Kim Arrington Johnson in BabyParenthood

Baby Sleep Training: Putting Baby on a Sleep Schedule (Summary of all the Books)

UPKiQ Sleep Training Putting Baby on a Schedule

What is sleep training?

In summary, sleep training includes both parent education and various levels of leaving baby to “cry it out,” or not.

Sleep training occurs during a time when baby no longer requires nourishment throughout the night, and this time or age varies, depending on needs of the child. However, most babies should be ready for sleep training by age six months or so.

The following are five major methods of sleep training, which may be applied individually or in combination with one another.

1) Parent Education

Before baby arrives or shortly thereafter, parents learn about infant sleep and how to establish healthy sleep habits.

2) Soothing Bedtime Routines

Parents establish bedtime routines that help baby wind down, such as taking a warm bath, reading to baby, singing softly, saying prayers, rocking, etc. Parents then turn off the lights and may or may not respond to any crying.

3) Scheduled Awakenings

This tactic involves waking baby before she would normally get up on her own, such as waking to feed her at your bedtime. The awakenings get fewer and further between as you progress, until finally they are phased-out altogether.

4) The full “cry it out” method

Once placed in a crib, parents leave baby to cry herself to sleep without comforting her. This is also known as the extinction method. Extinction sleep training is based on the idea that children have sleep problems because they rely on soothing from a parent to put them to sleep.

5) The Modified “Cry It Out” Method

Once baby is placed in a crib, parents let her cry, reassuring her at regular intervals, such as every five to ten minutes, while patting her on the back and whispering reassurances, without picking her up or removing her from the crib.

Cry It Out Methods: Some physicians contend that baby cries before sleeping because his nervous system is immature, and he doesn’t know how to wind down yet. Teaching baby to self soothe will help him get more sleep over time.
No Tears Methods: Others feel that babies cry to communicate needs, not to manipulate. Not responding to baby’s cries sensitively might adversely affect trust between baby and caregiver.

Summary of Books on Baby Sleep Training

Baby Wise

Gary Ezzo and Dr. Robert Buckman first published the book On Becoming Baby Wise: Giving Your Infant the Gift of Nighttime Sleep in 1993. The principles of Baby Wise encourage a parent-led approachto caring for baby, and the book stresses that family-centered philosophies should take precedence over child-centered ones.²⁷ A few highlights of Baby Wise are:

Baby is a welcome addition to your family, not the center of your family.
Parent-directed feedings (PDFs) every two-and-a-half to four hours after baby is ten days old will establish a routine. Baby should be sleeping through the night by seven to nine weeks.
On-demand, round-the-clock feedings are discouraged, since inexperienced parents may interpret all cries as hungry cries.
Baby’s activities should be separated into feedings, wake time, and sleeping. Keeping baby on an EAT-PLAY-SLEEP schedule will help him learn to stabilize hunger for faster nighttime sleeping and not demand feedings right before bedtime.
Pacifiers and sleep associations, such as rocking, nursing, or feeding before putting baby down to sleep should be avoided.

Note: On Becoming Baby Wise has raised concerns from some pediatricians for outlining an infant feeding plan that is associated with failure to thrive (FTT), low milk supply, and involuntary early weaning, due to its rigid schedule and refusal to facilitate feeding on-demand.²⁸

Ferber Method

Dr. Richard Ferber, founder and director of the Center for Pediatric Sleep Disorders at Children’s Hospital Boston, and author of Solve Your Child’s Sleep Problems, believes that you can teach a baby to soothe himself to sleep between three and five months of age.²⁵

The Ferber method includes a warm, loving bedtime routine (e.g., reading, rocking, singing, praying), followed by putting baby to sleep drowsy but not asleep.
At bedtime, leave the infant in the crib and leave the room.
If baby cries, mom or dad may begin “progressive waiting,” or patting baby on the back and comforting with soft words, but not picking him up or turning on the light. With consistency, baby should learn that crying means nothing more than a check and will go back to sleep.
Gradually increase the waiting time intervals (three to five to ten to fifteen minutes between checks), and baby should learn to fall back asleep without needing a parent or other soothing sleep associations.
Ferber stresses moderation with sleep training, stating that his gradual extinction recommendation, or delaying your response time to baby’s awakenings, is only a small part of his book and not appropriate for every sleep issue.
Ferber’s method of sleep training became so well-known years ago that parents described their children as “Ferberized” when they were able to sleep through the night.
The Ferber Method is designed for infants who are at least 4 months old. However, babies this age may not be able to go six hours without a feeding until age 6 months.

Weissbluth Method

Dr. Marc Weissbluth, author of Healthy Sleep Habits, Happy Child, offers a popular sleep guide that generally encourages parents to put their children to bed earlier. He also suggests “extinction,” or not going into baby’s room at all after an appropriate age, because it can be too confusing and cause prolonged crying. Weissbluth’s other key points include:

Sleep training doesn’t usually begin until four months or so, though good napping starts at age six weeks.
You cannot spoil an infant less than three months old, and you should not let a young infant “cry it out.” It is more important to build trust and let baby know that you are caring for him or her.
Babies should not be awake for more than two to three hours at a time until age eight months. Watch your child and put them down for a nap as soon as you see signs of tiredness (drowsy but still awake). If you put a child to sleep at the onset of sleep, there should be minimal crying.
Bed time should be between 6:00 and 8:00 p.m., even if one parent is working late. Parents typically put their children to bed later than they should.
Putting baby to bed earlier leads to more net sleep, causing a child to wake better rested, so that he or she naps better.
Every mother of twins knows that whimpering or low-level crying happens all the time. This type of crying can be safely ignored for sleep training at a proper age.
Weissbluth differs from Ferber in suggesting that baby may require one or two night feedings up to age nine months.

Happiest Baby on the Block Method and the Five S’s

Dr. Harvey Karp, author of The Happiest Baby on the Block, developed the five S’s system to help weary parents calm crying babies and get them to sleep. Dr. Karp often refers to the newborn phase (ages zero to three months) as the “fourth trimester.” He explains that in the fourth trimester parents mistakenly put newborns in a quiet room with no swaddle—arms loose and legs flailing. Yet baby just spent the previous three trimesters rocking and swaying in a tight, active, noisy environment with muddled voices and swooshing noises from Mom’s fluids. The “Happiest Baby” method attempts to replicate this environment for better sleep. Some babies may need all five S’s, while others require only a few to help trigger what Dr. Karp calls the “calming reflex.”²⁹

The 5 S’s are: swaddling, side/stomach position, shushing sounds, swinging, and sucking.

Swaddling: Tight swaddling provides baby with the confined feeling and snug support that baby experienced while still in Mom’s womb.
Side/stomach position: Place baby either on her left side while holding her, to assist in digestion, or on her stomach while providing support or rocking her. Once baby is happily soothed, put her on her backto sleep.
Shushing Sounds: These sounds replicate the whooshing sound made by blood flowing through the arteries and other fluids in and around the womb. Many parents choose to download white noise to their iPod or MP3 player and play it at the noise level of a shower through the night.
Swinging: Every step that Mom took caused a swinging motion for baby in the womb. However, this calming mechanism is suddenly taken away after birth, which is why rocking, car rides, and other swinging movements often help to soothe a fussy baby.
Sucking: Sucking triggers a calming reflex in the brain. This “S” can be accomplished with a breast, bottle, pacifier, or even a pinky finger.

Sears Method and Attachment Parenting

Dr. William Sears, author of more than forty books on pregnancy and parenting, coined the phrase “Attachment parenting” (AP), referring to a parenting philosophy based on the developmental psychology principles of attachment theory. Attachment theory implies that sensitive, emotionally available parents help form a secure attachment with baby that yields positive outcomes for life. The effects of early attachment are foundational to social and emotional health later. Attachment parenting can be summed up with Dr. Sears’ seven B’s:³⁰

Birth bonding: The first few weeks after birth are a sensitive period.
Breastfeeding: This practice promotes biological chemistry between Mom and baby, and it also teaches Mom to pick up on baby’s cues and body language.
Baby-wearing: Physical closeness with baby breeds familiarity and security.
Bedding close to baby: Co-sleeping helps busy daytime parents bond with baby. Sleeping within close nursing and touching distance minimizes anxiety and teaches baby that sleep is a pleasant state to enter. Sears believes that bed-sharing is okay, too, in the right circumstances (next to Mom, not with a drinker, smoker, or someone who is medicated, etc.).
Belief in baby’s cry: Babies cry to communicate needs, not to manipulate. Responding to baby’s cries builds trust.
Beware of baby trainers: Sears believes that watching the clock rather than assessing cues from baby is an “unwise approach,” an obvious dig at Baby Wise. Rigid cry-it-out sleep training can be convenient for tired parents; however, it establishes a palpable emotional distance between parent and child.
Balance: In your enthusiasm for providing for your child, do not neglect your own needs or your marriage. Note: Notice this is the last of the seven B’s.

The Sears sleep method suggests a “no tears” approach over cry-it-out methods. Leaving a child to cry alone in his room is unnatural and cruel. This practice can leave a baby filled with panic and anxiety, causing her to release adrenaline and cortisol stress hormones, which over time adversely affects the developing brain.³¹ Note: Several studies testing cortisol levels in sleep-trained babies have disputed this point. A parent should develop quiet nighttime rituals and respond to all of baby’s requests for food and comfort. The downside to the Sears method is parent exhaustion.

Pantley Method

Elizabeth Pantley, author of The No-Cry Sleep Solution, also proposes a no-tears approach, which she thinks is middle ground between the “cry it out” and “live with it” schools of thought. Pantley, an attachment parent herself, addresses all types of parents and reminds them to first be sure that baby has no medical reason for interrupted sleep.

Her program could be summed up in these steps: Parents should do a safety check, then learn infant sleep facts and information, then create a sleep log for naps and nighttime, and finally, implement a sleep solution based on their recorded log.

In her book, Pantley contends that one or two longer naps is better than several cat naps, that before bedtime routines are very important (“Children thrive on routine”), and she specifically addresses the most common sleep association: sucking to sleep. For younger babies (less than four months old), she recommends a full feeding before bedtime so that baby doesn’t wake due to a partial feeding. For older babies, Pantley supports a “Gentle removal plan” for sucking and feeding. Parents can give baby a pacifier, bottle, or breast before bedtime, but they should gradually and continually remove it until baby falls asleep without her crutch, replacing it with a lovey.

Kim’s sleep training checklist (combining all of the above methods)

Adjust for your individual child

My approach to sleep training is a combination of all of the above methods, with cuddling, bonding, and feeding in the early months and encouragement toward sleep independence after six months or so. Adjust your schedule for multiples, preterm babies, or babies with other health problems.

Observe baby carefully. Make sure that he does not have a medical condition preventing him from sleeping.
Watch out for these common infant sleep busters.
- Poor nap habits: missing naps or too many naps in a car seat
- Overtiredness: putting baby to bed too late
- Overstimulation: watching an action movie with baby before bedtime
Make baby tired. Encourage active play throughout the day. Get baby out of her car seat and on the floor, even if she cries at first. Establish clear tummy time guidelines for nannies and caregivers.
Establish a good sleep environment. One key factor in regulating sleep and baby’s biological clock is light. Provide a darkened room with a nightlight, using room-darkening shades or blackout curtains (especially for summer). Play soft music or white noise to drown out jarring household and street sounds. Make sleep a pleasant experience for baby.
Maintain a regular feeding schedule during the day, such as every two to three hours in the first few months, to support a consistent routine at night. Some parents like to establish a feed-play-sleep pattern, so that baby will be more alert when feeding, especially if they were preterm or low weight at birth.
Establish a soothing bedtime routine, such as a warm bath, a massage with baby lotion, and a loving swaddle for newborns. Add books, prayers, songs, feeding, and rocking for younger babies, as desired. Soft verbal cues, such as “It’s time to go to sleep,” or “It’s time to get ready for bed” will help your little one learn when it is time to sleep.
Decide whether to feed before bedtime. Some sleep experts warn that feeding and sucking to sleep can lead to poor sleep habits, as baby will require the same ritual to fall back to sleep. I didn’t abide by this rule at all, as a full feeding before bedtime seemed to help everyone sleep longer. As baby gets older, you may want to feed and then read a book or do a diaper change just before sleep to prevent direct association. if desired.
Wake baby to top her off at your bedtime with hopes of adding an extra hour or two of sleep. This strategy works well for many parents. Even if Mom is breastfeeding, she does not have to be the only middle-of-the-night parent. Pump before bedtime and let your partner help out with some nighttime feedings. If no pumped milk is available, pump for ten minutes, and let Dad feed and rock baby back to sleep. Shared responsibilities may help prolong the overall breastfeeding effort.

Switch baby from a bassinet to a crib or portable playard between two and three months old. Many shallow co-sleepers and cradles can become dangerous, as baby gets heavier and becomes more mobile. Use a travel crib, playard, or firm floor mattress if you want to keep baby in the room with you longer but need a more stable bed. If baby moves to her own room, you can keep tabs on her with a baby monitor.
Continue to feed before bedtime as baby gets older (between four and six months), but do not rush to feed her in the middle of the night. If baby wakes crying, try to soothe her with a gentle caress or a soft lullaby. If you must nurse or warm a bottle, keep the lights low. Shorten nighttime feedings as you progress to night weaning.
If baby is having a hard time returning to sleep, skip middle-of-the-night diaper changes, unless baby has a rash, bowel movement, or a leaky diaper. If you are cloth diapering with simple inserts and they are soaked, you may need to change them as well. If you must change at night, avoid talking and interacting with baby.
If baby is consistently waking at night, especially after six months old, you may want to break the cycle with gentle sleep training. Put baby to bed early between 7:00 and 8:00 p.m. When you know that baby’s needs have been met, lay her gently in the crib. Pat her with reassurance and let her fuss a little, checking in as desired.
If baby is inconsolable, cuddle and rock her for a few minutes and put her back to sleep. If you must nurse or feed, keep it short and sweet.
Consider having Dad or a partner reassure baby if night weaning is a goal. Do not expect night weaning to be successful during times of transition, travel, or sickness.
If your child is still waking frequently after twelve months, let her sleep with a favorite soft toy or blanket. Experts agree this should be safe since the risk of SIDS decreases after twelve months.
Enjoy the quiet, peaceful moments with your baby. In a busy and frenetic world, some of your most precious memories of bonding with your baby will occur in the middle of the night.

For more articles on Baby Sleep, read the following:

Innovative Baby Sleep Products

Curated through crowd-sourced reviews

Put the Shushing of the 5 S’s Into Practice

Babyshusher Portable Sound Machine

This product uses a real human voice to lull your baby to sleep with a calming shush. Portable, with 15-min and 30-min timers for automatic shut off, comes with 2 AA batteries for immediate use.

Grows with Your Child: A Sound Machine, Nightlight, and Time-to-Rise in One

Hatch Baby Rest Sound Machine, Night Light and Time-to-Rise

Hatch Baby Rest combines nightlight, sound machine, and time-to-rise alert (for early rising pre-schoolers) in one easy-to-use device that you can control from your phone! Customize color, brightness, sound, and volume level. Set programs to turn off and on automatically based on your family’s sleep schedule.

Budget-friendly Sleep Soother that Mimics the Womb in 3-Stages

Munchkin Shhh Portable Baby Sleep Soother

This inexpensive portable light and sound machine calms little ones with three different sounds – shushing, heartbeat and white noise. Requires 2 AA batteries and comes with a shut-off timer.

The Only Swaddle (for now) That Lets Baby Sleep ARMS UP

Love To Dream Swaddle UP

Over 90% of babies sleep with their ARMS UP around their head when placed on their back to sleep, and the Love to Dream sleeper gives baby the ARMS UP option. The snug fit from the 4-way stretch fabric of 93% Cotton and 7% Elastane creates a familiar and secure feeling just like in the womb to calm the Moro (startle) reflex. Does not contain flame retardants or any harmful chemicals.

Sleepsack that is Lightly Weighted to Feel Like a Reassuring Palm on the Chest

Nested Bean Zen Sack Classic

This wearable sleepsack is lightly weighted on the chest (tiny weighted beads are in the chick on the chest) to give the feeling of your reassuring palm. This is based on the “medically proven benefits of touch,” according to the company. The Zen Sack also is the #1 Best Selling Wearable Sleepsack on Amazon for some crowd-sourced reassurance. Comes with shoulder snaps that grow with your child and a 2-way zipper down below for quick changes.

Sleep Train Your Baby with This Affordable, Portable, and Durable Video Monitor

Infant Optics DXR-8 Video Monitor

Not many products have been reviewed and rated 4.5 stars on Amazon by 32,000 people! This video monitor has a great combination of features that have been fine-tuned over the years: lightweight, portable for travel/moving around the home, durable hardware, privacy via a secure 2.4GHz channel with FHSS technology, and excellent features (pan/tilt/zoom with interchangeable lens.

The Mother of All High-Tech Bassinets

SNOO Smart Sleeper by Happiest Baby

This product didn’t make the top list of helpful products because it’s so dang expensive ($900-$1300)! But let’s imagine for a moment that you could own a bassinet, designed by The Happiest Baby’s Dr. Harvey Karp, that…

Boosts sleep 1-2+ hours by soothing babies with a constant rumbly sound and gentle rocking,
“Hears” fussing and responds with gradually stronger white noise + motion to find the best level to calm fussing,
Prevents baby from rolling off her back,
Has an app that logs baby’s sleep and lets you adjust motion, sound and cry sensitivity, and
Comes with a 30-day no risk guarantee.

This product has come down in price ~$400 in a short time, so the Happiest Baby folks are likely fine-tuning how much parents will pay for baby’s sleep. For me, it’s fun to read about innovative products, but the clincher is this: it’s a product that will be used only for six months, or so. When baby is mobile, watch out! There’s a reason why cribs are deep and built for containment!

In summary, baby will outgrow this high-tech bassinet before you can sneeze, or say SNOO. 🙂

Don’t miss all the free baby content on UPKiQ covering:

Sources

27. Ezzo, G. and R. Bucknam, Baby wise : how 100,000 new parents trained their babies to sleep through the night the natural way. 1995, Sisters, Or.: Multnomah Books. 198 p.

28. Aney, M., ‘Babywise’ advice linked to dehydration, failure to thrive, in AAP News. 1998. p. 21.

29. Karp, H., The happiest baby on the block : the new way to calm crying and help your baby sleep longer. 2002, New York, N.Y.: Bantam Books. xv, 267 p.

30. Sears, W. What AP is: 7 Baby B’s. Ask Dr Sears 2014; Available from: http://www.askdrsears.com/topics/parenting/attachment-parenting/what-ap-7-baby-bs.

31. Ahnert, L., et al., Transition to child care: associations with infant-mother attachment, infant negative emotion, and cortisol elevations. Child Dev, 2004. 75(3): p. 639-50.

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