Wednesday, September 17, 2014

5 Ways to (or not to) sleep train your baby

Sleep training like most things related to motherhood is controversial because there are so many ways to do it, and since each baby is different, every mother whose child has ever slept through the night, thinks they have the formula. So, I'm not going to hash on about what's right or wrong, I'm going to instead tell you about the four schools of thought on sleep training your child - from not really sleep training at all, to a no cry solution, pick up/ put down, to cry it out, because I've really tried them all.  My son fights his sleep like a little wrestler and so I've been through all stages of this and finally came up with my own way hybrid that worked well for me (the Fifth way), by combining the different techniques so that I didn't have to step too far out of my comfort zone, or deal with too many tears (mine, I mean). 

(Note: sleeping through the night for all medical experts means 5 continuous hours only. That gives parents a few minutes to sleep by the time they get things done and get to bed. 

All babies wake up at night, many times, as do adults, the goal of most sleep training methods is to have them go back to sleep on their own in their beds without help, without tears and without actually needing to get out of bed.

I receive no endorsements from any author but have tried all these methods - and read all these books- myself to figure out what works for my baby.) 

Yes, this position is safe but only if baby puts himself or herself into it.

1. The no sleep training way - pure attachment parenting: 

-  Attachment parenting experts believe in letting your baby nap and even sleep at night attached to you. Either in your bed (atleast in your room), or in a sling. 

- Co-sleeping is advocated and nursing/ feeding is the usual way to put baby back to sleep. 

- Babies fall asleep nursing, and stay by the mom (between mom and a safety gate, not between the parents, for safety's sake) through the night.

- Nighttime parenting is the required mind set and sleeping through the night is not the priority, but developing a trusting relationship with your child is.

- It is advised that moms feed on cue and on demand during the day to tank up baby and wear baby during the day to keep them calm and satisfied. 

- Also, make baby nap regularly, and set a predictable bedtime ritual that calms baby down. You can also wear baby down, nurse baby down, father baby down (let dad do the cuddling), nestle baby down, rock baby down or try a mechanical mother (a rocker or gadget that stays in motion). 

- Put baby to bed completely asleep by watching for a limp limb sign (do not sneak away when baby is in light sleep but wait until baby is in deep sleep this can be tested by watching for dangling limbs or a motionless face.) 

- Your baby will eventually be mature enough to sleep well and on their own but the goal in the newborn and infancy stages are to build attachment and trust, not to get baby to sleep through the night.

- More on this methodology can be found in The Baby Book, by Dr. Sears et al. 

The Attachment parenting and everything baby bible.

My experience with this: attachment parenting is instinctive and easy, and I definitely started and spent months this way. I did not baby wear or co-sleep (unless I fell asleep while nursing) intentionally, but nursing or rocking my baby to sleep was the right and normal thing to do and helped me build a trusting relationship with my child. We would then put him down asleep in his bassinet. However, my baby did eventually learn to only and exclusively sleep in his parents arms. He was sleeping through the night (and more), at two months and attachment parenting was the way to go - I wouldn't have done it any other way. By 4 months though, the night routine (that included feeding and endless amounts of walking), would take us hours to get baby into bed and once the sleep regression hit (and his sleep cycles matured), it was impossible to get him to sleep even 3 hours at a stretch let alone the 8-9 hours he was doing before. He would wake up and cry to nurse (but fall asleep the second he was in our bed or arms), which was when I realized that it was time to outsmart my smart little baby. 

2. The mild way - the No Cry Sleep Solution. 

- This method is for babies 4 months and older.

- It also involves tanking up your baby during the day, developing a nighttime routine (and following it to the night after night altering it based on your baby's needs and age), establishing an early bedtime (to ensure that baby isn't overtired,) establishing a routine through the day, making sure baby takes regular naps, and making sure you have a nighttime routine. 

- Really ensure that your baby is not overtired, as that actually makes them sleep less not more! Ugh!! 

- Observe your baby carefully for a few days to get a hang of their usual sleep patterns in the day and then try to stay consistent with these.
Try and track your baby's sleep and pattern at least for a few days.

- Put baby to nap as soon as you see signs that he or she is tired.

- Stick to a nap routine while putting baby to sleep.

- Get the short napper to nap longer. This involves waiting for your child when you know they usually wake up, and repeating the steps you took to put them to sleep in the first place. For example, if you nursed  (or rocked, or bottle fed,) them to sleep, begin to nurse just as they are about to wake up, so that they go right back to sleep. 

- During the day, teach your baby to love their bed by keeping them in their bed and playing games. Do not leave baby alone but stay with them and engage them, get them out as soon as they are about to cry. The goal being to teach them to go back to sleep in their bed by being comfortable there. 

- Allow baby to fall asleep in different ways and places, like the bed, car seat, stroller. 

- Introduce a lovey or a transitional object. This is a safe toy that your baby can use for comfort instead of you, and can be introduced by keeping it between mom and baby during feeding, and making it smell like mom (mom sleep with it for the first few nights so it smells like you.) Remember to choose a safe lovely, not something with small objects that can fall off or that can suffocate your child, also remember to keep multiple of these (incase it gets lost), and to keep switching them so that one does not get too ratty (as baby  will then know the difference between them.) 
Try to cultivate a sleep lovely (don't worry, that blanket is well tucked in).

- Make night and day sleep different through different routines and cues (like light and dark, or activity in the room). 

- Develop sleep cues or sleep words, Always say the same words to your baby before putting them to sleep. 

- Try to slowly break the suck to sleep association (nursing, pacifier, bottle feeding to sleep), by removing the object/nipple from the baby's mouth when they are about to fall asleep. Replace it if baby is about to wake up or rooting and then try again in a minute or two. (This actually worked really well for me as my baby still nurses to nap and wouldn't let me move, he would nurse through the nap. However, it took a week or so for him to get used to. Now, when I pull away, he turns his head and sleeps!) 

- Night Wean by gradually shortening nighttime nursing, and for co-sleepers, move away from baby (can put lovey in place of you.) 

- To get baby to sleep on their own: Comfort until baby is almost asleep. If baby wakes, repeat process. Then move to comfort till baby is sleepy, (put baby in crib, pat and repeat key words), then comfort without picking up baby, eventually, comfort through soothing pats only, then verbally soothe baby only and eventually from outside the door. (Note, each step takes time and patience.) 

- For more on this, you can read the no-cry sleep solution by Elizabeth Pantley. 

The No Cry Sleep Solution Book

My experience with this: the gentle removal method to stop associating sleep with sucking really helped me as I would be stuck with my son while he napped (in my bed not in his own), and couldn't move him or me till his nap was done. My son only catnaps and I gave up trying to change that (as long as I could get him off me to eat and do things!) and he has recently started to consolidate his naps on his own. However, overall, I found this method too optimistic as it didn't take into account a child who screams bloody murder the second you put him down (even wakes himself up from the drowsy state), doesn't want a lovey, and only calmed down with his mommy. (This was inspite of a consistent sleep routine, regular naps, writing down and even graphic sleep patterns, and all the other suggested steps.)

3. The Medium Way - Pick up/Put Down

- The "baby whisperer" way (book by Tracy Hogg), relies on creating a consistent and predictable routine for your baby.

- EASY, is the suggested routine. That means, Eat, Activity, Sleep and You (take the time while your child is sleeping for yourself).

- This is not a schedule per say but a routine that has to be repeated consistently through the day with eating, activity and sleeping happening at consistent intervals (parents decide the intervals depending on your childs' age and what is comfortable for your baby).

- For the night, it also depends on creating a bedtime routine for your baby which should be consistent, and positive, and then putting baby down in their bed to sleep when they are drowsy. 

Mommy loves Naptime, when else will she take all these adorable pictures?

- If baby cries, pick him/ her up, for a few minutes, say soothing and calming words, pat the baby, and then put the baby down. If the baby continues to cry, put them down anyway, but then pick them back up. If baby is not crying, leave the room. 

- Continue to do this until baby goes to sleep. 

- For babies up to 3 months of age, put them down as soon as crying stops, and pick up baby when the crying starts. For 4 months or older, put baby down after 5 minutes. Pick up again if they are upset but make sure to put them down. For older babies (5 to 6 months), put baby back in 2 or 3 minutes. And 6 to 8 months, offer to pick up baby but don't do it unless baby reaches out to you. Only pick up baby in cradle position, do not rock. And then put baby back down. For older kids, try to use your voice and only pick up if really needed. 

- The goal being that the baby falls asleep in their own bed and not in your arms (sleep associations should be with the bed and not with mommy, daddy or anyone else.)

- This sounds tedious and apparently can be for some parents, but I have read success stories of parents who had to pick up/ put down over 150 times the first night, and then a third of that the second night, and then baby gets the point in a few days and sleeps quicker, sometimes without any need to pick them up at all. 
The Baby Whisperer book (isn't 2425 pages unless you also read it on your phone).

My experience with this: I nurse and nap on demand. My baby does have a consistent bedtime routine but goes down for naps when exhibiting signs of being tired, not after a specific number of hours. Same with the feeds - while I have approximate times for feeding solids, I still nurse on demand. So, I didn't really follow this methodology though I know parents who swear by it. I have incorporated a bit of picking up into what I do with my child, but more on that to come (below). 

4. The Hot(ly debated) way - Cry it out

- Before you skip this paragraph, this does not mean let your baby cry endlessly or forever. In a majority of cases it is for a controlled amount of time with you checking on your baby and for approximately three nights. 

- Also, keep in mind that research has shown that crying is a baby's way of communicating and does not actually harm your child. That doesn't mean I am advocating your child screaming endlessly (particularly given that I was completely against even hearing about that and my child's tears make me all emotional too), but I do think that this is an important method of training to at least be aware of before you dismiss it completely. 

- Cry it out, also revolves around the dogma that babies sleep based on sleep associations - so the goal is to get them to put themselves to sleep in their bed, so that when they wake up (repeatedly), they don't feel like they have been moved from where they fell asleep, and panic, but instead, they take comfort in being where they were when they fell asleep and go back to sleep. 

- If and when you decide to do this, keep in mind that it is harder on you, the parent your the child. You may feel like the worst parent in the world initially, but when your child is sleeping through the night you will be grateful that you taught your child to sleep (Trust me, I really am, specially since I know 11 year olds who still sleep in their parents beds.)

- This is not advocated for children under 4 months of age, some people say 6 months, but most pediatricians say 4-6 months is the way to go. 

- There are two ways to do this: the Ferber method or the full extinction method. The latter is where you leave your baby to cry, till they fall asleep, after going through their sleep routine and putting them down awake. I personally don't have the stomach or the will for this (nor have I read that book), so I will tell you about Richard Ferber's "Solve your Child's Sleep Solution," Way, also called "Ferberizing."

- Start on a day when baby has napped well. 

Our Lovey during nap time, Bunny Bun.

- At night, go through your entire sleep routine (massage, bath, nurse, read, etc - whatever it is that works for you and your baby), then burp or walk your baby as you would but only until they are sleepy, not asleep.

- Put your baby down in their bed drowsy but awake, in a crib that is absolutely safe. 

- Leave the room. You can go back in to console your child if they are crying a lot, do this at periodic intervals but increasing intervals. 

- For example, night 1, go in at 3 minutes, then after 5 minutes, then 10 minutes, then 12 minutes. Hopefully you won't have to go in again but decide what your maximum is for the night (12 minute intervals etc), and then after that go in only after that. Increase the intervals the next night.

- When you go in to your baby, stay in for only a minute or two and talk to your baby, say soothing and comforting words, pat your child, but don't pick up baby, and leave even if they are crying. 

- The key is that you are conditioning a behavior and teaching them to self soothe, so if they fall asleep in your arms, all that crying is actually for nothing because you taught them that crying leads to mommy/ daddy cuddling you (so please cry more). 

- When they get that you are there for them, but want them to fall asleep on their own (with the night routine, and the lights off, there are enough clues), they get that they need to sleep. 

- Parents who experience this, claim that, the first three nights are the toughest, after which baby sleeps with little or no fuss.

- Most kids, sleep better through the night. Some do wake up more, but if you are consistent even at night it will pass. 

- When baby wakes up at night, do the same thing which is ignore/ soothe, with increasing intervals. Put baby down awake. Unless it is time for baby to feed, then feed your child and try and put them back down in their bed drowsy but awake.

- Do not try to alter the bedtime when you are first starting, you can do this gradually over time (10-15 mins a day, as needed).  

- If using cry it out for naps, if baby cries over 30 minutes, end the nap! (I have no experience with this though as I won't let my baby cry in the day.) 
The original CIO book

My experience: Yes, I did try this. I was desperate and I had multiple doctors tell me it was the only way to break my baby's now learned habit of sleeping in my arms or while suckling (for hours at a time). I was exhausted and my milk supply… blah, blah. I don't know why I started to justify this. I know I did the right thing and I know I am a great mother and my child sleeps better, and he is a happy baby, and his trust in me was not affected at all. However, I cried with him the first two nights, before I realized that he immediately (from night 1) slept 8-9 hours without making a sound. He slept better and deeper and woke up happy and well rested. The maximum he cried in total on any night was 30 minutes (the first night), and has not cried that long again ever. I am not claiming that this is the universal answer for everyone, do what you are comfortable with. I am not comfortable with letting my child cry endlessly so I picked him up and calmed him down every time and I put him down awake. He still screams sometimes for about 5 seconds (seriously, thats it), and then turns around and goes to sleep before I am even out of the room. I still do that if he wakes up at night, but now when he wakes up it's usually cause of teething or congestion or something other than that he doesn't know how to put himself to sleep. Two weeks in, he did start waking up more frequently, but we stuck with his plan and he got over it. TIll date, my smart little cookie will, if he falls asleep in our arms, wake up within minutes or an hour or two, but not if he falls asleep on his own.

5. My Way - In summary:

- I've stated a lot above about what I did, under my experience but here are the key points. 

- Attachment parenting for as long as I could to build my child's bond and trust in me. I respond to him when he needs me and he knows I am there for him. This will never change. 

- No cry method for getting back to stop suckling to sleep, and to try and cultivate a transitional object (I am not very consistent with this but I am still working on it).

- Be careful when your child makes noises, they cry in their sleep and may not actually be awake. So, do wait a few minutes before going in.

- Pick up/ Put down, I combined this with Cry It out/ Ferber, as I do pick up my baby every time I go into the room and I hold him till he stops crying but I put him down awake and leave the room. I go back as needed. 

- Note: I was sleeping in the same room when I did this! My baby did wake up somehow a few minutes after I got into bed every night, he just knew I was there. I let him whine and he would go back to sleep, if he cried I would go to him. He no longer does this in his own room, but if you do not have the space to move your baby, don't worry about it, it doesn't mean you both need to be up all night.

- I cannot do 10-15 minute intervals if he is really crying, my intervals are a few minutes max. If he's whining or talking (I know there are no tears), I do wait. But, the first few days when I started, I did go up to twelve minutes and now I don't have to. Now  if I know he is unwell, I am with him for as long as he needs me (but I put him down at least a little bit awake). 

- He went through a phase in between when he fell asleep nursing, so I adjusted his sleep time and started nursing a little earlier so that I could put him down awake. 

- If your child starts to wake up more often, don't panic, it does happen, stick with it until you are positive that it's not working (baby is consistently not sleeping well or won't stop crying for longer periods than you can handle). 

- Yes, you feel like real crap when your baby is crying. But it's worth it when your baby is sleeping and you taught them to do that, on their own! 

- Only do what you are comfortable with. You are the parent and this is your child to raise. DO not let anyone shame you or feel like what you are doing is wrong.

- I still feed on demand (my baby is 7 months now), even though he has set mealtimes, I nurse him whenever he wants. However, at night I won't nurse through the night (unless he is crying uncontrollably and won't stop, which he really doesn't do). He gets one 9-10 hour gap between nursing sessions at night. I pump before I sleep to keep up my supply.

- Babies can fall asleep in multiple ways and know the difference between night and day. I still walk/ nurse/ rock baby to sleep in the day, and it doesn't affect his nighttime sleep. I will not let him cry in the day, under any circumstances. He is a catnapper but is consolidating his naps on his own. He does know how to sleep for long and will eventually learn to do that in the day. 

- If you are making a change like moving baby to their own room, a new place, or even stopping to swaddle, there are going to be some tears involved. Don't be afraid to make multiple changes at the same time, as it's better that your baby gets used to everything as opposed to one thing and then has to adjust again - that prolongs that adjustment, stress, and tears. Try to rip the bandage off but make sure you are there and available to comfort your little one as needed, - just, please, put them down awake! 

- Remember: Just cause baby is sleeping through the night, doesn't mean you will. You are likely to still wake up and wonder why your little one is actually asleep!

Are you sure I can't just sleep on daddy?

Mom and Dads, 
this post took me a long time to write so I do hope it is really useful to you. I am not advocating any method but giving you the option of all the ones available in summary so that you save time from having to read full books. Feel free to reach me if you need advice on any of the techniques above. 
More to come!

All content on this blog belongs to the author and cannot be replicated or reproduced without permission. 


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