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.
I finished my pediatric training in 1973 and began to practice general pediatrics in Chicago’s Chinatown. In 1978, I was recruited to join the full-time faculty of Children’s Memorial Hospital in Chicago (now Lurie Children’s Hospital). A third of my time was devoted each to patient care, teaching medical students and residents, and research. My research interests were infant colic and sleeping difficulties. I founded the first Sleep Disorders Center in the Hospital and began counseling parents on how to help their child sleep better. The program involved a variety of strategies but primarily focused on using the child’s natural sleep rhythms as an aid to help the child sleep better. I had no name for this program.
My first son was born in 1967, and also as a practicing pediatrician, I was aware of the different approaches currently and historically to the subject of toilet training. In 1973, my wife and I participated, with our German Shepard, in a course called obedience training, so our dog would respond to our commands and accompany us safely without the need for a leash. A few years later, we enrolled in in a P.E.T. course to help us become better parents. P.E.T. stand for Parent Effectiveness Training. Whether it be toilet training, obedience training, or Parent Effectiveness Training, there is not just one way or one strategy to achieve the desired goal.
“Sleep training” is the term I eventually coined to describe the variety of ways that I taught parents how they might help their child sleep better. This phrase, “sleep training”, first appeared in print in the first edition of my book, Healthy Sleep Habits, Happy Child, published in 1987, on page 96. However, in the popular mind, “sleep training” has become to mean only Extinction or Graduated Extinction (Blog Post 25).
In the popular mind, and without any scientific support, Extinction or Graduated Extinction is thought to be never attempted under 4 months of age. Thus, it is commonplace for the general public and some professionals, especially in Australia, to state that sleep training should not begin until the child is at least 4 months old.
To help your child sleep better, please review ‘What A Parent Can Do’ and, if possible, start when you come home from the hospital with your newborn baby. The earlier you start to teach self-soothing, the better. It is never too early to start—but it is also never too late to begin. For example, it is never too late to help your child sleep better by encouraging earlier bedtimes or establishing bedtime routines. A result of your effort to help your child sleep better might be that she develops an easier temperament (Blog Post 48).
Hello Dr. Weissbluth! You say that the general advice is not to start sleep training until four months. However, you seem to also say that it’s not too early to start and there are testimonials on your blog and book about babies as early as 4 weeks being sleep trained, and sometimes, the earlier we start, the less crying will be involved. Can you clarify if I could start the extinction method with my eight week old? Thank you!
There is a common notion, without any scientific evidence, that sleep training should not start before 4 months. Blog Post 105, the parents’ reports you mention, and my book and emphasize the importance of parents promoting healthy sleep as soon as possible. Early bedtimes, many nap opportunities, frequent, regular and consistent bedtime routines, brief intervals of wakefulness, drowsy but awake, leave the room after putting down, and if needed, extinction, can safely and effectively help children sleep better, at any age.
Thank you so much!
I currently am nursing to sleep for most sleep and doing contact naps in order for my baby to sleep as long as well as possible during the day. If I put him on another sleep surface, he wakes up within 5-30min. He also has two stretches of 2 hours of sleep overnight, followed by hourly wakings. By 4am, I usually get so tired that I bring him to bed with me. Which issue would you recommend that I tackle first? He is 8 weeks old and we begin our bedtime routine around 6:30 with a bedtime between 7-8pm currently. Nap times are not organized. His wake times are 1-2 hours, and then I nurse to sleep.
Encourage your child’s ability to self soothe (Blog Post 16). An earlier bedtime based on drowsy signs is needed (Blog Posts 7, 9, 74, 83, and 91). The Parents’ Reports, Section 2 (‘Bedtime’) will give you more information. Read the age-appropriate section in my book. Make your husband read all of these items to guide you because you are likely to be short on sleep yourself. How does this sound?
Hello! Thank you for your tips. I read the age-appropriate section in the book, but it is a little confusing as you have the second month as primarily talking about up to week 6-8 and then the book jumps to month 3-4. Should I consider weeks 9-12 as the same as month 3-4?
When I practice self soothing, does that include at nap time? Even though naps are not well organized until month 6?
Thank you for your responses!
Please read the single page “How to use this book”.
When I practice self soothing, does that include at nap time? Yes.
Hello Dr. Weissbluth,
My son is 9.5 weeks old and we just started extinction today. Here is how our day has looked. Before this, we were bedsharing and having contact naps (nursing to sleep) for 95% of sleep.
Awake and fed at 8:15. Awake. In crib at 9:10, cried for 15min, rescued with rocking, then breast.
9:40 asleep. 10:00 awake. (Nap 1= 20min) fed at 10am.
Offered nap at 10:35am based on sleepy cue, cried until 11:28am. Asleep on his own. awake at 12. (Nap 2=30min)
Fed at 12. in crib by 12:58 cried until 2:16. Decided to get him, fed and contact nap starting at 2:36 until 4:30pm (nap3=2hours)
Nursed at 4:30pm upon awakening. Bedtime routine. Bottle 4oz at 5:20.
Laid to bed 5:45pm calm. Fusses at 5:55. Starts crying 6:00 stops crying 7:45pm (asleep).
Please give your advice. Thank you.
Please make your husband read the section on ‘Extinction’ in my book to fully understand how to proceed. Have your husband post a narrative report and a detailed sleep schedule.
Hi Doc,
Started graduated extinction on my six week old and i also have your book where you have mentioned that it’s never too early . But am i putting my child through too much at this age and must i wait longer ?
I’m a gynaecologist from India and we didn’t sleep train our first and your guidance has helped us set an earlier bedtime with him! Looking forward to your guidance and advice
Chapters 4-7 should answer all your questions.
Hello Dr Weissbluth,
My daughter is now 13 weeks and we have begun starting to sleep train her.
As per your suggestions in the book we started five days ago with the first nap of the day.
She is now successfully starting to settle after periods of between 5-25 mins of fussing.
However she wakes after half an hour, and repeats this at bedtime (we have started letting her self soothe at bedtime as of a few days ago) where she becomes particularly distressed.
After around ten minutes of hysterical crying I have gone in to soothe her, but only nursing suffices. At which point she falls asleep on the breast.
Should I continue this, or leave her to cry?
Thanks in advance!
Camilla
Please describe her nighttime sleep and her mood and behavior when alone with toys (no screens nor parental interaction) during the 60 minutes before the bedtime.
What was her gestational age at birth?
Is she exclusively breast-milk fed or does she also receive a bottle (expressed breast milk or formula)?
Thanks for the reply Dr Weissbluth.
Nighttime sleep and mood: Her nighttime sleep varies. She can sometimes sleep through the night to about 5am, but other nights wakes at about 2am, at which point we leave her a while before feeding her.
Before bed at night she is generally quite relaxed, but some night we have missed her drowsy state due to putting her older brother to bed, at which point she can become upset easily but is easily soothed.
Gestation age: she was born at 40 weeks+4 so now a little over 13 weeks.
Food: She is exclusively breastfed, and currently refuses expressed milk.
Thanks!
Camilla
Usually, what time do you begin the bedtime and what time does she fall asleep?
“some night we have missed her drowsy state due to putting her older brother to bed, at which point she can become upset easily” How often does this occur
We begin bedtime around 6:30 with a bath, with the aim for them both to be in bed by 7:30 latest.
She is late to bed a couple of times a week.
Thanks!
Camilla
Please consider a 3-5 night trial of a 5:30-6:00pm bedtime (she has been bathed, fed, put down drowsy but awake, and soothed and you are leaving the room at 5:30-6:00pm) to see if that improves her sleep. Keep a written record of night and day sleep and latency to sleep onset and report back.
Hi Dr Marc,
In your book on page 478 you discuss Method A, and putting your baby down drowsy but awake.
I would like to clarify whether putting baby down drowsy and giving them a pacifier to soothe themselves to sleep is still considered as putting them down “drowsy but awake”?
Due to having a toddler, I cannot spend too much time soothing. Currently I am trying to nurse baby to a drowsy state, and then put him down in his crib with a pacifier so he can then soothe himself to sleep.
Sometimes I have success putting him down drowsy without a pacifier. This seems to work if I have soothed him for a bit longer, but at times when my toddler is getting up to no good or requires my attention, I need to quickly end the soothing and place him in his crib with a pacifier.
Furthermore, Is it confusing to sometimes use a pacifier and sometimes not? And again, my main question is: does using a pacifier in this scenario still count as putting him down drowsy but awake?
I hope my questions are clear.
He is currently about 2 weeks old.
Thanks in advance.
Use the pacifier.
Your main challenge is to not let your toddler distract you from drowsy signs (see Blog Post 115X) in the evening when your baby is 6 weeks old (counting from the due date, not the birthdate) because the bedtime then needs to become much earlier. Blog Post 190 describes this situation and more detail will appear in Blog Post 231.
Thank you Dr Marc,
Appreciate the advice and will do the recommended reading. I am aware of the 6 week early bedtime and look forward to implementing this with him.
Hi Dr. Weissbluth,
My husband and I have used your book with all of our kids and really love it. However, I’m struggling with our fourth baby’s sleep and need some advice!
My almost 5-month old struggles to stay asleep during naps and has a hard time falling asleep at night. It takes me over an hour of nursing, burping, nursing again, etc to soothe him enough that he’ll stay asleep. He’s our fourth, and I assume his struggles are mostly due to our crazy schedule — or lack thereof — since he was born. He was also a premie (36.5 weeks), so I haven’t been very structured with his sleep, afraid to expect too much of him. He was a healthy premie and didn’t need any extra care in the hospital, besides one week of supplementing with a bottle. After a crazy few months, we are now able to stay home and focus on good sleep.
My main question: Is it too early to start extinction? He is almost five months old, but if calculated from his due date, he’s a week shy of four months.
Thank you for your time.
First, place your baby alone (no screens nor parental nor sibling interaction) with toys for 20-30 minutes during the hour before you start the bedtime routine and describe to me his mood and behavior. Do this for only 3 nights. Then, I will give you specific advice.
Dr. Weissbluth, I hope I did this correctly. Day 2 was a weird night, so if it’s not helpful information then I can do one more night and report back.
Day 1
Minutes 0-10: Happy, babbling, looking at toys and the fan
Minute 12: Started complaining quite a bit (little cries, unhappy sounds/moans?). I gave him a new toy.
Minutes 13-22: He played happily, little babbling, kicking around
Minutes 23-25: Getting a little fussy (little, frequent grunts)
Minutes 26-30: Complaining quite a bit. Not full crying, but unhappy and definitely wanting a change of scene
Day 2
We had a family party, so we were commuting 40 minutes back home. He was in his car seat with a toy. He stayed awake for the whole ride (40 minutes) — despite it being close to bedtime — and quietly played with a little robot toy. I thought he was asleep because he was so quiet.
Day 3
Minutes 0-20: Babbled, sometimes sounded a little fussy, but was lifting his legs, kicking, body running in circles from kicking legs, looking at toys and trying to grab or kick them
Minutes 22-27: Quite fussy, complaining a lot. Not full crying, but definitely unhappy. By minute 26/27 almost crying.
When you recommended this I thought he would last five minutes and then just cry. He’s just starting to try to grab things and play with toys, so we haven’t done that very much.
In the last three days I have been protecting his sleep schedule and keeping wakeful periods to 1-2 hours. His naps have been much better, but I’ve found that he struggles to stay asleep in his crib for naps. He sleeps great in a motionless swing, so I have been doing that for the last three days for naps. Is that okay? When I lay him down in his bed, he spits up or struggles to get his burps out, or startles himself awake. Nighttime sleep is still taking 1+ hours to get him to stay in his bed and sleep, despite him falling asleep while nursing many times in that time frame. He wakes when I lay him down, or within a few minutes of laying him down.
Thank you so much for your help. Sincerely, Suzy
What is the usual time that you begin a bedtime routine?
What is the usual time that he actually falls asleep?
The fussy/complaining behavior is from pre-sleep arousal. Please read Blog Posts 171,172, and 204 to understand what is causing it and we will fix this quickly.
I’ll read those today, thank you! I usually start sometime between 7-8, but he hasn’t been staying in bed asleep until 9ish. Last night I started bedtime routine at 6:30, but after several times of putting him down and then him waking up, by 8 he was wide awake. I let him play for about 45 mins and then we tried again. He didn’t finally go to bed until 10. I know he’s exhausted (although happy in temperament when not in his bed) and needs to sleep, but I’m hesitant to let him cry it out since he’s still so young.