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

COMPARING DIFFERENT METHODS

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.  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, bedtime resistance) 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 21) and effective treatment strategies that do involve letting your child cry are ‘Graduated Extinction’ and ‘Extinction’ (Blog 22).

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 (Blog Post 21).  Nevertheless, here are some general observations that might help you:

• If there is moderate or severe marital distress or perhaps 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’.

Here are the published facts about the different methods:

• Graduated Extinction takes about 4 to 9 nights. In general, it is easier to implement because it is more acceptable. 
• Graduated Extinction, compared to Fading, produced more consolidated sleep and longer sleep durations but both shortened the time to fall asleep.
• Graduated Extinction and Extinction in infants 5 to 6 months old: First night crying duration was 43 minutes and dramatically decreased after the first night. The highest first attempt success rate was for Extinction and the most common second attempt was a switch from Graduated Extinction to Extinction.
• Extinction takes 3 to 4 nights. In general, it is more difficult to implement because it is less acceptable.   
• Extinction in infants 6-months-old; No crying by the 3rd night.
• Extinction is chosen over Graduated Extinction when there is less stress in parenting and among mother’s whose discipline style was not lax (they noticed and acted on misbehavior) and not verbose (they used appropriate parental reasoning and explanations instead of coaxing or begging).
• Extinction success rate is age dependent:
  

• Starting when child is younger than 4 months:
  • Night 1            Crying for 30-45 minutes.
  • Night 2            Crying for 10-30 minutes. 
  • Night 3            Crying for 0-10 minutes.
  • Night 4            No Crying.

• Starting when child is 4 months or older:
  • Night 1            Crying for 45-55 minutes.
  • Night 2            Crying for a little more or less than Night 1.
  • Night 3            Crying for 20-40 minutes.
  • Night 4            Crying for 0-10 minutes.
  • Night 5            No crying.

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.

RESET

Real life events will occasionally disrupt your child’s sleep and a sleep debt might occur.  A reset is an extremely early bedtime (for example, 5:30 PM) that is strictly enforced for one night only.  A reset might be needed just a few times a year or more often, depending on the specific circumstances of the family (Blog Posts 14 and 20).

My observation is that families who choose Graduated Extinction or Extinction are more able or willing to do resets when needed so that the child continues to maintain healthy sleep habits.  The reason(s) for this might be because of the parental factors (Blog Posts 17 and 18) that originally allowed them to choose these methods and/or the rapid success they experienced when they originally tried these methods gave them confidence that allowing crying again, for one night, would not harm their child.  In contrast, families who choose Fading appear to be less likely to employ resets and thus, they are buffeted by periods of healthy sleep habits interrupted by periods of struggling with unhealthy sleep.