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

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.)