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.
Here is a 2021 research paper to illustrate why I think parents should put forth an effort to help their child sleep better as early as possible.
The title is “Persistent Short Sleep from Childhood to Adolescence: Child, Parent, and Peer Predictors” and the primary author is Professor Bror Ranum.
They defined ‘Temperamental Negative Affectivity’ as the tendency to experience negative emotions (sadness, fear, anger, and discomfort) more often, more intensely, and for a longer duration than others. Temperament is viewed as primarily a within-the-child trait or a part of the child’s nature.
They refer to Parental Emotional Availability (Blog Post 17) as “the ability of parents to demonstrate warmth, consistency, understanding, and positive communication.” “Typically, parents are children’s most salient and important regulatory scaffold and thus constitute the environmental factor which impacts children’s sleep the most.” This is part of parent’s nurturing. They cite the following factors that comprise parental emotional availability:
They studied 800 children and made assessments every 2 years between 6 and 14 years. Sleep duration was measured objectively with hip-strapped devices and Parent Emotional Availability was measured by coding video recordings of parents (82% mothers) and children during 4 consecutive structured sequences: free play, child led play, parent led play, and a clean-up task.
A subgroup of children (20%) was identified as having persistent short sleep between 6-14 years. “Temperament negative affectivity and low parental emotional availability predicted membership to that group.” In support of this finding, they cited my 1981 paper that showed an association between a ‘difficult temperament’ and short sleep durations at 4 months of age (Blog Posts 46–48).
Because short sleep durations (Blog Post 6) are associated with many adverse outcomes, the questions are:
My opinion is that genetics do play a role regarding child temperament and parenting but genetics are not destiny. Temperament characteristics appear to show individual stability after the age of about 3 years of age, but not before. However, at any particular age, younger children, older children, and even adults (Blog Posts 1–5) feel better, behave better, and think better with more sleep. Furthermore, when parents are able to put forth the effort, in infancy, more sleep over time might help create an easier temperament (Blog post 48). It is never too early to help your child sleep well and it is never too late to help your child sleep well.
For your child, there are two main reasons why you should try to start early to help your child sleep well. Start with your newborn, or as early as possible, to help your child sleep well because:
Another reason to start early to help your child sleep well is that the transition to parenthood, by itself, may stress a parent or the marriage. The additional stress of parental sleep deprivation, caused by a child with unhealthy sleep habits, may act as a trigger causing turmoil within a parent, the marriage, or both.
So staring early to help your child sleep well benefits your child concurrently and perhaps in the future, benefits the parents and also benefits the marriage. This statement might be true in general but there might be qualifications that limit its generalizability. For example:
Because healthy sleep is so important for everyone in the family, and starting early to help your child sleep well is desirable, if you see speedbumps or roadblocks ahead, seek help from your child’s caregiver, a professional, or a community sleep consultant (Blog Post 27).
My name is Marc Weissbluth and I’ve been a pediatrician since 1973. This baby sleep blog will help you create a healthy sleep schedule for your child. My baby sleep advice and sleep training will teach you how to get a baby to sleep through the night. To stay updated with my latest baby and child sleep blog posts, be sure to subscribe today.
Hi Dr. Weissbluth,
I have a 7-week-old daughter (6 weeks corrected from her due date), and we’ve been working on establishing an early bedtime over the past week. Because her naps are still inconsistent, bedtime has varied depending on when her last nap ends. However, she is typically showing sleepy cues within about 60 minutes of waking, which is usually between 6:00 and 6:30 p.m.
Following your recommendations, my husband is usually the one who attempts to settle her for bedtime. The challenge we’re running into is that soothing her is taking close to two hours, and she often doesn’t fall asleep until 8:30 p.m. or even later. The same thing happens when I try to settle her. Occasionally we have gotten her to fall asleep around 6:30 pm but only for about 45 minutes, then we are back to soothing her for an extended period of time.
During those two hours, we cycle through the soothing techniques that work well during the day and overnight—rocking, offering a pacifier, and, when I’m settling her, breastfeeding for comfort. Despite this, she remains difficult to settle, and the bedtime process is becoming exhausting. We’re feeling unsure about what to do next.
We’ve also been practicing putting her down drowsy but awake, and she’s doing remarkably well with this for her first two naps of the day, often falling asleep with little or no crying. By the evening, however, it feels almost impossible to even soothe her to sleep, let alone give her the opportunity to self-soothe.
The encouraging part is that once she finally falls asleep for the night, she typically sleeps for 5–7 hours before waking to feed.
Is this prolonged bedtime struggle typical at this age, or would you recommend adjusting our approach? Any guidance would be greatly appreciated.
Thank you
Describe in detail the “sleepy cues” that you observe.
She often becomes quite still and quiet and stares off into the distance. Around 6 30 she will begin yawning, we try to have her down in her bassinet by this time.
Around 6 weeks of age (corrected), there is a peak in fussiness, wakefulness, and the onset of specific social smiling. Because she has self-soothing skills (We’ve also been practicing putting her down drowsy but awake, and she’s doing remarkably well with this for her first two naps of the day, often falling asleep with little or no crying) and you have good bedtime timeing with no pe-sleep arousal (She often becomes quite still and quiet and stares off into the distance around 6:30pm), I would encourage you to be patient for a week or so to see that she becomes easier to soothe to sleep at night. Fortunately, she does not have evening fussiness. Has she begun to make specific social smiles? Alternatively, for 2-3 nights only, you might try to begin a soothing routine around 5:00pm and try to put her down drowsy but awake around 5:30 or 6:00pm even though her last nap of the day ended shortly before these times. If there is mild fussiness or very quiet crying, maybe leave her alone for 5-10 minutes to see if she settles on her own. Do this only if you feel comfortable. How does this sound.
Yes she does make social smiles. I will wait a week and see if she settles then try to put her to bed earlier if it’s not improving. Last night she was put down by 6:30pm and ended up finally asleep by 7:30pm which was our earliest sleep time yet. She did require dad to come in 3 times to soothe but it was minimal.
The direction of improvement is encouraging: falling asleep earlier means less pre-sleep arousal and more consolidated night sleep. I suggest you consider working toward earlier expected falling asleep times. Blog Posts 159, 172, 204, 233X and 235C explain why. Let me know your thoughts.
Update from the last post.
Night 1: Attempted a 6:00pm bedtime, 30 minutes earlier and left her to cry for 10 minutes before soothing. Ended up doing a cycle of this until 10:30pm
Night 2: 6:00pm bedtime and she fell asleep at (soothing throughout this time as well) 6:30pm until 7:10pm, then we did the previous cycle of soothing until 10:45pm.
Night 3: 5:30pm bedtime, continued the cry/soothe cycle until 11:00pm.
Night 4: Desperation set in, we were out and got home later than anticipated, it was a bedtime of 6:30pm and we used extinction, she cried for 1 hour 20 minutes.
Night 5: Extinction used again, 30 minutes of crying but bedtime was late because we were at a family event so bedtime was 8:30pm
After nights 4 and 5 she did have longer stretches than she typically does. Night 4, 6 hours and night 5 8 hours. We will continue with a 5:30 bedtime the next few days to catch up on sleep. How long do you think we should keep that up? I don’t want to be stuck in the 5:30 rut.
Please explain in detail what you mean by “the previous cycle” and the “cry/soothe cycle” in Night 2 and 3. Please do not attempt to help her sleep and allow any crying until you see ahead that you can devote 3-5 consecutive nights to an early bedtime. Night 5 might undo any progress that was made from your earlier attempts.
We would soothe (pacifer and rocking in the bassinet) until she was calm, leave the room, after a few minutes she would cry again and we would let her cry for 10 minutes before going back in and soothing her until calm again. This week will be fully devoted to an early bedtime. Tonight was 5:30pm, she fell asleep within minutes with very minimal crying and she stayed asleep.
We have consistently had a 5:30 bedtime the last 7 nights. It has been extremely challenging. The last 6 nights she has fallen asleep well at 5:30,however between 6:30 and 7:00pm she wakes and will cry quite intensely for well over an hour. The first 3 nights we let her cry for an hour before going in changing her, and attempting to breastfeed her. She wouldn’t take a full feed indicating she wasn’t that hungry and mostly just soothing. Then, she would fall asleep after a short bout of crying, however her sleep did not seem restful, she moved a lot, and had many whimpers until about 10:00pm when she would wake again and I would feed her, she would take a full feed. After this feed, she would fall asleep quickly until around 5:00am when she woke for her next feed, then would sleep again until 8:00 or 9:00 am. The last 3 nights she has still had a wake up between 6:30 and 7:00pm but we have only let her cry around 10-15 minutes before going in to feed/soothe her. After we would do extinction again until her next feed. She would cry for over an hour each night after that feed and once she fell asleep it was restless again with on and off crying until around 10:00pm when I would feed again.
We are beginning to feel discouraged, like we are doing something completely wrong but cannot determine what it is.
I will help you.
Please describe in detail what a common daytime sleep/wake schedule looks like. During the day (and at night) are you still able to put her down drowsy but awake?
Describe her mood and behavior between 4-5pm; for 1-2 nights only, put her alone with toys(no screens, no sibling or parental interaction) for 10-15 minutes then and observe her mood and behavior.
Is your husband also putting her down often at 5:30pm?
I would say she “wakes for the day” around 6:00 a.m. when her overnight feed happens before 3:00 a.m. However, this awake period is quite short—usually only about 45 minutes. After a diaper change and feeding, she is back asleep by 6:45–7:00 a.m. For this first nap, she is put down drowsy but awake and typically falls asleep with little to no crying, sleeping for about 60–90 minutes.
Sometimes she wakes around 4:30 a.m. for a feed instead. On those mornings, she will usually sleep until about 8:00 a.m., with her first nap occurring around 9:00 a.m. Again, she is put down drowsy but awake.
After those first naps, we try to follow her cues based on how long she has slept. Most of her naps last between 45 and 60 minutes. She is typically awake for about 45 minutes before we begin soothing her, with the goal of putting her down around the 60-minute mark. If she seems well-rested after a longer nap, we will occasionally extend her wake window to about 75 minutes before putting her down again. Overall, she has approximately four naps each day.
As the day progresses, however, putting her down drowsy but awake becomes much more difficult, particularly the last 2 naps. She requires more support to fall asleep, such as a pacifier being held in her mouth until she drifts off. If that doesn’t work, we will allow her to cry, although she rarely cries intensely and usually settles within about 15 minutes.
Her last nap typically begins between 3:00 and 3:30pm and ends between 4:00 and 4:30 p.m. It’s difficult to describe what she is like between 4:00 and 5:00 p.m. because she is either asleep or we are beginning her bedtime routine. Once she wakes from her last nap, we usually spend about 10 minutes playing, followed by a diaper change, feeding, and getting ready for bed. The bedtime routine takes close to 30 minutes because she has reflux and needs to be held upright for at least 20 minutes after feeding. She is very tired during her feed and is often falling asleep.
My husband is the one who usually puts her to bed at 5:30 p.m., although my mom occasionally does bedtime instead.
Because she has self-soothing skills, please be optimistic.
Because fussiness/crying/wakefulness in the evening peaks around 6 weeks of age, please be patient.
Stay the course and give me a progress report in 2-3 days.
Thank you. I will update you on tonight as we changed it up a bit. We opted for a 5:00 pm bedtime instead. There was more success initially but ultimately we ended up with the same issue. She fell asleep immediately at 5:00 pm. Awoke briefly for around 5 minutes at 5:45 pm, then fell back asleep until 8:00 pm. At this time, she fully woke and began to cry intensely as she normally does when she wakes at this time. I am beginning to think that since the crying at this time has not reduced in duration or intensity this last week, that maybe she actually is hungry. My husband went in to check on her after 30 minutes of intense crying and she continued to be inconsolable. I went in, changed her and fed her, she took a full feed. After feeding and holding her I put her back down where she softly fussed for just over 20 minutes before she fell asleep. I believe she will be asleep for her long stretch now which is anywhere between 6-8 hours typically.
Should I continue with this pattern of feeding her at this wake up time if she is crying intensely or should I do extinction or should I wean the feed? Will this feed naturally go away as she becomes better rested?
I feel like part of what is making extinction so hard for us is her crying during her wake ups is very intense, it is not a soft cry, it is intense like the cry a baby would make during vaccinations as you mention in your book. With our son, when we did extinction he never cried this intensely and we saw immediate progress within a couple days with him.
With two children, it is possible that at the end of the day, your milk supply is not as ample as needed and she needs this feeding. Always feed her when you think she is hungry. Will she take a bottle?
Continue with the 5:00pm bedtime if it seems to allow her to fall asleep easier.
Blog Post C2522AX will be published on August 14 and describes why extinction with your second child may be different from your first.
Blog Post 190 might be useful.
Yes, blog post 190 sounds very familiar to our situation. I wouldn’t say she is colic, but I do believe reflux contributes to some waking at night.
She somewhat takes a bottle, 4 oz is typically a full feed for her based on weighted feeds with a lactation consultant. Since my husband does the bedtime routine he attempts to give her a bottle, she will drink 2oz, sometimes 3oz but has never finished the full 4oz. I also try to top up with breastfeeding just in case but she will maybe feed a small amount or none at all. It leads me to believe she is full at bedtime.
I feel I am not confident on when to use extinction during night wakings, it has been difficult to determine whether she is crying out of hunger or out of habit now.
After the 8:00pm waking and feed last night she continued to wake every 3.5 hours last night, she was fed each time. She breastfed actively each time, each time it was close to a full feed believe. It was the most night wakings we’ve had since she was 2 weeks old. She never had a long stretch. I am hoping this is a one time thing and as we continue with 5:00pm this week these wakings fade.
Thanks for your support and advice.
Update after 3 nights:
Night 1: Bedtime at 5:15 pm, minimal crying, woke again at 6:30 pm, cried softly and fell back asleep until 10:45 pm for a feed. Woke again at 3:30 am for a feed, 6:00 am wake up.
Night 2: Nap went later, until 4:30pm so attempted a 5:30pm bedtime, she is very slow to take the bottle so bedtime ended up being 5:50pm. She cried softly then would fall asleep on and off until almost 7:00pm when she finally went down for the night. First waking for a feed 1:00 am, then 3:30 am, then 5:45 am, then woke for the day 7:30 am.
Night 3 (tonight): Nap ended quite early, 3:00pm, tried to get another short nap in before bed but it was unsuccessful so 5:00pm bedtime. She is being bottle fed before bed by my husband she she kept falling asleep so she did not quite have a full feed. She fell asleep quickly until 6:00 pm when she woke and cried softly for 10 minutes then began to cry intensely, since she didn’t quite have a full feed I decided to feed and change her at this time. I put her back down at 6:30 she cried softly for about 15 minutes where I believe she is asleep for the night.
So there has been improvement. The last 3 days naps have improved too, they are at least an hour long now and some extending to 90 minutes.
I know naps don’t settle until around 3 months, she is 10 weeks now (9 weeks from her due date), but I am not sure how to handle bedtime when the nap ends at an awkward time, like 3:00 pm. Should I try for another nap around 4:00 pm and have a later bedtime or should I do what I did and have a 5:00 pm bedtime?
Congratulations! You have done a remarkable job in a short time. Please consider writing a narrative account of your sleep journey to see how far you have come. Please try to have no new nap starting after 3pm to protect an early bedtime. Some days, the bedtime might be 5 or 6pm based on when the mid-day nap ended and how long it lasted. Is this OK?
Hi Dr Weissbluth,
I am still concerned we are not doing something correctly. She continues to have an early bedtime between 5:00 and 5:30 pm typically. She falls asleep quickly and easily but is still waking up 30-60 minutes later where she cries quite hard and I end up going in to feed her. She is feeding well at that time but I find it hard to believe that she is that hungry as she is consistently taking a bottle at this point and she drinks it in its entirety. I fear we are creating a habit but when we leave her to cry she will cry for well over an hour quite intensely. So despite having an early bedtime everyday for the last couple weeks she really hasn’t fallen asleep until around 8:00pm every night.
Please clarify your feeding description around bedtime. About. what time is her last feeding around bedtime (breast or bottle-how many ounces?) and the feeding 30-60 minutes later.
At bedtime she is offered a bottle of 130 ml. Sometimes she will drink the entire bottle and sometimes she will only drink 70-80 ml. In either scenario she still wakes. When she wakes again after 30-60 minutes I would breastfeed her so I don’t know how much she is taking at that time. I would assume at least another 50 ml as she feeds for at least 5 minutes.
Last night, I decided not to go back in and she cried for 2 hours. She feel asleep around 7:45pm. She did have her longest stretch of sleep though last night, she didn’t wake until 2:30am for her feed then slept from 3:15am to 8:30am. This evening we tried to do this again. She cried for 2 hours, when she stopped she was not quite asleep and was very restless for another 45 minutes before she began crying again. At this point I went in to breastfeed and change her as it was almost 9:00pm. She took a full feed at this time, approximately around 10 minutes.
It feels as if she is treating the 5:00-5:30 pm bedtime as a nap. I do wonder if we should adjust course and treat this as a nap starting around 4:00 pm and if she wakes up around 5:00 pm prepare for a bedtime around 6:30 pm. It has been 3 weeks of an early bedtime and this is the only issue that has not improved but instead remained constant. While some nights the crying has been less intense than others she always wakes up after being put down for the night.
Would we lose the progress we’ve made by doing that? I don’t want to make things worse.
“At bedtime she is offered a bottle of 130 ml. Sometimes she will drink the entire bottle and sometimes she will only drink 70-80 ml. In either scenario she still wakes. When she wakes again after 30-60 minutes I would breastfeed her…” Going to her and breastfeeding her after 30-60 minutes is not a good idea because she cannot be hungry (unless sometimes she needs more than 130ml). Is it expressed breast milk or formula in the bottle?
Currently, describe a common nap pattern (onset and durations).
It is mostly expressed milk. I pump the night before or just before bedtime so my husband can feed her. Recently, however I discovered my frozen milk is high lipase and she wont drink that so if I haven’t pumped enough I top up the bottle to 150ml with formula just to be safe, she has never drank that much though.
Shes been waking later in the mornings this last week, between 8:00am and 8:45am so her first nap typically starts between 9:00am to 9:30am. She is breastfed and then held for 20 minutes before being put down, once down she may fuss for a couple minutes or cry softly before falling asleep for usually 90 minutes, sometimes 2 hours. Her second nap is around 11:30 – 12:00pm and lasts at least 60 minutes sometimes 90 minutes. The 3rd nap is 45 – 60 minutes beginning around 2:30pm.
For the naps, why do you hold here for 20 minutes? Is she drowsy but awake when you put her down for naps.
She has reflux so I hold her upright after the feed to prevent spit ups. She is often very drowsy when I hold her, sometimes even asleep. Once she is put down though she is more awake.
She has great naps and self-soothing skills. How old is she now?
In the evening, do you see drowsy signs before soothing her to sleep for the night?
How do you and your husband feel about trying extinction or graduated extinction?
She is 11 weeks old today. Yes there are definitely drowsy signs before putting her down. Honestly she could probably be put down at 4:15-4:30 but is that too early?
We were comfortable with extinction with our first child because it worked quickly, there was a significant decrease in crying after the first night. She seems to cry a lot longer and considerably harder, with more intensity. We have attempted extinction several times over the last 4 weeks and while there was initial success the first 2 nights right at sleep onset with the early bedtime, she no longer cries much or at all when put down for the first time, she still woke after 30-60 minutes. During this awake time we have attempted extinction until the crying became intense usually after 20 to 30 minutes then we felt she must need something. Some nights she was too hot from crying so we would adjust what she was wearing or calm her down enough to cool her down, some nights we thought she might be hungry so I would breastfeed. The last 2 nights have been cool and she has been offered bottles so we felt that there was no reason to go back into the room. However her crying has been intense for 2 hours, her voice is very hoarse. Last night, when she began to cry again at the 3 hour mark after settling for 45 minutes, we finally decided to end the extinction for the night and feed her in which she fell asleep almost immediately afterwards. We are willing to do extinction if we can see results but she does not seem to be responding as well to it. We will try again tonight. I hope to see an improvement because I don’t know how much longer my husband or I will be able to tolerate the intensity of her crying for that long period of time.
Before attempting extinction, please try for 2-3 nights only putting her down at 4:30-5:00 pm if she seems drowsy. Just to see what happens.
Update on the earlier bedtimes
Friday: We did the 5:00 bedtime. She woke at 5:50 and had the usual intense crying. She cried for 70 minutes then I went to check on her. She had a dirty diaper and as I soothed her to go back down she rooted so I breastfed her and she fell asleep around 7:30 pm. She then slept until 2:30 a.m. and fed. At 4:30 she woke and Dad tried to soothe her, but she ultimately needed breastfeeding to settle back to sleep. She then slept until 7:30 a.m. for the day.
Saturday: Her last nap ended at 4:00 and she wasn’t drowsy until 5:15, so we put her down at 5:30. She cried for 10 minutes and fell asleep. She slept until 6:40, then softly fussed for 10 minutes before escalating. We spent about 35 minutes soothing her with rocking/pacifier and a diaper change. She became very drowsy but woke whenever the pacifier fell out. At 7:25 we stopped intervening and allowed her to try to settle independently. Around 7:45 she fell asleep on her own
Sunday: We tried 4:40 pm. She fell asleep quickly and slept until 5:40. She cried for 15 minutes, then we checked and found a dirty diaper. After changing her and putting her back down within 5 minutes, she cried hard for about 8 minutes, then repeatedly tried to settle herself. She continued cycling between crying and attempting to self-soothe for about 1½ hours, but ultimately fell asleep independently at 7:15 without another feed or soothing.
Should we continue with the 4:30-5:00 pm bedtime? She is becoming better at self soothing but all 3 nights she had a dirty diaper that needed to be changed when she woke up after her bedtime so she needed intervention anyways.
I see the last 2 nights as a big improvement but ultimately the issue of the false start is still there and she is requiring interventions to attempt to self soothe.
Please tell me in detail exactly what you see as a big improvement.
There is a lot less crying and more self soothing happening in her awake time after the false start. Even though she is awake (usually an hour and a half or so) for similar periods of time she is trying to put herself back to sleep more than she had been during that time.
Last night, we needed to be out a bit later so bedtime was 7:00pm, she did not have the false start but had more difficulty falling asleep. We treated it the way we had been treating the false start the last 2 days, we let her cry for 15 minutes, went in did a quick soothing, she cried after for 12 minutes before soothing herself to sleep by 7:40. So despite the later bedtime her ability to settle herself was faster yesterday too.