What do the families who come into Sleep Clinic have in common? Almost all of them have tried sleep training and failed. There are some common sleep training mistakes that parents make. Knowing about them may make the difference between success and failure.
Parents often feel guilty about sleep training. One of the reasons is that they have tried for a bit and then encountered severe resistance, often in the form of tears and crying all around. Then parents quit.
This always makes me feel terrible– both the parent and the child have suffered without even fixing the problem. Often, if they had persistent, their child would have started falling asleep more easily with just a day or two more of effort.
Many people think that sleep training exclusively implies a “cry it out” approach, which is technically referred to as extinction.
When I say sleep training, I am thinking of a range of behavioral (non-medicine based) methods that parents and physicians may use to help children fall and stay asleep.
If you want to know the best ways to sleep train, I wrote a comprehensive post on the best sleep training techniques here.
Here is my list of the top ten sleep training mistakes:
Avoid these problems and you will be much more successful at fixing your child’s sleep problems.
1. Starting sleep training at the wrong time.
Infants develop the ability to self soothe between 4-6 months of age. To be safe, I usually recommend starting around six months of age, but efforts in the 4-6 month window may be helpful. Before four months, just follow your child’s cues. Lately there have been some articles in the news about training younger infants but I don’t recommend this.
Also, avoid starting around potty training, or learning to walk. These big milestones are associated with lots of sleep disruption.
2. Not changing bedtime.
A well structured bedtime is the key to success. Kids with irregular bedtimes continue to have poor sleep through childhood. Bedtime should be enjoyable, predictable, and last no more than 30 minutes. Additionally, moving bedtime later (called “bedtime fading”) can really help reduce crying.
3. Missing the medical causes of the sleep difficulties
Children with some medical problems (obstructive sleep apnea, restless leg syndrome, anxiety or severe nocturnal fears, asthma, pain, etc.) won’t necessarily respond to behavioral changes.
It is very common for patients presenting to Sleep Clinic to have more than one sleep problem. If I find multiple sleep issues in a patient, I start with treating the non-behavioral sleep problems first before suggesting a behavioral plan. This is why you should discuss your child’s sleep issues with your pediatrician before starting.
4. Being inconsistent
This is probably the biggest problem that I see in clinic– parents who respond differently to their child at night. There are a lots of reasons for this. Exhausted parents have trouble being consistent and may sometimes fall asleep in their child’s bed. Sometimes, one parent handles bedtime or awakenings differently than the other. If the parents are separated, there may be different rules in different homes. Sometimes, a working parent may have the child sleeping at a grandparents’ house until later.
The most powerful form of conditioning is inconsistent positive reinforcement— like pulling the lever in a slot machine. If your child fusses nightly, and is brought into your bed some of the time, that is a very powerful message which validates the fussing.
5. Challenges in the bedroom
Many families live in apartments where the neighbors complain if their child fusses. The child may share a room with a sibling, or live on a noisy street. Sleep training in an apartment may be challenging. If the child shares a room with a sibling, I may recommend that the other child be moved to the parents’ room or another room for a few days to facilitate training.
Also sometimes kids like to sleep in a room with the light on. This is not conducive to great sleep. If it is bright enough to read in your child’s room, it’s too bright for good sleep. Trying putting the light on a dimmer or moving it out of your child’s line of sight.
6. Not being ready
When people quit smoking, experts encourage them to have a “quit date” and not start until they are ready. If one parent is ambivalent, it is OK to wait. Also, defer starting until you can allow a few weeks for the new sleep pattern to be established. Don’t do it right before a vacation, or when house guests are staying, or right before your big presentation at work.
For more on this, read When Not To Sleep Train.
7. Moving your child into his or her room at the same time
your child has never slept in his room successfully, he is going to have a real hard time if you move him into his room and start sleep training. You may need to move with your child into his room for a week until he is ready for you to start sleep training. Here is my article on how to stop cosleeping.
8. Feeding your child all night long
After six to nine months, most children don’t need calories at night. If you are feeding your child multiple times at night, you need to stop it so both you and she can sleep better. I have a guide on stopping night time feeds right here for you.
9. The “Extinction Burst”
This is a behavioral term describing that an undesirable behavior worsens before it improves when you are trying to get rid of it. This is especially common with “cry it out” sleep training.
Here’s what it looks like. Nervously, you decide to let your 9 month old cry himself to sleep. The first night wasn’t too bad. On the second or third night, he’s really screaming. For an hour. Finally, you give him and decide that it wasn’t work.
Sometimes this can get pretty real. Sometimes kids may cry to the point of throwing up. And sometimes little acrobats get creative.
Several years ago I received a frantic call from a friend. Their 18 month old had jumped out of the crib when fussing and had landed on her head. I happened to be nearby and went to check on her– she was fine. However, her parents elected to move her to a big girl bed and it took her issues a while to resolve. If you are sleep training an older toddler, remove things from the crib like bumpers that they can climb.
Unfortunately, if you persist, your child may be done with crying in a few more days. Sleep training usually works in 3-7 days in younger children. People imagine that it will take weeks but it should not. If you are trying and you are stuck after this period of time, call your pediatrician.
10. Switching to a bed prematurely
I usually recommend switching kids to a bed around age 2.5-3 years of age, when they are sleeping well. Parents often try switching their kids out of a crib when they are sleeping poorly. Or they may buy an expensive mattress or sheets for their child.
I get it. If you’ve lain down next to your child in a toddler bed or crib, it’s pretty uncomfortable.
Let me tell you though– the problem isn’t the bed or the crib. It’s the behavior. And if your child is sleeping poorly in their crib, it usually gets worse when you make the switch.
The exception is the crib jumping. Then you have to make the switch.
What are the most common sleep training mistakes?
If I had to narrow it down to the two most common reasons why parents struggle and fail with sleep training, I would say that inconsistency and the extinction burst are the most significant.
Parents: what speed bumps have you encountered on the way to a good night’s sleep? Pediatricians: what are the common problems when guiding a family through this process?
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