Healthy Sleep Habits, Happy Child
25
‘Let Cry’ Sleep Solutions: Graduated Extinction & Extinction (Sleep Solutions #3)
May 3, 2021

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Healthy Sleep Habits, Happy Child

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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 25‘Let Cry’ Sleep Solutions: Graduated Extinction & Extinction (Sleep Solutions #3)

SLEEP PROBLEMS:
PREVENTION VERSUS TREATMENT

All the items listed below in “WHAT A PARENT CAN DO” contribute to the prevention of sleep problems developing in the first place; the earlier you start, the more likely your success. Also, all of the items listed below in “WHAT A PARENT CAN DO” also contribute to the treatment of sleep problems, but they might not be sufficient. Specific family circumstances (Blog Posts 14 and 17) and individual differences in babies (Blog Post 20) might make this difficult to accomplish and a sleep problem (difficulty falling asleep or staying asleep) might develop in your child. 

Two safe and effective treatment strategies that do not involve letting your child cry are ‘Fading’ and ‘Check and Console’ (Blog post 19). 

Two safe (Blog Post 24) and effective treatment strategies that do involve letting your child cry are ‘Graduated Extinction’ and ‘Extinction’.

Because of differences in specific family circumstances and individual differences among babies, it is difficult to give specific advice regarding which method best suits a particular family. Nevertheless, here are some general observations that might help you:

  • If there is moderate or severe marital distress or perhaps if either one or both parents have symptoms of anxiety or depression, consider starting with ‘Fading’ or ‘Check and Console’.
  • If there is mild marital distress or perhaps only one parent has symptoms of anxiety or depression, consider starting with ‘Graduated Extinction’.
  • If there is minimal marital distress and neither parent has symptoms of anxiety or depression, consider starting with ‘Extinction’.

GRADUATED EXTINCTION

Graduated extinction means that after a bedtime routine including soothing, at sleep onset and in the middle of the night, you let your baby fuss or cry for a predetermined brief period, say five minutes. It may be a little less or more. Then you pick up your baby, talk to him, feed him if hungry, and do whatever is necessary to calm him down. You might either calm him to a drowsy state or to a deep sleep state and then you put him down and possibly leave the room. On a given night, you might keep the interval constant, say five minutes, or progressively increase the delay interval by, say five minutes, with each episode. Or, on a given night, keep the interval constant, but on each subsequent night, progressively increase the delay interval. During one of these delays, your child learns to fall asleep unassisted because he is learning self-soothing skills.

EXTINCTION

Extinction (you are extinguishing the habit expectation that crying out always brings parental attention) means that after a bedtime routine that includes soothing, at sleep onset and in the middle of the night, except for feeding, changing, and any suspicion of medical distress, you let your baby fuss or cry without time limit until the morning.

  • Extinction with a cap: Some parents put a cap on the number of minutes of ignoring their child, so they know they are not committing to endless fussing and crying, for example 45 minutes. Too brief a cap might allow your child to learn to cry to the time of the cap for the reward of parental soothing.
  • Extinction with parental presence: Some parents remain in the room until their child falls asleep. 

Your child learns to fall asleep unassisted because he is learning self-soothing skills.

CAUTION

Neither Graduated Extinction nor Extinction will work if:

  • Parents are inconsistent, for example, “just once” take the child back to their bed for nursing.
  • The bedtime is too late.
  • Naps are not going well.

(To be continued.)

Comments

  1. Hi Dr Weissbluth

    We are 13 days into extinction with our daughter- 8 months old. After 45 minutes of crying on the first night, she gradually improved until there was only a few minutes of crying on night 5. However, since then, it’s been more of a roller coaster. She’s had some nights where she’s cried for an hour and others of 15 minutes or 45 minutes. Last night there was no crying but tonight she cried for 58 minutes! This inconsistency is making me doubt myself.

    Her naps total about 2.5 hours a day, and we try put her down when she shows drowsy signs. We put her to bed between 5:30 and 6:30, depending on when she wakes from her final nap.

    There has been an improvement in terms of her night waking- she was waking twice a night for a feed but since we started extinction she has dropped to one feed and has no trouble falling back to sleep after her feed.

    Given that she’s been so inconsistent with her crying, should we give extinction a break? Or is it too early to give it up as we’re only on day 13?

    I appreciate any advice!

  2. Yawning and rubbing her eyes and face. Her wake window before bedtime is usually around 3-3.5 hours after the last nap.

  3. I’ve read Blog posts 9 and 83- thanks for directing me to them. She is definitely showing fatigue signs on the nights with crying. I am going to try and start the bedtime routine earlier while she is happy and soothe her to sleep when she shows the drowsy signs instead of starting the routine when these first appear.

    Thanks again

    1. Please let me know how the next 3-4 nights go so we can fine tune this if needed.
      Sweet Dreams,
      DrW

  4. Hi Dr Weissbluth

    We’ve had a huge improvement over the past 5 nights. We’ve gone through the bedtime routine much earlier than we were and have started soothing our daughter to sleep as soon as she yawns. Her routine now starts around 4:30 pm and she’s in bed between 5 – 5:30pm. Out of the past 5 nights, we’ve had one where she protested then cried for 28 minutes, but on the other 4 nights, she went to sleep with no tears. She even woke up after an hour on several nights but put herself back to sleep with no tears. It’s hard to believe that all she seems to have wanted was an earlier bedtime- we are in shock!

    Thanks again for responding and for your amazing blog.

    1. Hi Crystal,
      I am happy that you had the courage to try a super-early bedtime. Not all parents are able or willing to give it a try. As weeks go by, she will be napping better and then will appear less drowsy in the late afternoon and early evening. At that time, slowly and in small increments, allow the bedtime to become later. Follow her lead and don’t be tempted to rush her. Also, please resist family and friends who might suggest that it is all right for her to stay up later. By the way, today I started to post ‘Fake News’ reels about children’s sleep on Instagram (#marcweissbluth). If you find it worthwhile, please spread the word.
      Sweet Dreams,
      DrW

  5. Thank you for that extra advice- I will look for the signs that she’s ready to go a bit later over the next few weeks.

    Friends and family have been quite surprised to hear how early we’ve been putting her to bed and some have suggested to me that she may wake early as a result- she hasn’t! I just tell them about your book and blog. I’ll have to mention your instagram too. My husband has also had a few days where he’s not seen her because he’s had to work late. However, we know it’s just a short term thing and we’re so happy to have seen her sleep so soundly this week.

    Thanks again

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