinction and set limits. In the middle of the night when all you want to do is get back to bed it's pretty tough to set limits.
Most parents who tell me they've tried letting their child scream and it hasn't worked don't have realistic expectations regarding what they can accomplish and how long it will take. You can teach a child to stay in his crib. You can eventually teach him to be calm while he's there. And eventually he will learn to fall back to sleep. But you can't teach him not to wake up. However, once he learns to calm himself and to fall back to sleep in his crib, his awakenings will be brief and he will be on the road to developing good sleeping habits.
Many parents ask me how long it's okay to let their child cry. Once you've weaned your child down to the minimal intervention and face protests and tears you can't set an arbitrary time limit for yourself. If you decide that you can't let your child cry more than half an hour, he will learn to cry for at least half an hour in order to get your intervention. If you have a real screamer on your hands you could be in for several hours of screaming, and the first few nights there may be multiple awakenings with very little sleep. You can't afford to take that step unless you have the resolve to see it through. Any halfhearted efforts will teach your child to scream longer and for more days. During this phase you must make your intervention only long enough to make sure your child is okay and to make it clear to him that he isn't being ignored but he is staying in his bed. From that point the length of time crying will decrease progressively over a period of days to weeks. The number of awakenings will also decrease once he adjusts to not being taken out of his crib. But if your child's natural sleep rhythm includes one or two awakenings per night it could continue for a few years with some brief crying. Your response should be to check him briefly and tell him, "Everything is okay. Go back to sleep."
Whenever I give this advice some parents feel that there are reasons it just can't work for them:
If you wish to read more on the subject the book Solve Your Child's Sleep Problems by Richard Ferber is available at Amazon Books.
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