As a physician I tell patient’s that it is safe to sleep train starting at 4-6 months as long as the infant has no concerns with growth and development. Newborn sleep is challenging. I only started sleep training Madi at 11 months event though I knew it was safe to start earlier. I knew it was safe to start sleep training Madi earlier, but struggled with hearing her cry during the process. Whether or not you decide to sleep train is up to you! Sleep training baby is tough! And if you family doesn’t feel comfortable that is totally ok too! However, if you want to sleep train your child, there are a few types of sleep training methods you can try. Graduated Extinction and Unmodified Extinction are two popular methods. It is important to note first though that your child has a regular bedtime routine.
Newborn sleep can be challenging and take time to develop a good routine. These are the techniques I know of to help a child fall asleep and maintain sleep.
Some infants/children will just fall asleep without any difficulty once a consistent bedtime routine is implemented. Unfortunately, this was not the case with Madi and we had to use the extinction technique. Creating a bedtime routine for your baby or toddler is very important. A bedtime routine consists of relaxing and self-care activities that allow the brain to “slow down” making it easier to fall into sleep. I wrote a post here about how to get your little one into a good sleep bedtime routine. I have also written a post here that applies to older infants, older, children, adolescents, and parents about “sleep hygiene” that is the first step to helping patients with disrupted sleep patterns.
Systematic ignoring – also known as “extinction”
There are two types of systematic ignoring, or “extinction” – Graduated Extinction and Unmodified Extinction.
There are two methods of Gradual Extinction that I will talk about here. Method one is where you allow your baby to cry for longer periods of time each night and method 2 is where you position yourself farther and farther from your baby’s crib each night.
Method 1 of Gradual Extinction:
This method of sleep training is where you time your return to your babies room when you put them to bed. When you put your baby to sleep, make sure they are already sleepy or drowsy (but still awake).
Make sure they are comfortable in their crib, and leave them alone in their room. Then, wait until your baby cries. When your baby does start to cry, wait before checking on your baby. In Graduated Extinction Method 1, each time you go check on your baby, you wait longer and longer periods of time. The goal of this method is to allow the child to fall asleep independently, there is no recommended “optimal” period of time between the checks. The amount of time between checks should be determined by the parents’ tolerance for crying and the child’s temperament.
For me, I tried 5 minutes to begin with on night one, Night 2 I tried 10 minutes, and Night 3 I tried 15 minutes. You can modify this time how you like, but provided the time is getting longer and longer on each subsequent night.
This is What I tried for Method 1 of Gradual Extinction (timed return to the room):
Night 1 of Graduated Extinction Method 1: put your baby to sleep, say your goodnights and I love you’s. Try and refrain from excessive cuddling or breast-feeding to make your baby fall asleep. Then leave the room. If your baby starts to cry after you leave the room, wait until they have been crying for 5 minutes. When you re-enter the room, you can tell your baby how much you love them, comfort your baby by rubbing their back and gently saying go to sleep. Do not pick them up, breastfeed, or cuddle. Rub your baby’s back and gently tell them to go to sleep for 1 minute, then promptly exit the room again. If they begin to cry again, do not re-enter the room until they have been crying for at least 5 minutes.
Night 2 of Graduated Extinction Method 1: put your baby to sleep, say your goodnights and I love you’s. Try and refrain from excessive cuddling or breast-feeding to make your baby fall asleep. Then leave the room. If your baby starts to cry after you leave the room, wait until they have been crying for 10 minutes. When you re-enter the room, you can tell your baby how much you love them, comfort your baby by rubbing their back and gently saying go to sleep. Do not pick them up, breastfeed, or cuddle. Rub your baby’s back and gently tell them to go to sleep for 1 minute, then promptly exit the room again. If they begin to cry again, do not re-enter the room until they have been crying for at least 10 minutes.
Night 3 and onward of Method 1: Repeat the same process of Night 1, and Night 2. On Night 3, you can increase your time to 15 minutes. On Night 4, to 20 minutes, On Night 5, to 25 minutes. So on, and so forth. With Graduated Extinction, every night that passes you should try to gradually increase the time that you take from when your baby starts to cry, until when you check on your baby.
For Madi, the first night we tried Graduated Extinction she started to cry and we waited 5 minutes before checking on her the first night. Then the second night we waited 10 minutes. On the third night, we waited 15 minutes.
Graduated Extinction is a method for sleep training your baby that is used by many parents and has worked successfully for many families. I will say though that Graduated Extinction didn’t work for us and we stopped after night 3. I found that when Madi would see us come back into the room it would be very hard to leave as she seemed more upset than when we left her room the first time. Also since I started sleep training she was 11 months old, she would scream “Mommy!” “Mommy!” while standing and I would give in and breastfeed her to sleep.
One other strategy that I have heard others use and was recommended to me by other physician involves a more gradual approach to Graduated Extinction. This is the second method of Gradual Extinction.
Method 2 of Gradual Extinction:
When you put your baby to sleep, again make sure they are already sleepy or drowsy (but still awake). Make sure they are comfortable in their crib. Do not leave the room, instead lay on the floor beside the crib or sitting in a chair until your child falls asleep. In this method, you will gradually exit the room so your child becomes more and more comfortable with falling asleep on their own. The goal of this method is to allow the child to fall asleep independently, as you move further and further out of the room.
This is what I tried for Method 2 of Gradual Exctinction:
Night 1-3 of Method 2: Put your baby to sleep, say your goodnights and I love you’s. Try and refrain from excessive cuddling or breast-feeding to make your baby fall asleep. Lay on the floor beside the crib or sitting in the chair until the child falls asleep. If your child cries, tell your baby how much you love them, and gently tell them to go to sleep.
Night 4-6 of Method 2: Again, put your baby to sleep, say your goodnights and I love you’s. Try and refrain from excessive cuddling or breast-feeding to make your baby fall asleep. Sit or stand by the door of their room, until the child falls asleep. If your child cries, tell your baby how much you love them, and gently tell them to go to sleep.
Nights 7-9 of Method 2: once again, put your baby to sleep, say your goodnights and I love you’s. Try and refrain from excessive cuddling or breast-feeding to make your baby fall asleep. Sit or stand outside the door of their room, until the child falls asleep. If your child cries, tell your baby how much you love them, and gently tell them (from outside of the door) to go to sleep.
Some families find this approach more successful as a gradual approach to sleep training. I did try this technique with Madi but quit after night 2, again as I found that her seeing me lying on the floor next to her made her even more upset and she would continually cry out for me until I picked her up.
The “Cry it out” Method: This is a third type of sleep training called Unmodified extinction or “crying it out”
This is the “Cry it out method” and it actually worked for us! I will say that it was an emotionally challenging experience for my husband and I, but fortunately only required 2 nights and then Madi was able to fall asleep herself and maintain sleep. The Cry It Out method involves putting the child to bed at a designated bedtime (for us, this is around 8:30 PM), and then essentially ignoring the child until a set time the next morning (for us, this is around 7:00AM the following morning).
Essentially, all we did was put her into her bed after her normal bedtime routine, and let her “cry it out” until she fell asleep. Simply put your baby to sleep, say your “Goodnights” and exit the room. You can watch your baby on the monitor to see how much time it takes for her to settle. If your baby begins to cry, refrain from entering the room, saying anything, picking up your baby, or breastfeeding your baby.
Over time, she will gain skills to self-soothe. She will likely cry less and less each night, and it will take her less and less time to fall asleep each night. Madi took 30 minutes to fall asleep on the first night, and then 20 minutes the second night.
I will be honest, the first night we did it, I had tears in my eyes as I watched her cry and stand by her crib, but after 2 nights she would fall asleep immediately. I will say that this approach is also very emotionally draining for parents/caregivers and it is hard to wait the full time until the infant fall’s asleep.
In my personal opinion I do believe that extinction techniques work to help a child develop self-soothing skills in infants that are not naturally able to fall asleep independently, so long as the parent is still on stand-by for support. I would suggest you watch your baby with a baby monitor through the sleep training process.
What do I do if my child wakes up in the middle of the night crying?
The goal of sleep training is to allow your baby to develop skills to fall asleep that gradually requires less adult intervention. I have a lot of parents asking me about what do to if your child wakes up and cries throughout the night. What studies have shown is that graduated extinction is effective even if used only at bedtime, and not when your child wakes up in the middle of the night. The good news is that most children, within one to two weeks after the child has learned to fall asleep easily and quickly at bedtime, the self-soothing skills usually generalize to nighttime arousals. This means that they will probably gain some skills to soothe themselves back to sleep, and not need their caregiver in the middle of the night if they do wake up.
What are some other methods of sleep training that I should be aware of?
This technique is used for older children and use reward strategies if the child meets their sleep goals. For example, if the child sleeps in their own bed all night they get a sticker in the morning. Positive reinforcement is a method of parenting or discipline, so to speak, that emphasizes and rewards positive behaviours in a child. This method can also work for sleep, to encourage good sleep behaviours. For older children, the rewards can be modified to suit the child’s interests. This is a very important part of sleep training, and parenting. Your child should be congratulated for mature and “good” behaviours as much as you possibly can!
This sleep training method is to be used if the child is in bed for a prolonged period of time not sleeping, which may indicate that the child is going to bed too early. This can happen partly because your child’s sleep needs will change throughout their lifetime. For example, if your child has a night time sleep schedule of 12 hours, but only requires 10 hours of sleep, they might have difficulty falling asleep. This occurred For example, prior to 18 months, Madi would go to sleep at 7pm and wake up around 7am. But once Madi turned around 18 months, she had more difficulty falling asleep and would wake up at 5am. I reviewed what the guidelines were for sleep at the age of 18 months, and based on Madi’s age, she likely required only 10 hours of sleep at night given that she was napping 2-3 hours during the day.
Bedtime fading involves advancing the child’s bedtime over time to eventually align with the child’s new sleep onset time when the child is more biologically ready for sleep. For Madi, we gradually moved her bedtime from 7 pm to 8:30pm and then instead of waking up at 5 am, she woke up at 7am.
Please note: If your child has continued difficulty falling asleep or maintaining sleep, it is important to see your doctor to ensure that the infant is not suffering from pain, sleep disorder, or medical problem.
Learn more from Dr. Mom
- Foley LS, Maddison R, Jiang Y, et al. Presleep activities and time of sleep onset in children. Pediatrics 2013; 131:276.
- Falbe J, Davison KK, Franckle RL, et al. Sleep duration, restfulness, and screens in the sleep environment. Pediatrics 2015; 135:e367.
- Hale L, Guan S. Screen time and sleep among school-aged children and adolescents: a systematic literature review. Sleep Med Rev 2015; 21:50.
- Brockmann PE, Diaz B, Damiani F, et al. Impact of television on the quality of sleep in preschool children. Sleep Med 2016; 20:140.
- Carter B, Rees P, Hale L, et al. Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis. JAMA Pediatr 2016; 170:1202.
- Cooney MR, Short MA, Gradisar M. An open trial of bedtime fading for sleep disturbances in preschool children: a parent group education approach. Sleep Med 2018; 46:98.
- Owens JA, Babcock D, Blumer J, et al. The use of pharmacotherapy in the treatment of pediatric insomnia in primary care: rational approaches. A consensus meeting summary. J Clin Sleep Med 2005; 1:49.
- Cortese S, Brown TE, Corkum P, et al. Assessment and management of sleep problems in youths with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2013; 52:784.