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.
Extinction may be used in babies under 4 months of age with success and without any harm.
Here are some parents’ reports:
Blog Posts 105–107:
3-4 weeks-old (four reports)
5-8 weeks-old (four reports)
9-12 weeks-old (four reports)
Blog Post 210: “Our daughter is 2 months and 4 days old…”
Blog Post 213: “This was right when she turned 3 months old…”
Blog Post 216: “This began at 3 months old, …”
Blog Post 229A: “So by 3 months old we worked on sleep training…”
Blog Post 231: “I was determined to instill the same methods with my 8-week-old…”
Jaime Blog Post 237C: “Many parents of newborns at this age (6 weeks) say they’re “surviving”, and I say we’re “thriving”,
Hi Dr Marc,
Is it possible to get some clarification on the below?
In your book under the 4-12 month chapter you suggest to decide on the times when willing to go to your baby at night and ignore them at other times.
When you say times, do you mean actual clock time or amount of hours of sleep since their bedtime?
You suggest no more than two feeding per night. .
Our baby is 6 months old. He has shown to be able to sleep between 6-8 hours in the past, sometimes even 12 hours before a feeding, but for the past week is consistently waking up after 5 hours, then 3 hours. I would like to ignore him, but am not sure if I should choose the same clock time every night when I am willing to go to him, or the same amount of hours since his bedtime?
Also a struggle I have is that between 3-4am, sometimes earlier, he is playing in his cot for an hour or more, not necessarily crying. What do I do in that scenario? How do I stop that? After about an hour of playing I go and feed him with hopes that he will go back to sleep after, but mostly he continues to play for a while after.
His bedtime is early, some nights as early as 3pm. He wakes up very early and his naps are very short, 30-40 minutes and I am therefore not able to meet the typical morning nap at 9am and at the end of the day his bedtime becomes very early.
Tbanks in advance.
Before the sleep issue developed about a week ago, describe his common nap and nighttime sleep schedule and nighttime feedings (if any).
Did anything occur that might have triggered his sleep issue such as an illness or vacation?
Currently, for the past few days, describe his common nap and nighttime sleep schedule and nighttime feedings (if any).
Hello Dr Marc,
Thank you I spoke to you a couple of weeks ago under another blog but could not find the link again.
He was sick three weeks ago, we had to take him to the ER on the third night as he had croup and was not breathing well. His sleep was poor the entire week due to sickness, but the week after the sickness his sleep was mostly fine, the night time was especially good. Naps were a combination of 30-40minutes and usually one of them would be an hour or two hours. His bedtime in that week was 4.30pm and he would sleep 8-10 hours before a feeding, sometimes 11-12hours. All was well for about 5 days after the sickness.
However, after the sickness we got into a rut of an early 3pm bedtime because his naps became very short, even though the week prior he would at least have one long nap around 1pm, that long nap disappeared and became very short. He was also more easily overtired then and we may have stretched him a bit for a few days unintentionally with the time awake inbetween naps because of how short they were, but bedtime was always 3pm to make up for it.
After a couple of days of that he started waking more in the night and also playing in the night. Main takeaway was that his naps suddenly got a lot worse, bedtime because very early, which I think then resulted in more night wakings.
So at the moment a typical day is as follows:
Wake up somewhere between 5am and 6.30am
First nap is around 8am and lasts about 30min only, I tried to stretch him closer to 9am but that backfired as he became very overtired and cried quite hysterically. Currently he cannot be awake longer than 1hr30min or he does cry a lot. He is usually very content to put himself to sleep without any crying at all.
Second nap: somewhere between 10 and 10.30am, lasts about 30-40mins only.
Third nap: this varies a lot, usually somewhere between 11-1pm.
Bedtime has been at 3pm due to the third nap starting early and being short.
Last night we tried to give him another nap at 3pm, and then woke him up after one hour. Did the bedtime routine and he was asleep by 5.15pm. I only did this because I have been very low on sleep myself if he goes to bed at 3pm.
Hope the above is clear. Thank you for the help!
Before three weeks ago (the croup episode), describe his common nap and nighttime sleep schedule and nighttime feedings (if any).
Does he snore loudly, mouth breath during night sleep, or have respiratory pauses during night sleep? If you do not know, sit in his room for a while at night and observe.
Between about 3pm and the morning wake-up time, describe any night wakings (when, how often, for how long?) and separately night feedings.
If he sleeps from 3pm to about 5-6:30am, why can’t he make it to a mid-morning nap?
I also switched from breastfeeding to a bottle at night 3 nights ago, he was often awake for a while after breastfeeding as I think it was a bit too stimulating, the bottle seems to sometimes help him go back to sleep faster after the feeding.
Before the croup his naps were quite all over the place as well, however it was more often about a 1 hour duration for all naps, and less frequently did he have the shorter 30-40min naps that we have been seeing, however they were sometimes short as well.
For most part he would go to bed at 4.30pm and sleep about 7 hours and more before his first feeding. Usually there would be a feeding around midnight and then again at 4am. He would only wake twice in the night. Sometimes he would play for a bit after a feeding, but he would only wake up twice and not outside of those two typical feeding times.
Regarding his breathing, I am very unsure and can definitely observe that going forward. He does sometimes sound like he has a bit of flem on his throat, even before the croup, but I am not sure if that is at all related.
Currently when sleeping at 3pm, he wakes up after about 5hr30mim for a feeding, then again 3 hours later and then again one hour or two hours later, and he will at least one time in the night play and be wide awake for more than an hour somewhere around 1-3am. He will then wake up shortly after playing again at 5am and sometimes I managed to get him to go back to sleep until 6.30am if lucky.
He cannot make it to 8.30am or 9am without him ending up extremely overtired and crying. I tried to do this yesterday, but he cried hysterically and struggled to then fall asleep. I could try again to see if we can get to 8.30am but I was about nervous about trying that again.
Just to further clarify, his sleeping at night before croup was often good, but there would be weeks here and there where he was suddenly waking up more again, however, overall I feel his night sleep was mostly not too much of a problem and the hours he was sleeping inbetween feeds seemed mostly age appropriate to me.
“Currently when sleeping at 3pm, he wakes up after about 5hr30mim for a feeding, then again 3 hours later and then again one hour or two hours later, and he will at least one time in the night play and be wide awake for more than an hour somewhere around 1-3am.” appears to describe fragmented night sleep which is less restorative than consolidated or continuous sleep. This probably is the reason why he cannot easily make it to a 9am nap, even though the total duration of night sleep is ample.
I think you need to impose an age-appropriate sleep schedule on him to achieve healthy sleep. This might involve doing extinction at night and re-scheduling naps. Would you and your husband be willing to commit to a 3-5 day trial?
Hi Dr Marc,
That (fragmented night sleep) sounds like the problem to me too and I definitely agree that this is the reason he can’t make it to a 9am morning nap. In the past he could stay awake up until about the 2 hour mark or just less without too much struggle, whereas now anything past 1hr30mins and we have a screaming, wired and overtired baby.
We can commit to 3-5 days and do exctinction at night.
Now my questions is, how do we go about this?
I’m aware of the typical schedule from your book, 9am and 12pm for the naps. Then instead of a third nap, an early bedtime around 6 months is ideal as apposed to a third nap.
Do I just stretch him to those times? Or aim for as close as possible?
What bedtime do I aim for? Is the 3pm bedtime a bit too early? Does the bedtime shift accordingly to when the second or last nap ended?
If the last nap is very short, do I give a third nap or go with the 3pm bedtime?
Lastly, if he is just awake playing for an hour do I leave him despite worrying about the fact that he has been awake for so long? If he is not crying, but just playing do you think that will eventually correct itself if a nap schedule is imposed on him and if those wakings are ignored?
Thank you!
Nap rhythms are well established by 6 months of age. There is a bidirectional interaction between day sleep and night sleep. Therefore, it makes sense to simultaneously work on day sleep and night sleep. However, improvement will be sequential: first night sleep, then the morning nap, and then the mid-day nap. Consider starting on a Friday night so your husband is available on the week-end to help out.
For night sleep: Do extinction (read and have your husband read the section in my book). Extinction overnight ends around 5am. If you start the day earlier, it will mess up naps. If your baby is hungry overnight, have your husband feed him once and only once without any soothing. The goal for the bedtime is 5:30pm. As you stretch him to a later bedtime, in the beginning, you might only get to 4pm or so.
For day sleep: Do the Nap Drill (read and have your husband read the section in my book). The goals for the naps are 9am and 12-2pm. These are our goals and in the beginning, you will not reach them.
Here are 2 conflicting or opposing ideas:
1. Keeping your baby up to the time of his natural sleep rhythm will enhance his sleep quality and it will be easier for him to fall asleep and stay asleep.
2. Keeping your baby up might cause pre-sleep arousal that makes it more difficult to fall asleep and stay asleep.
Trial and error will guide you regarding how much wakefulness he can comfortably tolerate. While keeping him up, he will need more distraction and soothing but avoid situations like car rides which might lull him to sleep. The soothing to sleep when you do put him down for a sleep period might be extra-long.
Don’t do this if you cannot commit to a 3-5 day trial. Keep a written record.
Later, when naps are well in place, the bedtime will be later, based on drowsy signs. During the day, feed him whenever you think he is hungry but remember, sleep comes from the brain, not the stomach.
How does this sound?
Hi Dr Marc,
That sounds like a plan. Both my husband and I are on board.
We can commit to 3 days uninterrupted, however on the 4th day our nanny will be with the baby during the day time. I can try to give her instructions throughout the day as it is unfortunately not something I can reschedule. On the 5th,6th and 7th days I will be at home and can continue with the trial. My husband will be here in the evenings and on the weekend to help out, and can do bottle feedings in the night.
My husband says we should start with extinction at night immediately, we used exctinction with our older child and this worked very well, so he definitely thinks it would be good to start as soon as possible with that. If it goes alright, I could attempt to work on the morning nap as well and then try to work on the midday nap.
We looked over the exctinction portion of your book again, we have read it and done exctinction in the past.
I just want to confirm that we should aim for only one feeding in the night and ignore all other times? (My husband feels it is maybe a bit ambitious, given his current night sleep, but we also discussed that he has shown to be able to only do one feeding in the past, so in fact it should be doable…).
BUT, if it is around 5am and he wakes, I can feed him again with hopes that he will return to sleep so as to not start the day too early? I think if he is fed around 5am he might be excited and take some time to go back to sleep. Say he falls asleep again after a while of playing after a 5am wake up, and then he sleeps in a bit extra up until about 6.30 or 7am, is that fine or would the sleep be too fragmented in the morning to then stretch him to close to 9am?
Thank you for all your help and for giving us this action plan, Dr Marc.
The idea to start on Friday was just a suggestion; “My husband says we should start with extinction at night immediately, we used extinction with our older child and this worked very well, so he definitely thinks it would be good to start as soon as possible with that.” Go for it!!
Regarding the Nanny; you will have enough data to give her fairly specific instructions so again, start now.
Because the time of his last feeding before falling asleep time might be early and/or variable during these next few days, he might be hungry once in the middle of the night and if so, feed him. If this feeding is before midnight, yes he might again be hungry very early in the morning and if so, feed him again. But no playtime or soothing in the early morning. If he promptly returns to sleep early in the morning, great…it will make it easier to get a nap around 9am. But if he is up at 5ish for a while, don’t let him take a mini nap then, go ahead and start the day. The mini nap would throw his naps off schedule.
Another principle is ‘Control the wake-up time’: If he is asleep at 7am, wake him up in order to get a mid-morning nap that starts around 9am.
How does this sound?
Great, this helps a lot.
Let’s see how it goes over the next few days!
Thank you Dr Marc.
Hi Dr Marc,
I hope it’s okay that I report back on some of the progress that has been made since our discussion last. I thought it would be helpful to ask for feedback now so that I can course correct on amy mistakes before continuing in the same way for the next few days.
(PS: Our time zone is quite ahead of yours as we are in Cape Town.)
Some back information:
Last night (Monday night) I only managed to return home from my part-time lecturing job at 5pm, which is not the usual time, I am usually home by 3.30pm.
However because of this, my husband returned home early to bath our son and do the bedtime routine with him after the nanny had been with him. The night before consulting with you, we agreed to do the following, which we also did on Sunday night.
Essentially, we let him take another afternoon nap between 3-4pm, which would be capped. We would then wake him up, do a quick play and bedtime routine, and he would be asleep again for the night at 5.15pm. I think because he has been quite tired the past few days, it was possible for a later afternoon nap to still allow for a 5pm bedtime. We did this for Sunday night and Monday night (last night).
Regarding the naps on Monday, according to the nanny’s nap logs on the app we all share, he had two one hour naps during the day on Monday. Although only one of them fell at a good time (between 1-2pm) but still the lengths were longer than previous days. However, there is always the possibility that she is not as effective at logging the times on the app as I am.
Then when I returned home on Monday evening we discussed the action plan you gave us and decided to start exctinction immediately. However, he slept for 7hrs before waking up for a feeding. When he woke up, it was 20minutes past midnight and so we felt it was reasonable to feed him. He had been sleeping since 5.10pm. After the feeding it took him about 5-10 minutes to return to sleep on his own. He did not drink as much as the past nights. I’m uncertain as to why his first stretch was suddenly longer, although the previous two nights I did to some degree ignore a few of his wakings for the most part, so it is possible that this helped. But I hope that with time the first stretch will become even longer than 7hrs.
Later on in the night he woke up again at 4.20am (3hr 37min later), sounding very jolly. Considering what you mentioned about extinction ending at 5am to avoid a too early wake up time, I was very uncertain as to what to do if I may be honest as 5am was approaching. I decided to go and feed him with hopes that he would go back to sleep. (For a while he had a pattern of waking up at midnight and again at 4am for a feeding, so it reminded me of that.)
However the result of the decision is something I’m not too sure about whether it was in our favour or not – considering what you mentioned about avoiding a “mini nap” in the early morning. What happened was that he ended up being awake and playing for over an hour after the brief feeding, and only fell asleep again at 5.45am. I did consider fetching him to start his day, but then I thought things would really be off track for the morning nap if the day started at 4.20am. So I left him. He then slept an additional hour until 6.45am. An additional note was that he drank much less than usual at this early morning feeding.
For the morning nap, I then managed to stretch him a bit, he was awake for 2hours and took the nap at 8.45am and was able to put himself to sleep after I left the room without crying. Sadly the morning nap was only 30min and he was up again by 9.15am. I have always struggled to get him to nap longer than 30mins in the morning. (My daughter was the same with her morning nap. However with her I found it much easier to reach the 9am, 12pm and 5.30pm bedtime schedule and did not struggle as much with her schedule as I do with our son now.)
Because the morning nap ended so early, I only managed to stretch him to 2hrs 10min of being awake, he was asleep by 11.25am for the second nap. He was a bit wired toward the end, with his arms flying all around in the cot, but he still managed to put himself to sleep on his own after I left the room without crying.
He then woke up from this nap 25 minutes later, which really felt like a mess at this point.
BUT, since I was about to be busy putting my daughter in her room for her own nap, I decided to leave him. He cried (not intensely) for about 15mins and then was back to sleep for an hour until 1.10pm. At his wake up our neighbours were trying the jumpstart their car which is close to his bedroom window, so it is possible that this woke him, but I am not sure since we do use a whitenoise machine.
From this point I am not sure what to do. Another nap around 2.30pm or a 3pm bedtime, if I can be honest I am not too thrilled on the 3pm bedtime, as his wake up time is usually well before midnight in that scenario.
Thanks for all the help.
Congratulations! You are doing great.
“After the feeding it took him about 5-10 minutes to return to sleep on his own.” “but he still managed to put himself to sleep on his own after I left the room without crying.”
His self-soothing skills tells you to be optimistic.
“I’m uncertain as to why his first stretch was suddenly longer, although the previous two nights I did to some degree ignore a few of his wakings for the most part, so it is possible that this helped.” Yes, it helped.
Because of the variability of timing of an early morning feeding (e.g. 4-5am) consider a more variable onset goal for the first nap to be 9-10am and the second nap 12-2pm. But for now, temporarily don’t let a new nap start after 3pm and stick with a 5:30 expected falling asleep time.
As you begin this 3-5 day trial, please also record his behavior and mood when alone with toys (no screens and no parental or sister interaction) at different time points.
Does this help?
Hi Dr Marc,
Great this helps and I will aim for that.
Thank you for the encouragement as well.
I read your post just after putting him down for another nap, I was aiming for 2.30 but he fell asleep at 2.40pm and slept for 50mins. He then went to bed for the night at 4.45pm this evening. I will aim for no nap after 3pm going forward. Thank you.
Good idea about recording his mood as well! That will be interesting to see.
Let’s see how it goes.
Clarification:
No new nap starts after 3pm.
If he is asleep at 3pm from an earlier onset nap, do not wake him.
Perfect!
Hi Dr Marc,
Today marks 7 days since we’ve applied the age appropriate sleep schedule and exctinction to our son, based off of your guidance above.
We’ve had quite the turnaround with his sleep.
I want to wait another week or two before I give an update, as I first want to see if it sticks going forward.
Thank you for all the help so far!
I just have one question in the interim and that is:
If the mid morning nap starts around 9am and runs past 10am to say 10.30 or 10.45am, is that a problem or is it better to cap the mid morning nap?
At the moment it pushes out the midday nap to about 12.30 for us, which I think is fine?
I just want to know if there are any pitfalls you see with letting the midmorning nap run too long.
Thanks in advance.
Congratulations! You have accomplished a lot and are on a positive sleep path.
Please do not cap any naps. If the morning nap is long, watch for drowsy signs as a cue to start the mid-day nap and expect it start anytime between 12-2pm.
Improvement in the morning nap may precede improvement in the mid-day nap. When the mid-day nap starts later and/or is longer, than the bedtime might be a little later, based on drowsy signs.
Please consider writing a narrative report of your sleep journey that I would use as a Blog Post. Mothers would be more attuned to your voice than mine.
That makes sense. I definitely do not want to cap any naps, so that is great.
I will definitely write a narrative report on the progress we have seen.
Thank you again!
Hi Dr. Weissbluth,
I was wondering about your statement at the top of this blog, I just read the 5-9mo section and it does not say that you cannot use extinction after 4mo, unless I missed something?
We started sleep training at 4months with Ferber intervals because I did not think I could manage cry it out. We progressed through Ferber but then we got to day 7 and did not have any new interval guidance so we just stayed the course until our intervals were 45/50/55. At this point, we decided to start cry it out because we were basically doing that anyways. We have seen some improvements in his sleep (going to sleep earlier (8ish) vs before we couldn’t transfer him until 9pm) but he is still crying for 45 minutes before sleep. We have tried increasing the final wake window, earlier bedtime and even a later bedtime. He is fully contact napped and naps great during the day, I maintained this because I was trying to “maximize daytime sleep” while we were working on his bedtime. His nightime sleep is great, he wakes up 1-2x to feed, we put him down awake and he settles himself after 10 min usually.
Now we don’t know what to do next. We have been at this for 31 days, 20 days of Ferber intervals and then 11 days of CIO. He is a happy, easy baby and we do not think there are any medical issues that need to be addressed. I did wonder about a negative bedtime association so we adjusted the order of the bedtime routine to reduce the crying triggers. Should we address this as a negative sleep association or continue on with adding nap training to the mix?
Thank you
Please clarify, what exactly are you referring to “I just read the 5-9mo section.”? How old is your child.
Do you have a copy of my book? If so, please read the descriptions of ‘Extinction’ and ‘Graduated Extinction’ to fully understand how you failed to follow my guidelines.
I will help you; do you want to fix his sleep quickly or slowly?