Healthy Sleep Habits, Happy Child
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Graduated Extinction and Extinction
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Healthy Sleep Habits, Happy Child

5th Edition: 
A Step-by-Step Program for a Good Night's Sleep

Buy now

Healthy Sleep Habits, Happy Child

5th Edition: 
A Step-by-Step Program for a Good Night's Sleep

Buy now

Report 1Graduated Extinction and Extinction

Introduction

Graduated Extinction and Extinction are safe and fast methods to help your child learn how to fall asleep at bedtime and return to sleep in the middle of the night unassisted (Blog Posts 2427). Both methods work best when the bedtime is early, based on drowsy signs (Blog Posts 79) because a late bedtime causes an increase in neurological arousal (a second wind) that interferes with falling asleep. The younger the child is when you start, the better the outcome. Better night sleep will cause better naps and as a result, and eventually, your child will be able to stay up later. A temporary, super-early bedtime might be needed to get things going. When you establish an early bedtime, the wake-up time might be only a few minutes earlier or surprise, she might sleep in later!

My baby was deemed colicky at 3 weeks old. I wasn’t happy with that answer, and that is when I got the book Healthy Sleep Habits, Happy Child. This book changed my life. I really don’t believe my child was colicky. I think she was just way overtired and completely strung out. She has always been a spirited baby and would never just fall asleep like typical babies. Ever since I started implementing Dr. Weissbluth’s advice, she has become a totally different baby. Sometimes I wonder if a lack of sleep can cause colic or colic-like symptoms. I truly believe there are colicky babies, but sometimes I wonder if some are misdiagnosed.

In retrospect, I think that my baby was colicky. He was terribly sensitive to light/noise—couldn’t sleep anywhere but his quiet room by himself at 6 weeks, and would scream and scream to fall asleep even if I held him. Thankfully, my aunt had a colicky baby, and she recommended letting him cry. Starting at 4 weeks, I would just put him down in his room when he was tired [that is, drowsy but awake]. He would cry for five to ten minutes, and then sleep a full nap. If I had tried holding or rocking him, he would have screamed for a long, long time without sleeping. If it weren’t for the fact that he got so much sleep (because I was willing to let him cry), he would have been full-blown colicky. As it was, he slept a lot! I am so grateful that I experimented with letting him cry to fall asleep. I can’t even imagine how much screaming he would have done if I had insisted on holding him when he cried.

I asked a group of new parents in my practice how they soothed their babies when fussy or soothed them to a drowsy state before sleep. Some mothers in the group started teaching self-soothing when their babies were only a week old, after hearing from other moms how they had also started early. One mother described how, after feeling comfortable with some successes, she decided that she would let her baby cry at night to learn some self-soothing for night sleep. Her baby cried quietly one night only for twenty minutes and then slept well at night and has slept well since. She did this at age 4 weeks, and her baby was now 5–6 months. There were no gasps or astonished looks but simply smiles and nods from the more experienced mothers. I shared with the group a curious observation: In the office, after soothing a 2-week-old following an exam, I put the baby down on the examination table, and the baby began whimpering and quietly crying. I said to the mother, “Let’s watch the minute hand of my watch and leave your baby for one to two minutes, as long as the crying does not become loud or strong, to see if she might fall asleep.” Her immediate response was, “Isn’t she crying hard?” I pointed out that hard crying occurs after an immunization, and this was quiet crying. So it appears possible that some mothers, in the beginning, are less able to make the distinction between very quiet crying or whimpering and hard, loud crying and are therefore loath to allow any crying to occur in the context of allowing a child to learn self-soothing. I asked the parents in the group about this and their experiences with teaching self-soothing, and one mother said:

I wanted to respond to your comment about the mother who felt her baby was crying hard. I can relate to this and found with my baby at the start that his crying would actually “hurt” me. My partner, in contrast, didn’t know what my problem was and didn’t feel he was crying particularly hard (other people also commented that he didn’t sound very loud or upset). For me, I feel that the combination of sleep deprivation, hormones, and the overwhelming responsibility of being a first-time mum meant that I overreacted to every single cry, and this has gradually reduced with time and experience.

I am a frequenter of the new parent group at Dr. Weissbluth’s office and have had tremendous success with letting my now 11-week-old daughter cry it out. I let her do it the first time for twenty minutes at 4 weeks of age and had success pretty immediately. After about four nights the crying was either extremely limited or nonexistent. Some people might think it’s crazy or terrible, but I feel as though I was able to help my daughter sleep and feel better. I limit her to short periods of wakefulness (thirty to forty-five minutes usually), put her to bed early (5:30–6:30 p.m.), and let her cry it out when she needs to. She is now 11 weeks, sleeps twelve to fourteen hours each night, naps really well, and is just the happiest little girl. In addition, I am well rested, happy, and am able to give her my best self. I think you need to be comfortable and do what you believe is the right thing. But no, I don’t think it’s too early to let her cry it out. My opinion is to put her to bed in a dark, quiet room well fed with a clean diaper and close the door. Turn the baby monitor off and the TV up for twenty to thirty minutes and see what happens.

My maternity leave had ended, and I went back to work for the first full day. My 12-week-old daughter had “colic” (screamed for three to five hours every day) for the first 10 weeks, which I felt was 100 percent her being overtired. I did graduated extinction at 6 weeks to get her solid naps during the day, which helped her daytime crying/screaming immensely, but these naps were attained through use of a dark room, swaddle, and some quiet soothing.

Keep a log or diary to see if any trend or improvement occurs. Here’s an account from Allyson’s mother, who helped her baby make a dramatic—and permanent—improvement in her sleep habits at about 8 weeks of age:

Day 56: Allyson woke up from an afternoon nap, and I thought she was ill—she was so calm! No jerky movements or agitated behavior, which I guess I’d assumed was just “normal” for her. About this time, though, she still cried a lot when not nursing, and she still had trouble falling asleep.

On day 59, the mother decided to ignore some of the fussing/crying.

Day 59 (first day of extinction with a one-hour cap): Let her fuss 1 hour—and she went to sleep for 3.25 hours (5:45 to 9:00 p.m.).

Day 60 (second day of extinction with a cap): Allyson fussed all morning and wouldn’t sleep, but I kept her in her crib from 10:15 a.m. to noon, staying with her most of the time. Got her up to nurse at noon. That night she woke up at 2:30 a.m.—for the first time in several weeks. I nursed her until 3:00 and then put her down. She fussed off and on until 4:00, when she went to sleep.

Day 63 (fifth day): Breakthrough! She went to sleep for forty-five minutes in the morning and took a really long nap in the afternoon (12:45 to 5:00). But she woke in the middle of the night again (3:20 a.m.). She went back to sleep at 4:30 and slept until 8:30. She was happy in her crib—no screaming as I changed her diaper, which was new behavior!

Review of this mother’s records showed that up to day 59, the total sleep duration per twenty-four hours was about six to twelve hours. After day 63, the total sleep 

duration was longer—twelve to seventeen hours. The five-day training really helped her child sleep longer.

Day 64 (sixth day): Two wonderful things happened. First, Allyson took a midmorning nap (10:45 a.m. to 1:30 p.m.), and when I put her down for the night, with her eyes wide open, she did not fuss at all. I quickly left the room and heard no crying. She slept from 8:35 p.m. to 5:05 a.m.

Days 87–96: Allyson is just about perfect. If she starts to fuss, I know she is hungry, wet, or tired. If she’s tired, I simply put her in her crib and within two minutes she is asleep. It’s a miracle!

We did extinction around 8 weeks for my first two children. The first was colicky, and I was at my wit’s end. The second was one of those kids whose sleep was worsening. After she got out of the “sleep around the clock” phase, around 6 weeks, she started sleeping less and less at night—up for hours at midnight or 2:00 a.m. I was depressed, and my husband was the hero, sleeping with her in the living room so it didn’t disturb me. Oh, and we had an 18-month-old at the time, too! By the third night, both babies were falling asleep, on their own, at a good time, and sleeping all night (with a couple of feeds). While I sometimes feel guilty about doing it so early, and wonder if I could have just stuck it out, I don’t really regret it. We did do full-on extinction. My first, the colicky one, was much worse off when we tried checking and leaving. With my second, we just saw how well it had worked with the first and did it. I went in on the first night after she had cried for two hours, nursed, and she went to sleep, but it didn’t hurt progress at all.

I used extinction for my first two children at around 2 months. Both were still being swaddled at the time, and we kept them swaddled through extinction. They did not use pacifiers and did not suck fingers or thumb (though both started around 5 months). So it is entirely possible to do extinction with a swaddled baby (we started unswaddling them around 4 or 5 months with no problem at all). But if you know your son likes to suck on his fingers or thumb, then you can unswaddle him, too. A lot of parents decide to just do it all at once.

When Ron and I interviewed and selected our pediatrician before David was born, we left his office comfortable with the care we felt our child would receive. Although we knew the doctor had a special interest in sleep disorders, we never dreamed we would be faced with a baby whose internal clock thought day was night and night was day.

Oh, it didn’t happen right away. In fact, the first few weeks were spent nursing and changing diapers in between. At the same time, I was beginning to relax and feel, yes, everything is going along normally. David became more alert; Ron and I knew it was a great step in his development. We looked forward to his periods of wakefulness as a time to interact with him. But a pattern began to develop: David didn’t want to go to bed at night.

The doctor listened to what we were going through and assured us that, first of all, this was normal for some babies. David was really too young to go through sleep training at 6 weeks. So Ron and I resigned ourselves to some more of the same.  When David was 2 months old I began to panic. My maternity leave would soon be over. I could barely stand up most of the time, I was so tired. I also wanted to continue to nurse David whenever I was home. I knew we had to do something before I went back to work. So we called Dr. Weissbluth and made an appointment to see him.

First, the doctor checked David’s physical condition. He was in perfect health. Then we talked. Dr. Weissbluth explained that we would have to make some changes in the way we handled David’s sleep periods. David was to have a quiet, darkened room when sleeping. No more night-light, music, et cetera. Naps should last at least forty-five minutes to an hour. If David got up sooner, we were to leave him there until he got the rest he needed. Instead of letting David stay up late, we were told to put him to bed between 7:00 and 9:00 p.m. No rides in cars, strollers, or swings, where sleep occurred for a short time.

We decided to start that next Monday, since Sunday was Mother’s Day. I nursed David at 9:00 p.m., and by 9:30 p.m. he was asleep in my arms. I tiptoed him into bed and crept back to the living room and turned on the intercom. It was quiet until 9:45, when I heard David sucking his fingers. I thought, Okay, he’ll get back to sleep soon, but by 10:00 the crying began. David cried until 12:30—two and a half hours. For every cry I heard I shared his frustration, anger, and seeming pain. And I was angry—at David, the doctor, Ron, and myself. Finally, David fell asleep and he slept until 6:45 the next morning, when I woke him to nurse. The morning wake-up was planned and agreed to with Dr. Weissbluth. The idea was to get David to wake before I left for work so that I could nurse him. David seemed fine. I was exhausted.

Tuesday I let David wake himself up. That day he took naps ranging between two and three and a half hours, but his schedule was rather loose. At 8:30 that night, when he woke up, I fed, bathed, and played with him until he had one last nursing and I put him to bed at 10:50 p.m.this was later than Dr. Weissbluth had recommended. This time he cried from 10:50 until 11:15. Only twenty-five minutes? Could it be this easy? I was very encouraged. Weeks of David’s inability to get to sleep at night seemed to be at an end. Once again he slept through the night.

Although we were still unsuccessful at getting David to bed early, the periods of crying himself to sleep were getting shorter. On day three he cried for twenty-one minutes and then didn’t let out another peep until the next morning.

Just when Ron and I began to let out our breaths, David put us back in our places. On day four David cried for nearly an hour and a half. My spirits dropped. Was this just a temporary setback, or had the last three days been a fluke?  We found that if we responded to him quickly, assuming he wanted to nurse, he became irritable and difficult to feed. Those were the nights the crying seemed to go on forever.

At the end of our third week of sleep training, David, Ron, and I really had our acts together. Ron and I could tell when David was ready to call it a day, and we didn’t push him to stay up any later than he wanted.

I started sleep training my first at 10 weeks and my second at 12 weeks. My oldest was an extremely fussy baby who was insanely sleep-deprived, and waiting until he was 16 weeks old to sleep train him seemed impossible! While I was ready for him to sleep, I wasn’t nearly as ready as I thought I was to hear all of the crying while training him! Regardless, he was ready, even if he didn’t know it, because he needed sleep! We went from co-sleeping to putting him in his crib, so it was a significant difference for him. While he did cry, after the first couple of nights he fell asleep very quickly on his own in his crib. Soon thereafter, he began going to sleep at 5:00 p.m. to make up for all of his lost sleep, and waking up at 7:00 a.m. He did wake to eat, but would go back to sleep on his own. Our second, who is much easier than our first, already could soothe himself to sleep pretty well. After the first two nights of sleep training, he made immense leaps and bounds. I found that it was more me who was not ready to sleep train, less the kids, but once I sucked it up (and had my husband hold me back from going in to check on them when they cry) they became happier kids, and I became a happier, less tense mom. You need to keep reminding yourself about the big picture, and one day you’ll thank yourself for doing what seemed impossible and heart-wrenching.

My son, who was 11 weeks at the time, was extremely colicky. Having experienced colic in the past with my daughter (different type of colic, with more constant fussing and less crying), I felt that there might be the possibility of sleep training now rather than waiting until he was post-colic, around 4 months old. Not only was it for his sake, but in all honesty it was for us as a family also. We are so worn out and my poor little guy is so sleep-deprived. We started putting him down at 5:30 p.m. and did complete extinction. Within four or so days he started doing much longer stretches at night and better, not great, but definitely better sleep during the day as well. He still has days that seem more colicky than others, but our bedtime routine and early bedtime have made a world of difference for him.

We used extinction with a twenty-minute limit at 12 weeks. Our little guy would cry in our arms for two hours before he’d finally fall asleep. We’d take turns rocking him in our arms, swaying back and forth. When we finally decided to just try it, we were surprised at how little he cried before he fell asleep—eight minutes! The second day was equally easy, but then he quickly learned the twenty-minute time limit and would cry up to that point. We adjusted the bedtime from 6:30 to 5:30 [earlier bedtime] and removed the time limit [no cap]. First night, he cried for two hours. It was awful! But after four days, the crying stopped.

Our son was colicky and sleep was nonexistent in our house for three months. He refused to go in the swing or the bouncy seat, and hated the car even more (and still does!). If he did sleep, it was after being rocked for hours and he was put down in his crib in a dead sleep. At 12 weeks we did graduated extinction because he had no self-soothing skills. Our goal was four hours of sleep, and it worked. Within five nights, he was sleeping through the night! We were shocked to say the least. It was an absolute miracle and the best thing we ever did. Everyone in the house was much happier, and we started to really enjoy being parents. For the first 3 months he was definitely going to be an only child. Your book Your Fussy Baby helped us tremendously!

I’ll never forget the night and early morning at about 3 months of age when Eric was so sleep-deprived he could not go to sleep. I tried everything—nursing, rocking, walking, bouncing, and singing. Eventually he did fall asleep while I pushed him around the house in the stroller listening to his favorite CD, only to wake up the second I tried to move him into his crib. The hours stretched on and Eric became more and more tired, overstimulated, and agitated. He began trying to pick the flowers off my pajamas. Though he seemed to want to go to sleep, he appeared unable to get there. I felt I didn’t have any choice but to put him in his crib, awake and crying. After about twenty minutes of crying, he fell asleep.

He did best with his first midmorning nap, crying only one or two minutes, if at all, before going to sleep. The evenings remained the most difficult. The longest crying episode was twenty-one minutes. My husband and I would sit in the den holding hands, listening to the baby monitor, and engaging in self-doubt: “Does he need us? Are we bad parents for letting him cry?” We kept reminding ourselves that Eric was learning a valuable skill that would serve him (and us!) well for life. After about three days, we felt he had achieved success. He has been a terrific sleeper ever since. Now, at age 11 months, he sleeps from 7:00 p.m. to 7:00 a.m. and naps twice for an hour or two. Everyone who meets him says he is happy, joyful, and alert.

We just utilized the total extinction method for our 3-month-old (13 weeks) son. It took three or four days (the first two days of which were quite difficult) but has been unbelievably successful and a lifesaver for our family and our son. At least in our case, 3 months old was the right time for him. Essentially he would only sleep tightly swaddled in his car seat with a pacifier. We had to constantly reinsert his pacifier every fifteen minutes or he would cry and wake. It was exhausting for both us and him, as his sleep was terribly choppy. We tried graduated extinction at various times from 8 to 12 weeks—waiting ten, fifteen, or twenty minutes before going in to soothe—but he would always outlast us. Last week at 3 months old we decided to utilize total extinction, and while extremely difficult emotionally, it has been an unbelievable success. The process took three or four days. The first night we put him to sleep at 6:30 p.m. and he cried almost ninety minuteshe had a second wind. It was heartbreaking, as most parents experience. He then slept until his normal feeding time of 1:00 a.m. but had several night wakings where we allowed him to cry. The second night he cried approximately sixty minutes. He woke only for his two feedings.  The next night, we moved his bedtime up half an hour to 6:00 p.m. He cried for just five minutes and then woke only for his feedings. Last night he did not cry at all when he was put down! He slept his longest stretch of sleep ever—eight hours—then woke to eat. He had one second night waking to eat and then slept until 7:30 a.m. rather than the 6:00 a.m. waking he has been having. His naps are also now falling into place, and he is finally sleeping on his own, in his crib without a swaddle, taking three or four naps a day of one to three hours each. He goes down for a nap after an hour to an hour and a half of wake time. He is now going to sleep for naps and nighttime without any crying, and waking up cooing and smiling in his crib rather than crying. While it took several days and was emotionally very difficult (and perhaps not over yet), his overall crying has gone from constant to very infrequent, and he is sleeping wonderfully. When he is awake he is alert, smiling, and interactive. I am sure we will have to continue to reinstitute the technique as he grows, but it has been so worthwhile.

I have only one child, so my experience is limited to her. Based on our experience, at 6 weeks, all we were trying to do was survive. She was extremely fussy between 5 and 10 weeks. At the time, we felt that the best thing to do was soothe her and try to get the maximum sleep possible. Things were “messy” in the sense that we used swing, holding, the crib, extensive soothing—whatever worked that day/night. We made repeated attempts at drowsy but awake, but it never worked before 3.5–4 months of age. Ultimately, we felt it was more important that she get some sleep in those earliest months, so we did what it took. From my perspective, parents of colicky children should be prepared to be somewhat flexible until about 4 months. You can attempt earlier bedtimes or some extinction, but if things are really disastrous, abandon the effort and try again later. We knew it was time around 3.5 months because we were soothing more and she was sleeping less—it was like we were annoying her! I would add that dealing with colic is incredibly taxing, physically and emotionally. In the first 4 months, we were lucky to get four to five hours of consolidated sleep in a day. Most days, it was two to three hours. Add to that dealing with a fussy child almost around the clock, and you have a recipe for frazzled and distressed parents. I can certainly understand why many parents struggle with a post-colic sleep plan, as it can be hard to be resolute when you are completely burned out.

We had success with my 4-month-old son (he’s now 2 years old). We decided on extinction because it seemed to be likely to cause everyone, including my son, the least amount of stress. Our plan was to get him to a sleepy state and make sure all of his needs were met, and then put him down to bed awake. The first night, he cried for thirty-five minutes, and I cried, too. But then he slept seven hours! He woke once and went back to sleep for four more hours! I thought I’d died and gone to heaven. He was in a much better mood the next day, and his napping was much better as well. I began to wonder if this was really my son! The next night, he cried for twenty minutes and then slept for nine hours straight before waking. He was even more content and had even better naps the next day. I’ll never forget how he had his first night without waking on Labor Day, a few days after starting the extinction method. I told everyone that it felt like a gift for all of my motherly labors. After a few days, he no longer cried when I put him down. My husband and I are such believers that babies/children (and parents!) need sleep to function well. We call what we did for him “sleep empowerment.”

My baby was colicky and never slept. He did not take naps at all for the first 3 months of his life. At 4 months he started taking naps only in the car or in the swing. I feel like he was in the swing more often than not. As soon as the swing was stopped, he would wake right up. At 4 months I decided to do extinction; graduated extinction only riled him up and extended the crying. So we did extinction with no problems at night. He always went right to sleep, no crying and no night-waking problems. He wakes two times a night to nurse. The problems were his naps. He did not know how to self-soothe. So I taught him, and he caught on rather quickly. After two weeks he was going down every two hours for naps without much crying. At the beginning of this nap training there was a lot of crying. At first his naps were short, forty-five minutes or so. After a few weeks the midmorning nap lengthened to about an hour and a half, the midday nap went from forty-five minutes to an hour, and the third nap declined to about thirty-five minutes. I have been very happy with this! My family and friends think I am out of my mind because I schedule everything around his naps.

The hardest thing about dealing with colic was that we didn’t know when it would end. People kept telling us, “Don’t worry, it’ll get better,” but we had no idea whether that would be in a week, a month, a year. The need for twenty-four-hour intensive soothing efforts took a huge toll on me, emotionally and physically, and on my relationship with my husband. Almost a year later, I believe we are still dealing with the fallout from our very intense and difficult first few months. The turning point for us was when we discovered Healthy Sleep Habits, Happy Child and began sleep training at 4.5 months. It was like suddenly we had our lives back. We knew that he would be in bed at 5:30 p.m., and while he would wake up to eat a few times during the night, he would go right back to sleep. Once we had naps under control it got even better. I believe that at a certain point, his natural colicky tendencies were fading, but still being exacerbated by his being horribly overtired. I will know for my next baby (won’t be for a while!) that healthy sleep habits begin on day one, and that most babies don’t just know when to sleep—they need us to help them.

The moment my daughter, Amanda, arrived home from the hospital, she exploded with a very bad case of colic. I took her to the pediatrician’s office several times, only to be told there was “not a thing wrong, relax.” I also received several suggestions about nursing and a pat on the back. All of these suggestions irritated me, and I felt as though I was being perceived as an anxious, first-time mother.

After twelve weeks of crying and screaming, Amanda was evaluated by two child development specialists. I decided we should work with one until my daughter’s crying and screaming settled down. We also saw a psychiatrist, who recommended medication and also suggested that we continue to be followed by the development specialists. In the meantime, our lives had become a nightmare. Amanda cried most of the day and always screamed in the evening. To our horror, this behavior had worked itself into the night hours, too.

By 5 months, we were referred to Dr. Weissbluth for what we hoped was a sleep disorder. I say “hoped,” because we were at the point of seeing a pediatric neurologist and having an EEG done. I was very frightened for my daughter, and my husband and I were exhausted. I was eager for the consultation. My daughter had definitely been cursed with colic. Could this now be wired exhaustion from a sleep disorder caused by the treatment for colic—rocking, swinging, motion all the time? It was.

Amanda was old enough now to try “crying it out.” It was the most difficult thing I’ve had to do as a new mother.

The first night, Amanda screamed, choked, and sobbed for thirty-two minutes. I remember feeling sick to my stomach.

The first two days weren’t too terrible. However, the third and fourth were almost intolerable. Amanda would cry through her entire nap time. Then I would get her up to keep Dr. Weissbluth’s time frame going. Her temperament after these episodes is known only to mothers who have been through the same ordeal! When she would scream for over an hour during nap time and in the evening, I felt cruel, insensitive, and guilty. Three things kept me going: my husband’s support; Dr. Weissbluth’s concern, encouragement, and compassion; and the fact that I knew it had to be done—Amanda had to learn to sleep.

It took Amanda about a week to catch on to the idea. The bags under her eyes faded, her sporadic screaming attacks stopped, and her personality was that of a predictable baby—a sweetheart when rested and a bear when past a nap time or her bedtime.

I would offer these suggestions to other mothers and fathers who have to take this measure in order to teach their babies to sleep. You, as parents, have to understand and believe intellectually that it is the right thing to do. Otherwise feelings of guilt will overpower you, and you will give in. You must have the support of your spouse, as it will be too much of a strain to bear alone.

You are doing what is best for your baby. It seems cruel and unacceptable, as a loving new mother, to let your baby cry. But it is a fact of parenting—many, many things will bring tears and protests in the years to come.

Enlist the support of a sympathetic friend as much as you feel the need to. I found close telephone contact a tremendous help. Some parents may not need this close interaction, but many of us do.

My son is now 5.5 months. He was extremely colicky and also had reflux. My son cried pretty much all day and evening. He would only sleep fully swaddled in a swing in our bedroom, and even then he probably averaged six to eight hours of fragmented sleep in a twenty-four-hour period. Needless to say, once the colic ended and his reflux turned into just being a “happy spitter,” my husband and I were desperate to figure out how to get some sleep for all of us! After trying the gradual approach and graduated extinction with no success, we decided it was time for extinction. It was very hard to do, but luckily he didn’t scream every night for as long as we had expected. I kept reminding myself that we weren’t making him cry: we were allowing him to cry.

At 6 months of age, Stephen was strong, happy, and healthy in every respect but one—he didn’t sleep well. He did all his daytime napping in the car, the stroller, or our arms. If we put him in his crib, he awoke immediately and cried until we picked him up. His nighttime pattern was different but equally exhausting. He went to sleep in his crib promptly at 8:00 p.m. but usually awoke within the first hour for a brief comforting, and two or three times between 11:00 p.m. and 5:00 a.m. for a feeding.

This routine was taking its toll. I was almost as tired as when Stephen was a newborn, and I had no emotional reserve for handling everyday problems. I was sharp with the rest of the family and got angry if my husband was even ten minutes late getting home from work. We needed to make a change. We had the weekend ahead of us, when my husband would be around for support, so we decided to start that night.

We put the baby to bed at 8:00 p.m., and he awoke for the first time around 9:30. We didn’t go in to him, and he cried for twenty minutes before going back to sleep. He awoke again around 2:00 and 4:00 a.m. and cried about twenty minutes each time. When he cried at 6:00 a.m., I rushed into his room, anxious to hold him and be sure he was the same healthy, happy baby I had put down the night before.

Over the next few days it was amazing to see how quickly he fell into the schedule we had set up for him. He cried ten to fifteen minutes several times, but never again for an hour. Now he naps regularly and sleeps all night, occasionally crying for one or two minutes during the night as he puts himself back to sleep.

Letting my baby cry was one of the hardest things I’ve ever had to do. Now that the experience is behind us, however, I have no doubt at all that it was right. It gave me more confidence in my abilities to handle tough issues as a parent.

We became very sensitive to signals of sleepiness  and were able to adjust our sleep routines to his needs.

As a psychologist and researcher I knew a lot about mothers and babies, about crying, feeding and sleeping problems, and about attachment. However, I was not prepared for the real-life experience when our son was born. We learned some things rather accidentally.For example, we wanted to bathe him every one to two nights so he could get more comfortable with bathing. Afterward it appeared just natural to make him ready for the night. This was how we developed an early and regular bedtime ritual between 6:00 and 8:00 p.m. Another example is how he learned to fall asleep on his own. We had this one evening where I would sit with him as usual watching him fall asleep. This must have been very early, maybe at 2 months. In this evening, he did not fall asleep, but was watching and babbling in a calm and cute way. For no reason, I decided to go to the kitchen instead of watching him any further. Together with my partner, I sat listening over the baby phone until he went asleep without any further interaction from us. This was how we all learned that he is able to self-soothe. After this night, we let him fall asleep alone after his normal bedtime routine using his own competent self-soothing strategies.

Other things we learned the hard way.

Due to our rough birth experience and a longer hospital stay after the delivery, we were forced to stick to strict breastfeeding and sleeping routines that were based neither on our son’s needs nor on my own. We then enjoyed a huge sense of freedom after coming home, resulting in a lot of co-sleeping and breastfeeding on demand, which felt very comfortable at the time. However, after about 6 months we had developed a very challenging night-waking habit. Although I breastfed him, he would not fall asleep again. Also, he would wake up every one or two hours, leaving us all exhausted. Additionally, we were troubled by the unpredictability of his daytime naps. I could just not figure out when he would nap. So planning any appointments became a disaster.

In the midst of this distress, I happened to remember the copy of Healthy Sleep Habits, Happy Child on my bookshelf. Although I had read some chapters before, I was surprised to find new answers to our sleep problems and a very sensitive nudge in the right direction. So the first thing we established was a good and solid midmorning nap by adding a little more energy to our morning routine and putting him down no later than ninety minutes after his first waking up. For example, we would go for a walk enjoying fresh air, nature, and close body contact through a baby sling, and then we would have breakfast, breastfeeding, and a fresh diaper before starting the nap routine. This did include some singing and rocking ritual and a cozy crib in a dark, cool bedroom without me. So step-by-step we developed a healthy nap routine.

With regard to night waking, we identified the crude feeding times through a ‘daddy night.’ Fortunately, both Daddy and our son were well experienced with bottle-feeding since the first weeks in hospital, and we always had a small supply of breast milk in the freezer. So we were able to determine two actual feeding wake-ups at midnight and 4:00 a.m. To our surprise, all the other awakenings were just for social interaction and caregiver-driven soothing! After this discovery, we went for extinction for no-feed signaling to emphasize sleep times as compared with wake times. I remember this time as very intense and hard, but also very short.

Nevertheless, it took a while to feel comfortable and secure again, especially when talking to other parents. I got the impression that ‘attachment parenting’ was a very popular opinion in Germany at the time. To my disappointment, it was often and fiercely misinterpreted as (A) the one true parenting strategy and (B) the opposite of encouraging self-soothing. This was not only in contrast with my own beliefs for I had a securely attached child despite our imperfect but good enough parenting. Furthermore, these interpretations were contradictory to the current state of research that promotes variability between infant-cued and limit-setting parenting behaviors. So I felt really bothered by unrealistic parenting goals, like ‘Never let your child cry, never let your child sleep alone, never give him a bottle or pacifier’. I fear that these opinions might put parents at risk for self-sacrifice and resulting mental problems, while children could be put at risk for regulation problems and later childhood disorders. I would prefer parenting advice—in personal contact, book, and through social media—that is evidence-based, flexible, and balanced, so that every parent could choose their own path without feeling guilty or intimidated.

In the end, our typically well-rested, calm, and attentive baby was a good reward for all the distress, and furthermore a good reassurance that he was perfectly fine. Of course, we would experience difficulties along the way (when we started going to daycare, holidays, sickness, et cetera). In these situations, we consulted the book again or got advice from Professor Weissbluth, directly. In most situations, a super-early bedtime around 5:00 p.m. [Reset, Blog Post 26]  helped to compensate for a slight sleep deficit to reestablish our son’s healthy sleep routine.

When we had our second son, three years later, it was a huge relief how easy we could establish good and healthy sleep routines right from the beginning. Since we were very sensitive to signals of sleepiness, we were able to adjust our sleep routines to his needs. In the end, we needed no extinction because he never developed a night-waking habit or any other sleeping problems. He would, of course, get sometimes sleep-deprived as all babies would (because of the erratic nature of life itself), but we feel more confident and calmer in dealing with it, now.

Our most important insights can be summed up in four sentences:

1. Whenever you or your child get sleep-deprived, consider an earlier bedtime.

2. Prevention is much easier than treatment.

3. Be indulgent and kind with yourself, your baby, and your partner—you are a family now.

4. Whenever you get lost, go and get some professional help.

We decided that because our son had been premature, and so colicky and sick, we really needed to wait until he was closer to 5 or 6 months to start any kind of sleep training. So we did. My husband and I are both psychologists, and we both work with people who have been severely neglected or abused as children, so we are acutely aware of the importance of building a secure attachment in children. As such, we were also very nervous about trying any kind of cry-it-out method, fearing it might undermine our son’s attachment to us. However, we were also desperate for sleep, and so was our son. I think the phrase that stuck out to me in Dr. Weissbluth’s book (and that I still hang on to to this day) is that a sleepy brain is not an awake brain. When babies cry at night they are not lonely, afraid, and anxious or any of the other things they might be when they are awake; when babies cry at night, they are tired. So when our son was 6.5 months old we laid him down for the night at his usual time (7:00 p.m.) after his bath and bottle and left the room [extinction]. He cried for almost an hour and then fell asleep, and he didn’t wake up until 5:30 the next morning. I couldn’t believe it. The next night we did the same thing, and I was sure the night before had been a fluke, that there was no way he could sleep that well two nights in a row. He did. He cried for forty minutes and slept until 5:30 the next morning. He is now almost 3 years old, and we still put him to bed between 7:00 and 7:30 at night. He talks to himself happily in his crib for about thirty minutes and then sleeps until seven the next morning. He naps for anywhere from an hour and a half to two hours a day. If our premature, sick, colicky son can learn to be a good sleeper, any baby can. It was the most difficult thing we’ve had to do as parents, letting our son cry, but it also taught us an important lesson—that even as babies what our children want and what they need are not the same thing. Teaching our son to sleep gave me the confidence to trust my instincts as a mother and to weather the criticisms I receive from others for “letting my baby cry.” We firmly believe that tolerating or accepting some crying is worth the payoff of teaching our children to sleep. Refusing to allow them to develop this skill constitutes a form of selfishness of the part of my husband and me. I hope our experience can give other families who are suffering the confidence to succeed.

I read that you should always take your baby everywhere and “wear” your baby like the Native Americans did. I carried him around in a BabyBjörn carrier on walks and to do errands. By the time he was 10 months old, his nighttime routine was established. I would nurse him to sleep at 8:00 p.m., put him in his crib, and he would wake up at 10:00 p.m. and cry. I would change him and nurse him back to sleep, and carefully, oh so carefully, put him back in his crib, and repeat this process all night every two or so hours. Sometimes he would wake up when I put him back in bed and I would have to start all over again. As the night progressed, and he became more and more exhausted, he was more likely to wake up when I put him down, and it took longer to soothe him back to sleep. By 6:00 a.m. he was up for the day, napping occasionally and only briefly. Sometimes I couldn’t even put him down long enough to eat dinner. I held him while I ate. One night I went to him when he cried and nursing did not soothe him. He could not stop crying no matter what I did. I realized at that moment that he didn’t need me so much as he needed to sleep. We were all exhausted.

We had heard about “crying it out” before, and I thought it sounded cruel. But my husband wanted to do it, and it was clear that we had to change our methods, because although I was perfectly willing to deprive myself of sleep on his behalf, Ares was clearly suffering from sleep deprivation. Ares had all the symptoms of an overtired child. He was easily startled, and cried uncontrollably at sudden or loud noises. He was unable to go to sleep on his own, and unable to stay asleep once he did. The book explained that in going to Ares every time he cried at night, I was stimulating him and keeping him awake, not soothing him and reassuring him as I had thought. All that stuff I had read about “nighttime parenting” and “attachment parenting” was not only not helping, it was hurting Ares. We decided to try extinction.

The first night I put Ares to bed at 8:00 p.m. as usual, but when 10:00 came and he cried, I didn’t go to him. It was one of the hardest things I have ever done, but I wanted to give it a try for his sake. He cried for forty-five minutes. I thought I would die. My nervous system went haywire. I cried, my whole body got hot, I was shaking and sweating, and my heart pounded. He’s going to think I abandoned him, I thought. He will never trust me again. But once he stopped crying he slept all night long. Ares had never slept for more than four hours in a row. I thought for sure he had died. But he woke up the next morning happy and rested and then fell back to sleep a couple of hours later on his play rug, another first. Ares had never in his life fallen asleep without nursing.

We worked to make sure Ares got the sleep he needed. At night we developed a sleep ritual of bath time, reading to him, and nursing him at 6:00 p.m., and putting him down sleepy but awake. He took two naps a day, following a slightly abbreviated sleep ritual, and slept for two hours in the morning and one hour in the early afternoon. For some reason he didn’t cry at nap time, he just went quietly to sleep. At night, however, for several weeks he still cried for forty-five minutes when I put him down. This was extremely difficult, even painful. But once he fell asleep he stayed asleep for twelve hours, which was incredible to me, and he was so much happier during the day that we stuck with it. In the daytime, he was so much calmer; he even seemed sleepier for the first few weeks. He almost never cried anymore, and his attention span was longer. Eventually Ares went to sleep without crying, and he still sleeps every night all night long, for at least twelve hours a night.

For many reasons (living in a one-bedroom condo, et cetera), we did not sleep train our daughter until 10 months old. We thought things would improve once we moved into a larger townhouse when she was 9 months old and had her own room. To our surprise, her sleep got worse. What we thought would take a few days to adjust went on for weeks of disastrous sleep for all of us. One day I sat down and wrote up our typical daily routine. To my surprise, I realized that I was spending up to two hours total per day just soothing her to sleep. I told Dr. Weissbluth our story. Although he said she might fight us pretty hard at her age (10 months), he assured us that we could still sleep train her. He set us up with a weekend plan so my husband could help out. In just four nights we made it happen! Dr. Weissbluth followed up with me until we had reached success. Here’s how it went:

First night: Cried intermittently for seventy-five minutes

Second night: Twenty-five minutes

Third night: Forty-five minutes

Fourth night: Fifteen minutes

Fifth night: Done!

She goes down without a fight and sleeps like a baby—or, shall I say, like a baby is supposed to sleep! We wished we’d done this sooner. The many sleepless nights really took a toll on our new marriage, our health, and being able to enjoy our new baby. I think many new parents get stuck in the fog and can’t bear to hear their babies cry. While it does take a degree of courage, my husband and I were astounded by how quickly our baby learned to soothe herself to sleep. So to all the parents out there who are sleep-challenged, it doesn’t get any easier the longer you wait. Educate yourself on the vital importance of sleep (not only for infants but adults, too). Start sleep training early, engage others to assist (Dad, partner, Grandma, best friend, et cetera), and you’ll be healthier, happier, find newfound freedom, and enjoy quality sleep where everyone wins!

My daughter was 14 months old, ate poorly, resisted naps, woke two or three times in the night, needed to be rocked to sleep, and was tired all the time. My husband and I were exhausted, angry, resentful, and blaming each other for the situation we were in.

We were ambivalent, scared, concerned, and skeptical about letting our daughter cry, as the treatment plan recommended. We thought she would feel unloved and worthless if no one responded to her.

After only one episode of crying, she learned how to lie down and fall asleep on her own! It was very difficult listening to her crying, but when she woke in the morning smiling and kissing us good morning, we were reassured that she loved us. Now she naps regularly, sleeps through the night, eats better, plays better, and is able to play in her crib before going off to sleep on her own.

Comments

  1. Dear Dr. Weissbluth,

    My baby is 5 months old. He wakes up a lot at night and naps only 20-30 min each nap. We sleep trained him at 4 months (graduated extinction) but failed. Please help us.

    We provide more detail about his pattern and schedule below:

    1. At night, he wakes up for a long time (1-2 hours) between 1-3.30 am, then every 45 min after that.
    2. During the day, he has two naps. He sleeps within 2h from the time he wakes up. He always naps 20-30 minutes in his crib then wakes up. I try to extend his nap by laying next to him in my bed until he is asleep. It takes 30-60 min for him to fall asleep then he can sleep for 45-60 min in the morning and up to 2h in the afternoon. We really hope to move away from this and have him nap only in his crib in the future.

    Here is his rough daily schedule
    7 am: up for the day, bottle & play time
    9 am: mid morning nap- 30 min (9.30 am – 10.15 am: soothing by laying next to him in bed to sleep)
    10.15 am: extending nap – 60 min
    11.15 am: bottle & play time
    1.15 pm: mid afternoon nap – 30 min
    (1.45-2.30 pm: soothing by laying next to him in bed to sleep)
    2.30 pm: extending nap – 120 min
    4.30 pm: bottle & play time
    6.30 pm: bath and bedtime routine
    6.45 pm: bottle
    7-7.30 pm: sleep

    At 4 months when we weaned him off all night feeds to sleep train him using graduated extinction. We terminated the training after 7 nights of horrendous crying 🙁 He started to roll on the 3rd night of the training so he needed to be out of his swaddle. With his free hands, he started to take the pacifier out of his mouth then cried hysterically.

    These days, I rock him to sleep occasionally and still have to hold him in my arms until he is asleep then put him down in his crib. During his night wakings, I give him pacifier. His hands still take the pacifier out of his mouth so I have to hold his hands down until he is sound asleep. By the time I leave his room, he wakes up again within 5-10 min. As a result, I ended up staying in his bedroom almost all night after 1 am till he wakes up.

    Could you please help us address his night wakings and cat nap problems? We are thinking of trying extinction method but after the first failure we are very worried. We are not sure where to start and what need to be changed before sleep training him. We really want to be prepared and ready this time.

    Thank you.

  2. Dear Dr. Weissbluth,

    Thank you for your prompt response.

    Because his last nap tends to last to 4.30-5 pm, he is happy and playful between 4- 6pm. He would get hyper and fussy after 2h-2.5h from the time he wakes up so around 6.30 m-6.45 pm.

    We just recently cut his third nap hoping to achieve an earlier bedtime. But he seems most awake during this period before bed so it’s difficult to put him down.

    Last night he was up a lot (10.45pm, 2am,3am,..) and he couldn’t go back to sleep after 4 am. We soothe him (in crib with pacifier and holding his hands down) until 6 am then got him up to start the day. We are all exhausted. Receiving your response gives us so much hope.

    Please let us know what we can change and when / how we should proceed with the training (if we should).

    Thank you again.

    1. There are many variables that are discussed in my book related to choosing a sleep solution for your family such as whether you want to move quickly or go slowly or whether your husband is supportive or not supportive of your plan. The book gives much more detailed and individualized information than what I can offer here, but here is an outline based on your child’s age and basic principles:
      Your child lacks self-soothing skills and after only 20-30 minutes of a nap, he cannot return to sleep unassisted. He needs to learn self-soothing skills to be able to fall asleep and stay asleep for naps and night sleep. Therefore, you may wish to impose an age-appropriate sleep schedule as follows: a mid-morning nap around 9am and a mid-day nap around 12-2pm (which you are doing, but only spend a few minutes trying to extend naps) but no day sleep after 3:00pm. Or consider abandoning the attempt to extend the naps. Temporarily, lights out for night sleep at 5:30pm (all feeding, bathing, soothing occurs before 5:30pm). Overnight, feed him when hungry but at other signaled awakenings, consider extinction or graduated extinction. All these elements need to be implemented simultaneously to be successful. Perhaps start this on a weekend when both parents are available for extra soothing because he will be extra fussy due to short naps. Expect to see improvement in night sleep in 3-5 days and improvement in naps a few weeks later. Night sleep improvement will help naps improve and when naps are better, the bedtime might become later. I know that you have many questions, but I hope this helps you a little. Good Luck!

  3. Thank you Dr. Weissbluth. This is very helpful. Also I have read your book in the past, which has lots of useful information. I will work on this plan and report back in a few weeks.

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