My son, Cal, is 20 months old, and so far, my husband, Patrick, and I have been too chicken to sleep train him. I have a sinking feeling it’s too late. While Cal’s sleep isn’t terrible, it’s not great, either—whether or not he’ll snooze until morning is pretty much 50/50. If he wakes up, a tummy rub while popping the pacifier back in usually works like a charm. Plan B is rocking him back to dreamland and, on really rough nights (or just lazy ones), the last resort is letting him cuddle with us in our bed. It’s felt almost manageable, but not ideal.
Should we be OK with “good enough” sleep, when, if I listen to my pro-sleep-training friends, blissfully restorative pre-parenthood zzzs are achievable with even just a little tough love? Maybe we should endure the short-term pain of cry-it-out (CIO) methods to secure the long-term gain of more sleep (and more sanity) for everyone in the family. Plus, learning to self-soothe and sleep independently is a great life skill. (Just ask an insomniac.)
Those who are vocally anti-CIO may claim that only cold-hearted parents let their children cry, and that it causes long-term emotional scars. But the latest studies fall squarely on the pro-sleep-training side, promising quality sleep for both babies and parents, lower stress levels and a healthier body weight as a child grows.
What, exactly, is sleep training?
Sleep training and CIO aren’t the same thing. Cry-it-out is one method of sleep training, and sleep training is the broader goal of creating good sleep habits. Doctors and baby-book authors sometimes refer to this as “good sleep hygiene.”
“Sleep training means creating a good sleep environment, establishing a healthy bedtime routine and separating feeding from sleep,” says paediatrician Ian Paul, author of a Penn State study of infant sleep patterns that was published by Pediatrics in June 2016. “It’s building good sleep associations and teaching a baby to self-soothe.”
Epidemiologist Michelle Garrison, a sleep researcher at Seattle Children’s Research Institute, has encountered the same confusion. “It’s frustrating to me that there’s a dichotomy of either cry-it-out or nothing at all. The reality is there are so many middle ground options.” Garrison, a new mom herself, explains that learning to sleep is a set of developmental skills that require practice, just like walking. “Some kids are just slower to reach those milestones—and it’s the same thing with sleep.”
The Ferber method, popularized in a 1985 book by paediatrician Richard Ferber, is the most well-known approach and basically means letting a baby cry, with intermittent check-ins. You may also hear it referred to as “modified cry-it-out,” “gradual extinction,” “controlled crying” or the “cry-and-console” method. Parents must leave their baby in the crib to wail but then follow a strict schedule of checking on her at intervals that get further apart as the night goes on.
Other cry-it-out methods fall into the “fading” or “camping out” group, which involve staying with your baby while she cries herself to sleep in the crib. Some allow back rubs; others suggest a parent initially sleep on the nursery room floor. A few “fading” or “gradual retreat” plans advise sitting on a chair and moving it away from the crib over a couple of nights until you’re keeping watch from the hall. (Online it’s called the “disappearing chair” technique—but let’s agree it should be renamed the “definitely bring wine and your phone” approach.)
“Total” or “complete extinction”—also known as the Weissbluth method—is when parents shut the door and don’t go in again until morning. While it sounds extreme, frequent parent check-ins can be stimulating or confusing for some babies, who calm down faster if they’re left to figure it out on their own and aren’t enraged or puzzled by a present (but non-responsive) parent.
Another Pediatrics study, this one out of Flinders University in Adelaide, Australia, received lots of media attention this past summer. The study looked at different sleep training methods with 43 babies, ages six to 16 months, divided into three groups: fading or camping out; gradual extinction (a.k.a. crying with checks); and a control group (whose parents simply kept doing their normal bedtime routine). The researchers found that fading—when the parent stays in the room as their baby falls asleep and the sneaks out—and gradual extinction—letting your baby cry for increasingly longer periods before returning to check on her—are both effective and neither causes long-term harm. (Total extinction wasn’t part of the study.)
After three months, the babies from the fading and the crying-with-checks group dozed off faster than the control group babies, who hadn’t been sleep trained. The crying with-checks infants slept longest overall and were less likely to wake during the night. The researchers also found that levels of cortisol, a stress hormone, were actually lower in the sleep-trained infants than in the non-sleep-trained ones, reassuring many parents who have fretted about attachment issues and whether or not it’s “unnatural” to leave your child to cry. (Thank you, science!)
Paul says CIO is misunderstood and often demonized. “Cry-it-out implies that even if a child vomits from crying, we should ignore him, and I think that’s extreme. We’re not that militant. It’s not ‘shut the door and that’s it.’ Letting a baby cry could be part of sleep training, but it’s not the only component.”
In his Penn State study, the babies who hadn’t been sleep trained had poor sleep associations—meaning, their parents relied on common crutches like rocking or feeding to sleep. He found that the sleep-trained babies who had been taught how to self-soothe and could fall asleep in their cribs on their own (using a variety of sleep-training methods) began sleeping through the night at a younger age, woke less and slept, on average, 80 minutes longer. Furthermore, the babies who were routinely rocked to sleep while nursing or drinking from a bottle were more likely to be overweight by age one. That’s a pretty resounding victory for the pro-sleep training camp.
When I outlined the bedtime routine at our house to Paul, who is also a dad of three kids (ages eight, six and almost two), he wasn’t impressed. Cal’s nightly ritual includes a bedtime bottle while we read stories. Then he asks for his “bink” (pacifier), and he drifts off to dreamland snuggled in our arms. “Are you going to get him a cellphone when he’s four? What about a TV in his room? It’s about setting limits,” Paul scolded me, albeit playfully. I couldn’t help but sputter excuses. Yup, I’m an editor at a parenting magazine, committing cardinal bedtime sins. But just because I still rock my toddler to sleep doesn’t mean I’m an overly permissive parent, right? (Right?)
I admire parents who have the fortitude to commit to CIO, and I don’t think it’s akin to child abuse, like some attachment parenting proponents might. (For the record, you can be an attachment parent who also lovingly and gently sleep trains her baby.) But I do find it hard to listen to a crying baby when (a) I’m trying to sleep nearby, and (b) I know a simple feed could quiet him faster. (My husband and I used to joke, “Put a boob in it!”—our Beyoncé-inspired solution to any baby problem.) So my opposition isn’t philosophical; it’s impatience plus laziness.
Paul says babies older than one don’t need bottles, and many doctors advise that using pacifiers past two is probably a bad idea, too, because they can cause orthodontic issues later on and change the way a child’s lips and tongue muscles develop. But the bedtime bottle is especially problematic, because kids usually brush their teeth before the bottle, not after, leading to tooth decay.
“The most effective strategies are not, sadly, the best strategies long-term,” Paul says. “When babies wake, many parents’ first instinct is to feed them. But setting them up for that expectation is a bad cycle. If they can only nod off after being fed, how are they supposed to soothe themselves after a brief wake-up at 2 a.m.? It’s important to recognize how sleep, comfort, food and rewards can get tangled up as our kids get older. We know that babies who sleep less are more likely to become obese or overweight. My patients say, ‘Stick a bottle in their mouth—they’ll stop crying!’ Well, it does work, but we should be using food for hunger, not other things. Feeding isn’t a reward or for soothing. It’s about developing healthy long-term patterns.”
When’s the best time, or ideal age, to sleep train?
Neither the American Academy of Pediatrics nor the Canadian Paediatric Society have a position statement on sleep training, nor do they recommend a specific age to do it. Michael Dickinson, a spokesperson for the CPS and a paediatrician in Miramichi, NB, says there is no data on what proportion of Canadian parents sleep train, but it’s a common question he gets from exhausted parents.
“Most of my patients say, ‘Dear God, please let this get better on its own,’” he says. “But for most people, I’m sorry to say, it doesn’t.”
Darn. I had hoped that like many of the toughest phases, if we simply waited it out, it would eventually resolve itself. (And that in a few years we’d laugh at ourselves for fretting so much.) But Dickinson says once you’re past the six-month mark, the earlier you sleep train, the better. “The first six months is dicey—you’re in survival mode. Feed to sleep or rock to sleep if you need to. But six to 12 months is the sweet spot.”
Physiologically, by two months, a baby should be able to go five hours between feedings. The ability to make sleep associations (good or bad) really kicks in when your baby is around four months old, explains Garrison. This is when you should start creating rituals to signal it’s bedtime, and treating nighttime sleep differently from the rest of the day (for example, changing into PJs is a nighttime thing, not a nap thing). You could try phasing in new, positive sleep associations (like a white noise machine or special bedtime song to signal the beginning of the routine) and then phasing out the bad ones (like rocking or feeding to sleep). Don’t be afraid to skip the bath and books, either. “Bath time and stories are too exciting for my child,” says Garrison, whose son is now nine months old. Take some time to find out what’s relaxing for your baby.
There are a slew of reasons why it never felt like the right time for us. Cal had always been smallish—25th percentile—and I think that made us err on the side of “he’s probably hungry” more often than if we’d had a baby in the 95th. He’d also been diagnosed with gastroesophageal reflux disease at two months old, which meant he spit up a lot and needed heartburn medication to keep his milk down. We were always worried whether he was getting enough. Then we had to endure the lovely infant phase known as the four-month sleep regression. During the magical six-to 12-month window, we were travelling across time zones to visit family on both coasts. Keeping a routine was tricky and we felt we were already asking Cal to adapt to a lot of change—it felt unfair to enforce a bedtime crackdown, too. Then he started daycare and it felt like everything was changing again: teething, milestones like walking and talking, a new nap schedule, winter colds, and winter colds that turned into ear infections. I cherished our nightly cuddles in the rocking chair, and I convinced myself that Cal needed them, too. The bottles allayed any calorie intake concerns now that he was no longer nursing. Plus, he clearly loved the ritual and started asking for his “baba” (bottle) when he was tired.
“Most parenting decisions start from a place that’s understandable,” says Dickinson. “Solutions that are justified in the short term turn into long-term habits that aren’t the best for the infant or for the family, and then the parents don’t have an exit strategy.”
Having the space in your life to attempt something like sleep training is a privilege— not everyone can devote the time and energy to it. If you have other big stressors, focusing solely on your baby’s sleep for a week or two is probably low on your list of priorities. “Sleep training does take a certain amount of mental fortitude while the kid cries,” says Dickinson. “You have to be in a good place to pull it off, and that’s why I’m sympathetic to families who can’t do it.” On the other hand, some parents don’t have the privilege of not sleep training, like if you’re working long shifts or have a physical job and can’t function well on broken sleep.
Some parents don’t find night wakings to be that big a deal. “If you’re happy waking up with your baby, and sleeping through the night isn’t your goal, that’s fine,” says Dickinson. “There are lots of people who just can’t let their baby cry, and we support that.”
Sleep training older babies and toddlers, he says, is much more difficult. “Some people come to me with kids who are two or three years old, and we’re trying to undo bad habits. You’re fighting a bigger battle at 18 months than at nine months.” Garrison agrees, but reassures me I haven’t missed the sleep training window. The toddler years can be an ideal time to create healthy sleep associations. Kids this age love patterns and routines.
Sleep training requires planning, and for all caregivers to be consistent. In fact, dabbling in CIO but then failing at follow-through is exactly what not to do. “If you start and backtrack, you’re actually worse off than if you never tried at all,” says Garrison.
Instead, commit to the routine. Start on a weekend instead of a work night, stock up on good ice cream and trashy magazines, queue up some Netflix shows to binge watch as distraction—whatever helps you cope. Or plan for your partner to be on screaming baby duty while you go for a walk to get out of the house.
Interestingly, Garrison says there’s some evidence that sleep training is more successful when dads are involved, but scientists don’t quite know why. “It could be that dads have an easier time being consistent. It could be that moms do the feedings more often and the baby is associating Mom with food, or it could even be the tone of voice: Dads have a lower, flatter, more modulated voice. When women talk to babies, our voices go up and down a lot.”
Christine Davidson, a Toronto mom of two, found CIO to be easier at night when her partner, Dave, was there. “He didn’t waver—he had no problem going in, shushing the baby and walking out.” It was harder to ignore the cries of their five month- old son, Sam, when she was home alone, enforcing a two-hour afternoon nap and trying not to second-guess herself. “He’d cry alone in his crib for half an hour. I was thinking, What am I doing? This is crazy!”
With their first baby, Alexandra (now three), Davidson says she didn’t even know what sleep training was. Her daughter slept through the night from three months on. “Alex was so easy. She didn’t need soothing and was comfortable being alone. I loved mat leave because I could take her anywhere,” says Davidson. But Sam was a fussy baby and didn’t settle easily. She remembers leaving a mom and baby music class in tears, apologizing because Sam had been so disruptive. “I was always saying, ‘I can’t figure you out.’ He was unpleasant, and I was, too.”
Davidson reached her breaking point after Sam barely slept—just catnaps—for two days and two nights straight. “Some people say, ‘Oh, I would never let my baby cry it out.’ But talk to me when you have a screaming baby in your arms and you haven’t slept in three days,” says Davidson. “My emotions were all over the place: I was laughing my head off and then suddenly crying. That’s when I said, ‘OK, this has to change.’”
Night-weaning Sam and instituting CIO with check-ins worked after just two nights. “We kept telling ourselves that it was the best thing for everybody, and it was,” says Davidson. “Sam’s a good sleeper now, and I really think it’s because we taught him how. It wasn’t until Sam was getting enough rest that his goofy, loving personality emerged and he was a lot more fun to care for.”
For my birthday this year, I asked for something unusual: eight hours of sleep alone in a fluffy hotel bed. My wish was granted. With my husband on baby duty for the night, I was free to do whatever I wanted. I had a bath. I read a book in peace while drinking a glass of wine, luxuriating in the high-thread-count sheets. I didn’t set an alarm. And then I woke up at 1 a.m., 4 a.m. and 7 a.m. My son had sleep trained me so thoroughly that I could no longer sleep through the night.
It was a clear sign that we had to make some changes at our house. Both Paul and Dickinson told me to go cold turkey, especially with the bedtime bottles and rocking to sleep. And yet I’m still dragging my feet about when to do it. Not before our upcoming vacation and cross-country flights—terrible idea. Not the week the grandparents are in town; they’re total softies. And definitely not the week I’m solo parenting—that would be disastrous. It never seems like a good time.
“Just circle the date on the calendar: D-Day,” says Dickinson. “Throw out the bottles and never go back.”
Sleep do’s and don’ts
By four months, it’s not normal for an infant to wake up multiple times a night, says paediatrician Ian Paul. Here are his tips for better baby sleep.
* Don’t rock or feed your baby to sleep. Instead, put her into the crib drowsy, but still awake.
* Don’t feed as your first response to fussiness.
* Respond to night wakings with other “care-taking behaviours:” Go in, let your baby know she’s not abandoned, pat her on the back and use a calm, reassuring voice.
* If your baby is older than two months, try not to pick her up while soothing, because if you do, it’s hard not to move on to feeding, especially if you’re a nursing mom.
* Be consistent.
Consider a super early bedtime
If your baby or toddler is waking up in the night, try this gentle, no-tears tactic first: an earlier bedtime. Sleep consultant Alanna McGinn of Good Night Sleep Site explains that if your baby has entered the overtired zone, bedtime becomes a battle and the stress hormone cortisol contributes to more restless sleep and frequent wake-ups. “Shifting bedtime earlier, even just by 15 to 30 minutes, can allow your child to accept sleep much easier at bedtime and then sleep through the night,” she says.
McGinn suggests a bedtime of 5:30 to 6:30 p.m., but it depends on your child’s age and the quality of his or her daytime sleep. (“The 5:30 p.m. bedtime is for the younger babies who aren’t napping great yet,” she says.) She recommends even two-year-olds go to bed no later than 7 p.m.“This might necessitate having separate meal times for the baby instead of family dinners, but remember that it’s not forever and focus on quality time together in the morning instead.”
She knows it’s easier said than done. “Parents pushing back against my early-bedtime advice is probably the biggest fight I get from clients, and I completely understand,” says McGinn. “As a sleep educator and a working mom of three, I have also had to make adjustments to our schedule, like meal planning and keeping routines consistent, in order to facilitate earlier bedtimes. But once parents see how well their child does with an earlier bedtime, they get it.”
A version of this article appeared in the October 2016 issue with the headline “You’re not evil if you sleep train your baby” on p. 27.No Comments