Healthy Sleep Habits, Happy Child
49
“Sleep Training”: When to Start
October 18, 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 49“Sleep Training”: When to Start

History of “Sleep Training”

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).

When to Start “Sleep Training”

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).   

Comments

  1. 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!

    1. 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.

  2. 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.

    1. 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?

  3. 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!

    1. Please read the single page “How to use this book”.
      When I practice self soothing, does that include at nap time? Yes.

  4. 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.

    1. 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.

  5. 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

  6. 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

    1. 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)?

  7. 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

    1. 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

  8. 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

    1. 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.

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