Sleep is an important part of any little one’s daily routine. Not only do their sleep habits give parents a much-needed break, it’s also necessary to support a baby’s rapid mental and physical development. Rhonda Patt, MD, medical director of Charlotte Pediatric Clinic, shed some light on the subject by giving us her answers to parents’ top sleep training questions.
Question 1: What is sleep training?
Answer 1: Sleep training refers to ways that parents can promote healthy sleep habits for their baby. The way to approach sleep training varies according the age of the infant.
Q2: On average, how old should your child be before starting sleep training?
A2: Sleep training and fostering healthy sleep hygiene can begin right away. In the first two months of life, babies need 16-18 hours of sleep a day; however, many of these babies sleep better during daytime hours than at night.
The best way for parents to assist a baby to develop a good circadian rhythm is to promote more daytime wakefulness and keeping lights and stimulation low overnight. Between 3 and 4 months of age, parents should develop a bedtime routine that is consistent each evening and may consist of lullabies and rocking. At this age, parents are encouraged to put their baby to bed when drowsy but not fully asleep.
Q3: Is sleep training for everyone?
A3: Some people may think of sleep training as allowing a baby to cry at night, but it is better to think of sleep training as a process that begins in the newborn period by creating a healthy, nurturing sleep environment.
Many people do not realize that sleep is developmental, and that infant sleep development follows a predictable pattern. When parents know what to watch for and make adjustments accordingly, babies will often develop healthy sleep patterns on their own. Some babies never have to "cry it out" or end up with tired parents sleeping on the floor beside the crib. However, more often than not, parents will hit a bump in the road with sleep along the journey of the first year so understanding some sleep training strategies that apply to those situations can be beneficial.
Q4: Do the same principles apply for napping?
A4: Yes- the same principles apply to napping. Napping is also developmental. During the early months, babies nap around the clock after brief periods of wakefulness. By 4 months of age, most babies are taking a predictable first morning nap. Between 6-9 months, babies are generally taking 2-3 predictable daily naps.
Q5: What are the sleep training options?
A5:
- Cry it out - The "cry it out" method involves putting a baby to bed and allowing the baby to cry himself to sleep without parental intervention. For many reasons, this would be a last resort method- when all else has failed and the risks of lack of consolidated sleep for baby outweigh the stress associated with listening to your baby cry.
- No tears - The "no cry" sleep training method is really the opposite of "crying in out." With the "no cry" method, babies are tended to quickly and comforted by a parent.
- Fading - Fading is a method that is sort of a compromise between the "no cry" and "crying it out." With the fading method, parents provide less and less stimulation and support for baby gradually until their baby learns to fall asleep on his own and a parent is able to leave the room while the baby is still awake- without tears. If their baby does cry, the parent can return to the room after a few minutes and comfort the child but then exit again while their baby is still awake.
There is no "one size fits all" for sleep training. Every baby is born with his or her own temperament and innate sleep skills. Some babies fall asleep easily with little need for rocking and swaying and stay asleep for longer stretches of time. Other babies may "fight sleep" and wake from sleep entirely at the end of each sleep cycle. For this reason, what works for one baby may backfire on another. In my opinion, the best sleep strategy is for a parent to know the options and tailor the strategy to best meet the needs of the family as a whole.
Q6: Do eating patterns have an effect on a baby’s sleep routine?
A6: Interestingly, there are many misconceptions about the role that feeding plays in sleep. Many people believe that if they feed a baby enough, or give formula instead of breast milk, that their baby will sleep longer at night. However, infant sleep wake cycles are a part of brain development and not always related to hunger cues. Studies of children who were receiving continuous tube feedings at night (due to certain medical conditions) still demonstrated the same pattern to nighttime waking as those who were waking for intermittent feedings by bottle or breast. This is not to say that nighttime feedings should be eliminated- but simply that babies are generally not waking because they are hungry. They are waking because their brain roused from sleep. At that time, the baby may be due for a feeding and showing hunger cues. He should be fed if this is the case.
Q7: Does the mother need to adjust her nursing schedule with sleep training?
A7: If a mother decides to let her baby cry through a nighttime feeding, it is important to consider what this does to the baby's feeding schedule and intake. For breastfed babies, this may mean that the baby needs to feed an extra time during the daytime hours. Forced elimination (through "crying it out" or "fading") should not be done prior to 4 months of age. It is also important to be sure that your baby has been gaining weight well enough and that your breast milk supply is robust enough to provide adequate caloric intake once that feeding is dropped. Many breastfed babies will continue to wake at least once overnight until 9 months of age.
Q8: What are the long-term effects of sleep training?
A8: When sleep training is well-executed, the long-term effects are positive. Babies are sleeping longer at night, and parents are also well-rested.
Q9: When and in which age/condition can we determine that a child has an actual sleep disorder, and that is not just "acting like a baby"?
A9: If your baby is having sleep problems, it is important to discuss this topic with your child's pediatrician. Sorting between sleep disorders versus being a "bad sleeper" can be extremely difficult and would be very individualized.
Q10: Why is this topic sometimes considered controversial?
A10: Sleep training is sometimes a controversial topic because of concerns of increased maternal and infant stress levels when babies are left to cry. The good news for parents, however, is that a randomized controlled trial published in 2016 in Pediatrics demonstrated that infants whose parents used the "cry it out" method fell asleep an average of 13 minutes sooner and woke up less often during the night compared to the control group of infants who were not left to cry. Furthermore, stress levels based on salivary cortisol readings of the infants, parental stress or mood, or measurements of parent-child attachment were no different between the control group and the "cry it out" group.
