Healthy Sleep Habits, Happy Child
67
When to Start Sleep Training, #2
February 21, 2022

Found in age groups

Healthy Sleep Habits, Happy Child

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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 67When to Start Sleep Training, #2

When to Start Baby and Child Sleep Training

Blog Posts 49 and 57 discusses beginning sleep training as early as possible. What about letting your child cry at night to help your child sleep better using Extinction or Graduated extinction (Blog Post 24)? My book includes several parent reports describing how and why some parents allowed their children to cry to help them sleep better during the first weeks of life. But many find this objectionable for theoretical reasons. What are the facts regarding allowing very young infants to cry in order to help them sleep better?

  • One study showed that the more frequently mothers ignored their infant’s crying in the first nine weeks, the less frequently their infants cried in the following nine weeks. No adverse effects were noted regarding the mother-infant bond. “We found that crying at home did not differentiate between secure and insecure attachments” (Attachment & Human Development, 2000).
  • A second study asked the question: “Have you ever tried leaving your baby to cry it out during this time?” Here is their data:
Age of Child   Never/Once (%) A Few Times (%)  Often(%)  
Newborn (40-41 weeks
Gestational age)
63 29* 8
3 months 38 49 13*
6 months 40 52 8
18 months 32 37 31

The reason that I am showing the actual data is to emphasize that at term, 37% of mothers, and at 3 months, 62% of mothers allowed their child to cry sometimes in order to help their child sleep. This is in contrast to a popular misconception that nothing can or should be done to help children sleep before the age of 4 months.

Here are some of their findings and conclusions:

*:  Leaving an infant to cry it out a few times at term or often at 3 months was significantly associated with less crying at 18 months.

Leaving the child to cry it out “Was not associated with either adverse behavioural effects on infant development or infant-mother attachment at 18 months of age. We neither recommend leaving an infant to cry out nor responding immediately. Rather, most mothers appear to intuitively follow a differential responsiveness approach with most of them responding immediately at term and starting to adopt a differential approach from 3 months onward. Leaving an infant cry it out might not reflect parental neglect but it may rather reflect authoritative parenting which includes both limit setting and high levels of emotional warmth. If leaving infants to cry it out is occurring within the context of a warm mother-infant relationship, no adverse impacts have been demonstrated.” (Journal of Child Psychology and Psychiatry, 2020)

  • A third study asked mothers “Have you ever tried leaving your baby to “cry out’?” Cry out Users are mothers who used cry out “a few times” or “frequently”. Nonusers were those who reported not using cry out or used “cry out” only once. Here is their data:
Age of Child     Nonusers or Used Once(%) Users (%)  
3 months   77 23
6 months   55 45
18 months   39 61

Comparing ‘Users’ and ‘Nonusers’ (excluding those who used only once), it was observed, at 6 months, there were no differences in measurements of caregiver sensitivity (refers to direct observation of affectionate caregiving that is sensitive and responsive to the infant’s needs). Also, at 20 months, there was no difference in direct measurements of infant-mother attachment. By 12 months of age, infants of ‘users’ , compared to ‘nonusers’, had an easier temperament, fewer night wakings, and longer sleep durations.

Among ‘users’, “early adopters” used cry out at 3 months while “late adopters” started to use cry out at 6 months. Comparing early adopters and late adopters, at 12 months of age, there was less crying at bedtime and fewer night wakings in the early adopter group.

“Our data suggests that cry out contributes to the trajectory of infant development, including potentially preventing later problems. Infants of cry out users had reduced negative temperament, reduced night waking, and increased hours of sleep at 12 months of age, compared to nonusers. Cry out is not associated with infant-maternal attachment.” (Journal of Developmental and Behavioral pediatrics, 2020).

For more information, see:

Blog Posts 102104: It’s never too late, helping older children sleep well.

Blog Posts 105107: It’s never too early, helping young babies sleep well.

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.

Comments

  1. My baby is 10 weeks old and I have been trying to lay him down drowsy but awake. I’m finding that he often fusses until he is over tired and then it’s very difficult to get him down. He ends up pecking at my chest and clawing at me until I finally nurse him sleep.

    1. Simply shorten the interval of wakefulness by 5-10 minute increments until you see that he fusses less or not at all during your soothing. Please let us know how it goes.

  2. I want to say that you changed my life and have changed thousands of mothers’ lives here in Brazil. I’m a doctor who became a sleep consultant at FSI after devouring all your books and applying them to my children. Today we are pioneers in the method of extinction, and thousands of families have been transformed into happy families. All because of you. Thank you, thank you, and thank you.

  3. We sleep trained our baby (6 months old) and he started to sleep through the night. But on the fifth night of the training he woke up around 3.30 am and cried till morning. We’ve been putting him to sleep early ~5.30 pm with two day naps. He was fussy all day perhaps because of teething. What can we do at night during teething time to give him some comfort and not create bad sleep habits?

    1. Whenever there is an acute change in your child that might indicate pain or illness, call your child’s doctor. Teething pain disrupting sleep is a myth (Blog Posts 36-37).

  4. I slept trained my 2 older sons with the help of your book. One at 6 months & younger son at 5 months. I have a 4 month of son, never got the girl ha, i tried to sleep train him on the day he turned 4 months. Was i overzealous? He cried for 1 hour i than got him & nursed him. I put him down & he cried again for 15min.

    1. Because of your experience, follow your heart. I gently suggest attempting a 3-4 night trial. It is important to look carefully for a trend to improvement over a few days before abandoning the effort. Be mindful that the older boys (we tried four times and never got our daughter!) might distract you from nap opportunities and early bedtimes. Be ultra consistent during the 3-4 day trial. Let me know how it goes.

  5. Okay thank you. I will try again definitely! I tell everybody about your book. I feel bad for parents who do noy have “time to read.

  6. Hello,

    I have a 15 week old daughter. I read your book and we have been doing the extinction method for 14 days now. We follow all the suggested steps: consistent routine at the same time (6pm) every day, she is fed, then the father burps her, rocks her, and puts her down drowsy but awake. On the first day she cryed for 1h20, and it has been decreasing since, but she still cries for ~20’. We noticed that she is usually asleep by 7h40pm. Should we try for an earlier or later bedtime? Will she ever not cry?

    Thank you very much for all the resources you make available.

    1. Because of the variability of naps, the bedtime should vary a little. Instead of a “consistent routine at the same time (6pm) every day” be mindful how she looks around 4-5pm (drowsy signs).Sometimes, her soothing to sleep might begin at 5pm with lights out at 5:30, other times it might be a bit later than 6pm. It might take a little practice but within a few days, there should be no crying at all. If unsure, go for the earlier bedtimes (lights out at 5:30pm). Let me know what happens over the next few days.

  7. Thank you so much for your response, doctor! I will keep an eye for the sleep signals before she is overtired and I will report back.

  8. Follow up sleep training. I week away from 6months i started sleep training my son. He is difficult & definitely cries a lot, 1st night was 5 hours on & off. Night 6 & 7 finally some improvement cried 1 hr & fell asleep. However he is also waking up 2 hours later & cries for 3 hours. Does this indicate an earlier bedtime? I do my routin, nurse him & place in drowsy & i leave his room by 6 :15pm.

  9. He has a morning nap usually 2 hours. However he still sleeps every two hours after each feeding. His pm nap has not started. We’re on night 11 now. I do the same routin but i have been putting him down later. Tonight it was 7:45. He took a long nap & i woke him up at 6:15. He had fell asleep on me & i couldn’t put him down. I was hungry & needed to eat dinner.

    Last night he was much better. Left his room at 7:45. He went to sleep without a fuss. He woke up at 1 hour later & cried untill 10:30pm. He woke up at 11:45 & i fed him. He woke up sometime around 2am but i let him cry it out & he woke up at 6:45am & i went to change & feed him . I put him down around 730am & he fell asleep at 8 :30 on his own untill 10am.

    1. Because of multiple variables (older siblings, no pm nap schedule, a too late bedtime), please consider a community sleep consultant as described in Blog Post 27 to decide which variables are more salient and need to be addressed first.

  10. Hello, I am desperate and developing depression because of this. I got Your book and I find it very useful, but do not know how to implement things. I have a 6 week old daughter and I think she is colic. She overtires extremely quickly even though I pay close attention to signs of fatigue. However, I think she is permanently overtired. I only get her to sleep when I bounce her in the carrier on a ball (Rarely has it worked out differently: breastfeeding or swaddled. She refuses the pacifier completely – sometimes she gags so much from it that she spits her milk out). I have to bounce her too to keep her asleep, too (I also do that at night until I almost collapse – mentally and physically). I can only put her down if she has been sleeping in the carrier for a while. Otherwise she wakes up crying after 40 minutes. Or she cries right when I put her down in her crib. Sometimes I have watched her connect sleep cycles in her cot, so she can do it. But often that was when she was not that overtired. I know sleep in the carrier is not that restful, but if I don’t choose that remedy, she doesn’t sleep at all. Drowsy but awake currently doesn’t work or I’m always to late. I have a toddler too and don’t know how else to get her to sleep. It’s a vicious cycle. I’m considering letting her cry at night at 8 weeks (with feedings of course and only if she’s ok). But won’t that make things worse because she’ll be completely overtired? It breaks my heart and when she cries I can’t shut. I know she is so young but we both get miserable sleep. It’s a nightmare.

    1. My first son had colic and my first book was on colic so I know what you are going through and I will try to help you. Are there any resources (husband, family members, community services, faith groups, etc.) that might be called in to give you a break? As on airplanes, you have to take care of yourself first (put on your oxygen mask) in order to take care of your children. Please try to take some breaks, without guilt! You are probably in survival mode now and totally exhausted so I will keep it simple:
      How old is your first child? Did you use extinction or graduated extinction when he was younger?
      How supportive is your husband; will he agree to use extinction or graduated extinction for your baby?
      Was your child born on the due date?

  11. Wow, I don’t even know how to thank you for trying to help me. We have people around us who can help us e.g. by taking our older son or cooking etc…. My husband also helps as much as he can but he has a demanding job. He was home for the first few weeks. My fear if others take the baby is that they will not make the effort necessary to get the child to sleep (due to lack of knowledge about overtiredness, etc). I’m afraid of then having an even more overtired child at the end of the day who can’t be calmed down. Actually, it is not so comfortable for me to share so much details here about my life here publicly. Is it possible to communicate more privately? But I also understand if it’s not possible and I absolutely respect it! Maybe I can also help others with my case:

    My son is just over 2, we did graduated extinction at 5.5 months. I was at a low point then too. Our son was already difficult. Unfortunately i kept falling into old patterns out of panic but he slept so well then that we didn’t mind.

    my husband is very very supportive but I have to make it clear to him that I can’t do the nights without him; even if he has to work.

    My husband is absolutely fine with both methods.

    Our girl came 2 weeks before due date. Does that make a difference?

    Thank you very very much!

    1. Please read Parents’ Reports topic 1. Graduated Extinction and Extinction on my Website.
      Here are some specific suggestions that might be helpful because you are an experienced parent and your husband is supportive. Think of your daughter as about 4 weeks old counting from her due date. Colic is gone in about 50% of children by 2 months of age. Because of her age, you might decide to get as much help from others (they are to maximize sleep and minimize crying by whatever means possible) to regain some sleep for yourself and implement my suggestions in a few weeks or, because you are desperate, you might want to commit to a 3-4 day trial now and abandon it if you see no improvement. Let me know your thoughts.
      1. Because of your experience with graduated extinction and your current exhaustion, I think you should try extinction for a trial of 3-4 nights.
      2. During the day, do whatever you can (with help) to maximize sleep and minimize crying.
      3. After feeding and soothing, you put her down at 5:30pm (awake, drowsy but awake, or deep sleep) and leave the room.
      4. Because of your experience, I assume that she will be well fed around 5-5:30pm. At or after 9:30pm, if she cries and you suspect she might be hungry, feed her and leave her. Repeat the feedings at 4 hour intervals if you think she is hungry. Extinction means that in between these feedings she is left alone.
      5. You might want to temporarily sleep in your son’s room (to reassure him that his sister is ok) or camp out in the living room during this 3-4 night trial.
      6. You might want to start this on Friday night so your husband is more available to help out during the day on the week-end
      7. Keep meticulous records of nap and night sleep times and durations and crying times and durations. The expectation is that there will be substantially less night crying on night 3.
      Do not do this unless you can commit to a 3-4 day trial. This trial might succeed because all children fuss/cry more as they approach 6 weeks of age. This trial might fail because colic can persist for 3-4 months of age. If this trial fails, go back to whatever works best and consider trying it again in 3-4 weeks.
      How do you feel about this?

  12. Thank You so much. It sounds like a well thought out plan. And I have to be honest, I can’t go on like this even though I would give anything for my child. I can hardly calm her down in the evenings sometimes, she cries despite all attempts to calm her down and when she sleeps it is torture to keep her asleep. Yet I have such an urge to make it work. I also feel so guilty because I use the carrier and prevent her from sleeping restfully enough.

    It will be extremely hard for me mentally to implement the plan (even though I know that if I succeed it will be the best thing for her). I would really have to lock myself in another room and let my husband endure the crying. I have a few questions:

    – Regarding the time: I know the importance of an early bedtime, but is that possible with newborns? I have only read about later bedtimes for newborns.
    – should I swaddle her? Or leave her arms open?
    – What if she cries all night or hardly sleeps at all?
    – What if she screams hysterically for hours? I know that it is fatal to resort to old remedies when she already has been screaming for so long. But I want to be prepared for all scenarios….
    – Can she sleep at all if she inevitably gets overtired in the process? Won’t things get worse then?
    – Will it hurt her in any way since she is so young? Will she be able to self-soothe at all?
    – How do I know she’s not in pain? (The doctor said at the last checkup 2 weeks ago, everything is okay with her and I don’t notice anything special besides the crying – the crying definitely increases throughout the day).
    – Should I wake her up for feedings if she doesn’t wake upon her own? Should I not feed under 4 hours? Or stay flexible (3-4 hrs).
    – Should I change her diaper once?With bowel movements anyway, I mean urine.

    I suggested that our baby is considered not premature since she was born at 38 weeks?

    She has been smiling for a few days and today she sucked on her hand to calm down.

    Thank you so much for the concrete plan. Can you link me to the recommended article? I can’t find it on your site.

    1. Go to my Website, ‘More for Parents’, ‘Parents’ Reports’, item #1.
      Swaddle if you wish
      If, and only if, the bedtime is super early, the crying will not go on forever. Do not begin this plan if you cannot be 100% consistent for 3-4 days with the 5:30 lights off bedtime and the commitment to extinction.
      Do not wake her for feedings; most children who are well-fed can go 4 hours between night feedings; change her then.
      Social smiling starts around 6 weeks of age after the due date in most babies and heralds the start of more ability for self-soothing which you just now noticed regarding sucking on her hand to calm down. This is a dramatic observation that should give you confidence that the crying from extinction will dramatically decrease on night 2 or 3. Have your husband read the section on ‘Extinction’ in my book so he understands exactly what his role is.
      Maybe leave the house for a few hours after 5:30pm to take a break and not endure listening and worrying about your baby, just a thought.

      1. Once again, thank you for your reply. I was thinking that it would be better to leave her hands out so that she eventually can use them for self soothing?

        Should I try to organize the naps in a way, so that the wake time towards betime is as short as possible? Although it seems impossible to me to organize any naps at the moment.

        I also bought the Snoo out of desperation (I could still return it). So far I haven’t had much success with it. Do you think it will be useful in any way with our baby within the next few weeks or months? Or is this tool even more counterproductive?

        I will try to implement your valuable advice (just not sure at the moment when to start the 3 night trial)

        1. During the day, try to maximize sleep and minimize crying. Keep the intervals of wakefulness between naps brief. Watch for drowsy signs. Try swaddling for 1-2 days and then swaddling with hands free for the next 1-2 days to determine what works best.

          1. Hello again,

            If it’s ok to ask, some more questions came to my mind.
            I noticed that since today in the evening our baby can be soothed a little bit easier and faster. Could this indicate that the peak of crying is slowly going down? (Even though she was born 2 weeks before due date)? Or maybe it’s just an exception.

            She only sleeps in the carrier with constant movement. Mainly on the exercise ball – for falling asleep it has to be pretty hard bouncing. Also the first half of the night I spent my time like this…as soon as I stop she wakes up. If I put her down asleep, she wakes up after one cycle and it all starts over. When I try other methods (swaddled and on the ball), she doesn’t fall asleep or it takes to long for me to give up because I can’t do it anymore physically. I’ve heard over and over that I can’t spoil a newborn and she doesn’t have a solid sleep association yet. But I somehow doubt that. She also is not allowed to see anything – as long as there is a little bit of light, even a red night light, she won’t shut her eyes (That may be the reason why the carrier works cause she can’t see a lot).

          2. As I wrote,”Social smiling starts around 6 weeks of age after the due date in most babies and heralds the start of more ability for self-soothing which you just now noticed regarding sucking on her hand to calm down.” So maybe the peak is past. I can not visualize bouncing on an exercise ball for sleeping, please clarify.

  13. I mean, that I have her in the carrier strapped to my chest and then I bounce on a yoga ball. As long as she is in light sleep and I stop moving, she wakes up and cries. So I keep moving and when she is in deeper sleep, I stop and try to sit down. But if she wakes, I have to keep moving. I try to transfer to crib when she is deeper asleep. But as I wrote with minimal success. Only sometimes she has longer stretches, mostly second night half.

    1. Understood. Have you tried a swing? Have you tried having your husband try to soothe her at a time when you left the house?

      1. What kind of swing is meant? I cannot imagine it. I only have something like that [https://www.mytoys.de/ingenuity-babyschaukel-hoots-hugs-4548784.html?sku=4548784&mc=deu_mts_onl_sea_google_mytoys-shopping-baby_wippen_874291566&gclid=EAIaIQobChMI6Znri_qu_AIVhI1oCR1fRgdMEAQYASABEgI-2PD_BwE] but I don’t think that’s what’s meant.
        My husband takes over the second half of the night if she is restless then too, and he calms her during the day using the same method. I feel like he sometimes succeeds faster than I do. I don’t know if she wants to reach my breast if she is strapped to me. But at the breast she is totally restless, often crying and not falling asleep often. It seems to me that she wants to comfort but is to tired to latch or something like that…

        1. During the day on weekends, leave the house. Your husband should attempt to soothe her by bouncing like you do, rocking her in his arms, or swaying in a swing, and then transfer her to her crib. She will know that you are gone and that he cannot nurse, so he might be more successful. The goal is to wean her off her current sleep associations to begin the path toward self-soothing. I think his attempt should be about one hour and he should ignore some low level crying. Try this once or twice on a Saturday and a Sunday. If the attempt fails consistently after 3-4 trials, abandon this plan.

          1. Thanks again for the advice. I read through the Extinction chapter on your blog again and also read briefly about extinciton with a cap, but didn’t quite understand this. Can this also be used on our daughter for the 3-4 nights trial? I’m already very much in favor of extinction, but don’t know if I can go all the way without calming her down at all (although that would actually be the faster method).

            I’m really strongly considering doing it this weekend or next. She doesn’t get restfull night’s sleep in the carrier but putting her down doesn’t work either. Even during the day, I don’t see how I can help her anymore. Your blog said extinction won’t help if daytime naps are bad, but I don’t know how to improve that. Today she was screaming before every nap even though I keep the wake times extremely short, but she just wakes up from every nap already screaming, shows signs of overtiredness all the time. The only time I was able to put her in hercrib today was from 4pm after she had slept in the carrier for an hour. Then she slept until 6 and I nursed her briefly (she woke up hungry), changed her diaper and immediately gave her to my husband. She fell asleep with him in the carrier with a bit of crying around 6:30pm and at 7:45pm he tried to put her in her crib. She woke up immediately and cried (I waited if she would fall asleep but did not) and now she screams since 8pm in the carrier and can not be calmed. I’m sorry for the long text but I just don’t understand. It is so frustrating. She nearly screamed for an hour now and it is almost feeding time now.

            Thank you very much again for your help

          2. Yes, you can do extinction (with or without a cap) for a 3-4 night trial. Because naps are so difficult, I would declare a 5:30 bedtime (lights our, you are leaving the room). The weekend is best for your husband to help out (with or without my suggestion for naps).

  14. Hello and thanks for the reply,

    I think we will start today with the attempt, because next week I will not create as good naps as today, when I still had support at home with my toddler.

    I wanted to make sure again what exactely I do at the “cap” if I would do extinction with a cap. Do I then go to soothe the child and how? I didn’t quite understand that. After how many minutes should you do the cap? I read 45? What does that depend on?

    I don’t know if I can do full extinction completely as a depressed mom (even with support and leaving the house). It would help me in my stressful situation to somehow be present for the child in some way or to know that my husband can go. I have also thought about check and console. Would that be possible with her age as well? (Almost 7 weeks old or 5 because of the earlier birth). But maybe the cap will give me the peace I need…

    1. The ‘cap’ means, for example, you totally ignore the crying for 45 minutes if the cap is 45 minutes. Then you go to your child and do whatever appears appropriate to you. Follow your heart. Play, bathe, feed, or soothe your child back to sleep then or later. When you decide to soothe your child back to sleep, then do so and put her down drowsy but awake and repeat extinction with the 45 minute cap.

      You can try ‘check and console’. In your sleep-deprived and depressed state, is it appropriate to talk to a professional about your state of mind before embarking on this path?
      What does your husband want to do about all of this?

  15. Thank you so much again for your help,

    I think the cap is a good tool for me to have some peace. My husband supports me in every way. I am in discussion with midwife and gynecologist about my situation.

    I believe that if she sleeps better at night (possibly due to the training) my internal condition will also improve. I have to at least try. If extinction with a cap doesn’t work, I plan to try it again a little later with “check and console” (1-2 weeks later, again on the weekend).

    The plan for tonight: I fed at 4pm. My husband is putting her to sleep right now (around 4:45pm) and when she is in a deep sleep phase (sometime between now-7pm (?), we will put her down and start training). Then when she wakes up (which I expect), I will feed her again and leave the house. Does that plan sound appropriate? I will keep you posted on how it worked out tonight.

    Last night, after a restless 1st half of the night, my husband got her to sleep at 1, put her down at 2 and she slept in her crib until 5. That sounds like an improvement in her night sleep in general.

    1. As I wrote, “Yes, you can do extinction (with or without a cap) for a 3-4 night trial. Because naps are so difficult, I would declare a 5:30 bedtime (lights our, you are leaving the room).”
      This means that your husband has done whatever he wants between 4:45 and 5:30pm but he is leaving the room at 5:30pm. This is the bedtime. This is the beginning of night sleep. Whether she is fully awake, drowsy but awake, or in a deep sleep. This is the beginning of extinction. This early bedtime is key to minimize crying.
      What happened last night?

      1. Okay I understand. I was thinking that it would also be okay to put her to sleep before or at 17:30 (e.g. in the carrier) and then put her down at some point, because she was in fact already asleep at 17:30. My husband was in a dark room all the time.

        Last night was not easy: my husband put her to sleep in the carrier between 5 and 5:30. At 7 he put her down in a deep sleep (she was in the carrier until then). She woke up 7:30 (which I expected because of hunger). I fed her and changed diaper and at 8pm calmed her down a bit and put her down. She was already very fussy while nursing and actually cried the whole time after the feeding. She also cried when I was soothing. After putting her down she cried, I was then not in the house until 9:45.

        My husband said she cried all the time (sometimes intense), but got calmer around 9:10, even closed eyes for some seconds but the crying then continued. When he calmed her down after 45 minutes, she was calmer and closing eyes but as soon as she was put down, she cried. At 10:30 I fed her, which was very hard because she was very tired and had little strength. She was sleepy. Put her down and she cried immediately. Unfortunately this went on until 1:30.

        Then i fed her again and unfortunately we both fell asleep from exhaustion while doing this (in a safe co sleeping position). at 5:30am i woke up, she was still laying there, i fed her and we fell asleep again until 9:45. this was not the plan but i couldn’t keep myself awake. I know that this is not conducive to circadian rythm (sleeping in so late), should we have a set wake up time?

        My husband does all naps today completely in the carrier in a dark room, that she gets as much rest as possible. We tried to put her down in crib in light sleep, she woke up…

        The poor girl was awake half of the night for hours.

        1. Please have your husband read the section on ‘Extinction’ and ‘Extinction with a cap’. “When he calmed her down after 45 minutes, she was calmer and closing eyes but as soon as she was put down”. The attempt to soothe is 5-10 minutes. She is getting to much parental attention at night that will interfere with her ability to learn self-soothing.
          Here is a clarification:
          At about 5:30pm she is put in her crib (awake, drowsy, or asleep) after you have bathed, fed, and soothed her.
          She is ignored until the cap or until about or after 9:30pm when you might go to her to feed her for 10-15 minutes.
          After feeding, a brief soothing attempt for 5-10 minutes, she is put back in her crib (awake, drowsy, or asleep).
          She is ignored until the cap or until about or after 3-4 hours from her last feeding when you might go to her to feed her for 10-15 minutes.
          After feeding, a brief soothing attempt for 5-10 minutes, she is put back in her crib (awake, drowsy, or asleep).
          She is ignored until the cap or until about or after 3-4 hours from her last feeding when you might go to her to feed her for 10-15 minutes.
          After feeding, a brief soothing attempt for 5-10 minutes, she is put back in her crib (awake, drowsy, or asleep) or start the day.
          Keep a detailed record of the duration of crying. If she always cries to the cap you have chosen (after a 3-4 night trial) then consider making the cap longer or consider extinction.

  16. Hello Dr. Weissbluth and thank you a lot for your reply again. Sorry, it’s gonna be a long message.

    After our first attempt with extinction we had to stop after the 2nd night due to health problems. The second night was not better than the first and she was even awake longer in the night.

    Now our sleep situation has worsened (baby is now 9,5 weeks old and 7,5 weeks adjusted). During the day she still only sleeps in the carrier and now won’t let me put her down at all (before I could put her down after 2 sleep cycles in deep sleep). Now she wakes up no matter what: immediately or after 5-10 minutes and scream cries. I have let her cry in her crib in the morning out of necessity as I had to take care of the other child. She sometimes fell asleep after massive crying, but only for 20 minutes (waking up with crying). I think she was overtired and went into emergency shutdown, hence no successful self-soothing? Daytime sleep is an extreme effort for me with seemingly little success (almost 24/7 with baby carrier on exercise ball).

    At least in the evenings she falls asleep earlier for ehr longer strecth (between 9-10 instead midnight) and has slept 4-5 hour stretches at times (even in cot) until recently! Now that’s also over: she wakes up nearly every hour and refuses to sleep other than sucking on my breast continuously and held. I think I do not need to describe how I feel mentally and physically. When my husband takes over in the night (with carrier, she refuses other way) he also can’t put her down asleep like some weeks before…

    She is actually permanently overtired (even in the baby carrier she wakes up screaming after 40 minutes and it is a huge effort to get her to sleep or continue sleeping). At night she definitely shows overtired signals. Neither of us sleep well. I am desperate.

    Regarding early bedtime: my husband puts her in the carrier immediately after 5pm and from then on she stays in a dark room with little stimulation at feedings. It doesn’t help, between 5pm until she falls asleep for the night we have partial sleep refusals again and long periods of wakefulness.

    Would you recommend starting sleep training again soon (this weekend)? Why has everything become worse, why is she constantly overtired? I am really at my wits end. Even if it fails, it can’t get worse…

    Thanks for reading

    1. I am sorry, but because of multiple ‘Anonymous’ comments and the organization of this thread, please write a summary from the beginning. If possible, have your husband write a chronological report of everything because he is probably less sleep-deprived.

  17. Hello again and sorry for the confusion.

    I will try to summarize once again: Baby born 2 weeks before calculated due date (now almost 11 weeks – adjusted 9). Definitely had or is having colic. Is much better though. For daytime sleep she only sleeps in the baby carrier (have tried a hammok swing, have tried her sleeping alone but nothing works only 20-30 minute scream cry naps). Because of the chronic overtiredness I stayed with the method carrier (out of desperation). Also in the evening she is carried in the baby carrier until her longest sleep phase, because at that time (between 8- midnight) she cries massively and sleeps only with extreme difficulty, but does not stay asleep.

    Putting her down is generally not possible (she wakes up immediately or then directly after deep sleep). Kast weeks between 10- midnight she was breastfed to sleep and then had sleep phases between 2-4 hours in my bed in my arms. between sleep cycles she always wants to suck on the breast. In general, ituation worsened (e.g., even in the baby carrier only 30 minutes of sleep; awake every 1-2 hours at night; sleeps only at the breast etc). because she falls asleep so late, we let her sleep late in the morning (up to 9 in some cases).

    For this reason we have done the following for 2 nights so far (today is night 3):
    – Daytime sleep assisted to minimize overtiredness (waking periods no more than 1 hour). even if wake time is shortened she fights sleep and she is tired.
    – Early bedtime (starting at 17:30).
    – Cry it out method with checks if she is inconsolable; breastfeed every 3-4 hours.

    Result: crying per se not much worse than in baby carrier, but less sleep at night as she cries a lot between 17:30-midnight and has only short sleep phases of 30 minutes to 1 h and then is awake for 2-3 hours until midnight and cries. Then she sleeps about 4.5 hours until next feed. Then we both fall asleep in my bed because of pure exhaustion while feeding.

    What else can we change? How can we help her? What can a daily routine look like (e.g. she is sleeping in the carrier since 3pm now and it is 5:15 now; how and when to organize bedtime in this case?)? Is it okay that she then sleeps longer in the morning because she is overtired? Or does it harm the rythm? Why does she sleep so little between 5:30pm and midnight? Naps are so much longer and easier because her nights are so short but she looks exhausted.

    Hope its more understandable now.

    1. I do not know what you mean by “Cry it out method with checks if she is inconsolable”
      Please have your husband read the relevant sections in my book (Chapter 5) and have him reply to this question: Which sleep solution are you using and why?

  18. Hi Dr Weissbluth,

    My husband and I love your book ‘Healthy Sleep Habits, Happy Child’. Your extinction method worked like a charm on our first child.

    With our second child though we faced a problem during extension and we couldn’t find an answer in your book.

    What do we do when we are doing extension and our child wakes multiple times in the night and we think she is only hungry some of those times? Do we do extinction for the times during the night when we think she is not hungry?

    Thank you in advance

    Julia

    1. “Do we do extinction for the times during the night when we think she is not hungry?” Yes.
      If extinction is not working as quickly as it did with your first child, it is likely that your older child might be distracting you from subtle drowsy signs early at nightor having too many late scheduled activities that result in a too late bedtime for your younger child. Does this help?

  19. Thank you Dr Weissbluth! Just to follow up.

    On your second point – we aren’t being distracted. We carefully put her down at around 5:30pm because that is usually 2 hours since the time she woke (we follow your suggestion of only keeping them up for maximum 2 hours). I nurse her, tell her we love her, put her in the crib, then leave and we don’t go in until she stops crying and goes to sleep. My oldest child and I leave my husband at home while the crying happens.

    We are on night 4 and she is still screaming for already 30 minutes and no sign of stopping. Can I ask:

    1. Length of crying
    If she cries tonight for an hour again, should we reconsider our strategy above given she keeps crying for so long night after night?

    2. Other explanations
    Could she have a more serious problem that we are not diagnosing? In addition to problems with tryout, she often goes to sleep but then wakes up randomly after 10-20 minutes screaming.

    Thank you

    1. What was her gestational age at birth? How old is she? Please describe a common nap pattern. For the past 3-4 nights of extinction, please describe the approximate times of crying and the duration of crying.

  20. Hi Dr Weissbluth,

    Thank you! In answer to your questions:

    1. Gestational age at birth – 39 weeks

    2. Age – 4 months, 2 weeks

    3. Common nap pattern – during the daytime she has 4-5 naps of around 40 minutes (if unassisted) up to 2 hours (if we hold her, but we cap it at 2 hours)

    4. Approximate times of crying and the duration of crying – usually from around 5:45pm till about 6:45pm – 7pm. So:
    Night 1: 1 hour of crying
    Night 2: 1 hour
    Night 3: 1.15 hours
    Night 4: 50 minutes.

    She then usually wakes about 2-3 after going to sleep, normally when I dream feed her. I think she is hungry at that point.

    We’d love any advice you might have!

    Thank you,
    Julia (sleepy parent)

    1. Has there been any improvement regarding the intensity or severity of crying over nights 1-4?
      For her unassisted naps, is she put down drowsy but awake?
      Can you attend to her and feed her only 2 times (not 3 times) at night?

  21. Dear Dr Weissbluth,

    My wife and I are using your great book ‘Healthy Sleep Habits, Happy Child’.

    We have started extinction for our child’s night time sleeps a few nights ago. Our child is still crying a lot! Should we do extinction during daytime naps too? A lot of crying for one day!

    Thank you!

    John
    PS We recommend your book to every parent we know!

    1. Thank you.
      Why is “Our child is still crying a lot!”
      “Should we do extinction during daytime naps t
      Please review the age-appropriate section(s) in my book and provide me with the details of all the variables mentioned in order for me to respond.

  22. Hi Dr Weissbluth!

    Thank you so much for getting back to us.

    In response:

    Has there been any improvement regarding the intensity or severity of crying over nights 1-4? – Not really. Slightly less severe crying last night but still really bad. Nights 1-3 much the same.

    For her unassisted naps, is she put down drowsy but awake? – No: we rock her to sleep.

    Can you attend to her and feed her only 2 times (not 3 times) at night? – We only feed her once or twice in the night. Depends on whether she wakes hungry for the second feed.

    1. “She then usually wakes about 2-3 after going to sleep, normally when I dream feed her.” Please clarify, do you ever go to her at night more than twice?
      Are you willing or able to start putting her down drowsy but awake for naps?
      One idea is to stay the course for 2-3 more nights because of “…Slightly less severe crying last night” and 50 minutes instead of over and hour.
      Another idea is to abandon the extinction attempt for now because of prolonged and severe crying without much improvement; focus on encouraging self-soothing skills for naps to get her better rested during the day and in the near-future, retry extinction.
      The choice to persist or not is based on how much stress this is causing you and your family.

  23. Hello Dr. Weissbluth, it is me again. No problem if you don’t remember the case. I think the current situation is enough info:

    I try to summarize the most important: Baby is 16 weeks now (14 adjusted) and had bad colic. I have your book and at the moment I try to read chapter 8 about sleep habits in month 4. I think the colic in my daughter is gone BUT she is extremely chronically overtired and I am really exausted after 4 months and a toddler on top. I don’t know how to implement sleep training and a good schedule on this child because she fights me all the time (understandable due to overtiredness).

    Since 1 week we do full extinction at bedtime and until the one and only night feed anywhere between 3-6 am. Mostly it is between 4-5am. In those hours I don’t apply extinction at the moment because she is so overtired and won’t sleep and it destroys the whole day (I tried it and she was up 4:30-7:30 one night not sleeping!). So I first try to have a quick diaper change, no stimulation, pitch black dark room (for naps and night), white noise. Then I nurse and try to get her to sleep in my arms. This worked well until the 4 month mark where she nearly slept through the night (I think due to the 4-month sleep cycle change this stopped working). Now she rarely goes back to sleep and cause I won’t start the day at 4 I put her in the carrier as my last resort (that’s where she does all her naps because she just won’t sleep). She is whiny and tired in those early morning hours and wants to sleep but needs huge effort (bouncing, holding). Then I start the day anywhere between 6-8am.

    She starts the day overtired. I try to do the first nap in the crib (I keep awake time extremely short etc., putting her down no later than after 1 hour fed, clean etc.) and she sometimes manages to fall asleep BUT with lots of crying and after 1:15-1:30 hours of awake time no matter how early I put her down. One time it was 2 hours. BUT she only sleeps 40 minutes all the time, tries to sleep more but just won’t. I think she just crashes from overtiredness and thats it. I try to lengthen naps in the carrier or do a long lunch nap when the toddler naps. So I know she has the ability to fall asleep on her own but she is to tired to sleep well and it’s so frustrating…

    How in the world can I help her? Its a vicious cycle of overtired, sleep crutches, ealry mornings etc. How do I implement a lose schedule? Do I just do CIO for naps, accept a short nap and keep her up until the next naptime? So having 3 short naps? I doubt that it will help. Do I focus on awake times (but I read sleeping at the wrong times won’t help)? I try to do early bedtime but it is not really working. When should the last nap end? I was able to shift bedtime to 7pm at the latest because I do not let her nap past 5pm. this way she had a 6:30 pm bedtime one day but she always screams until she crashes after 2 hours awake time – 7pm the latest. Then sleeping till the dreaded early wakings. After the last nap ending at 5pm, I do a bedtime routine and put her down between 5:30 and 5:45. Then the screaming begins and I feel horrible but I know she needs to sleep.

    I need help.
    Thank you.

    1. I reviewed our past comments and want to be certain that my understanding is correct, please confirm or clarify.
      Your 4 month old baby had colic that has now ended and you have a toddler about 2+ years.
      Your husband is supportive but you take care of almost all the sleep issues day and night 7 days a week.
      You have done extinction up until early morning when she is nursed usually around 4-5am and thereafter you are helping her sleep.
      What time does her last nap often end (I know this is variable but give a common time or range)?
      What time do you begin a soothing to sleep routine at bedtime, how long does it last, is she drowsy but awake when you put her down, do you leave the room after you put her down?
      What time is her usual fall asleep time, how many times does she cry out at night before her early morning feeding, what is the duration of her crying out, describe the intensity of these crying events (mild, moderate, severe).
      How would you describe your current mental health in addition to been sleep-deprived?
      Because of your sleep deprivation, please dictate your responses to your husband and have him succinctly reply to the above.

  24. That is very kind of You, Thank You.

    My husband helps as much as he can (doing all assisted naps on weekend and early morning wakings at weekend; coming home earlier from work etc.), he has a very demanding job, so I don’t know if he can follow this conversation but he knows that I reached out to You for help.

    Otherwise I am alone with the kids, but try to invite people to play with the toddler from time to time so I can assist the naps. My children are exactly 2 years apart. I somehow try to balance their routines and needs…more or less successfull.

    The worst is behind us I hope, so every 40 minute nap she takes in her crib feels like a vacation. Yes, I think most of her colic is gone.

    “You have done extinction up until early morning when she is nursed usually around 4-5am and thereafter you are helping her sleep.” That’s correct. Because she usually doesn’t go back without more effort and I once had the situation that she didn’t sleep from 4:30-7:30 and I am afraid this will happen again.

    She usually sleeps well until then, sometimes she has a false at bedtime start from being overtired, but falls back asleep. Once she was up at 3, struggling to go back to sleep but she finally did at some point. Hours between 4-5 are more critical. She tries to self sooth etc, crying is switching between mild and moderate.

    Last nap always ends 5pm. It usually starts somewhere between 4-5 (30-40 minutes, rarely 1h). I try to have lunch nap as long as possible (until 3) because the toddler naps or is calm in his bed.

    I start soothing for bedtime as soon as possible after last nap, because she wakes crying from the nap and is very tired (yawning, hyperactive). I assist nap till 5, feed toddler at 5 (feeding her as well). Then around 5:20/30 I try a quick routine (bath but not every time). Last step is comfort nursing with dimmed lights and white noise. I put her down around 5:45 wide awake; while nursing she is arching her back, struggling to latch, drowsy eyes BUT she is put in the crib wide awake and I leave, not going in until she sleeps. She usually cries until 6:30-7. Mostly asleep at 7. Crying goes from mild to moderate to extreme. It has quiet breaks in between. Around 6:30 she sometimes closes her eyes and seems to be asleep but the fight goes on.

    My mental health is okay because I have our evenings back and at least try to go to bed early. It is just frastrating that all the efforts and knowledge don’t seem to help.

    1. “Last nap always ends 5pm. It usually starts somewhere between 4-5 (30-40 minutes, rarely 1h)…I start soothing for bedtime as soon as possible after last nap, because she wakes crying from the nap and is very tired (yawning, hyperactive)…I put her down around 5:45 wide awake; while nursing she is arching her back, struggling to latch, drowsy eyes BUT she is put in the crib wide awake and I leave, not going in until she sleeps. She usually cries until 6:30-7. Mostly asleep at 7.”
      1. Your post-colic daughter is sleep deprived as a result of colic, you did everything possible and you did help her, but her colic messed up her sleep.
      2. By the end of the day, her sleep tank is empty (she wakes up from her last nap crying, “she is very tired”, she’s arching her back,…
      3. The good news is that she can self-soothe at bedtime and you have survived her colic without major mental health problems or severe insomnia.
      Because of the above, here are my suggestions to be implemented when your husband is available to help and when you can commit to 4-5 sequential nights with 100% consistency:
      Her Night sleep is well developed, so: No naps start after 3pm. If she is asleep from an earlier nap at 3pm, let her sleep. If she is awake at 3pm and subsequently gets drowsy, entertain her, soothe her, comfort her, distract her, but do not let her sleep (no car rides or swings). Around 5pm, begin a bedtime routine that ends at 5:30pm. You are leaving her alone either awake or drowsy but awake at 5:30pm. Plan to feed her once (or twice because her last feeding is around 5, not 7pm); the feeding duration is 10-15 minutes and you quickly leave after the feeding (and changing) without soothing. All crying is ignored until about 5-6am. No more holding her for sleep at night. Keep a detailed record of sleep and crying for the 4-5 nights.
      Her Day sleep develops well between 4-6 months, so: Do whatever you can to maximize naps and minimize crying (short intervals of wakefulness, dark and quiet room) but don’t worry about habit formation (you might use a stroller or your arms to extend naps).
      What to expect: More night sleep first, second, weeks later, better quality morning naps, third, weeks later, better quality mid-day naps +/- a brief third nap that starts before 3pm. As her naps improve over the next several weeks, then the bedtime will become a little later.
      Brainstorm with your husband how you will manage her temporary super early bedtimes and care for your toddler (maybe hired help, maybe he will watch screens between 5-5:30pm,…?)
      How does this sound?

  25. Good evening Dr. Weissbluth,

    Once again I am very grateful for your help and detailed answer.

    The plan sounds very good and also makes a lot of sense in relation to the chapter I read.

    I have only a few questions:
    How to handle the coming time change. on March 25 in Germany. For waking up early it’s fine, but how is it in the evening? What do I have to consider? Won’t she have big problems in the evening then, because the clock is shifted forward by one hour?

    If I have to feed her 2 times at night, do I set times? Do I wait a few minutes first to see if she is really hungry?

    My biggest uncertainty: in principle I have no problem ignoring her until 5/6am, but what if she doesn’t fall asleep anymore (possibly not even from 4am on)? Then the whole daily rhythm is messed up and I don’t think I can keep her awake until just before 9. Should I try by all means from 5/6am at the earliest that she sleeps at least once more until 7/8am? Or what should I do with the first nap? She only lasts 1-1.5 hours on average being awake.

    Today she slept from 6:30-5:20 and I forced her to sleep again from 7-7:40 and then I was able to structure the day so that she finished her last nap at 4:40 and was in bed at 5:30. She fell asleep shortly after 6pm (she did cry a lot but she was very overtired). I have the feeling she doesn’t fall back asleep in the wee hours of the morning until she crashes….

    The super ealry bedtime we will manage to organize.

    Thank you very much!

    1. How to handle the coming time change. Do your best to use the new clock time. She will adjust quickly.
      Feed her at night once or twice if you are quite certain she is hungry. Once might be around midnight. Twice might be before midnight and again around 3-4am.
      Because of her age, forget about nap schedules, they will evolve around 4-6 months or later in post-colic babies. So you ignore her until 5-6am as part of extinction. Her day starts around 5-6am. And if she has been up for a long time (for example 4-5am), when you start her day around 5am, she will be changed, fed, and probably soothed down for a nap then or shortly thereafter.
      Is this OK?

  26. That sounds like a doable concrete plan. It is very helpfull. Very quick answer: as I understand it, I’m not paying that much attention to nap rythm yet, but trying to stick to the fixed points (e.g. extinction until 5-6am, feed 2 times at night, bedtime 5:30 etc. everything you mentioned) and keep the periods of awake time short, extend naps etc.?

    Thank you very much again, I will report back how it worked out.

    1. Yes. You might be helped by reading Blog Post 60 written by a German mother/pediatric sleep researcher and Blog Post 62 written by a German mother/clinical psychologist.

  27. Dear Dr. Weissbluth,

    I will copy and paste the blog above so that everything is in the one place. Please see below:

    Previous communication
    – – –

    From me: ” We have started extinction for our child’s night time sleeps a few nights ago. Our child is still crying a lot! Should we do extinction during daytime naps too? A lot of crying for one day!”

    From you: Please review the age-appropriate section(s) in my book and provide me with the details of all the variables mentioned in order for me to respond.

    My response now: we have read the sections and believe that we might have three problems which are contributing to ongoing problems with the extinction method at nights (1) We are only doing extinction for night time sleeps, not day naps (2) for naps we put the child into the cot only once we rock her to sleep (3) if she wakes from a nap after around 40 minutes we rock her until she falls asleep (and she often then sleeps for an hour or so longer but we always cap it at 2 hours).

    Can we ask your advice on what we should do next? I am thinking at least 3 main points which respond to these points above:

    (1) Do extinction during the nights AND day naps
    (2) For naps – put our child to bed drowsy but awake and then do extinction
    (3) For naps – if she wakes after 40 minutes let her cry and she will either go back to sleep or not.

    Can we ask your views on this approach?

    Thank you!
    John

  28. Dear Dr Weissbluth,

    I hope you are well.

    Just following up from our exchange above. In summary;

    Our post: We have started extinction for our child’s night time sleeps a 10 days ago. Our child is still crying a lot! Should we do extinction during daytime naps too? A lot of crying for one day!

    Your post: Please review the age-appropriate section(s) in my book and provide me with the details of all the variables mentioned in order for me to respond

    My question: we took your advice and have reviewed those sections and now think the following – our child is still crying a lot during cryout extinction. I think this is due to the following reasons (1) we are doing nighttime extinction but not extinction during the day (2) for naps – we rock her to sleep and then put her in her cot to sleep (3) also during naps – if she wakes (usually around 40 minutes) we then rock her until she goes back to sleep and then put her down (often she can then sleep for another hour, but we never let her nap for more than 2 hours).

    We are thinking of revising our strategy as follows:

    (1) do nighttime sleep AND daytime nap extinction
    (2) put her to sleep for naps drowsy but awake
    (3) If she wakes after 40 minutes of napping, leave her so that she rocks herself back to sleep.

    Can we ask your advice on this strategy and any other thoughts you might have?

    Thank you!
    John

    1. How old is your child?
      What what are the common times that naps occurs?
      When do you usually begin a bedtime routine, how long does it last, is she drowsy but awake when you put her down at night, do you leave the room then, what is a common fall asleep time, what is a common pattern for crying or fussing at sleep onset and in the middle of the night, is the crying or fussing mild, moderate, or intense?
      When unattended, alone with toys (not screens) please describe her mood and behavior during the hour before you begin your nighttime bedtime routine.

  29. Hi Dr Weissbluth,

    Thank you! Can we ask whether you or you firm does sleep consultations? We’ve tried the extinction method for over 12 days.

    We seemed to get some improvement (20-25 minutes of crying rather than an hour) but then our daughter got an ear infection. Around that time the crying went back to an hour again.

    We’d love to talk to someone about next steps and think a consultation might be easier to answer your questions above.

    Thank you,
    John (on behalf of a tired family)

  30. Hi Dr Weissbluth,

    Thank you for getting back to us! In answer to your questions

    – How old is your child? – 5 months

    – What what are the common times that naps occurs? – depends when she wakes up first thing in the morning. Normally we have her asleep about 1 hour 45 minutes after she woke up from her last nap so naps are spaced out over the course that day.

    – When do you usually begin a bedtime routine? Varies because it depends when she first wakes in the morning. We want to make sure bed time is 1 hour 45 minutes / 2 hours from the time she woke up from her last nap, making it hard to pinpoint set times. Normally between 5:45-8pm.

    – How long does crying last during extinction? Initially around an hour. Then was shortening to around 20-30 minutes. Then she got an ear infection about 5 days ago. The next few nights were still short (around 20 minutes) but then last night was long again (1 hour) and night before quite long too (30 minutes).

    – Is she drowsy but awake when you put her down at night? No, my wife feeds her and then gives her a kiss goodnight. We re-read components of your book yesterday and noted that you suggest dad puts her down for bed time, so last night I put her down rather than my (and she cried for an hour).

    – Do you leave the room then? Yes. We don’t return until she is asleep.

    – Is the crying or fussing mild, moderate, or intense? The first few nights crying was really intense. Now it is more occasional. She will be quiet for 5 minutes and then cry moderately. Last night she did this for an hour and the night before 30 minutes.

    – When unattended, alone with toys (not screens) please describe her mood and behavior during the hour before you begin your nighttime bedtime routine? Similar mood as the rest of the day. Pretty smiley and happy unless she gets stuck in the one place for too long in one spot (eg one part of the playmate) which case she makes a bit of noise until we move her to another spot.

    Also, like I said, she did have an ear infection about a week ago. But we have been giving her medication the doctor recommended (Tylenol and Amoxicillin) and the symptoms appear to be easing.

    Should we stop extinction until we finish the are infection medication (which is another 5 days)? We’ve done 12 days of extinction so are just reluctant to stop because then we think we will have to start again!

    Thank you!

    John

  31. Oh Dr Weissbluth, I forgot to add that we also rock our daughter to sleep for her daytime naps (rather than put her down drowsy) and when she wakes after about 40 minutes into the nap, we rock her back to sleep and often she sleeps on us for another hour or so. We never do more than 2 hour day naps.

    Could our actions with rocking her to sleep for her daytime naps make nighttime extinction less effective? Should we do extinction for all day naps and nighttime sleeps?

    Thank you!

    1. Please read the Blog Posts 9, 10, 16,70, 83, 87, 89, 90, 115X, and 119 to appreciate my following comments.
      Everything will be smoother with more night sleep and less crying when you focus on drowsy signs to time your naps and the bedtime. Wake-windows are fake. Focus on a much earlier bedtime, based on drowsy signs in the ballpark of 5:30-7:00pm. Continue extinction for now. Maximize day sleep any way you can and focus on drowsy signs for the time of nap opportunities. If she is asleep at 3pm, do not wake her, but no nap will start after 3pm. Do not have in a situation then (such as a car ride, stroller, etc.) that might cause her to fall asleep. Because of normal variability of naps, the bedtime will vary. If she is awake at 3pm and becomes drowsy, amuse her, soothe her, distract her and start a bedtime routine around 4:30-5:00pm so you will leave the room (asleep time) at 5:30 pm. Keep a detailed record of her sleep times and crying (duration and intensity) and report back in 3-5 days. As night sleep improves (over several days), naps will improve (over a few weeks), and then her bedtime will become a little later.

  32. Good evening Dr. Weissbluth,

    I followed the last conversation with “John” and found it interesting to read that “Wake Windows” are fake (I read about them everywhere).

    I am the mother with the daughter who was colicky and is now 4 months old. We have been doing extinction for over 2 weeks for night sleep. Your recommendations were: Extremely early bedtime (5:30pm), ignore until 5/6am, do everything to maximize daytime sleep, etc. I am trying all this with all my might. The early bedtime was having a good effect (one night she slept through from 5:45pm-5:45am). Right now she mostly sleeps until about 4/5am and then we sleep together for another 1-2 sleep cycles (Nursing, co-sleeping). This is working out well (but she still wakes up tired and cranky). But since the time change, she cries so much longer in the evening and doesn’t find sleep until well after 6pm (sometimes 7pm) – new time- even though I put her down 5:30. Can this be temporarily due to the time change? I also notice it extremely on my toddler that the kids are affected by it.

    What hasn’t improved unfortunately is the bad overtired crying in the evening and daytime sleep. It is unfortunately getting worse and I am desperate (my husband also has Covid and has been in isolation for 1.5 weeks so as not to infect us).

    I am getting tired of the contact naps (to put it kindly) and they seem to get useless. I also realize that the change in sleep cycles (keyword regression) has made everything worse. I often can’t even make her naps longer than 40 minutes in the carrier (it only happens randomly and rarely; before that was my safe solution to short naps). She has also slept alone in her crib several times, BUT always with an extreme amount of crying (no matter when I put her down) until she gives up from exhaustion and then it’s always only 40 minutes (I always let her stay in crib for about 15 minutes to give her the chance to go back to sleep, but it never works, although she tries).

    She always screams and fights (falling asleep, waking up, in the carrier) and it drives me crazy. Her “awake time” seems to be minimal, which is fine in itself, BUT I just don’t recognize a “drowsy state” in her to be able to put her down in time. When it’s really bad, I have to rock her extremely hard on the exercise ball (in the carrier) to get her to calm down and fall asleep. She is now 18.5 weeks old or 16.5 adjusted. We are taking 4-5 short naps a day. I have noticed that after 1.5 hours she has an extreme overtiredness meltdown (I have had to keep her awake several times to get to 5:30 bedtime). She doesn’t even sleep in the stroller (I try it for the last nap that the toddler gets some time outside). I have to drag the poor toddler from the playground, because she has a horrible meltdown from being tired.

    I really want to start training for naps soon, but I’m afraid of doing her wrong or that it will get worse. But my strength and patience is starting to run out. I looked up the procedure in the book, but I don’t think 3 naps can be possible because everything is still too unstructured and she doesn’t want to stay awake for long. How can I start with naps and be consistent if she is always overtired and screaming? Should I wait some more weeks and keep try a combination of crib and carrier naps (although they are all short?). So sorry, that this post is so long.

    1. Please clarify:
      In general, has night sleep improved with the earlier bedtime? If so, in what way? At nighttime, is she able to self-soothe at sleep onset? Between sleep onset and 4-5am, if calling our or after a feed, does she self soothe back to sleep? Or do you have to soothe her to a deep sleep at these times? Your answers will guide me is suggesting what to do at 4-5am and how to handle naps.

  33. Hello again and thank You so much for Your answer again,

    I would say, yes. Night sleep is better so far, that she sleeps more overall at night. However, she is still crying and awake between 4-5am and I can see her trying to self soothe.

    I need to correct my last message: She does wake up between 4-5am, but since I’m sure she’s not extremely hungry (because she doesn’t appear to be when she feeds), I set an alarm for myself around 5 and don’t go to see her until then (reason: I wouldn’t be able to fall asleep after 4 because I’d be too worked up). So she gets fed around 5 and I snooze while she falls asleep nursing next to me (this also takes about 30-40 minutes). If I notice she’s not falling asleep while nursing after a while, I put her back in her cot and leave the room. She has fallen asleep then too, but it has taken way longer but the nursing helped to get her drowsy. I thought it would be a good compromise…since she can fall asleep until a reasonable morning wake up time and I don’t have to carry her in the carrier…

    It is generally the case that she always falls asleep (even during naps) only out of exhaustion. I can watch her on the monitor: she tries to self soothe, closes her eyes often but cries and screams a lot until about 1.5 hours of wakefullness. This seems to be her maximum. Then she is up after 40 minutes, self soothing and crying until I get her.

    1. Please clarify: At bedtime, when does the bedtime routine start, how long does it last, what are her common fall asleep times at night, do you leave the room, if there is crying then, how long does it last, how intense is it?
      Perhaps a contribution to her sleep issue is what is happening around 4-5pm: She awakens around 4-5am and is “not extremely hungry”. Then, around 5am you feed her by sleeping with her for 30-40 minutes. Am I correct, even if she is asleep, “I set an alarm for myself around 5 and don’t go to see her until then”?
      If you go to her very early in the morning because “I wouldn’t be able to fall asleep after 4 because I’d be too worked up” and she is not really hungry then:
      1. You are depriving her the opportunity to learn self-soothing in the early morning.
      2. She may have very light sleep next to you, at the breast, so that she does not start the day well-rested. This contributes to or causes difficulty in naps throughout the day and is partially compensated by a super early bedtime.
      Please share with me your thoughts and I think I have a concrete plan of action.

  34. Good evening Dr. Weissbluth,

    Thank you for your tips! We’ve forged on with cry out as you suggested. It is broadly better, but once in every 2 nights our daughter will cry for 20-30 minutes before going to sleep.

    Could she be hungry? We wonder if my wife/the daughter’s mother is not producing enough milk so our daughter is crying directly after we put her down at night because she is hungry.

    Thank you!
    John

    1. Please read the section in my book regarding how to tell if your child is hungry or meet with a lactation consultant to help.
      Perhaps experiment with a bedtime that is 10-20 minutes earlier. If she falls asleep at this slightly earlier time but continues to have some nights of crying, then go to an additional 10-20 minute earlier bedtime, repeat if necessary until she no longer cries or no longer falls asleep quickly at these earlier times.

  35. Hi again Dr. Weissbluth,

    Just to follow up again to my message above, is it just the case that some babies just don’t do well with sleep cryout? We have tried everything for almost 3 weeks and some nights work but some nights really don’t.

    Thank you,
    John

  36. Hello Dr. Weissbluth,
    I forgot to mention my name for my last comment.

    So bedtime is always the same: feed around 5 (bottle and breast because lower supply), sometimes a bath or wash, at 5:30 she is put down clean, fed, awake and I leave until she falls asleep. This is the worst hour of my day because she is very overtired and screams a lot (before the time change it was about 30 mins and now its up to 1 hour). Of course the screaming has breaks in between and is not the same intensitiy all the time but its pretty bad and I can barely listen…and she tries to fall asleep. We have been doing that since over 2 weeks and have been consistent. She usually is asleep after 1,5-2 hours of wakefullness and I think it’s just the time she can’t keep her eyes open anymore. Before time change she was asleep between 5:45-6pm, now it is between 6-7pm.

    Tonight she slept 6pm-5:45am, so as I mentioned, night sleep is better over all but she still wakes up cranky crying in the morning and is tired and naps don’t work no matter what. I am really worried because she gets less sleep than my toddler.

    I try to summarize my reasons why i handle those early mornings like I did so far: I wanted to get away from carrier in those hours but I was afraid that she wouldn’t fall back asleep at all (we had that once from 4:30-7:30). So I tried to find a compromise. I know she only needs one feeding and that she usually is awake around 4-5am. So I sleep with earplugs until my alarm at 5am. My husband would always wake me if she was screaming before my alarm (like pain or hunger) but because of my sanity and sleep deprivation I set this time around 5. I wouldn’t wake her if she was still sleeping at 5 (like tonight she slept till 5.45). The nursing to sleep just happened when I realized it worked for both of us. Sometimes she slept more than one cycle next to me but often only 45 minutes until 6-7am.

    This baby is completely wired and overtired but I can’t keep up the old methods, especially because they are less effective and exhausting and my toddler has way to much screen time

    Thank you so much for your help.

    1. Thank you; here are my suggestions to try for the next 4-5 days only. Our goal is for her to get more sleep and learn more self soothing in the early morning so that she starts the day better rested. Although I am using clock times for clarity, I do not intend that you exactly follow them as rigid rules, try to see the general principles based on “I know she only needs one feeding and that she usually is awake around 4-5am.”
      Stop the current practice of nursing and sleeping with her in the early morning. Continue to give her a bottle after nursing her at bedtime to know that she is well fed then. Based on your past experience:
      Around 4am (or earlier), if you think she is hungry. You do not go to her. Dad responds promptly, feeds a bottle (changes diapers), and leaves. A 10-15minute encounter. No soothing. Ignore her for a least one hour if there is hard crying or longer if there is intermittent quiet crying/sleeping. So her day starts around 5ish or later. Do not wake her to start the day.
      Around 5am (or later), if you think she is hungry. You do not go to her. Dad responds promptly, feeds a bottle (changes diapers), and leaves. A 10-15minute encounter. No soothing. Ignore her hard crying for a short while only if you think she might go back to sleep or for a longer time if there is intermittent quiet crying/sleeping. So her day starts around 5ish or later. Do not wake her to start the day.
      Sometime around 5ish or later is the start of her day, mark that time. The hope is that she will sleep more in the very early morning.
      At that start of the day time, you attempt to put her down for a nap after only 60 minutes later. This means from the start of the day time, she might be changed, bathed, fed, played with briefly, and soothed down for her first nap (her first nap starts one hour from the start of the day time). You are leaving the room one hour after her start the day time. Use the ‘nap drill’ for this first nap and only for this first nap. This first nap might be viewed of as a continuation of night sleep. By keeping the interval of wakefulness short, the hope is she will learn some self soothing for a better quality first nap. The rest of the day, follow your heart regarding naps: maximize day sleep any way you can.
      Our hope is that she gets more very early morning sleep (she starts the day later and has a morning nap) thus creating a ‘snowball’ effect for better subsequent naps and bedtimes.
      Please keep a detailed written record for the next 4-5 days.

  37. Hello Dr. Weissbluth,
    thank You so much for your long message and this helpful advice. Unfortunately our situation didn’t improve and I’m really starting to run out of strength and patience. Our daughter is now 5.5 months (5 adjusted) old. Reference to the last suggestion: because of my husband’s work and because I didn’t want to give up my milk production, instead of sending my husband (for a bottle), I nursed, changed diaper and then put her back in her crib. That way she takes very very long time to go back to sleep (she is always awake between 1.5-2 hours in the early morning hours; crying varies, sometimes she cries extremely, sometimes mild but not sleeping either). Between 6-8 we start the day. I let her sleep until 8 the latest because sometimes she doesn’t get back to sleep until just before 7. Since I wanted to listen to my heart, and she got more sleep by co-sleeping, I tried that again, but that doesn’t work anymore either. She doesn’t seem hungry in the ealry hours, should I night wean?

    The only way she sleeps the last few hours of the night is when my husband carries her (I think she would also do that if I carry her; it’s the rocking motion that keeps her asleep I guess). Then she sleeps until you wake her up (e.g. from 5-8am). This shows me that she is completely overtired and actually wants to sleep but just can’t. And that makes me extremely sad and frustrated because we don’t want to carry her in those hours but if she doesn’t sleep, she never comes out of her overtired cycle.

    And naps are the next horror story: I let her fall asleep alone as often as possible, I try to keep her awake times extremely short (before I see tiredness, which I don’t see anyway). She can fall asleep on her own, but she always always cries and doesn’t sleep until she’s completely crashing. I think she is just full of cortisol due to lack of sleep. she takes 4 short naps a day and some days I even have to fight for them when I realize she wouldn’t sleep at all. But assisted naps are also always short, I can’t extend anything. I just can’t help her. She laughs a lot but I know she is hyper as she cries a lot in between, has mood swings and from 5pm she sometimes screams extremely from tiredness plus she always goes to bed 5.30 and screams herself to sleep for at least 30 minutes. It breaks my heart. There is no structure except I always start the last nap around 3pm and put her to bed 5.30. Should I force a nap structure? I mean they are short anyway…it really stresses me out and I fell guilt towards my toddler. I worry about my daughters lack of sleep…I hope it doesnt hurt her but I can’t keep the carrier naps up, after the colic and 4 month ‘regression’ I can’t take it anymore. I just want her to take longer naps and be happy.

    1. I am sorry that I have not been able to help you achieve better sleep for your child. I know how exhausted and frustrated you and your husband feel. Perhaps there is something that I am missing that a community sleep consultant would discover to help you help your baby sleep better. Please consider contacting the Family Sleep Institute for a recommendation.

  38. Hello Dr. Weissbluth,

    I would like to thank you from the bottom of my heart for all your messages and help. It was very very helpful and encouraging! Through you and your book the situation was definitely improved, even if not everything was ideal, the night sleep was greatly improved in the first place and that helped to get through the days. Our daughter has been diagnosed with neurodermatitis, so maybe that is another aspect that has complicated things. Naps are still a challenge but she is coping better (with bad nap days) and there have been days when the first nap has prolonged; rare but things are improving.

    Thanks for lsitening and have a good Sunday. I always recommend your book to friends.

  39. Hi Dr. Weissbluth,

    I’m a huge fan of your methods and have sleep trained my 2 older children with them. We just had twins (boy/girl) ~ 7 months ago and I’ve struggled with sleep training the boy. I can’t seem to crack it. He had pretty severe reflux which has since improved with solids and time, but got used to me holding him up before going to bed for 30 minutes. Now 1.5 months into attempting sleep training and he still cries himself to sleep every night around 45 minutes and is typically very fussy between 4-5pm. He’s happy the rest of the day. We have tried a bedtime as early as 6pm – and it doesn’t seem to matter. He typically taking a morning nap 9-10:30 and an afternoon nap 1-2:30pm. Occasionally I get him down for a 3rd nap when he’s really fussy with a slightly later bedtime. The girl may fuss slightly but she was quick to sleep train, thankfully. Any advice for what to do? He sometimes sleeps with a pacifier too…

    Best,
    Allie

    1. Maybe this week-end when your husband is around to watch the other children, focus on your twin son between 4-5pm. Is he showing any drowsy signs then (watch Drowsy Max on Blog Post 115X)? I assume he has self-soothing skills for naps. It is possible that there is enough going on in the early evening with your four children that he is stimulated by the commotion (masking drowsy signs) or you are naturally distracted (not noticing subtle drowsy signs). Alternatively, just try a super strict consistent 5:30 lights off, falling asleep time (you are leaving the room then) for 4-5 nights to see what happens to the crying and sleep latency. Is this doable or impossible? How does this sound?

  40. Yes, he loves the other kids and they love to interact with both twins. It’s typically a hectic time after school, so it’s very possible he’s getting extra stimulation. We can definitely shift plans a bit – I’ll watch him more closely for drowsy signs and give a 5:30pm bedtime a go for 5 nights to see if that does the trick. I’ll report back. Thank you again for the guidance!

  41. Dr. Weissbluth,

    I’m hoping for some help. My son is 15 weeks and we are on day two of extinction. He averages about 3 to 4 hours of daytime sleep some unassisted and some assisted naps. His last nap ends at 5:30 and I put him to bed by 7 PM. we have gradually been moving his bedtime earlier in hopes of it helping at night. He still typically only sleeps max 3 to 4 hour stretches before awakening. I still feed him one or two times a night. But he has such a hard time with long stretches. Was hoping for some advice or recommendations. Night one he cried 40 minutes and night 2 50 minutes. I have seen improvement with him self soothing through the night which is awesome. But I’m still concerned with his lack of long stretches and frequent waking through the night. Should we only focus on nighttime sleep right now or do you recommend doing night and nap extinction at the same time?

    Thank you so much,

    1. “I have seen improvement with him self soothing through the night which is awesome.” Congratulations!
      Because of his age, my suggestion is to not let a nap begin after 3pm. At 3pm, if he is asleep, let him sleep, do not wake him.
      No nap starting at or after 3pm means that the fall asleep time (you have done the feeding and soothing and are leaving the room) will be around 5:30pm.
      Your expectation is that there will be less crying at sleep onset, more consolidated sleep at night, and no major change in his awake time.
      Night sleep begins to develop after 6 weeks of age so focus on night sleep. During the day, do whatever you can to maximize sleep and minimize crying.
      As naps mature between 4-6 months of age, they will become more regular and longer. When this occurs, he will be able to comfortably stay up later depending on the quality of his naps.
      How does this sound?

  42. Dr. Weissbluth,

    I will work on moving bedtime earlier. I do have questions though because his maximum awake period is typically 90 minutes (which is what I usually do before bedtime). Do I need to work on extending that time frame? Also, the last two nights (night 3 and 4 of extinction) have become even more difficult. He is waking/self-soothing 2-3 times (takes about 30 mins) during non-feeding times but also is waking 30 mins before the 4 hour mark waiting to bed fed which was lead to shorter sleep segments as well. Do you have any recommendations? Can I just immediately feed him if its near his typically feeding time (since he doesn’t do long stretches yet)? Also, typically I wake him between 6-7 am to start his day in order to get enough day time calories into, but on nights he has slept not great (ex. last night he nursed 11, 230, 530) and total sleep is only approximately 7.5 hours can i let him sleep later 7;30 or so to make up time? I do appreciate all your advice. I am trying really hard to stick to the extinction program but it is difficult with night time feedings and his lack of consolidated sleep. Should I retry at a later time?

    1. If he is healthy and gaining weight normally, whenever you think he is hungry at night, feed him. But maybe there is no reason to wake him between 6-7am. Please try to focus more on your baby than the clock.

  43. Dr. Weissbluth,

    Yes, he is a healthy boy who makes sure he is fed 2 times during the night. That’s good to know about morning wake up. We will start.I’ve started moving bedtime up gradually and he did have a 3 hour stretch before waking for a bottle. Will hopefully the longer stretches just come with time? I am making sure to put him down drowsy but awake to learn self soothing. Do you have any other recommendations that could assist with decreasing his fragmented sleep spurts?

    Jillian

    1. Because of his age, please be patient and optimistic, brain maturation, with your help, will make him a champion sleeper soon.

  44. Hi Dr. Weissbluth – reporting back that the earlier bedtime (5:30pm) made a big difference, especially for my son. He still needs a 6pm bedtime, which we strive for every night. Thank you again for the help! We are now working through whether we need to drop nighttime (breastfeeding) feedings. Both babies eat at night (once and occasionally twice), but they are now 9 months old. The time varies – sometimes 3am, sometimes 4:45am, sometimes even 2am (it gets a little hectic when it’s different times for each baby – it can feel like I’m up all night!). With my other two singleton babies, once they could get themselves to sleep, they didn’t need any process/encouragement for dropping nighttime feeds. It just happened – they slept the 12 hours. I don’t want to compromise their sleep, but I also don’t want to deny them a feeding. Is this something we should work towards at 9 mo (or later), or wait and let it naturally happen with time? Their pediatrician said their weight gain is solid and they don’t need to eat in the night… Any advice for how to proceed is greatly appreciated!

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