Healthy Sleep Habits, Happy Child
10
Pre-sleep Routines
January 18, 2021

Found in age groups

Healthy Sleep Habits, Happy Child

5th Edition: 
A Step-by-Step Program for a Good Night's Sleep

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Healthy Sleep Habits, Happy Child

5th Edition: 
Chapter 1 (only 16 pages!) outlines everything you need to know about your child's sleep.

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Introduction

A Healthy Child Needs a Healthy Brain, A Healthy Brain Needs Healthy Sleep

Sleep is serious business. If you have not already done so, please read Blog Posts 1 through 5 that describe how sleep is important and beneficial, from the point of view of the United States of America Department of the Army. A major point, emphasized by the Army, is that more sleep produces more benefits for Soldiers. Also, more sleep produces more benefits for children. Even small amounts of extra sleep help (Blog Post 6). At every age!

Another point made by the Army is that “Soldiers [Children] best accomplish sleep extension [more sleep] by going to bed earlier.” The Army is clear about who is in charge: “Planning for sleep is a leader [Parent] competency”

In addition, “Stress is incompatible with sleep. Pre-sleep routines [Bed-time routines and soothing to sleep] that promote winding down prior to bedtime tend to facilitate the transition to sleep. These routines will maximize sleep duration. Conversely, engaging activities tend to arouse the brain and delay sleep onset.”

Bedtime routines and soothing to sleep should begin at the time when drowsy signs (Blog Post 9) first appear for daytime and nighttime sleep.

Blog 10Pre-sleep Routines

SOOTHING TO SLEEP

Parents should experiment to see what soothing method works best and then try to be somewhat consistent so that your child learns to associate certain behaviors with falling asleep. But it is not necessary that Mom and Dad have the same soothing style. The goal of soothing is to create a calm and peaceful state compatible with transitioning to a sleep state.

  • Rhythmic rocking: swings, cars, arms, rocking chairs, stroller rides, crib swaying to and fro. Rocking motions may be gentle movements or vigorous swinging depending on what your child responds to.
  • Sucking: breast, bottle, pacifier, wrist, fingers.
  • Gentle pressure: swaddling, massage, soft cloth carriers.
  • Sounds: lullabies, nature sounds, music, quiet talking, shushing.

BEDTIME ROUTINES

Bedtime routines help children calm down before falling asleep because they associate them with the natural state of relaxed drowsiness. Pick and choose from the following list based on your child’s age and your personal preferences. Try to follow the same sequence at all sleep times, because a consistent bedtime routine has been found to be a predictor of better sleep, including, specifically, fewer night wakings. Follow any routine that you feel comfortable with and stick with it. But it is not necessary that Mom and Dad have the same bedtime routines. For both soothing and bedtime routines, your baby will learn to associate each style with each parent.

  • Bathe.
  • Dress for sleep.
  • Feed.
  • Read books.
  • Say prayers.
  • Brush teeth.
  • Reduce stimulation: less noise, less playing, dimmer lights.
  • Bedroom: quiet, dark, not too warm.

Research published by Professor Jodi Mindell showed that:

  • Within three days, instituting a new bedtime routine consisting of a bath, massage, and quiet activities (cuddling, singing, or lullaby), children fell asleep faster, had less wake time after falling asleep, and fewer night wakings.
  • “Having a regular nightly bedtime routine is associated with improved sleep in young children, and that the more consistently a bedtime routine is instituted and the younger started the better.” Furthermore, comparing whether there was a bedtime routine 0, 1-2, 3-4, 5-6, or 7 times per week, as the bedtime routine increased in frequency, sleep improved more. In other words, bedtime routines practiced every night produce the best improvements in sleep and, in a stepwise fashion, lower “doses’ of bedtime routines produce lesser improvements. Improvements were an earlier bedtime, falling asleep faster, fewer night wakings, and increased sleep duration. 
  • Among children who had a bedtime routine every night, those who had an earlier bedtime also had even longer sleep durations.    

The last point is important because if the bedtime is way too late, the power of bedtime routines and soothing efforts may be significantly diminished. Early bedtimes are discussed in Blog Post 7.

Comments

  1. Hi Doctor Weissbluth,
    When I put my baby (10 weeks old) down, his pacifier falls off within a few minutes, making him cry and ultimately, waking him up.
    I then stay with him for 10-20 min more to make sure that when the pacifier falls off again, I can quickly put it back (while patting his chest). I am not sure what to do as I can’t just put him down “drowsy but awake and then leave” as he can’t keep the pacifier for long. Would you have any recommendations?
    Thank you

    1. Please look at the ‘Sleep Wheel’ and the age-appropriate section in my book to determine whether all aspects of sleep are in order.

  2. Dear Dr Weissbluth, I’m hoping to get your assistance with getting your input on some sleep issues (night wakening, irregular schedule, trouble staying asleep in bassinet > 35 minutes for naps) we are having with our 3 month old who is post-colic (from CMPA, now under control). What would be the best way to do that? Can I provide information on this forum, or would it be preferable for a consultation? We would be happy to pay for any consulting fees. Thank you and please let me know.

  3. Thank you for the quick reply Dr Weissbluth.

    She has Cow Milk Protein Allergy, and it has been about 5-6 weeks from when the colic resolved. The CMPA was a clinical diagnosis (based on recurrent blood in stool, difficulty feeding – would arch her back, fall off breast easily, very gassy, sleep fragmentation from gas pains (would grunt in sleep and spontaneously start crying with arching her back). These symptoms started around Week 3. They improved after Week 10/11, and that is when her colic resolved as well. At that time, we made a change in her diet: new formula and stopped giving breast milk. She is now at ~Week 16.

    There is no clear schedule yet (attempts to maintain this are derailed but irregular nap lengths, causing her to be very very tired on days with all naps 7 hours with no wakenings yesterday, and was also tired during the day from only taking 40-45 minute naps). If the latter, then how should we do that (ie, try to have the same bedtime, or be ok that it varies by 2 hours depending on how rested she is and how much she has eaten that day). I also hear so much about placing baby “awake but drowsy” -it didn’t work before but I don’t know if I should try again, and/or if I was doing it wrong before? Any other recommendations you have for us? We are realistic and understand not everything can be fixed at the same time, but are just confused with where to start?

    Thank you sincerely, sorry for all the information and the lengthy post. I tried to be as succinct as possible while also providing any information that may be helpful, in you helping is.

    Deena

    1. Because she is now about 4 months of age, and night sleep rhythms begin to develop around 6 weeks of age, focus on night sleep: For now, every night, her falling asleep time is 5:30pm (she has been bathed, fed, soothed, and you are leaving the room at 5:30pm). Choose a sleep-solution that comports with your values (but know that extinction is fastest and maybe most effective in a post-colic infant). Feed her once or twice at night if, and only if, you are convinced she is hungry.
      Because she is now about 4 months of age, and day sleep rhythms begin to emerge now but are not well solidified until about 6 months of age, do whatever you can during the day to maximize sleep and minimize crying. At 3pm, if she is napping, do not wake her, but no new nap starts after 3pm to get the 5;30 bedtime.
      Improvement will be sequential: first night sleep, than the morning nap, than the midday nap. Later, when naps are in place, regular and long, the bedtime will be moved to a later time based on drowsy signs.
      Does this help?

  4. Dear Dr. Weisbluth,

    We read your book when our child was 6 months old and employed all of the methods. It worked like a charm. She slept through the night, barely cried if at all at bedtime (after only 3 nights of crying), and everyone was healthier and happier.

    Now she’s almost two years old and has been experiencing what we think is separation anxiety at bedtime. Or perhaps toddler obstinance. She still sleeps through the night (unless she’s sick), but she SCREAM-CRIES HERSELF TO SLEEP every night. She has a consistent bedtime routine that she enjoys (changing, books, prayers, cuddling and a bottle that she’s ok to part with immediately before going into her crib). Although she has been “fighting” her routine at various points recently.

    She always has an early bedtime (6-6:30pm), unless she doesn’t nap well on a day, then we push her bedtime back even earlier (5:30-6pm). She has a healthy sleep atmosphere — comfortable room temperature and large black-out tent over her crib for total darkness. We do not own a TV and try to limit her taking our cell phones as much as possible (this was our family philosophy well before reading the research on baby sleep; it comforts me knowing that the science supports my intuition that screens do more harm than good for child development). She eats healthy meals most of the time.

    What are we doing wrong? I am longing to regain the peaceful bedtime we used to have: she lay comfortably in her crib, chatted a bit to herself, and fell asleep. Why the screaming? It lasts anywhere from just a couple min to 30 min. She had a sibling born somewhat recently, but this behavior did not appear immediately when the baby was born so I don’t think that’s the cause. She also adores her little sister and has never shown any negativity towards her, so I don’t think jealousy is a factor. Any advice is much appreciated!

    1. Please describe a typical bedtime routine and its duration.
      Please describe a typical nap (time and duration).
      Is there any difference in her sleep resistance when mother or father does the bedtime routine?
      When she is often going to sleep around 6-6:30pm, how is her mood and behavior during the 1-2 hours before bedtime when alone with toys (no parental interaction)?

  5. Dear Dr. Weissbluth,
    I read your book when my first daughter was born in 2021 and it helped us so much to understand her sleep needs. Our second daughter was born in September (she’s 12 weeks now) and she sleeps really well. She naps three times during the day anywhere from 1 hour to 4 hours long. She goes to sleep between 5:45 and 6:45 and sleeps until about 6:45 am with one night waking (around 2 am). She puts herself to sleep after I lay her down in her crib swaddled with the pacifier in. Her eyes are almost always open and she falls asleep without crying within a few minutes. So everything is goin really well–but the issue is that I think I need to phase out the swaddle and she seems VERY reluctant to do that. She is rolling from tummy to back when she’s awake and I’m starting to worry that she’ll roll from back to tummy in her sleep. She’s very strong. She scoots all around her crib and has been breaking one arm out of the swaddle recently. I’ve tried a couple times (during naps and once at night) to put her to sleep with one arm out or both arms out and she cries until I reswaddle her and put her pacifier back in. How do you recommend stopping the swaddle? Similarly, is there any reason to break her of the habit of needing a pacifier to fall asleep (she usually spits it out within the first hour and that does not wake her up, but she does need it to fall asleep and sometimes I have to go back in within the first 15 minutes to give it to her).

    1. If swaddling and/or pacifier help her sleep, please use them until you get the impression that she no longer wants it.
      Separately, after 6 weeks of age, a common sleep issue is that Child #1 distracts parents in the evening and they miss drowsy signs in Child #2. Therefore, depending on naps and drowsy signs between 4-5pm, I suggest you consider a falling asleep time for your baby in the range of 5:30-6:30pm, just a little earlier. How does this sound?

  6. Thank you so much for responding so quickly. My husband has been saying he thinks it is too early to break her of the swaddle and your reply suggests he is right! I will keep swaddling her (and giving her the pacifier) until she seems like she no longer wants them. Am I right that for safety reasons once I see her roll over from back to tummy during the day I will need to stop swaddling her cold-turkey?

    I will aim for a falling asleep time of between 5:30-6:30 pm. I looked back at my sleep log and realized that a few times in the past two weeks I did not put her down until 7/7:15–so her bedtime has crept later and later (which also results in a later bedtime for our toddler, who we generally aim to have down by 7 pm…). I’ll be more diligent about following her drowsy signs (which do occur in the late afternoon/early evening).

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