Solve Your Child's Sleep Problems

by Richard Ferber

Thus, in children, the first three or four hours of the night are spent mainly in very deep sleep from which the child is not easily roused. Parents are often aware of this fact, because the period of lighter sleep that follows, with more frequent wakings, may well begin at about the time they are going to sleep themselves.

it usually takes between six and ten weeks for them to develop a consistent twenty-four-hour schedule with the longest period of sleep at night.

If your child wakes during the night, restart the schedule with the minimum waiting time for that night and work up to the maximum again from there.

Use the same waiting schedule for naps, but if your child has not fallen asleep after half an hour, or if he is awake again and calling or crying vigorously after even a short period of sleep, end that nap time.

The gradual approach accomplishes the same goal in a much more compassionate way. Your child has to learn some new rules, but he will not understand them at first. He should know that you are still nearby and taking care of him, and he can learn that only through experience. If you abruptly began staying out of his room all night, he would still learn that you always come back eventually and that you aren’t abandoning him, but the lesson would be unnecessarily harsh. By waiting only a short time before going in to check him, you put him through much less uncertainty. He will begin to see after only a few wakings that you are still around and responsive to him. He may be angry that you are not rocking him, but since you keep returning, he will not be frightened by your apparent disappearance. As you increase the waiting times, he’ll learn to anticipate that as well. Eventually he will simply find it preferable to go back to sleep than to cry for fifteen or twenty minutes knowing he won’t be rewarded with rocking, holding, or nursing. At the same time, he is learning to fall asleep, and feel comfortable, alone in the crib or bed.

Most families choose to correct their children’s sleep associations in a single step. However, you can choose to teach your child new associations in two steps or even more if you think it will be better or easier for you or for him. But bear in mind that at each stage you will have to start the learning process over again. How long that takes depends on how many steps are involved. It might sound easier for your child to learn new sleep habits in a few small steps rather than in one big one, but that is only occasionally the case.

Even if your nine-month-old has been sleeping fine on his own for months, if he gets an ear infection that keeps you up with him for a few nights, afterward he may suddenly have trouble getting to sleep, or back to sleep, without being held.

Similarly, while spacing out nighttime feedings in an effort to reduce or eliminate them, as discussed in Chapter 6, many parents initially prefer to respond to their child whenever he calls and in whatever way will comfort him (other than feedings). In one or two weeks, after the nighttime feedings have been phased out, the parents can change the child’s other associations as a second step.

Something you are doing, or not doing, could be interfering with your progress. Some parents have trouble following the program strictly and consistently. Common errors include letting your child fall asleep on his own at bedtime, but then rocking him during the night; staying with him until he falls asleep at bedtime but insisting that he fall back asleep alone later in the night; letting him fall asleep alone at bedtime and early in the night, but moving him into your bed when he wakes near morning; handling his pleas or crying differently from night to night, or responding differently when you think he is making enough noise to wake his siblings; and, in two-parent families, having each parent enforce the program in his or her own way. If you do any of these things, matters may not improve.

Threats and punishments are counterproductive: a young child should not be punished for a lack of self-control at night, when self-control is hardest. Do not insist that your child take on a job that he cannot yet handle; you must take it over for him.

Is Your Child’s Sleep Problem Caused by Nighttime Feedings?

If your child nurses only for a minute or so at the nighttime wakings, or takes just a few sips from the bottle, she is not taking in much food. Rather, she is behaving like a child who is dependent on a pacifier: it is the breast or bottle itself that she needs before she can go to sleep, not the food. This pattern can be stopped immediately, as discussed in Chapter 4. On the other hand, if she takes in a substantial amount of food—from extended feedings at the breast, or from bottles adding up to more than eight ounces over the course of the night—then she has learned that certain times of night are mealtimes. To eliminate these feedings suddenly would be neither wise nor kind.

One is to reduce or eliminate the nighttime feedings,

The other task is to teach your child new sleep associations

You can take these jobs on simultaneously or one at a time.

If your child feeds substantially at only one or two of the feedings, then the other “feedings” are not a response to hunger and can be eliminated immediately, like a pacifier.

(There is nothing wrong with continuing a single nighttime feeding for some months beyond that point, if you enjoy it, but be aware that this is a choice, not a response to your baby’s biological needs. However, if you have to feed her several times during the night, it may not be so nice for your child, even if you don’t mind. Instead of allowing her an uninterrupted night’s sleep,

For example, if you are starting with an interval of two hours on the first night, don’t allow your child to feed until at least two hours have passed since the previous feeding. If your child wakes before two hours have passed, she will have to wait for her next feeding; if she wakes later, she can be fed immediately. Increase the minimum time between feedings by thirty minutes each night.

If the minimum time between your child’s nighttime feedings is already more than two hours, then begin with the line in the chart one half hour longer than the current minimum and continue increasing the times from there.

By day seven, you will probably be feeding only once during the night, five hours or more after your child first falls asleep. If your child is young and you want to continue one feeding at night, you can stop here. Otherwise you can stop all nighttime feedings the next night. If you are nursing, and the remaining feeding seems to be a substantial one, or if you are bottle-feeding and have not made the feedings smaller, you can also choose to continue moving that last feeding further away from bedtime, an extra thirty minutes a night, until it moves out of the nighttime altogether.

If you are working on sleep associations and hunger patterns simultaneously, put your child in bed as soon as each feeding is over, even if she wakes and begins to cry.

If you are a nursing mother, it may be difficult to hold your child without nursing her. You may have a letdown response, and your child will smell the milk and expect to nurse. In a two-parent family, it is often easier for the non-nursing parent to settle the child at times when she is not being fed. Your child may still seem a bit frustrated, but in this way she will learn not to expect you and to nurse so often during the night.

A schedule with one or two nighttime feedings is a little more unstable than one with no feedings, because it means that sometimes your child gets fed before she goes back to sleep during the night and sometimes she doesn’t. If she has been waking once a night for a feeding, she may begin waking twice a night, and if you feed her at that second waking, she may begin waking three times a night. You can prevent this regression by sticking to a maximum number of feedings and a minimum time between feedings and, if necessary, by making certain that after she feeds she is always put to bed awake.

Teething pain, for instance, can cause a young child to sleep poorly for several nights, but it will not interfere with his sleep for weeks on end, as parents sometimes suppose.

If he usually stops crying quickly and seems fine once you pick him up or allow him something he wants, then he’s probably not in pain.

When a young child is frequently up at night crying inconsolably,

Children with reflux generally also show symptoms during the day: they spit up frequently and perhaps gag and choke. If your child has no such symptoms during the day, then it is unlikely that he is experiencing much reflux at night.

To make corrections—in fact, to understand and treat any child’s sleep problem properly—you must first understand the rhythm of her sleep-wake pattern.

The term sleep phase refers to the period of time that starts when you (or your child) become sleepy enough to fall asleep for the night and ends when you wake spontaneously in the morning after getting all the sleep you need.

In the evening, during the few hours before the start of your sleep phase, you enter the forbidden zone for sleep, an especially interesting period in which sleep is nearly impossible. If you tested your ability to nap at various times of the day, you would find it the most difficult to fall asleep during these evening hours: on the contrary, at those times you feel more awake, alert, and focused than ever. The same applies to your child. In fact, awareness of the forbidden zone turns out to be critical for understanding and treating certain common sleep problems in children.

This is the forbidden zone at work: the longest period of sustained wakefulness occurs at the end of the day, not in the morning—that

FIGURE 10. COMMON CAUSES OF SLEEP PROBLEMS AT DIFFERENT TIMES OF THE DAY AND NIGHT

Some families prefer early schedules, while others prefer later ones. You need only decide where the sleep phase should fall and take the proper steps to move it there.

Victoria was a nine-month-old girl with this problem. Her parents wanted her to sleep for ten hours a night, from 8:30 P.M. to 6:30 A.M. Victoria did get ten hours of nighttime sleep, but she got them between 7:00 P.M. and 5:00 A.M. Her parents were particularly unhappy about the early-morning wakings. On several occasions they kept Victoria up until 8:30 P.M., with great difficulty; she woke at 5:00 A.M. anyway, unhappy from loss of sleep. Her parents saw no point in continuing that approach. Victoria obviously had an early sleep phase, but her parents’ attempts to change it by moving only her bedtime had not worked. We needed to look at the rest of her schedule. Since she woke at five every morning, her parents were feeding her at that time. They gave her lunch at eleven and supper at 4:30 in the afternoon. She napped for an hour at eight o’clock in the morning and again at noon, after lunch. In short, her entire schedule was shifted too early, not just her wake-up time. If everything in her daily routine could be moved one or two hours later, the problem would go away. That was what we had to do. If we had kept trying to move Victoria’s nighttime sleep later without adjusting the rest of her schedule, we would have faced a couple of potential problems. First of all, because she was being fed at five in the morning—not unreasonably, given when she was falling asleep—she had learned to be hungry then. If we only made her bedtime later, she might still wake at five, no lon...

So, when parents tell me they are having trouble getting their infant or toddler to sleep twelve hours at night (say, from 7:00 P.M. to 7:00 A.M.) along with two hours of napping, I have to tell them that fourteen hours of sleep in a day is not likely. We can adjust their child’s sleep so that he has an early bedtime or a late waking, I explain, but not both.

Waking Too Early in the Morning Suppose your child falls asleep easily at 7:00 P.M. as desired but wakes every morning at 5:00, ready to start the day. His sleep phase runs from 7:00 P.M. to 5:00 A.M., again indicating a ten-hour sleep requirement. It’s unfair and unrealistic to force him to stay in bed until 7:00 A.M. and hope he will go back to sleep. The problem is much like an early sleep phase, differing in that only one end of the sleep phase is earlier than desired, not both—since he usually falls asleep at a desirable hour—and the solution is the same: to eliminate the early waking, you must make bedtime later. You can do this by gradually adjusting the schedule later until your child is sleeping the particular ten hours you prefer (from 8:00 P.M. to 6:00 A.M., from 8:30 P.M. to 6:30 A.M., or from 9:00 P.M. to 7:00 A.M.).