Often when I write about crying-it-out or controlled crying, I get comments from people who have done it asking what else they should have done in their sleep deprived state. The question concerns me because it highlights not only how mainstream the idea of leaving a child to cry has become, but also about how ignorant society is as a whole about the alternatives to sleep training. So here I thought I would present a few of the options out there and some resources that you may find helpful. Hopefully we can hit a stage where these become the “norm” in what parents are first told to try. Why are they “gentle”? Well, because they involve continuing to respond to your child’s needs for comfort and love instead of leaving them – even temporarily (and I’m not talking 3-5 min of sleep whining/fussing/talking/etc. here). However, if you are experiencing many wakings or lots of crying, please check this post out on what ISN’T normal sleep for infants so you can first address any underlying issues.
Education on Normal Sleep
I start with this because I believe it should be a component of any intervention on infant sleep. Providing parents with real information based on baby’s biology is important, regardless of what else is also promoted. The reason being that many parents express incredible anxiety over their infants’ sleep which is made worse when they are given unrealistic expectations of what to expect their infant to do. When parents have a greater understanding of not only what they might expect, but also the reasons they might expect it, it may be sufficient to remove anxiety and any need for further intervention. You can read more on normal infant sleep here and some of the reasons babies do wake and signal at night here.
In line with this education on normal sleep, we need to make sure families also examine the potential reasons behind the wakings looking at age-appropriate expectations. For example, an infant will feed frequently and often, that is normal. However, an infant who is feeding excessively coupled with lots of crying may have a tongue-tie that is preventing him or her from feeding fully, an infant who cries regularly at night may have a food intolerance (yes, they get proteins and other elements of food via mom’s diet) and may need mom to make some dietary changes to sleep well, or an toddler who is waking regularly in his own room may be experiencing severe separation anxiety and may need to be closer to his parents at night. So when we talk about what is normal, we must also encourage people to check these options out. It may be that one just has a very hungry infant or an infant with reflux or something else we don’t know, but as normal as most behaviours are, not everything is “normal” in the sense that it doesn’t reflect an underlying problem.
The Wait-It-Out Method
Not really much of a “method”, but it has a name and many people subscribe to it (yes, even working parents and those who have other kids). As you can probably imagine from the name, it involves simply waiting it out. This often comes when parents have read up on why their child might be waking and accepting that this, too, shall end. Notable here is that this is not for cases in which a child is showing clear signs of sleep deprivation (you can read up on the symptoms of sleep deprivation here) and this should not be based on the amount a child sleeps, but the actual physical symptoms of a child. But basically, you continue to respond to your child’s wakings and cries, knowing one day they will end (yes, this too, shall pass).
Evidence for using this method comes from trials which looked at the efficacy of CIO or CC in infants and compared them to those who simply did nothing (something that oddly is not often compared in sleep training research). At follow-ups 6 months later, there were no differences between the two groups, suggesting that if parents believe they can last that time, they may see no difference and spare themselves any hassle of an intervention.
It sounds so simple that parents seem to ignore it, but having a routine (not a schedule, for the difference see here) is hugely beneficial to children and infant sleep (and mom’s happiness). Some problems that often come up when people try to implement a routine include:
- Mistaking a routine for a schedule and being too strict
- Not having a nuanced routine that is child-centered
- Not being flexible in changing the routine as the child ages and changes
- Not being consistent with it
However, if parents can overcome these problems, they are often met with wonderful rewards when it comes to sleep. An added benefit is that with a set routine, if you need to move sleep a bit earlier, you can slowly do that by simply starting the routine 5-15 minutes earlier each night until you have shifted sleep gently and without too much disruption for your child. This has been found to be as effective as extinction methods of sleep training (specifically, controlled crying). Notably, this method works particularly well with toddlers.
These will not work for everyone, and as such there are other methods devised by individuals to help you. Because I’m not going to commit plagiarism, I will simply leave you with links to various resources that address infant sleep problems in a gentle, responsive manner.
Books (you can click on the book title for the link to Amazon which provides a small portion of the sale to EP at no cost to you to help cover our costs, but also gives you access to reviews and more information):
And coming soon…
- Gentle Sleep Book (coming March 2015 but I got to read it ahead)
Sites and classes that offer help (again, you can click to see):
- Understanding and Helping Toddler Sleep on EP
- BabyCalm Classes
- ToddlerCalm Classes
- Pinky McKay’s Website
- Dr. Sears’ Website
- Infant Sleep Information Source
- Mother-Baby Behavioral Sleep Lab at Notre Dame University
- Attachment Parenting International Sleep Strategies
- Dr. Jay Gordon’s Sleep Information
- Helping Toddler Sleep from Little Hearts Resources
- The Milk Meg’s Post on Night Weaning for Toddlers
If I’ve missed anything, please let me know and I will continue to update this section with more resources for families looking for alternatives to what has become the mainstream of sleep training.
Good luck and happy sleeping
[Image Credit: Bebo Mia]
 Douglas PS, Hill PS. Behavioral sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic review. J Dev Behav Pediatr 2013; 34: 497-507.
For a systematic review, see http://www.isisonline.org.uk/how_babies_sleep/sleep_training/research_evidence/
 Mindell JA, Telofski LS, Weigand B, Kurtz ES. A nightly bedtime routine: impact on sleep in young children and maternal mood. Sleep 2009; 32: 599-606.
 Adams LA, Rickert VI. Reducing bedtime tantrums: comparison between positive bedtime routines and graduated extinction. Pediatrics 1989; 84: 756-61.