The bulk of my practice involves helping tired parents teach their children to improve their baby's sleep and become independent sleepers. This need for the child to be more independent arises when parents find the way they are helping their child sleep is becoming unsustainable for the family either physically, mentally or both and they consistently need a good night's sleep. These parents are plagued with sleep deprivation, sleep problems and hoping that one good sleep tip will stop the night waking. Sometimes these parents even worry their babies have medical conditions! In many cases the parents feel their child isn’t getting much sleep or still seems tired on waking from sleep time. In many other cases, the parents were hoping their child would change their sleeping habits on their own by "growing out of it" but sadly good sleep habits often just do not appear.
Recent clients have included:
* A 5 month old who is nursed to sleep at bedtime and then wakes up 3 times in the night and must be nursed back to sleep. Any other offering such as rocking or patting brings tears. The child is also nursed to sleep for naps but will only nap for 40 minutes at a time.
* An almost 3 year old who requires a parent to lie with them to fall asleep, and then demands the parent return to their bed and stay there when they wake up in the night.
* A 14 month old who requires rocking to fall asleep and is then placed in the crib but wakes up around 1 am and will only sleep in arms.
What needs to be done to help these children sleep longer stretches at night independently and nap longer?
The child has associated something external with falling asleep, this is called a sleep association. This could be nursing, co sleeping, sucking on a bottle or a pacifier, being held or being rocked to sleep. Sleep is a learned habit. Think about yourself. If I told you tonight you couldn’t sleep in your favorite position and I’m taking away your pillow, you would be uncomfortable trying to fall asleep with under these new conditions. You would toss and turn, experience frustration, but eventually find a new way to fall asleep. Our children need to experience the same scenario to develop an independent way to fall asleep. In doing so they acquire self soothing skills. Self soothing skills are repetitive actions that can help them relax into sleep independently. Self soothing skills can look like tossing the head left and right, stroking a piece of fabric on the face or between fingers, or positioning the body in a certain way. Sometimes it's cuddling a stuffed animal. It’s true that all humans wake up in the night, but not all humans require rocking or to be fed to fall back asleep. Children who fall asleep independently at bedtime are capable of returning to sleep on their own in the night, assuming past the age of requiring night feeding.
Safe sleep is an important aspect of independent sleep. The American Academy of Pediatrics would like baby's sleep surface to be a firm mattress, free of crib bumpers, or blankets. This safe sleep space could be a pack n play, portable crib a bassinet or a crib. According to the AAP, parents should have their own bed. It used to be the AAP recommended room sharing until 6 months minimum and ideally until baby's first birthday. However in the fall of 2022 they changed this to be until 6 month. The purpose of the safe sleep guidelines is to reduce the incidence if sudden infant deaths which peak between 1 and 4 months of age, according to the AAP. That all being said, Dr. McKenna from the University of Notre Dame is a big believer in co-sleeping and feels it can be done safely.
What are the next steps to helping your baby sleep more?
Sleep training, or as I like to call it, sleep teaching, really should be called - sleep re-teaching. We need to remove the known way of falling asleep for self soothing skills to develop. It would be hard for them to develop new skills while receiving the existing and preferred external help.
However, in many cases similar to those above, the child has rarely experienced independence or struggled through a task on their own in the daytime, let alone at night time. How can they be able to self sooth in the night when they have no experience doing so during the daytime? Often these children have few experiences of seeing a caregiver go and come back in the daytime. They also have few experiences with emotional regulation as the caregiver is quick to quell the tears with breastfeeding, bottle feeding, pacifier, rocking or diversion in general. To place a child into the crib alone and leave them on their own to start “sleep training” would be a very dramatic change for the child and the parents. With such a big change the chances of a more intense reaction from the child and feelings of anxiety from the parents both increase. Does this big change set a child and parent up to be successful? It does not. How can we ease the transition to independent sleep?
Examining how you encourage a child's independent play in the daytime is a great place to start. Daytime play allows the opportunity for the child to work on emotional regulation and self soothing. Begin by exposing the child to more independent playtime. Having the caregivers leave and come back during a play session. Communicate what's going to happen, implement the departure, and communicate with words what happened on your return.
For example, " I'm going to go to the restroom but I'll be right back." On return..."Ah I can see that you were missing me while I was gone, but mommy/daddy always comes back."
The child may fuss or cry at seeing the parent leave, but working through the frustration as well as seeing them go and come back are exposures to the conditions that will happen at night time. In the daytime everyone is less tired, more patient and able to self-regulate a little better compared to night time and managing the parental anxiety associated with the tears tends to be easier.
In addition, play offers a good opportunity for your child to practice independence and motor skills. See our other blog post on language development. Put link in here.
To be an independent sleeper a child needs to develop some sort of self soothing skills. (Add link to self soothing skills blog) These are usually repetitive motions that offer some sort of sensory input. Common self soothing skills include sucking on a thumb or figure, rolling onto a side or stomach and rubbing the cheek into the mattress. Some children like to rub their ear or head while others love to rub a soft piece of fabric either on a lovie or their sleep sack. Gross motor skills are helpful so your child can position their body into a position they find soothing. Gross motor skills evolve with developmental age but also practice. Play offers the opportunity to practice hip flexion, throwing a leg across the body as the first stages of rolling to the side. Fine motor skills such as grabbing a piece of fabric to stroke or sucking on a thumb are also helpful for self soothing.
A few benefits of play:
- Self regulation
- Gross motor practice
- Fine motor practice
- Enhanced confidence
- Important for brain development
What is learning to sleep independently?
The ability to transition from being awake into sleep on their own. When a child is put down for the first time at bedtime without the known way of falling asleep and without being made relaxed, there will be frustration at a time when they are already tired. If we work on more independent play in the daytime, the child will have had experience with frustration, resiliency and practice with gross and fine motor skills as well as parents leaving and returning. A newborn baby doesn't have full capacity to learn to sleep independently. In the Helping Babies Sleep Method we teach gentle newborn sleep shaping where you're still assisting but giving space to learn. For babies in the age group of 4 months old and above, that's when true independent sleep is more possible. Baby's brain is able to put together cues, hand control is improved and the startle reflex is receding and self soothing consistently is much more possible.
What does independent play in the daytime look like?
For many of these children they have no experience spending time in a common area without being held or without an adult hovering over their every move and interacting with them non stop. We can start simply by laying the child down with 1 to 2 age appropriate objects, and as the child gets older up to 5 objects.
As early as 3 months we can start with the RIE™️ suggestions of a simple cotton cloth and an O ball placed in close proximity to the child, but not given to them. Then we engage in the hardest part; observing without interjecting unnecessarily. Sitting a few feet away from the child and observing the child without the temptation to shower them with praise, check our phone or tickle them or make them smile. At some point, the child will fuss and the temptation will be to stop the fuss by picking them up, handing them a toy or hovering over them making distracting sounds.
But what if we take a minute to pause and see what this child will do on their own if we don’t intervene? They may holler a bit and then find a new shadow or light to observe on the ceiling and self regulate down. Or they may continue to escalate. If they continue to escalate, can you bring yourself physically closer? Perhaps place a hand on your baby’s chest and offer some words of acknowledgement, bring your face closer to theirs, but not remove them from the situation? You can be close by and offer a confident, secure base while your child struggles. This is real life. The struggle is real. Struggle builds confidence, resilience and independence.
The challenge is most parents don’t believe their baby’s are capable of self regulating and tend to remove their child from the situation too soon, not allowing for growth, or cautioning them so much we reinforce fear. In addition we have remnant caveman brain programming which kicks in to activate our body’s fight or flight response at the sound of a fussing baby. This will be even more activated if a parent has had any sort of birth trauma, trouble conceiving or difficulties post-partum. Our cavemen brain is outdated and hasn’t caught up to today’s age. Your child’s fussing sounds are no longer signs a saber tooth tiger is approaching. There is no physical danger present. A few moments of observation while being close to your child will not harm the bond with your baby. In fact it will strengthen it as you learn to observe your child you become that much more in tune with what the root needs are. You’ll also see them succeed and work through frustration and your lens of how capable they are will change. In addition your baby learns to be seen and respected but not muted.
If you are able to let your child experience struggle in the daytime during playtime they will get more accustomed to not being rescued, have the opportunity to learn how to self regulate and self soothe. These daytime practice sessions will make it easier for your baby to learn to sleep independently at night, reduce the middle of thh night waking and have easier nap times.
RIE is Respectful Infant Parenting founded by Madga Gerber. Dr. Sarah is a RIE Foundations and Theory Class graduate. You can read more about the RIE philosophy or find a class near you on their website www.rie.org.