When Baby Can’t Sleep: Advice and Sleep Training Methods to Help Baby Sleep

My patient looked exhausted and frustrated. “She is six months old and is still waking up every two hours…then she barely nurses before falling back to sleep!”

We discussed measures they had taken. They “sort-of” had a bedtime routine but knew very little about “sleep training.” As we talked, we discussed ideas on how to create a safe and cozy sleep environment and establish a consistent sleep routine.

Then we discussed what sleep training methods are and how they could help break old habits and establish new, healthier ones. I assured her it was not too early to learn healthy sleep habits. and Hhealthcare providers agree that ages 4-6 months is the ideal time as by this age most infants no longer need to feed during the night and are able to go back to sleep without help from their parents. Here is a little more of what we know and discussed.

What the Experts Know about Infant Sleep

About 30% of infants at age 4-6 months have trouble falling asleep and staying asleep, meaning they are unable to “sleep through the night” (defined as 6 consecutive hours and not every single night) or have trouble initially going to sleep. Also, some babies continue to wake up every few hours and need help to go back to sleep. So, if your baby is struggling in these areas, know you are NOT alone! Understanding how infants sleep at this age can help you establish reasonable expectations and goals. Good sleep habits do not just easily happen for every baby; some will need help learning how to fall and stay asleep – and that’s okay! It all starts with knowing there are things you can do to help.

Forming Good Sleep Habits Early – Learning to Self-Soothe

Pediatric healthcare providers generally agree on two important sleep goals for your baby at this age: First, your baby needs to learn to fall asleep by himself and secondly, he needs to learn to go back to sleep on his own when he awakens. Learning to go to sleep without help is called “self-soothing” and while this might sound cruel or heartless, be assured, it is not. Learning to sleep independently is an important developmental milestone. Other examples of self-soothing behaviors are finger sucking, pacifier sucking, cooing, rocking, and babbling. Babies rouse frequently in the night because their sleep cycle is short, particularly in the light sleep phase. What this means is, babies often will awaken for no apparent reason (like hunger) and can learn to go back to sleep on their own. Helping baby fall asleep on their own and then go back to sleep when they lightly awaken, lays the foundation for consistent good sleep – not only for your infant, but for you and your entire family. Of course, for many families, this is easier said than done and once a baby has gotten used to falling asleep a certain way – such as while breastfeeding or being rocked – it can be a hard (but not impossible) habit to break. For struggling families, sleep training is often recommended by pediatric healthcare providers as a way to address sleep issues by breaking old habits and forming new ones. While breaking old habits is never easy, you can rest in knowing that much research has been done and results have shown safe sleep training methods are effective although typically only in the short term because baby’s sleep evolves as he grows.

Forming New Sleep Habits

When thinking about improving your baby’s sleep, consider safety first! The American Academy of Pediatrics has published research-based safe sleep recommendations outlining how to keep your baby safe during sleep. Make sure anything you might try is safe! For instance, it might be tempting to bring a fussy baby into bed with you – and this might actually work – but it’s not safe! You could accidentally smother baby with your bedding or body. Sleeping in your room in their own crib or bassinet is healthy and best for baby.

Creating an Enjoyable Bedtime Routine

First, establish an enjoyable bedtime routine, and remember each child is different! So, what might work great for one child might not for the next. The overarching idea is to create a calm and consistent bedtime routine that both you and your infant will come to expect and enjoy. This routine, coupled with a comfortable sleeping environment, will help cue your baby that it is bedtime and time to sleep.

Sleep Training Methods

Well, you might be thinking, I’ve tried all of this, and it hasn’t worked! If this is the case, a sleep training method might be considered. First, discuss your concerns with baby’s pediatric healthcare provider and decide together what might work best for you, your baby, and your family. Sleep training is a broad term used to describe many different methods used to train a baby to fall asleep (and go back to sleep) on their own. The good news is most of the common methods that have been studied have been found to have some degree of success and no method has been found to cause harm to the baby, either physically, emotionally, or mentally. Some of the most common (and studied) methods are briefly described here and most differ in how long the baby is allowed to cry, and what parents are “allowed” or suggested to do when they do cry. Some are more gentle and “tearless” while others are more extreme, such as the “cry it out” or “extinction” method. Breaking old sleep habits (such as being rocked to sleep, going to sleep with a bottle, or nursing a baby to sleep) may result in an unhappy baby at the beginning of the training, but will eventually pay off (often within a week). One important key to successful sleep training is consistency in the training once you start – it can take upwards of a couple weeks to see good results for some methods, and not all methods work for every baby! Here are some sleep training methods that have been studied with a brief description of how it works:

The Cry-It-Out Method 

This method is probably the most extreme, and it may feel too harsh for some parents. It has been shown to be effective and safe but can be hard for parents to listen to a lot of crying at the beginning. Parents lay the drowsy baby in the crib after feeding and bedtime routine and ignore crying until morning. Parents monitor the baby for safety and illness-type concerns until the baby goes to sleep, which on average the first night can be 45 minutes or more! A baby monitor with a camera works well here. This method often works after a few nights.

The Ferber Method: Graduated or Modified Cry-It-Out

This method is also called the “Ferber method,” or “controlled crying,” “or sleep-easy solution” as well as others. This method is like the cry-it-out method, but parents provide a routine of check-in’s and soothing behaviors, making this method easier for many parents. Parents lay the drowsy baby in the crib after a bedtime routine, say good night, leave the room, and ignore crying for a specific period of time before briefly intervening. The infant is soothed and patted, but not taken out of crib. Length of crying allowed is slowly progressed (increased) before returning to the room, generally progressing from 3 minutes, to 5, then 10, to 15 as needed. These methods are also quite effective and easier on parents.

The Parental Presence Method

This method is also called the “chair” or “camping out” method. Here, a parent remains in the room (seated) but ignores the baby and crying for a pre-determined and progressive length of time, before providing verbal reassurance and support. Support means picking up and maybe briefly holding baby. The chair is slowly moved farther and farther away from the crib each night. These methods are effective and produce less crying for most, but typically take longer to see results.

The Pick-Up, Put-Down Method

This method involves picking up a crying infant until they settle down, then laying them back down once comforted. This process is continued until the baby is settled and goes to sleep. This method does not work for all babies but is gentler and has less tears. It also typically takes more time and patience. Forming healthy sleep habits takes work and breaking not-so great habits even more work – but is well worth it if it leads to better sleep. Talk to baby’s healthcare provider, come up with a plan, and then start! Be compassionate and loving, as well as consistent and tenacious: Don’t give up! Eventually, your little one will be sleeping through the night, and so will you.

Routines for an Enjoyable Bedtime

First, aim to create a consistent routine: Keep it the same each night so your baby will come to anticipate what is coming and enjoy the quiet time with you. In the bedtime routine consider all or some of following strategies to help baby fall asleep on their own: