How a pediatrician advises parents on sleep training their children

At some point the novelty of a new baby wears off.

Waking up at two in the morning loses some of its appeal.  Parents often tell me that their baby does not sleep well.  I tell them how they can get their child to sleep through the night in just three nights.  I explain that learning to sleep is a training process, either the parents train the infant or the infant trains the parents.  Most parents are uncomfortable with my advice, but when they finally try it, they say it works.

Here is how it works:

  1. I do not recommend doing this until your infant is over ten pounds and over two months old.  Once your baby reaches these milestones, you are set to implement Operation Peaceful Night.
  2. I also do not recommend doing this while your child is sick.  It will just create one other variable that will make you worry, so if she has a cold, wait a week or two until she is better.
  3. Put down all the touchy-feely books about getting your baby to sleep.  All the psychobabble in the world is not going to make your infant sleep.  Your self-esteem is going to be just fine without them, I promise.  If they are not too worn, re-gift them at your next baby shower.
  4. Recognize if you have Wimpy Parent Syndrome.  WPS and Operation Peaceful Night are not compatible with one another.
  5. Remove the infant from your room.  Parents and infants that sleep together do not sleep well.  Move the bassinet or crib to the infant’s room.
  6. Feed your baby.  Change her diaper.  You want her to be sleepy, but not asleep when you place her into her crib.  Once she has been put down, leave the room.
  7. Close as many doors between your room and the baby’s room.
  8. Turn off the baby monitor.
  9. Consider buying ear plugs.
  10. Do not go back into the infant’s room until six or eight hours have passed.

That was easy, no? Okay, I will admit it seems a little mean.  The poor little baby is going to wake up and cry and you are not going to run to the rescue, which is going to make her cry louder and harder.  This may go on for hours or even all night, but at some point she will realize that crying is not going to get the result it once did.  Previously, crying has been rewarded with being picked up and held, being rocked, being sung to, and being fed.  Now, crying gets no reward.  At some point during these three nights, she is going to figure it out and start sleeping through the night.

Some points to consider:

  • Behaviors that are rewarded continue. When the reward is removed, those behaviors extinguish. The rewards for crying in the middle of the night have previously been a full stomach, a warm parent’s body, and a lullaby. Remove the reward and the behavior will stop.
  • “Isn’t it dangerous to let her cry that long?”  No.  In the history of human existence no baby has ever cried to death.  It just does not happen.  (This is of course assuming your infant does not have any underlying health condition.  If so, speak with your pediatrician before initiating Operation Peaceful Night.)
  • “What if she is hungry?”  That is why I do not recommend doing this until she is at least two months old and over ten pounds.  At his point, she can certainly go eight hours without feeding.  She may not want to, but she can.
  • Plan ahead before initiating Operation Peaceful Night.  Make sure everyone involved is using the same playbook.  Prepare for a couple of miserable nights before things get better.
  • “What if I can not take it and after two hours of crying, I go in and feed her?”  Think about what you just taught her:  If I cry for two hours I get what I want.  Guess how long she is going to cry the next night.
  • “Isn’t this going to emotionally scar her?”  No.  You will get plenty of opportunities to mess up your kid over the next 18 years.  Teaching her to sleep is not one.
  • “But I do not mind waking up and feeding her.”  Great.  Continue what you are currently doing.  However, realize that, once again, sleep is training.  If you wait nine months to remove the reward, understand that there has been nine months of training that you will have to overcome.  Also realize that as she gets older she will be able to do things that make training much harder, such as climbing out of the crib and opening doors.
  • “How long do I let her cry?”  However long it takes.

I must admit, it sounds a lot simpler than it really is.  It is stressful for everyone involved.  I have done this with my two children.  I remember my heart racing and my palms getting sweaty as each of my children went through this “learning process.”  My wife initially resisted the idea and took some convincing.  After a couple of nights, she became a believer.  Our kids have since then been very good sleepers.

Michael Gonzalez is a pediatrician who blogs at The Anxious Parent.

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  • Anon

    At 6 months old, for one year I left my baby fall asleep on his own every night. Most evenings he cried for an hour or more before going to sleep. After we moved him to a toddler bed and there was nothing to keep him there, he would hang up with us until he fell asleep. This might be good advice for most, but it’s not for all. If it doesn’t work for a week or so, go read The Spirited Child book and hang out with your kid.

    Is my kid healthy and happy? Yes. Do I regret that I did that? Absolutely, I have no idea what I was thinking.

    One size just doesn’t fit all.

  • Maria Antoshina

    Advise to sleep train infants before the age of five months or so has been linked to failure to thrive in infants. In addition, there is some research that shows that sleeping far from the parents can increase the risk of SIDS. The APA reco…mmends that infants share a room with their parents to reduce the risk of SIDS. This article is very irresponsible and goes against the latest research on what is healthy for infant development.

  • newborn nanny

    This absolutely works. I have trained many, many babies to sleep using this method. Many are now healthy, happy, thriving young adults and teens.

  • http://mommyblawg.blogspot.com The Mommy Blawger

    What a great plan. Too bad it runs contrary to studies which indicates this technique can be harmful to babies both psychologically and physiologically, and can be seriously detrimental to mom’s milk supply.

  • Anne Montgomery, MD

    Strongly disagree, especially at 2 months.

    Babies that young do not know that the world is safe without mom’s presence and moms know their job is to keep their babies warm and protected. (There’s a biologic reason most moms have a hard time tolerating this approach–otherwise why would you suggest all the closed doors???)

    Breastfed babies often cannot go “8 hours without eating” at 2 mos/10 lbs. And even if they could, it’s not a good thing for mom’s milk supply. Usually need to feed or express at least every 6 hours to keep a good supply for a young baby. And the system is actually designed to have more milk at night–prolactin levels are higher then. Probably because historically that’s when moms and babies had more time together!

    I tried this once. Didn’t work. Switched to having my baby closer to me and feeding on demand at night. We all actually got lots more sleep (and he grew better). He became a very independent sleeper when he was ready.

    I think loving, attached parents need to do what works for them, and maybe the “cry it out” approach is OK for some parents and some (older) babies if people are truly stressed out. But babies need their parents. It’s hard-wired. That’s how babies survived in the wild for millenia. “Training” them that their parents won’t come to them when needed doesn’t seem like the way to teach trust or connection or lots of other things that I think are much more important life skills than learning to sleep alone before they are ready to do so.

    If this approach doesn’t work or feel right, try “Nighttime Parenting” as an alternative. And agree with the above poster about “The Spirited Child” as a resource.

  • AnnR

    I’d always heard it was 12 pounds.

  • http://9davids.blogspot.com ErinKate

    Wow, that’s terrible advice. You’re teaching your child that no matter how much they need you, you are going to ignore them. What a terrible precedent to set. ESPECIALLY if you are breastfeeding (and what pediatrician advises against breastfeeding), babies who wake throughout the night are building their mother’s supply and intaking the nutrients they need to thrive and grow.

    Mommies and Daddies, your babies are small for such a small period of time. Love them. Enjoy the snugggles. Enjoy that your baby needs you so much because they day will come when they hardly need you at all. Go to bed earlier. Wake up with them. Babies will learn to sleep like they learn to walk and talk and smile – on their own, and in their own time. LOVE THEM and treat them like people with feelings, needs and thoughts. Don’t leave your baby to cry alone in the dark. They don’t learn to sleep. They just learn that you don’t care.

    Sincerely,
    The mom of a 1-year old who sleeps through the night, all on his own.

  • http://www.birthinjoy.wordpress.com/blog Tiffany Miller, CLD

    For actual evidence-based information on infant sleep, here are two great links that bring together SEVERAL resources on one page.
    Sleep-Training: A Review of Research

    Baby Sleep Resource Page

    I have done both the CIO approach, and the co-sleeping approach. I can testify to the VAST difference between the two. Yes, CIO “works” in the short term, but I am seeing the results in my now-8-year-old.

    Read evidence-based resources – don’t take my word for it, or this pediatrician’s word. Babies and mothers are biologically wired to sleep in close proximity to one another. Also, emotional and psychological development is every bit as important as physical development, and certainly more important than sleeping through the night at an arbitrary age or weight.

    The burden of proof is on those who give advice like this: Show me the evidence, please.

  • Sarah

    My 2mo has slept next to me since birth. She is breastfed and I sleep topless. Whenever she wakes up hungry, she knows how to meet that need. She rarely wakes me in the middle of the night and never by crying (I can tell by her movements that she needs to be burped or changed, but that doesn’t happen often). Considering that she doesn’t have to cry to get her needs met, she’s not learning that crying gets her what she wants. Problem solved without making us both miserable.

  • Christy

    I respectfully disagree with this advice. Sleep training a baby this young is linked w/ failure to thrive and could wreak havoc with a mother’s milk supply if she is breastfeeding.
    Infants (esp. a tiny 2month old!) are hard-wired to NEED mothers, comfort and a full belly. These are not wants, but rather actual needs.
    Having a baby means raising a human being, not managing an inconvenience.

  • http://9davids.blogspot.com ErinKate

    For a middle-of-the road approach, Dr. Jay Gordon has an excellent method:
    http://drjaygordon.com/attachment/sleeppattern.html

  • Sara W.

    I could not agree with this advice less. Even Ferber, who basically gave a face to ‘crying it out’ in the Western world (the ONLY place crying it out is done is North America and the UK; do you suppose that entire continents and hemispheres don’t sleep?) recommends that baby only be allowed to cry for short intervals, that it not be done until baby is at least six months old (any sooner and you CAN starve your child), and if baby doesn’t take to the training and continues to cry, that it should stop. That’s the advice of someone FOR crying it out and sleep training.
    I was never sleep trained, always was breastfed until I fell asleep, and all the things that you’re not ‘supposed’ to do. I sleep through the night just fine (and have since I was about a year old), I assure you! My daughter co-sleeps with me, I nurse her to sleep, and she’s never been sleep trained. She’s night weaning herself–no tears, no fussing, just good sleep for me and her. Please don’t abandon your child and ignore it’s cries, at least until they’re a year old and can actually understand. If you have to let your child cry it out, at least read the latest edition of Ferber.

  • http://tikvaadler.wordpress.com Tikva Adler

    I breastfeed + co-sleep, so my 16-month-old daughter sleeps through the night without any problems whatsoever. She has never woken me up even once (she has always been able to find the boob by herself, so all I have to do is fall asleep while facing her and not wear a top). I don’t agree that meeting your baby’s basic needs is a “reward” that will lead to spoiling them.

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