I call this the Golden Rule, and its importance cannot be underestimated. There are few things in life as wonderful and refreshing as a good night’s sleep. Unfortunately, with the act of becoming parents, we willingly place our nocturnal slumbers into jeopardy. This only needs to be a temporary condition, but sleeping through the night doesn’t happen by accident. You have to plan ahead and understand a few basic principles.
The first step in establishing healthy sleep habits, which should be accomplished either before the baby arrives or within the first few days after coming home from the hospital, is simply to define the period in which the parents plan to sleep. This must be a mutually agreed upon time frame determined by the mom and dad independent of any consideration for their infant. Now, a given couple may decide that nighttime in their home is eleven to seven, midnight to eight-thirty, or a quarter to ten until five forty-five, whatever. That is immaterial. What does matter is that they establish the time in which they would ideally like themselves and their child to be sleeping, and then set those hours in stone.
Next, the parents need to develop the mind set of consciously responding differently to their baby at night in contrast to the remainder of the day. In the daytime (or rather the non-nighttime) the mother and/or father should be playful, noisy, fun, stimulating, nurturing, rapid response units. They should feel free to spoil the little bundle of joy to their heart’s content. But during the hours designated for sleeping they must consciously limit their interactions to nothing more than feeding, changing, and putting back to bed. That’s it. Nighttime is not supposed to be play time. From all reports it is very, very dark inside the womb, and therefore children are born with no innate sense of days and nights whatsoever. It is entirely dependent upon us, the parents, to show them the difference, and the sooner this process is begun the better. You need to send a clear message, not only by how you respond to them during the night but also during the day. If left totally to their own devices it takes an infant an eternity to sort this out and join the schedule of the rest of the human race. But it doesn’t have to be that way.
Obviously there will be crying at night, and that’s okay, it’s just a part of the learning process an infant must go through on the road to achieving good sleeping habits. As long as she is in her bed and the parents are in theirs she must on occasion be allowed to fuss. Furthermore, make sure the baby is serious before paying a visit. Generally I recommend letting her call for help for at least one minute before going to the rescue, and then, in a dark, quiet environment, lights off and voice silent, perform the minimum duties necessary to attend to her physical needs only.
As has been stated elsewhere on this site, babies cry. The proper emphasis thus should not be placed on preventing or even minimizing crying but rather on responding to the crying appropriately. Always first eliminate the physical causes, a dirty diaper or hunger, and then proceed from there. The difference between daytime and nighttime is that during the hours designated for sleeping all of the other plausible interventions one might attempt with a fussy baby – rocking, singing, playing, nursery rhymes, etc – must be skipped. If the infant has been fed and their diaper is clean and dry then you are done. It is time for the parent to go back to their bed and give the baby an opportunity to settle themselves.
When it comes to sleeping in general, both daytime and nighttime, a major mistake I see parents making ALL the time is what I call The Error of Nap Technique. It goes like this:
THERE IS NO PROBLEM HAVING YOUR BABY FALL ASLEEP IN YOUR ARMS… THAT IS, AS LONG AS YOU ARE WILLING TO HOLD HIM OR HER IN YOUR ARMS FOR THE NEXT THREE TO FOUR HOURS WITHOUT MOVING
Herein lies the problem. If a baby does by chance or design fall asleep while being held, and then the holder tries to lay down the infant, the poor kid will be unable to handle the transition and will reawaken within five to fifteen minutes more exhausted than ever. Yes, there will be some infants who can accommodate the change in smell, warmth, and texture without arousal, but they are the rare exceptions. A baby should be laid down awake, tired, and fussy, allowed to fall asleep in that position, and not be disturbed once they do so. To have an infant drift off in one’s arms and then try to lay him down is the moral equivalent of waiting until he’s asleep and then pinching him. Both accomplish the same result and you’re right back where you started, each of you quite the worse for wear, the infant in particular being all the more exhausted and frustrated than before falling to sleep in the first place. Being aware of this one small fact will save both of you a ton of aggravation.
An appropriate minimum interval between feedings is two hours, a number which can be applied at all times throughout the day and the night. The reason for this is primarily to force parents to assume the crying is not simple hunger and make them search for alternative causes such as maybe, just maybe, their baby is tired. Now, the breast feeding literature will advocate ten to fourteen nursings a day for the first several months, but I believe this is categorically wrong and misleading. Eating should be physiologic, meaning that a baby needs to eat when hungry, not on some artificial schedule. When an infant is awake, alert, and motivated the feeding is highly likely to be successful, but if not the meal will more than likely be a dud. DO NOT EVER awaken a baby at night for the purpose of feeding them. Why on earth would any sane person wish to train their child to be up during those hours? The logic escapes me entirely. Parents may be okay with it for a while but eventually, as they begin to grow exhausted from the all the work of caring for a newborn, the realization will dawn on them that they have made a BIG mistake. If setting an alarm for 3 A.M. to go in and awaken a soundly sleeping baby for the purpose of trying to get him to eat seems like a dumb thing to do, it’s because it is. Don’t do it.
As soon as the mother feels physically and emotionally comfortable with her newborn I generally suggest the baby be moved into her own room. Now, the American Academy of Pediatrics recently recommended infants sleep in the same room with their mother for the first year of life, but I’m not buying this. The evidence that where the baby sleeps has any impact on the incidence of SIDS is pretty slim. It seems intuitive that SIDS is a silent event, and I will tell you with absolute certainty that I have NEVER in all my years in practice seen a mother and a baby who could sleep well in the same room. It just does not happen, and I guarantee this placement will not only retard the development of good sleep habits but will result in a myriad of not inconsequential repercussions down the line. The baby wakes the mother, the mother wakes the baby, the mother is far too quick to respond, and the cumulative effect of month after month of disrupted sleep can be devastating to the entire family. Having a baby sleep through the night is a fair and reasonable expectation, so go ahead and do what needs to be done to achieve this goal. And to accomplish this, placement matters.
Many parents like to use the infant monitor after they’ve moved the child out of the bedside bassinet into their own room. They find this very reassuring, being able to continue to listen to their baby throughout the night. But for the life of me I’ve never understood the rationale of this device. Just think about it for a minute…what a parent needs to hear they are going to hear with or without the monitor, that being sustained, “Mommy, Daddy, come get me!” bellowing. It seems to me all the monitor does is to allow parents to hear the stuff they DON’T want to hear, all of those kooky little sounds which are so disturbing and disruptive to one’s peace of mind and were the primary reason the baby was moved into their own bedroom in the first place. Just my opinion, but I personally would bag the monitor in a heartbeat.
If a proper program is instituted right from the beginning generally speaking the baby will be up every three to four hours at one month, skip a wake-up and be able to go six to seven hours uninterrupted at two months, and make it through yet another arousal and sleeping nine to eleven hours by three to three and a half months. It is critical to make him earn his nighttime feeding, starting at an early age. Don’t go rushing to his rescue at the first peep. Give the baby every reasonable chance to make it through a nocturnal arousal on their own, but if he is persistent and demanding then go ahead and feed.
Breast fed babies usually progress through this process somewhat more slowly. Human milk is the non-Adkins formula of the animal kingdom. It is very sweet, relatively high in sugar and low in fat and protein, so delayed night sleeping is often an unfortunate consequence of nursing. There are so many positives about breast feeding, however, that for most of us this one inconvenience is acceptable.
The progression of sleeping is oftentimes two steps forward and one step back, or even one step forward and two steps back. The nights get better and then they slip, but provided the process outlined here is followed parents will ultimately be able to achieve their goal of a pleasant, uninterrupted night’s slumber. And to those who have grandmothers insisting that early introduction of cereal will advance the cause of sleeping through the night I hate to inform you but any number of studies have clearly shown that it doesn’t make a lick of difference.
Many moms and dads don’t follow these guidelines for a variety of reasons, or their babies are simply inherently light sleepers. In these cases the infant will not be advancing as expected. So where does one draw the line in the sand and raise the bar? The answer is at five months of age. This is when it becomes okay to reject the idea that the baby is unable to make it through the nighttime hours without intervention.
IT IS TIME TO BEGIN APPLICATION OF THE GOLDEN RULE: YOU CANNOT WAKE UP AT NIGHT OUT OF HUNGER OR THIRST BEYOND FIVE MONTHS OF AGE
(…even a starving man can sleep through the night….)
Let me be honest here about something before proceeding further. Many of us in my field are secretly resentful of Dr. Ferber. It’s not that we disagree with anything he says – oh, no, not at all! Quite to the contrary, his teachings are most excellent and justifiably have been highly praised. Our beef is that universally pediatricians each in their own distinctive way have been telling mothers and fathers for hundreds of years the identical things he is espousing and then this dude comes along, writes a book about how to get your child to sleep through the night, proclaims it “The Ferber Method,” and half the parents in the world now believe he invented the concept! Oh, well. :]
The Golden Rule implies that if the five month mark has passed and the child is still waking and crying at night a different approach is now warranted. First of all, it is critical to understand very clearly exactly what is transpiring. It is a fact that babies at this age are still awakening every two to four hours, or at the least experiencing a lightening of sleep known as arousals. Videotaping five-month-olds in their cribs at night would verify that all actually awoke multiple times, even including the ones who are supposedly sleeping for twelve hours. Thus the infant who is “making it all the way through” is no different in his sleep pattern than the one who is crying periodically and having three to four feedings. Waking up is normal; it is the crying that is abnormal.
Not infrequently the parent of such a child will make excuses for the baby’s nocturnal crying. They will argue fervently that their infant is truly hungry. This is based on the faulty logic that when they offer a bottle it gets sucked right down. However, that proves absolutely nothing. The way my wife loved chocolate if you offered her an Ethel M candy bar at two in the morning I’m quite certain she would have accepted with gusto, but that doesn’t mean she would have starved to death without it. Parents will try to make the case that their baby is an exception to the Golden Rule, that he is the first born in the history of mankind who is truly unable to make if from bedtime to breakfast without an interim feeding. But that belief is categorically untrue. Their baby is up at night crying whereas other infants are not because the parents have TRAINED him to be that way. It’s that simple.
One of the craziest parts to all of this is when moms or dads start blaming the baby. I know it sounds insane but not uncommonly that is precisely what happens, a parent asking in complete sincerity, “What’s wrong with my baby? Why won’t she sleep through the night? She can’t sleep in her crib, she has to sleep with us, and she’s up crying every two hours throughout the night. Why is she like that? What’s wrong with her?” The answer? THERE IS NOTHING WRONG WITH THE BABY!!! Hey, you created this problem, you’re the one who’s treating her to a meal of her favorite food and the loving presence of her favorite person every time she transiently awakens. Come on, you couldn’t have devised a better reward system if you tried! Let’s turn this around for a minute. Suppose for some crazy reason a parent WANTED to train their baby to be up at regular intervals throughout the night. How would that best be accomplished? Well, probably the most effective method would be by rewarding them with food and attention every time they had a normal nighttime arousal. Simple conditioning – an approach which ought to work pretty darned well, don’t you think?
After a parent understands and accepts both what waking at night is (normal) and what it is not (hunger) the remedy becomes straightforward. All that has to be done is to apply the basic principles of Behavior Modification. Do not continue rewarding and reinforcing a behavior you do not wish to continue. It’s as simple as that. However, it is important not to assume, and one must never be judgmental. There are babies who are still having their normal night awakenings at this age (and, of course, are being fed, or why else would they still be crying?), but it is not an issue for their parents. Sleeping through the night is a doable but largely Western expectation. In many parts of the world infants sleep with their mothers and are exclusively breast fed for the first year of life. And ultimately there are no negative medical, nutritional, or psychological consequences to feeding the baby at night, so the cure is by definition optional. Of course, the crying during these normal arousals won’t vanish without intervention, or at least not for a very long time, but the timing for when this issue is finally addressed should be left solely to the parents. Oftentimes the working mom in particular misses her baby greatly during the day and actually enjoys the quiet bonding time alone with her child in the middle of the night. That is perfectly fine. But if being up with the baby during these hours is a hardship it can readily be resolved.
To accomplish the goal of establishing a new sleep routine one must thoroughly accept the concept that night awakenings are a normal and universal phenomenon in babies at this age, and that it absolutely does not represent hunger. Begin the process by following a pleasant, peaceful evening routine with lying the tired but awake infant in his crib. (Note: beware of committing The Error of Nap Technique cited earlier.) Later, when the inevitable arousal occurs, allow him the opportunity to self-settle and get back to sleep on his own. If this does not happen – which initially, of course, it won’t, or why would you be putting yourself through this in the first place? – go to his bedroom and with the lights off and mouth shut do nothing more than give him a pat on the back or a quiet “shhh.” The responding parent must be in and out of their room in less than thirty seconds, and they MUST leave while the child is still awake. Again, the point of the exercise is to allow the baby to learn how to get back to sleep on his own without the parent being present. Obviously, no food or beverage permitted, you are finished with that once and for all, and the baby is not to be picked up from his crib. Once placed into bed children need to understand that from that point on they’re down for the night.
Remember, nighttime is whenever the parents say it is. You are the boss, and you make the rules. A six-month-old can’t be in charge here. Clearly, establishing precise hours right from the beginning makes everything a whole lot easier later. And do not hedge. If five A.M. is not your idea of when to start the day then crying at that hour should be responded to in the same manner as a one A.M. wake-up.
Initially, of course, the baby won’t go right back to sleep. When this happens the parents should simply recheck on the baby every one to five minutes, whatever their tolerance level is for the crying. These later visits must be identical to the original one with the same ground rules – in and out of the room in less than thirty seconds, no lights, no noise and, most importantly, no feeding. This approach should continue until the child falls back to sleep without the parent being present, or until morning comes. Also, be aware of avoiding the temptation of substituting another equally addicting ritual such as reinserting a pacifier, handing the baby a teddy bear, or any other such nonsense. If the baby falls asleep with the pacifier in its mouth and wakes up without it she won’t be able to handle the transition and will cry just the same as if it dozed off nursing or sucking on a bottle. And it stands to reason that a mother who goes into her child’s bedroom to give her back her “fooler” five times a night is every bit as tired the following morning as the one who was up every three hours nursing.
Many parents will not want to follow these instructions because they fear it will make matters even worse. And, of course, on that point they are absolutely correct – initially. But there is no way around facing up to this problem sooner or later. You see, what’s at work here is what I call the Catch-22 of sleep training, which can be summarized by the following questions:
1) What is the quickest way to get your baby back to bed so that everyone can at least get some decent rest?
2) What is the worst possible thing you could do to reward a behavior you do not wish to continue thereby guaranteeing that the crying at night will continue indefinitely into the future for as far as the eye can see?
The dilemma is that the answers to each is the same – go to their aide, pick the baby up from the crib, and feed. In other words, one must suffer short-term pain to obtain the long-term gain.
I absolutely, positively guarantee this will work provided both the mother and the father take the pledge and commit, and I do mean both. It’s hard for me not to reflect back on Scenes From a Marriage, clinging to my wife’s right elbow trying to keep her from escaping our bed while with her left hand she was walloping me in a determined effort to get to our crying son. Ahh, memories…
For this to be successful it must be an all or nothing approach. Once you start you cannot go halfway. If entered into with the attitude of merely giving it a try you are defeated before you start. Doing works, trying fails. An attitude such as, “Well, we’ll give it a shot, but if she can successfully sustain the crying for thirty minutes we’ll give in and feed her,” you are toast. It is not a good idea to let the baby know she is in complete control, that if she can sustain her crying for long enough she can bend you to her will and you will do anything she demands. Therefore, there can be no turning back. If you’re going to do it, do it. If you’re not ready for this, fine, just be honest with yourself and continue as you are until you are ready to go the distance.
Be forewarned that as soon as you have this problem whipped, you’ve gotten your baby successfully sleeping through the night and are congratulating yourselves on your determination, fortitude, and superb parenting skills, there will be a relapse, and if you are not on your toes you will find yourself back in the baby’s bedroom at two A.M. sitting in a rocking chair feeding him a bottle and asking yourself, “How did this happen?” Anticipate this setback in advance and prepare yourself psychologically to dig in once more.
Some parents resent being up with their child at night but at the same time are unwilling to pay the price to correct the situation. And I will tell them that is perfectly fine, they can continue as they are if that is their choice, but they are categorically not allowed to complain about it any longer from this point forward. Because they are the ones who have created the problem with how they have chosen to respond to the crying. The first five months of life feeding the baby in the middle of the night is acceptable and forgivable, but beyond that age this habit is squarely on the shoulders of the mom and dad. All children are born with the same capacity for sleeping through the night. The variable is the parents.
The number of nights required to affect a cure is somewhat unpredictable, the major factors being age (the sooner the problem is recognized and addressed the better), the elaborateness of the rituals being performed by the parents, and the strength of will of the child. Admittedly, some of these kids are pretty darned tough. But surprisingly most children respond much more quickly than one would imagine. I am convinced a baby doesn’t really like this disrupted sleep schedule any more than their mommy or daddy, it’s just that they don’t know how to help themselves. That’s where the parent needs to come into play. Step up to the plate and teach them. Getting over hurdles such as this are not trivial in a child’s overall development, they are important stepping stones in the process of becoming an independent, self-confident adult.
So, there you go. Like so much of parenting it’s not nearly as difficult as one would imagine, just as long as a modicum of common sense is maintained. Start off correctly immediately after the birth by establishing a personal definition of nighttime, and then act accordingly. If crying at night should persist beyond five months of age refrain from committing any of The Three Deadly Sins – removing the infant from the crib, reinserting a pacifier, or offering a treat (breast milk, ice cream, formula, candy, pizza, etc). Accept The Golden Rule, believe it, and within a relatively short period of time your child will be sleeping like a baby. But beware. If you choose to reward a behavior you don’t wish to continue you do so at your own peril, and an infinite number of long, noisy, sleepless nights will be the unintended but inevitable consequence.
And you will have no one to blame but yourself.