Healthy Sleep Habits, Happy Child
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Sleep Training Success in 3-4 Nights!
July 3, 2023

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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

If you have not already done so, please read Blog Posts 1 through 5 that describe how sleep is important and beneficial. I will post specific information for parents and children based on my book, “Healthy Sleep Habits, Happy Child.” Please do not be put off by my book’s length. This is a reference book. Read only the topic of interest to you.

Blog 138Sleep Training Success in 3-4 Nights!

Here is how to get your baby to sleep well in just 3-4 nights:

EXTINCTION: Extinction (you are extinguishing the habit expectation that crying out always brings parental attention) means that after a soothing bedtime routine at sleep onset, and except for feeding, changing, and any suspicion of medical distress, you let your baby fuss or cry without time limit until the morning (Blog Posts 25 and 26).  Extinction does not harm your baby (Blog Post 71).

  1. It’s never too early to start.  The earlier you start, the better (Blog Posts 49, 57, 67, 105107, 115 and Parents’ Reports #1).
  1. Leave the room after you put your baby down; no ‘parental presence’ (Blog Posts 16 and 77).
  1. Temporarily, the soothing bedtime routine is super-early. You begin the bedtime routine at night early enough so that you leave the room (the expected falling asleep time) at 5:30pm, or perhaps 6-6:30pm if there is a long afternoon nap that begins before 3:00pm. The earlier the bedtime, the better. The early bedtime is essential to prevent heightened neurological arousal (Blog Posts 171 and 172) that makes it difficult for your baby to fall asleep.
  1. No nap is allowed to start after 3:00pm to achieve the super-early bedtime.   A nap that begins before 3:00pm is allowed to continue; you do not wake your baby. If there is variability in afternoon naps, then the expected falling asleep time, while still occurring super-early, might vary from night to night.
  1. Under 4 months of age: Do whatever you can to maximize day sleep and minimize daytime crying (brief intervals of wakefulness, rocking, carrying, pitch black room, noise machine, etc.).
  2. Over 6 months of age: Attempt to impose a biologically age appropriate nap schedule: Mid-morning and/or mid-day naps.
  3. Between 4-6 months:  Naps are developing; do A. or B. (Blog Post 95).
  1. Improvement will be sequential: Night sleep will improve first, then the midmorning nap second, and finally, the midday nap third. (Blog Posts 155 and 161).
  2. When naps become regular and long (Blog Posts 173 and 174), then the bedtime may be moved later, based on drowsy signs (Blog Posts 9 and 115X).

Comments

  1. Hi Dr. Weissbluth! I really enjoyed your book and it has helped my wife and I feel prepared to start sleep training our 8 week old daughter (6 weeks old from due date). We are planning to try the extinction method. I understand the guidance regarding overnight feedings, but what happens when she inevitably ends up with a wet/dirty diaper in the middle of the night and starts crying because of that? Do we change her without social interaction in order to keep her comfortable? Or would that be considered intermittent reinforcement and therefore, we should we leave her in a soiled diaper overnight?

    1. Try to always respond to your baby when wet, soiled, hungry, or when suspicious of distress. In the beginning, sometimes you will go to her when you think she is wet/soiled and she is not, but after a while you will become better in making this judgement call. Alternatively, put a very thick coating of zinc oxide paste on the diaper region to protect her skin from urine or stool and go to her much less often, knowing that no diaper rash will occur. Mineral oil is helpful to remove the zinc oxide paste. How does this sound?

  2. Hi Dr. Weissbluth–I’ve been following your advice since day 1. It’s been super helpful, and so far our baby has been a great sleeper. He is about 14 weeks and so far has napped often and up to now has had no issue with an early bedtime (6 pm) and sleeping until 5/6 am with only one night feeding (breastfeeding).

    However, within the past week he’s developed this habit of waking up 1 hour after he goes to bed and crying fairly hysterically for another hour. There have been no issues with him going to bed, and he’s wanted to go to bed at 6 pm since he was 8 weeks old. We have not done full extinction yet but we let him cry for 10-15 minutes at a time right now. He is a really easy going baby and almost never cries like this, so it is very distressing to hear and not something we’ve ever had to deal with. At first I thought maybe he was growing and was hungry and will sometimes nurse him when he does this, but that doesn’t really work. We try to just give him his pacifier and leave the room with minimal interaction but he’ll still be up and cry and cry. Nothing else seems to be the matter–he’s got a dry diaper, he’s eaten well throughout the day, had a lot of naps (at least 5-6 hours of naps during the day) with no issues. I’ll also say that he is still tired–when we go in and give him the pacifier his eyes are heavy, so I know that he’s still needing to sleep and the bedtime isn’t too early.

    Once he is asleep, he wakes up once for a feeding and then has no issue going back to sleep after.

    He’s currently sleeping in a snoo. I’ve had him nap in a pack and play, and he naps fine out of the snoo as well.

    Do we need to try a full extinction method when he does this? Is he just waking up because he realizes we’re not there, and he’s trying to get us to comfort him?

    Thank you!

    1. Please describe a typical nap schedule.
      How does he look (mood and behavior) when he is alone with toys and no screens and no parental interaction between 5-6pm?

  3. On a good nap day: Wakeup around 6 am/6:30 am, first nap around 8-9:30. Second nap around 11-1ish. Third nap around 3-4. There might be another short cat nap between first and second nap or second and third nap some days if he’s not sleeping a full hour or hour and a half in his first nap or full two hours in his second nap.

    From 4-5, he’s a happy camper. I can leave him in his play set by himself and he’ll be fine. But between 5 and 6 pm if he is just left alone, he starts getting fussy, rubs his eyes, seems tired and hungry, stares off into space. He will even start fussing in his swing a bit unless he’s given a pacifier, at which point he’ll just stare off into space. So I start getting him ready for bed around 5:20/5:30.

    Thank you,
    Alexis

    1. “But between 5 and 6 pm if he is just left alone, he starts getting fussy, rubs his eyes, seems tired and hungry, stares off into space. He will even start fussing in his swing a bit unless he’s given a pacifier, at which point he’ll just stare off into space.” This is proof that his current fall asleep time is too late given his age and his current daytime sleep quality. Hi is going to a higher state of neurological arousal which is causing hime to have his new waking up 1 hour after he goes to sleep because of his accumulated sleep debt. Do everything that you are currently doing but do not let a nap start after 3pm and begin all your nighttime soothing and feeding so that you are leaving the room, lights out, at the expected fall asleep time of 5:30. This super-early bedtime is temporary and over the next several weeks, the naps will lengthen and when this occurs, the bedtime might be moved back to 6ish based on his mood and behavior between 5-6pm. Does this help?

  4. Just an update–we tried this the past few days and it has worked! He will still rouse after an hour but he’s not hysterical and goes right back to sleep with a pacifier. Thank you again so much Dr. Weissbluth!

  5. Dr Weissbluth,
    I’m getting ready to sleep train my almost-4-month-old. He was a colicky baby and also had reflux. He has now passed through both of those but now his sleep isn’t great. Because of his colic, most of his sleeping happened on me (he doesn’t like the car, stroller, swing) to make sure he didn’t get overtired. He will occasionally nap in his crib, with me beside the crib helping him fall asleep but will only sleep 30-40 minutes. At night, he sometimes has a solid couple hour chunk to start the night and then wakes every 1-2.5 hours, often just needing a pacifier and sometimes needing to be picked up. He feeds twice a night – he goes to sleep around 7:30 and eats around 1:30-2 and then again 4-5am. After this feed he sometimes has a hard time staying asleep in his crib.

    I read your book and am planning on doing extinction. I feel comfortable with a plan for going to sleep at night and dealing with night wakenings with extinction, aside from still feeding him twice. I plan to put him down around 6:30 as he tends to fall asleep around 7:30pm and figure he’ll need some time. I’m less clear on how to do his naps. If he wakes up at 8am, when he’s drowsy around 9:30 is when I should be getting him to nap? I think I should use capped extinction like you talked about in your book. If he keeps only sleeping for 30 minutes, do I do the same steps in about another 1.5 when he gets drowsy again? Or do I wait for a noon nap time? I would think I’d want to each time he’s drowsy. Should I do a contact nap for any naps to ensure he gets enough daytime sleep?
    Thanks

    1. Temporarily, do what ever works to minimize day crying and maximize day sleep; focus on night sleep for now. Because of the past history of colic, I agree with your decision to try extinction (but no cap) for 3-5 nights coupled with a super early bedtime (for example, 5:30pm). Keep a detailed sleep day and night diary and let me know how it goes. Once night sleep is going well, then we will focus on the morning nap and later the mid-day nap.

  6. Hi Dr Marc!

    My baby is 3 months old and I’ve purchased your book but am struggling with where to start.

    My baby is now unfortunately used to being rocked to sleep. We started out this routine not knowing any better. Ayra (my daughter) started out sleeping around 5 am. Then she settled around 3 am and currently her bedtime is 1 am. She wakes up around 10 am, naps around midday and then around 2/3 pm, 4/5 pm, 6/7pm, 8/9pm and her last nap is around 11pm. During her naps, she only sleeps on our laps and wakes up when we put her down (either immediately or after a short while). But after 1 am she sleeps on the bed, wakes up for her feedings and doesn’t need to be rocked back to sleep.

    I wanted to try extinction but don’t know how to fix her nap routines as a prerequisite. And how do I implement an early bedtime? Please help.

    1. Read about circadian sleep rhythms in my book and Blog Posts 8 and 112 to understand my suggestions.
      Impose upon your daughter a biologically healthy age-appropriate circadian night sleep rhythm now; focus on night sleep. Do not let her start a new nap after 3pm; if she is asleep at 3pm, do not wake her. At 5:30pm you are leaving the room after having finished bathing, feeding, and soothing. Extinction means that you will feed her once or twice (middle of the night and early morning) but not otherwise attend to her unless you feel that she is in medical distress. For now, do whatever you can to minimize crying and maximize sleeping during the day, but there is no nap schedule. Keep the intervals of wakefulness brief between naps. Get Dad on board, if a pitch black room or a noise machine helps for naps, go for it. Does this help?

  7. Ok here’s my update!
    Night 1: I left the room at 6:55pm and it took him 2 hours and 44 minutes to fall asleep. He cried hard for the first hour and 15 and then multple times came close to falling asleep and then would startle himself and start crying again. He then slept for 42 minutes but only took 8 minutes to fall back asleep and then slept for 2.5 hours. He woke at 1am to eat, fell aslep nursing and stayed asleep while I burped him (he still needs lots of burping for his gas/reflux). He slept for 3.5 hours and woek just after 4:30am – I couldn’t tell by his cry if he was hungry or not so I gave him a soother to see his suck and he spit it out to suck on his fingers and fell asleep in a few mintues, but then work 7 minutes later so I fed him and he was hungry. This time he stayed awake and then took 25 minutes to fall asleep after going in his crib and then slept from 5:35-8:25am for a total night sleep of 9.5 hours.
    Naps next day: he was hard to get to sleep this day, even with ways that usually work. His first nap took him an hour to fall asleep (fell asleep 10:37am) and I ended up having to hold him and use a soother (often I could get him to fall asleep for a nap with me beside the crib). He slept 43 mintes. His second nap also took him an hour to fall asleep (fell asleep at 1:35pm), partially because he needed a poopy diaper change 20 minutes in; again I had to hold him and he slept for 40min. His third nap also took him an hour to fall asleep (so didn’t fall asleep until 4pm); I started with holding him but he didn’t want that so into the crib, and then had to pick im up close to an hour to get him that last bit to sleep. He slept for 50 minutes.

    Night 2: 6pm put him down in his crib. It took him only 30 minutes to fall asleep. He cried for the first 15 minutes and then his cries were intermittent. He slept for47 minutes then woke up with a brief cry nd then fell back asleep after 2 minutes. He then slept for 6.5 hours, waking just before 2am very hungry! I nursed him and he fell asleep nursing and during being burped (and he slept through spitting up). He then slept for 3 hours 20 minutes and I fed him at 5:25am. He fell asleep napping but then woke up about a minute after I put him in his crib (12 minutes of sleep). It took him 13 minutes of crying to go back to sleep. He then work at 7:14am crying and I wasn’t sure whether he should get up or stay (previously he always slept untiil atleast 7:45am) so I left him in his crib and e fussed some and came close to sleep again but startled himself. I got him up at 8am. His total night sleep time was 11 hours 55 minutes.
    Naps the next day: Nap #1 it took him an hour to fall asleep (fell asleep just after 10am) and I had to pick him up at the end to get him to sleep and then I held him for the nap and he slept 1.5 hour. Nap #2 took him just over 30 mintues (asleep at 1:38pm) to fall asleep but he fell asleep in his crib with me just replacing his soother and he slept for 49 minutes (longest he’s ever napped in his crib) getting up at 2:30pm. Nap #3 took him 40 minutes to fall asleep, mostly on his own and I briefly went in to put is soother back in and he slept 36 minutes, getting up at 5pm.

    Night 3: He was put down at 6:19pm and it only took him 23 minutes to fall asleep with no crying or even fussing really (he just babbled and sucked on his fingers – he seems to be finally getting that). He slept for 5.5 hours and work at 12:11am to eat. He fell asleep during nursing and stayed asleep during burping and transfer to crib. He then slept about 5.5 hours (an hour before he briefly cried out but his hands went to his mouth and he stayed asleep). When he woke at 5:44am I fed him and he stayed away. I put him in his crib as he was drowsy. It took him 36 minutes to fall back asleep (with no crying, only fussing; and he almost fell asleep earlier). He then slept for just over an hour and woke up at 7:45am. His total night sleep was 12 hours and 6 minutes.
    Next day is today: his first nap took him 21 minutes to fall asleep (I started in there but left just to see) with some fussing. He slept 37 minutes.

    He was such a fast learning after a really rough first night!

    Should I now just do extinction at naps? His drowsy cues are hard to read except sometimes yawning. I have tried less and more time after he wakes to put him down and he was almost always taking an hour to fall asleep. That may change now that he’s able to fall asleep independently. When he naps only 30-40 minutes, do I just get him up when he wakes?
    Right now he seems to be harder to move bedtime any earlier than 6pm given how long it was taking him to fall asleep at naps. If he falls asleep around 6:30pm, what time should I be getting him up in the morning? It’s sometimes hard to tell if he wakes whether I should get him up (he also is slow to wake up fully). Or do I roughly judge by how much nighttime sleep he has had?
    Thanks!

  8. Also if he only naps 30-40 minutes, that’s only 1.5-2 hours of nap time. Is that alright? I don’t know how I’d fit in another nap timewise.

    1. Congratulations! let’s look at the big picture:
      Latency to sleep Crying before falling asleep. Total night sleep duration
      Night 1. 2hr, 45min 75min 9hr, 30min
      Night 2. 30 min. 15 min. 11hr, 55min
      Night 3. 23 min. 0 min. 12hr, 6 min

      Day 2: Longest nap ever in the crib!
      Please stay the course. He is on the path to becoming better rested at night which will soon permit better naps. Nap rhythms develop around 4-6 months of age, but perhaps in post-colicky infants the nap rhythm maturation might be slower (6-9 months). Keep the intervals of wakefulness between naps brief when the naps are brief. Soon, drowsy signs will become more apparent. Does this sound OK to you? Please consider writing a narrative report describing your sleep journey that I would copy for a Blog Post.

  9. I like the breakdown of the big picture. This will be life changing for our family (especially my sleep and sanity). Naps yesterday he fell asleep on his own for 3 naps in about 30 minutes. And last night he fell asleep on night 4 in 18 minutes and slept a total of 13 hours 40 minutes. He’s just working on consolidating some of that morning sleep, but was doing it all without much fussing – each time I though mayeb he was awake for the day, he’d fall back asleep again. This morning’s nap only took him 5 minutes to fall asleep (which is where he is right now).

    What do you mean by a narrative report? What would you like? I’m fully in support of extinction and how he is so much more content falling asleep on his own so am happy to write something.

    1. By narrative report, I mean a chronological story about your infants sleep journey, your struggles, your observations, who helped (or did not help) you, how you came to your decision to try extinction, how hard (or easy) it was for you these past several days, and so forth. I would post it as a Blog Post. The more detailed, the better. Your voice would resonate with mothers more than mine. You can post it here.

  10. Hello,
    My husband and I will be starting extinction method with our 16 week old baby in the coming week. As background… Up until now I have co-slept with him, so he is not used to being in a crib. We feel we never observe drowsy symptoms, so we use the clock to determine when to start soothing. He has no self soothing skills and fights us to sleep with the largest problem being naps. I have 3 questions.

    1. Is it too much to start extinction training him to self soothe, sleep without a pacifier, and be in a crib solo all at the same time? (Vs work to get some successful naps in the crib first for example as a stepping stone)

    2. We do not have a nursery – if we successfully complete extinction while sleeping in a different space (him in our room), can we then return and sleep in our room with the crib there? Or will his new soothing skills regress with our presence back?

    3. Do we only use extinction during the night? Or should we tackle lack of naps with extinction at the same time? Currently he is not getting enough sleep in the day and we are spending excessive amounts of time soothing for what ends up being very short nap times

    1. Please read the ‘Parents’ Reports on Extinction’ for information and encouragement. You can do extinction for night sleep only or do it for night sleep and day sleep concurrently. You can use a pacifier when you put him down to sleep. Once he is well rested and able to self-soothe, most likely you will be able to return him to your room. A super early bedtime and short intervals of wakefulness before all sleep times is necessary for success. Let me know how it goes.

  11. Is there a max awake/cry time we should allow in the night with extinction? I don’t mean cap on length of single cry – I mean cumulatively. My son is waking every 20 minutes and crying for average 45 minutes over and over.

  12. Continued from above.. We used a 530 bedtime. Usually he wouldn’t sleep for longer night stretches until after 1030 pm. Is it possible the drastic early change is causing this? We can see that be twitches in his sleep a lot and assume this is waking him up. Is that anything to be worried about or cause us to stop with extinction?

  13. This was the 1st night. He had no long stretch of sleep at all as described above and I want to confirm that there’s no cumulative wake maximum we should have where the lack of sleep creates a problem vs is helpful.

    1. Please keep a record of total sleep and total crying minutes for each night. Distinguish between minutes of low-level fussing/crying and intense crying. Please re-read the section on extinction in my book. The first night or the second night is always the worst. Also, keep a record of total day sleep. How are you handling day sleep?

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