Dr. Gilgoff, our blog pediatrician, tackles the “sleep issue” for us: when is it okay to sleep train? Should we sleep train? If so, what are the best methods? We sleep trained Birch at 10 months and Willow at 9 months. I still feel badly that we ended up having to put Willow through sleep training when really we should have taught her to self-soothe earlier so we wouldn’t have had to “cry it out” later. I knew better, but I didn’t do it. Honestly, I loved co-sleeping with her and didn’t want it to end- that is, until I got mono and was so wiped out, we had to sleep train. We both needed our sleep then. I think you will appreciate what Dr. Gilgoff has to say about “Sleeping 101″.
by Dr. Gilgoff
I still remember the look on my wife’s face after our daughter slept through the night for the first time! As parents, we would do anything for our babies – so we suffer through the sleepless nights, and grin (or at least not frown) and bear it (or at least avoid a total breakdown)!
When thinking about a child’s sleep, I encourage you to look at their developmental stage. For the first 3-4 months, I view our little ones as pure newborns. Newborns are still quite upset that they are outside the womb. They are scared, fragile, and then NEED us frequently and immediately. I agree wholeheartedly with Dr. Karp and the “The Happiest Baby on the Block”. These little ones can not be spoiled. So please go to them when they cry, hold them close, and do whatever it takes to make them reassured and comforted. You can’t form bad habits – so don’t worry about holding them as much as they want and getting them in the middle of the night when they cry.
But around 3.5 – 4 months old, you will see a change in their character. They will no longer only cry when they NEED something – but they’ll start to fuss and tell you what they WANT. They are growing up, and they are developmentally ready to learn how to be a drop more independent, and to self-soothe. Now we may not be ready to let them be more independent, and as with many pediatric issues, we have to continually explore our own emotional and psychological make-up. But I guarantee that the majority of babies by 5 months old are indeed ready to learn how to sleep through the night.
Cycles of sleep
All babies will have sleep cycles that include periods of lighter sleep. When these little guys come to that phase where they are almost awake, they have a decision to make: mommy, nutrition, comfort…or back to sleep. You can guess which one they usually choose!
Well for the first 3-4 months, they actually may be hungry. I would err on the side of feeding them during these times, and I suggest avoiding all types of sleep training until they are a minimum of 4 months old. But after 4 months old, they are not waking up after only 3-4 hours because their glucose levels are low. So, while I hate the idea of baby boot camp, I do think that most babies 4-5 months can indeed be taught that night time is sleep time.
Methods of sleep training
The Ferber method calls for a gradual approach, and involves going to your baby, and soothing them with pats on the back, but not picking them up. But the majority of babies will get more excited, then riled up, and then livid if you come in the room but don’t pick them up. So I think that you should pay careful attention to the way they fuss, and the type of cry. When you feel that they are simply wanting comfort, but are not in pain (from illness or teething), and aren’t hungry (because they fed well and it’s been less than 4-5 hours), it’s time to let them learn to self-sooth.
Indeed, this means letting them cry it out. We all acknowledge that this is going to be extremely difficult for you. And, on any given night, the answer is clear – go to your baby and love them and soothe them! It will really seem like the easiest quickest way for the whole family (especially if there are older siblings involved!) to return to bed. But there is definitely a critical period that exists in infants – and if you miss it, you are only digging yourself a deeper hole. There have been too many amazing moms that have initially resisted any sleep training, only to come back at 9 or 10 months desperate for a solution. At that point it’s almost too late – your smart child now figures this is the way the game works – and it has worked just fine in their mind now for 300 nights! When I fuss, mom comes immediately to soothe me – so why change now!
I do have a number of nursing moms who aren’t bothered by a baby co-sleeping or sleeping right next to them, and nursing periodically through the night. Even in these cases, I believe the baby would actually feel more rested if they learned to sleep 9-10 hours in a row. But it is true that the idea of sleep training is a bit more for parents then baby. But moms and dads do count, and I guarantee that your baby isn’t going to hold a grudge or feel like they aren’t loved as they learn how to self-soothe.
Sleep Training Specifics
So now back to the specific advice. I would recommend gearing yourself up as a team around 4 months, and start paying more attention to what time they are going to sleep, and what time they are first waking. By this time it’s not a bad idea to try to get into a schedule of a night time routine and a time you are aiming to put your baby to sleep. This time by the way does not have to be by a certain time – it depends on your babies cues, and your routine both at night and in the morning.
But between 4 and 5 months, I strongly suggest that you attempt to let them fuss, or even cry it out when they are awake after less than 5 hours, and aren’t sick or actively teething. I would not go in, and I would just start the timer. I think 20 minutes should be your limit, as anything after this just isn’t realistic or constructive. We have all heard stories about the baby crying for an hour straight, and I know there is no long lasting harm on the baby. But there usually is for mom or dad, and I think 20 minutes is enough for one night.
In most cases, by 8-12 minutes, the peak of the crying is over, and indeed they learn to put themselves back to sleep. Hopefully each night gets better, and if we stick with the plan, it usually doesn’t take longer than 10 nights for our little ones to fully learn that night time is sleep time. Now after that first waking, they may wake again in a few hours. And while many 5-6 months old can quickly learn how to sleep 8-10 hours, the truth is that many still wake once in the night. So I choose my battles in a step wise approach, depending on their age. People talk about “skipping a night time feed”, but what that really means is teaching the baby to sleep longer (thus sleep through a normal feed).
So if it’s been longer than 5-6 hours, and the 4-5 month old seems to be fully awake and screaming, I would err on the side of feeding them. But if they are older than 6 months old, and it’s less than 8 hours, I can reassure you they are not fully hungry. Most parents will find that when they do feed the baby during those times, it’s more for comfort, and after a quick nursing (or an ounce or two of the bottle), the baby is immediately back to sleep. Or they didn’t really feed at all, but feel asleep on our shoulder after a few bounces. The comfort is not a harmful thing, but it’s a sign that the baby could have been taught to sleep longer, and you should aim to avoid the middle of the night comforting in the older baby.
Even when your baby learns to sleep through night, you’ll still worry whether they are sleeping enough in a total 24 hour period. We have to remember with feeding and sleeping, that these little ones are people, and they will eat and they will sleep. What we have to do is learn their cues, and help them to sleep even when they think they don’t want to. Easier said then done! Especially in the smart curious baby, they’ll fight their naps and they can get over-tired and cranky, and then even more difficult to be put down for a nap. This is just the norm – so don’t get too frustrated. Aim for the full night of sleep – between 8-11 hours for most 6 months olds, and take what naps you can get. For those babies that sleep more at night, they’ll need less during the day. Some will take their naps right on schedule, and some will have random naps when needed. I don’t like to publish my set of minimum sleep hours, because each child is different, and I find these numbers stress parents out more than they need to.
I think that sleep consultants have a role for the select few children that have real issues, or for the parents that really want firmer guidance. But in strumming up business, I fear that these consultants have put out unrealistic numbers in terms of hours of sleep. So please bring in your numbers to me, and we’ll go over them in an age appropriate analysis. I have no hidden agenda, and I will help guide you and your little one through this wonderful quest for sleep!
Dr. Gilgoff is a pediatrician relatively new to the Brooklyn community. He has a balanced approach to medicine, combining a western training at top institutions with an alternative outlook shaped by a mom who is both a midwife and creator of Mother Nurture Inc. – a Doula company since 1987. Dr. Gilgoff worked in Manhattan for 11 years, and now practices on 185 Montague Street. Dr. Gilgoff is available for free prenatal consults, second opinions, and accepts new patients with all types of insurance plans. To see his listing information, check the blog here under “Recommended Pediatricians”. To read all his posts, check out his Expert page (all of our Experts have their own page). He also has his own website now too: www.drgilgoff.com