By Nicholas B. Levy M.D.
It has been said that falling asleep is not like falling off a log. One has to learn how to fall asleep! The question then becomes: How does one learn to fall asleep and what is the best age at which to learn this?
The theory of psychological development indicates that during the first four months or so of life, the infant is developing trust. This allows for psychological integration and the ability to easily transition to the next developmental phase, separation and development of the self as a distinct entity.
During the first few months of a child’s life they develop trust by being attended to whenever they cry. They are, so to speak, impossible to spoil. If they suffer from any condition that causes prolonged crying, like reflux or colic, they should be held or cuddled despite their crying. This is extremely hard on parents but the psychological benefits are enormous and the temptation to “just let them cry it out” should be avoided at all costs.
The other interesting phenomenon that occurs early on in infancy is the internalization of sensation and the development of memory. This appears to happen at about two to three months of life. The first two months are certainly a time when it doesn’t matter where or how infants fall asleep.
It is important, therefore, that parents should ask themselves what it is they want from their child in terms of sleep behaviors. Do they want a family bed, where all of the family members sleep together, and, if so, do they want to go to sleep at the same time as the children every night or would they prefer to join the children later? Would they prefer to have children sleep in their own rooms and again how would they like the children to fall asleep? Do they want to rock them to sleep? Do they want to lie with them while they fall asleep when they are older? Would they prefer to say goodnight to them before they are asleep? Both parents should derive the answers to the above questions because bedtime can become stressful if there is disagreement. This is a time of day for many couples when they should be spending time together.
In many instances it appears that parents want their children to fall asleep on their own and sleep through the night, but they don’t know when to stop nursing or rocking them to sleep. They simply hope that the children will learn how to do it for themselves and get frustrated when it takes five or six years before the children do.
This simple technique will allow your baby to develop good sleep habits without a need for prolonged crying. For the sake of discussion, it will be assumed that parents want an independently sleeping child. If, however, they would prefer a family bed, then the same technique will apply if they want the child to fall asleep alone. Even though it does take some work, the results are well worthwhile.
The best time to start sleep training is soon after your baby is two months old. Most children will sleep their longest stretches during the night hours by this age. They will generally be falling asleep sometime between 8:00 pm and 11:00 pm and most will be waking once or twice during the night to feed. In many instances they are still sleeping in their parents room in a bassinette. Now is the time for the big move!
Set up the babies crib in their own room and envision it the way you think it will be when they are about one year old. Begin to pay careful attention to them at the time that they generally start to fall asleep. As soon as they begin to get drowsy or their eyes get heavy, put them gently into their crib. If they fuss, respond immediately and try to soothe them in the crib. Do this by patting or stroking them or gently shaking the crib, perhaps while singing softly or whispering to them. If they don’t settle down quickly (about 20 to 30 seconds is reasonable) then pick them up again. Walk with them, talk to them and watch closely for them to get drowsy again. As soon as this happens, put them down again. If they again start to fuss, respond as before and try and soothe them in the crib. If this doesn’t work, then pick them up and once again soothe them in your arms until they begin to fall asleep and then just before they do put them down again.
Every baby is different in terms of how many times they will need to be soothed again. If you persist, however, then the end result is that they will fall asleep in their crib even it means that a parent is present to begin with. Each night will be a little easier and fairly soon you will be able to put your baby down, say goodnight, and leave the room. Although the baby may vocalize a bit without really crying, eventually he or she will fall asleep. Ignore the little awakenings during the night but respond to any real crying.
After infants are about four months old, they are quite capable of sleeping for nine to ten hour stretches at night. They don’t need to eat during this time and, in fact, if they are fed, will develop a pattern called “trained night feeding”.
Everybody wakes up during the night and then goes back to sleep. We reassure ourselves that nothing has changed and don’t even remember having woken up the next day. Children that fall asleep in a parents arms and then wake up during the night in a crib, find this very difficult. They tend to need their parents help to fall sleep again.
It is acceptable to allow babies over four months of age to cry a bit. Sometimes a few minutes of crying in the middle of the night is all it takes to teach them to sleep through. Remember to always respond at first, with as little intervention as possible. If you are having trouble with sleep and sleep habits, talk to your pediatrician or arrange to meet with them for a sleep consult.
Parents who have had a good nights sleep are much more tolerant and have loads more energy to deal with the everyday needs of their children.