Healthy Sleep Habits, Happy Child
161
Sleep Training: Be Patient
December 11, 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

Blog Posts 15, based on the United States of America Department of the Army Field Manual: Holistic Healing and Fitness, describe what really matters for your child’s sleep. If sleep is an important enough topic for national defense than surely sleep should be considered a serious topic for parenting!

Blog 161Sleep Training: Be Patient

I created the term ‘Sleep Training’ as a shorthand phrase to describe several strategies that parents could use to help their child achieve healthy sleep. Blog Post 49 reviews the history of the term ‘Sleep Training’.

The phrase ‘Sleep Training’ echoes similar notions of ‘toilet training’, ‘Parent Effectiveness Training (PET)’, and ‘obedience training’ for our German Shepard. Although today, the phrase, ‘Sleep Training’, usually refers to only the extinction method (Blog Post 25), the original use of this phrase referred to a package of items (Blog Post 95A), not just one item. Just as there is not just one item that is performed for toilet training, PET, or obedience training, there are several different things performed to achieve your goal of healthy sleep.

To illustrate how the different items involved in ‘Sleep Training’ are interrelated, I used the image of a rotating Ferris wheel and created the metaphor of the Sleep Wheel (Blog Posts 152 and 153). The rotating Sleep Wheel also adds a dynamic quality to the notion of ‘Sleep Training’ because parents do different things at different times over a twenty-four period.

Another feature of ‘Sleep Training’ is that as your child becomes older, the items that are important to achieve or maintain healthy sleep change. For example, as your child becomes older, the bedtime hour changes, and napping patterns change.

Perhaps because some sleep deprived parents are in a hurry to get their own sleep back, some parents have unrealistic expectations regarding how quickly their child will learn to sleep better. It is important to remember that the ‘Sleep Training’ process or the development of healthy sleep habits takes time. It is a learned skill, like learning how to ride a bike.

Training Wheels

Training wheels are mounted parallel to the rear wheel of a bicycle to assist learning how to balance. Over time, they are gradually raised as the child’s balance skill increases. The emphasis here is that the wheels are slowly raised as the child’s skill slowly improves. Eventually, learning how to ride a bicycle without training wheels is achieved. Some children acquire this skill faster than others, but a parent’s patience is always rewarded with a confident bike rider.

Similarly, some very young children require a lot of parental soothing to sleep while other children require less. Over time, parents can reduce the intensity and duration of the soothing to sleep process as the child acquires more self-soothing skills. ‘Sleep Training’ is a learning process. It takes time to develop the skills of self-soothing to independently fall asleep at bedtime or for naps and the ability to return to sleep unassisted in the middle of the night. Fast learning occurs over only a few days in infants who have not experienced chronic sleep deprivation or have not learned unhealthy sleep habits.

When an older child is not sleeping well and parents start a sleep solution (Blog Posts 26, 133, and 138), the improvement is often sequential (First, night sleep. Second, the morning nap. Third, the mid-day nap). The improvement sometimes occurs fast and sometimes slow. The reasons for slow improvement might be related to the parent (Blog Post 155) or the child’s temperament (Blog Posts 46 and 47) or infant colic (Blog Posts 43 and 44). If your child has not been sleeping well for a long time, it may take a few weeks to pay back a chronic sleep debt and achieve a well-rested state (Blog Post 80).

Please remember that patience is required when you attempt to help your child develop healthy sleep habits or when you attempt to fix a sleep problem.

Comments

  1. Hello, Dr. Weissbluth!

    I read your book when my baby was 2 months old, and it has helped our family immensely. I am an enormous fan of your work. You are the only person I have found who gives sleep-related advice that is entirely evidence-based, solid, reasonable and humane. I’m from Brazil, and I think it is a great shame that your book hasn’t been translated into Portuguese; if it had, I would recommend it to all my friends! Thank you.

    Our baby is now 4 months old. I believe he was very fussy up until around 3 months of age; as a result of that and of my inexperience as a first-time mother, his nighttime sleep was terribly fragmented and he was always overtired before we applied extinction at 10 weeks of age. Ever since, he sleeps wonderfully well at night, waking only twice for a quick feeding. After his bedtime routine, we leave his room and he falls asleep all by himself, and does the same after the nighttime feedings.

    His naps, however, have been all over the place. He has had periods of excellent naps, and periods of terrible naps. His acceptance of the crib for naps has also been variable, with periods of acceptance and falling asleep by himself alternating with periods of much, much crying and very little sleep (especially recently). We have practiced “drowsy but awake” from day 1, having read this advice elsewhere before getting to know your work, but I think our lack of routine has undermined his self-soothing abilities for naps. Last month, we went on an extended vacation, and his naps were very frequently *not* in the crib for approximately three weeks. I also think he accumulated a very large sleep debt in this period, which we are still catching up on, even though we really tried maintaining an early bedtime during the trip. For the past 25 days, which is when we came back home, I have put him to bed no later than 7pm, some days much earlier, such as 5:30, some days 6:30, depending on the last nap. After about 2 weeks, he began sleeping for very long stretches at night (12 hours), and started having a good midmorning and midday nap, both for about 2-2.5 hours, totaling approximately 19 hours of sleep per day (14 hours at night). Unfortunately, at this point we rather inadvertently shifted his bedtime closer to 7pm, which I think was too late, too soon, if you understand my point. After a few days, he began to wake up earlier and earlier, to awaken more often throughout the night, and above all, stopped taking long naps and stopped falling asleep by himself for naps. Having realized what happened, I have put him to sleep at 5:30 pm yesterday and today, and plan to do so for the next several days. I am not allowing for naps starting after 3 pm to protect this super-early bedtime, as per your advice. His current behavior in the hour preceding his bedtime is very, very irritable (as is throughout much of the day – he spends a very small amount of time in “optimal wakefulness”). The only moments when he seems to be in a good mood and smiling often is right after waking up (in the morning especially). My questions for you are the following:

    1) When we put him to sleep at an early bedtime (5:30 or 6:00 pm), he tends to sleep in – up to 8:30, 8:40, even 8:50. I have always let him sleep as much as he likes in the morning, and put him down for the first nap according to drowsy signs. Now that he is 4 months old, should I wake him at 8:00 to try for the first nap around 9:00?

    2) When should I start making the bedtime a little bit later (say, 5:45 or 6:00) – when his behavior in the hour before bedtime improves? Or when naps become reliably longer? Or perhaps both?

    3) I go back to work in two weeks’ time from now. This is making us rather anxious, for two reasons: he currently breastfeeds exclusively, and when I go back he will be switched almost entirely to formula; also, he will be taken care of by a babysitter and by Grandma. Both of them have spent very little time with him up to now, and have never successfully put him down for a nap (babysitter has never tried – has met him once; and Grandma is very insecure and unsure of herself). I am, therefore, very anxious about his naps. I would like to make them as predictable and “easy” as possible before going back to work. He has a short and simple nap routine that he clearly recognizes as signaling “time for a nap”. Unfortunately, with the current accumulated sleep debt, he has been violently protesting his crib for the last few days. “Cry it out” has brought on suffering and no results, probably because he is chronically overtired. However, I am not opposed to trying it again as the fastest method of achieving self-soothing for naps, when the time is right. But if “the right time” only comes when babysitter and Grandma take over his care, what do you think we should do? They are counting on me to tell them what to do about his naps. Both would be strongly opposed to letting baby hard-cry for any amount of time.
    (Dad is very loving and participative on weekends, but works long hours during the week and doesn’t get to see baby from Monday to Friday.)

    I’m sorry for the excessively long post. Thank you, thank you, thank you for all that you’ve published and worked on. While reading your book, all I could think was “I sooo wish he could be our baby’s pediatrician”!

    1. Congratulations on doing so well on your sleep journey! Please be patient because naps mature over 4-6 months and perhaps later in post-colic babies. Be optimistic because of your past successes. For now, keep the bedtime super early (5:30pm) and do whatever works to maximize day sleep and minimize daytime crying; practice drowsy but awake as much as you can for day and night sleep and over the next several weeks, a nap pattern will emerge for a major midmorning and midday nap. Depending on the timing and duration of these now more regular naps, then the bedtime might be later. But always keep the bedtime based on drowsy signs; because of variability of naps, the bedtime will also vary. Start now to introduce a bottle (perhaps very slowly, perhaps the father gives it in the middle of the night, perhaps on week-ends and you leave the house) to make this transition more gradual.
      I think if you keep a strict 5:30 bedtime over the next 2 weeks, naps will improve. Keep a daily record of naps that will enable you to create guidelines for the babysitter and Grandma. Try to get them involved a little, to practice with you, before you go back to work. Show them the routines you use and be as flexible or rigid in the written guidelines regarding nap times as you think appropriate. Grandma may or may not follow your instructions and because you want to maintain family harmony, if she does not, try to involve the baby sitter more. If the babysitter does not follow your explicit instructions, fire her and hire someone else. I know this is daunting and you have a lot going on, but keeping a baby sitter who does not completely follow your instructions will cause you, your baby, your entire family major headaches in the future. As a back-up plan, read the section on the ‘Nap Drill’ in my book, but because of great night sleep and your past successes, I do not think you need to go there now. Also, review the the ‘Reset’ section for future vacations. Lastly, keep Dad on board for sleep schedules on the weekends when he might naturally attempt to mess it up because he misses his baby so much and wants to spend more time with him and prepare to criticized because you are a sleep pioneer in a culture that valorizes late bedtimes. Does this help?

  2. Yes, this really helps! Thank you for the quick and thoughtful reply. We will do our best to put to practice all the advice given. I will let you know when his sleep improves; I am confident that it will, with patience, consistency and early, healthy bedtimes 🙂 Thank you again and merry Christmas!

    1. I hope you are seeing some improvements. In this calendar year so far, but not in previous years, after the four English-speaking countries of the US, Canada, Australia, and the UK, the fifth country of most viewers of my Blog is Brazil! Many more than the sixth and subsequently ranked countries. Do you have any thoughts why my Blog has become so popular in Brazil over the past 12 months?

  3. His mood has greatly improved throughout the day! He is a happy, calm baby. We are protecting and maintaining the early bedtime at 5:30, some days even a bit earlier. For me, it has been very gratifying to watch my husband and even Grandma see for themselves the positive effect of the early bedtime on our baby’s well-being; they have become active advocates for it. (There was a bit of incredulity in the beginning.) Other family members joke quite often about how our “Dracula baby” is “always sleeping and doesn’t see the light of day” (not true!). We laugh and keep going, because you have given us the confidence to know what’s best for our baby. Once again, thank you!
    Naps are still short, but we are giving him the time he needs. Just seeing how happy he is when he wakes up in the morning, and observing him sleep for longer and longer stretches throughout the night, is more than enough motivation.
    As for your blog’s recent popularity in Brazil, how surprising! I’m rather stumped… My only guess is related to Dr. Dúnnia Baldissera, a sleep consultant certified by the Family Sleep Institute that has gained quite a following on Instagram. She mentions your name often enough, but I don’t know if that’s it… In any case, I’m glad! I hope Brazil keeps it up 😉

    1. Blog Post 38 explains why you will meet more incredulity, opposition, and resistance from those who do not appreciate the power of sleep. The phrase ‘Dracula Baby’ is both cute (sleeps and avoids the daylight) and ominous (suggesting up at night stalking victims). I’ll take the cute! Would you please be so. kind and send me a link to Dr. Dunnia Baldiserra’s web site?

  4. Very interesting post! In truth, I only became fully aware of the importance of sleep for (brain, but also overall) health *after* having my baby (and reading your book). I used to have awful sleep habits, and suffered with chronic sleep-onset insomnia. I never got enough sleep, relied heavily on coffee, and thought this was normal. When I read your book, I realized those bad habits went way back… The desire to set my baby up for well-rested success, rather than a life of sleep deprivation, strongly motivated me to change many aspects of my life so as to preserve his sleep routine.

    Sure, her official website is at
    https://sleeptight.com.br/imersao/
    But I think you will find her Instagram account to be her main form of outreach: https://www.instagram.com/dradunniabaldissera/

    1. Thank you. Please consider writing a narrative report of your child’s (and yours) sleep journey and post it here so that I can post it as a Blog Post (anonymously, if you wish). Your voice might resonate with other mothers more than mine and the cultural differences regarding infant sleep would be highlighted.

  5. Hi Doctor. Thanks to your book’s guidance, in just 5 days our little one changed from as many as 6 wakings per night to sleeping 12 hours uninterrupted from 6.30pm (gaining over 1hr daily).

    Recently our 8 month old has begun to crawl and assisted walking, and as a result she’s begun sitting up in the middle of the night and crying. Attempts to lay her back down worsen the crying and she immediately sits back up as I leave the room. How would you suggest we best navigate the issue?

    1. You helped her and did not harm her in the past, when presumably you gave her less attention: “in just 5 days our little one changed from as many as 6 wakings per night to sleeping 12 hours uninterrupted from 6.30pm (gaining over 1hr daily)”.
      Now, “Attempts to lay her back down worsen the crying and she immediately sits back up as I leave the room.” has failed. Again, give her no attention at night and she will quickly learn new skills and you will not harm her.
      How does this sound?

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