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.
A mother recently shared this with me:
“My daughter and I got off to a rough start. I had retained placenta for 12 days, my milk wasn’t coming in, and she was probably hungry the whole time. I believe this is where her sleep debt started. I did what I had to do to cope: holding her all day, bouncing on the birth ball for naps, bed-sharing at night.
Just before six weeks, I felt like I was starting down a path that was taking a huge toll on me. I picked up Healthy Sleep Habits, Happy Child and reached out to Dr. Weissbluth. He responded with a plan: put her to bed earlier, around 5:30 p.m., after a bedtime routine, bath, dressed for bed, feed, soothe, and then leave the room.
It was incredibly hard the first two nights. She cried for lengthy periods, sometimes a couple of hours. But I kept telling myself that she would already be doing this in my arms. By the third night we saw a huge improvement. By the fourth night, my husband did the entire bedtime routine himself, I left the house to get a massage, and came home to a sleeping baby.
She now sleeps 4–5 hour stretches and made it seven hours one night. I know people would say 6 weeks is young to do full-on extinction, but it really did work for us. Don’t tell people you’re doing extinction at 6 weeks, the family members who told me I was wrong caused a lot of stress and doubt. And give yourself grace.”
The family members who pushed back were repeating something they had read. At the top of the American Academy of Pediatrics’ HealthyChildren.org: “Babies do not have regular sleep cycles until about 4 months of age.” The Sleep Foundation, approved by a board-certified pediatrician: “Babies aren’t ready for sleep training until they’re 4 to 6 months old.” The message reads as unambiguous: the science says wait.
What that parent did not connect is what appears on the very same AAP page, a few lines below: “Put babies to bed when they are drowsy. Do not wait until babies are asleep.” No minimum age is attached. And in two AAP books, in a paragraph I wrote for them, the AAP states that letting a baby cry to sleep causes no harm and is how she learns to soothe herself.
The organization whose biological observation is used everywhere to justify waiting is simultaneously telling parents to begin right now. The circadian rhythm sentence was never a starting line. It was a description of normal development, published on the same page as advice that applies the night you bring her home.
The weeks a parent is told to simply endure are the weeks when her baby’s understanding of what sleep requires is being formed. The sleep onset association does not wait for the circadian rhythm to consolidate before it begins encoding. If a baby falls asleep at the breast every night for the first four months, she has been learning every night that the breast is a condition of sleep. By the time parents are told they may now act, four months of associations have been laid down. What might have taken three days of mild protest in the first weeks may now require considerably more.
The biological observation is true. The clinical conclusion drawn from it, that parents should wait, is not.
Put your baby down drowsy but awake. The sleep onset conditions she experiences in those first moments are what she will expect again at two in the morning. This association begins encoding from the very first night.
Many naps, brief waking intervals. A young baby often becomes sleepy within forty-five minutes to an hour of waking. Offering sleep frequently and early is management of the biology, not indulgence.
Many hands. A baby who always falls asleep in one person’s arms encodes that as a condition of sleep. On night four, this mother’s husband took over. The baby barely made a peep.
At six weeks of adjusted age, add an early bedtime. This is when evening fussiness has peaked and when a biologically meaningful bedtime begins to make a real difference. An earlier bedtime produces a longer night, not an earlier morning.
The evidence is consistent and reassuring. One study found that the more frequently mothers let their infant cry in the first nine weeks, the less frequently their infants cried in the following nine weeks, with no adverse effects on the mother-infant bond. Population data show that 37% of mothers allowed their baby to cry at term and 62% did so by three months.
A 2020 study found that leaving an infant to cry during the first six months was not associated with adverse behavioral development or attachment at eighteen months. Three independent replication studies totaling 365 mother-infant pairs found no significant association between crying it out and infant-mother attachment. Two 2023 studies of more than 2,000 families each confirmed that extinction and graduated extinction improved infant sleep with no negative effects on parental depression or parent-infant bonding.
A five-year follow-up study published in Pediatrics, the official AAP Journal, examined emotional and conduct scores, sleep problems, psychosocial functioning, chronic stress, attachment, and parental depression. No evidence of differences was found on any measure. The authors concluded that behavioral interventions have no marked long-lasting effects, and that parents can use them without concern.
The randomized trials enrolled infants six months and older because research ethics boards require strong justification for trials with younger infants, a constraint that reflects caution about experimental protocols, not a finding about harm.
Those who oppose extinction on philosophical grounds hold a view based of natural strong emotions; nobody wants to hear their baby cry. Crying is hard but sleeplessness is harder. What I ask is that the philosophical objection not be represented as a scientific finding, the evidence shows no attachment difference, and that it not become a prohibition on everything else. You can soothe your baby and put her down awake. You can offer frequent naps. You can move to an early bedtime at six weeks. None of these require a baby to cry alone and uncomforted. All of them work with the developing biology from the very first days.
Do not let someone else’s philosophy become a waiting period you and your baby pay for. She is learning from the first night. The only question is what she is being taught.
— Marc Weissbluth, M.D.
