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How To Sleep Train Your Infant... Yes You Can!

pattykwon

Most babies require some assistance from their parents to fall asleep in the first 2-3 months of life. However, if they do not learn to fall asleep independently with time, it can lead to longstanding sleep problems. The biggest interference to healthy sleep habits are sleep associations. A sleep association is anything that an infant or child associates with falling asleep - ex. being held and/or rocked, sucking on a pacifier/breast/bottle, or having a parent present nearby. If left unchecked, babies and children will often refuse to go to bed or stay asleep unless these associations are present. Falling asleep is a learned skill - some babies will find it easy (those lucky parents!) while others will need some guidance. The important thing, however, is that it is a skill that can be learned by ALL, including your child.


Sleep training can be initiated as early as 4 months of age as babies this age have the ability to soothe themselves to sleep and many are naturally starting to sleep longer stretches at night. Here's a step by step on how to tackle it!


Preparing for Sleep Training

  • Establish a consistent bedtime (between 6:30-8:30 pm) and wake up time (ideally between 6-8 am). You can start this around 2 months of age.

  • Establish a consistent bedtime routine ranging from 30-40 minutes and in the same order every night. Please start this no later than 2 months of age.

  • Around 4 months of age, get a sense of how often your baby wakes up during the night and how many of those wakings are for "real" feeding (not just pacifying). True feeds will last about 10 minutes if breastfeeding or consist of at least 2-3 oz of formula. It will lead to emptying of the breast or bottle as opposed to just a few sucks before falling back asleep.

  • If your baby is truly feeding more than 3 times a night, it would be advisable to wean off at least 1-2 feeds prior to initiating sleep training around 4 months. If your baby is having trouble gaining weight, please speak with your pediatrician first before weaning off some of the night feeds.

  • In order to wean off a feed, the key is to "beat him to the punch" by feeding your baby before he fully wakes up due to hunger. Offer the breast or bottle about 20-30 minutes prior to when your child will normally feed. For example, if you notice that your baby usually wakes to feed between 12-1 am, you should offer the milk around 11:30-11:40 pm. Do not fully awake the baby and keep the room dark. Put your sleeping baby to the breast or bottle and gently nudge him partly awake. Most will be groggy but feed anyway. Allow your baby to feed as much as he is willing to. When he appears to be done (stops sucking, de-latches, turns his head away), then gently put him back in the crib and leave the room. Don't worry about burping or changing his diaper at this time (unless you notice stool). Most babies will fall back asleep easily at this point because they were never fully awake. He will likely not wake up at the usual time to feed because his belly is already full. If you baby suffers from severe reflux, you may want to hold your baby upright for about 10-15 minutes before putting him back down.

  • The next night, repeat the same practice except decrease the amount of milk offered - either by decreasing the number of minutes you nurse for by 1 minute (you will need a digital watch!) or decreasing the volume of formula you put in the bottle by 1/2 ounce. Repeat this every night until you are down to 1-2 minutes on the breast or 1 ounce of formula. At that point, you can stop offering the feeds. Most babies will have adjusted to receiving less and less milk each night and will no longer feel much hunger during that time.

  • If your baby continues to wake up during the normal feeding time despite "weaning off" that feed, try going back to offering a small amount for 2-3 more days, weaning down even smaller increments each night.

  • This method can help eliminate an entire feed during the night but sometimes will lead to shifting of the schedule for the rest of the night. Let the dust settle and repeat this process for another feed if needed.

  • Once you are down to no more than 3 feeds a night, you are ready to sleep train!

  • 4-6 months of age really is the best time to sleep train. It becomes increasingly difficult to do so as babies get older as significant developmental milestones (ex. crawling, pulling up to a stand, walking) and natural onset of separation anxiety will interfere with this process.


Sleep Training: Wait and Check In

  • If your baby is still sleeping in your room, you may want to consider using this time to transition him into his own room if that is an option. In the 2-3 weeks before the starting sleep training, start spending more time and playing in his bedroom and crib during the day to familiarize him to the physical space.

  • On your first night, do your usual bedtime routine. Feel free to rock or hold him for a couple of minutes but do NOT allow him to fall asleep in that state. If he does doze off, wake him up! Give your baby some extra hugs before you put him down into his crib (in his own bedroom if that is an option). Your baby may start to fuss and cry but do NOT panic or try to pick him back up. As guilty as you may feel, leave the room and close the door.

  • Wait 5 minutes (probably the longest 5 minutes of your life!) and then peek in by the door and reassure your baby in the most soothing voice you can muster! Do NOT go too near or pick up your baby. As difficult as it will be, leave the room again. He will likely cry more now that he has seen you but he is still safe!

  • Wait 10 minutes and then check in again. Leave the room again.

  • Wait 15 minutes and then repeat the check in. Repeat this every 15 minutes until your baby falls asleep.

  • If it is time for a check in but you start to hear pauses in the crying, continue waiting as your baby may actually be starting to fall asleep. You don't want to wake him by walking into the room. If he starts to cry again, then do go in and resume your check in every 15 minutes.

  • How long you allow your baby to cry for will ultimately be up to you and your partner but I usually recommend that you try to stick it out for 2 hours. Yes - it will be so awful but majority will fall asleep within 2 hours. If it has been 2 hours but he does not seem to be slowing down his crying, then do pick him up and comfort him. Take a break from sleep training for a week and then try again.

  • You need to repeat this 5-10-15 minute "wait and check in" routine when he wakes up during the night except for those times that he usually feeds. Feed him during those times but do put him down in his crib again afterward, even if he starts to cry. Do the "wait and check in" again if you need to.

  • Repeat this step each night - the crying should get shorter and shorter each night. Most babies can be sleep trained within 1-2 weeks, although it may take longer for older infants.

  • Some babies may experience a sudden increase in crying after an initial decrease in crying over the first few days. This may feel like a regression but it is likely an "extinction burst," the last hurrah, and usually means that your baby is actually close to being sleep trained!


Some Pointers...

  • Try not to initiate sleep training during times of change or right before or after travel. If possible, try to aim for a period of 1-2 weeks when you can afford a bit less sleep.

  • If you have older children, explain to them why you will be allowing the baby to cry ("we're trying to teach him to learn to fall asleep on his own like you do and he's going to need some time to practice"). Yes, siblings' sleep may also be disturbed during this period in addition to yours but keep reminding yourself that once your baby is sleep trained, everyone will be sleeping much better!

  • If it is too difficult for you to hear your baby crying (very understandable!), try ear plugs, headphones with music, watching a funny show with headphones, or even taking a walk (as long as your partner is able to handle being on his/her own).

  • It is usually most efficient to sleep train your baby for both night sleep and naps simultaneously. However, some parents find it emotionally taxing to listen to crying during both day and night. If that is the case for you, first focus on sleep training your baby for the night. Continue your old routines for naps for the time being. Once the night training is done, nap training may also be a bit easier and faster.

  • This WILL feel miserable but remind yourself that you are teaching your baby a very valuable skill that will improve his sleep and rest (as well as for the rest of the family!). He will absolutely NOT remember this and will not resent you!!

  • The sleep book that I highly recommend for anyone interested or as type-A as myself is The Sleepeasy Solution by Jennifer Waldburger and Jill Spivack. It was gifted to me by a friend years ago when I had my first baby and it has guided me through sleep training my three children - and none of them resent me for it (as far as I know)!


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