Who should read this chapter? Parents who are tired of waking up several times a night to feed their infant. Need a good night's sleep? By understanding that parents unintentionally reward their infant for waking up at night, parents can modify their behavior to effectively train their infant to sleep through the night.
Summary: After the first few months of life characterized by frequent feedings in the middle of the night and chronic fatigue due to lack of a good night's sleep, it is time to train your infant to sleep through the night. Your infant must now learn that crying when it is dark results in no reward (no feeding), as opposed to crying when it is lighted, which does result in attention and feeding. It is now time to stop feeding your infant in the middle of the night so that you can get some quality sleep time. There may be emotional conflict within the household during this training. It is very important for all household members (and neighbors) to understand this training process to be successful. A tested and proven plan is presented.
As proud parents of a newborn infant, we are usually more than willing to make sacrifices in our lives to properly raise this newest member of our family. A newborn infant is precious and seemingly fragile. He or she demands constant attention and we are more than willing to make major changes in our lives to deliver this attention to our new infant. Before the new baby, we could sleep through the night, we could attend frequent social events, we could devote full-time work schedules towards our careers, etc. With the arrival of a new baby, we must sacrifice these things to properly raise him/her.
On average, these changes in our lives affect mothers more so than fathers. Breastfeeding provides health benefits and is encouraged. Fathers cannot breast feed an infant. Mother's milk can be expressed and fed by a father using a bottle, but for the most part, mother's do nearly all the infant feedings if she is breastfeeding. Fathers can more easily feed formula fed babies, but on average, mothers do most of these feedings as well.
Newborn infants are fed every two to four hours throughout the night. Parents (mostly mothers) are awakened by their infant frequently by crying. This signals hunger and mothers will awaken to nurse their infants.
Infants are rewarded for crying during the night. Remember the basics of reinforcement. Notice that when a newborn infant cries in the middle of the night, he/she is REWARDED for crying by a mother who responds to the crying by carrying the infant (positive reinforcement) and feeding the infant (positive reinforcement). No wonder infants cry a lot at night. The normal newborn infant care pattern of feeding on demand (when the infant cries) rewards the infant every time he/she cries. It is almost guaranteed that infants will cry periodically through the night for many months or years to come. Most parents are willing to sacrifice a good night's sleep for several months to properly care for their precious newborn infant. However, after 6 months, 9 months, 12 months or 15 months of interrupted sleep, a good night's sleep without interruption seems like pure gold. When your infant is older and is no longer being breast-fed (this could be 12 months or longer), fathers can provide relief by doing more of the night feedings. While this is helpful, it is stressful to both parents who are usually getting back to work and need a good night's sleep. Is there a better way ? Of course there is!!
At some age, infants no longer need to be fed at night. When newborn infants are small, they need to be fed every two to four hours. How long do infants need to be fed through the night like this? There is some controversy here. Many pediatricians will recommend that infants be fed this way until age 4 months. Some will say less than 4 months and others will say 6 months. If your infant is very small (smaller than the average infant for age) due to prematurity or being born small, this age should be later and you should discuss this with your pediatrician or family physician. For healthy "term infants" (infants born close to your due date and of average weight for age), may I suggest that you use 3 to 4 months as the age at which your infant no longer needs to be fed every 2 to 4 hours through the night. If you have some anxiety over this age, then use 5 to 6 months.
After you decide on this age, you must now "train" your infant to sleep through the night. If you are really lucky, this will happen by itself. Don't count on being this lucky. Recall that during the first several months of your infant's life, the practice of feeding your infant every 2 to 4 hours on demand (when crying) has reinforced the behavior of crying through the night. For several months now, you have reinforced (encouraged) your infant to cry during the night. Now that you have endured sleepless nights for several months, you should try to get back to your routine of sleeping through the night by teaching your infant to sleep through the night as well.
To train your infant to sleep through the night, you must avoid rewarding your infant when he/she cries in the middle of the night. From now on, when your baby cries in the middle of the night, you must NOT carry or feed your baby. This sounds cruel and many parents cannot do this, but finish reading this whole chapter to get the entire story before making a judgment on this.
First of all, you need to understand that your infant is used to being fed and carried at night when he/she cries. When this suddenly stops, your infant will cry LOUDER and LONGER. Everyone in the household must expect this and accept this. If you have close neighbors who will hear the crying, you must also explain to your neighbors that your infant will be crying LOUDER and LONGER while you train him/her to sleep through the night. While this sounds awful, the good news is that your infant will be trained to sleep through the night within one week (if you do everything right).
Follow these steps:
1. Involve everyone in the plan. Get everyone in the household and your neighbors to understand and accept the fact that for the next week, your infant will be crying a lot during the night. Failure can result when one family member decides that all this crying is too much. Grandparents typically fall into this category. If your parents or in-laws live with you, this may be a problem. If grandma or grandpa hears their grandchild crying too long, they will typically not hesitate to get up and feed the baby themselves. This will cause the plan to fail. Avoid this by getting them to understand this plan ahead of time. If they will not agree, send them on a one-week vacation while this is being done. If all goes well, your infant will be trained to sleep through the night in less than a week.
2. No feeding or carrying at night. Stop feeding and carrying your infant when he/she cries during the night. Feed your baby just before you go to sleep with the lights ON. This is usually at 11:00 pm or so. Turn off the lights after this last feeding. While the lights are off, you must not carry or feed your baby until the morning (usually 5:00 am) when you turn the lights on. Your infant needs to learn that crying in the dark no longer results in any rewards (carrying or feeding). If you are worried about the long period of time that your infant is not fed at night, then do your last feeding late at night (midnight or 1:00 am) with the lights on, then turn them off until the first morning feeding early in the morning (such as 4:00 or 5:00 am) when the lights are turned on. This way, your infant will go without a feeding for only 4 hours or so. You can control this period of time by adjusting the times of the last night feeding and the first morning feeding.
3. Your infant will cry for a long time. This is where it may get rough. During the night, your infant will cry for a long time. You may be shocked at how long an infant can cry (several hours initially). You must be tolerant of this and not carry or feed your infant. You may take a sneak peek at your infant to make sure he/she is OK. But generally, when they are crying, they are OK. If you take a sneak peek, don't let your infant see you. If you can't stand it any more and you decide to carry or feed your baby, you have just reinforced crying at night. Remember the reinforcement basics in the previous section. Partial reinforcement is STRONGER reinforcement than consistent reinforcement. By allowing your infant to cry for a long time, only to give in and then carry and/or feed him/her, you are providing your infant with partial reinforcement. This will strengthen your infant's will to cry at night. It will make sleeping through the night more difficult to train the next time you attempt it. I used to tell parents to check their infant's diaper to be sure it does not need changing. However, today's modern diapers are super absorbent and do not need to be changed at night at all. When you have decided to train your infant to sleep through the night, it would be best to not approach them at all. If your infant sees you, he/she will cry more. While this plan may sound cruel, read on and find out what the alternative to this is.
4. Baby should sleep in a different room. It would be best to have your infant sleep in a different room from you if at all possible. The crying is not as loud if your infant is in another room. Eventually, you will become sleepy as well and both of you will fall asleep. But if your infant is in the same room as you, the crying is so loud, that you will become irritable and will be frustrated by this whole plan. If you do not have an extra bedroom, use any other room (a hallway, the bathroom, the den, etc.). It may seem cozy and intimate to sleep with your infant; however, your infant should ideally be sleeping in a crib in a different room. Read on to find out why. In addition to these reasons, there are instances of parents rolling over in their sleep and smothering their own baby.
5. If it gets too noisy. During the first and second night of this plan, your infant will spend a lot of energy crying during the night. As pointed out earlier, be sure that your neighbors and other household members understand what is taking place. It may be that not everyone is totally comfortable with all this crying. Since most families do not have access to sound proof rooms, it may be easier to tolerate all this crying during the first and second nights by leaving on an air conditioner or a muffled vacuum cleaner. The monotonous sound produced by an air conditioner and a vacuum cleaner will not bother the neighbors or other household members. This sound will partially cover the sound of the crying so it will be less noticeable.
6. In the morning, turn ON the lights and feed your infant. You can "wake up" as early as you want. On the first day of this plan, you can "wake up" at 3:00 am if you want to start feeding your infant. But, you MUST turn the lights ON and leave them ON. Your baby must learn that when it is dark, crying results in no reward, but when there is light, crying results in his/her usual rewards of being cuddled and fed. On the second night, you may want to "wake up" later with progressively later "wake up" times until you've reached your usual wake up time.
7. The first two nights might seem like hell. The first two nights will clearly be the worst. For this reason, most parents find it less frustrating to "wake up" early (for example, 3:00 am) to feed their infant. The lights should be left on until sunrise once this first feeding at "wake up" time takes place. While these first two nights may seem awful, most parents find it amazing how quiet it is on the third night.
8. Be strong, don’t give up. If you experience a moment of weakness and you give in by carrying or feeding your infant, even just once, this will be PARTIAL REINFORCEMENT. By doing this, you have strengthened your infant's desire to cry at night. If you do this, it will be more difficult to train your infant to sleep through the night.
9. Amazingly quiet on the third night. While I can't absolutely guarantee this, it is very likely that your infant will be fairly quiet by the third night. If you have been strong and have stuck to this plan, you will now be rewarded. While the first two nights were difficult and it seemed that your infant would never stop crying, the benefit of this training plan should now be showing some benefit. Your incredibly smart infant now has learned that crying at night results in no reward. Your infant now understands that when it is dark, it is much better to sleep than to waste energy on useless crying. Expect your infant to sleep through the night by the fourth or fifth night.
Common questions about this method:
Wouldn't it be better to wait until my infant is older before training him/her to sleep through the night?
Many parents are concerned that their baby is too young to go without feeding during the night. Healthy normal infants are able to do this as described earlier. If you think about the time span from 11:00 pm to 6:00 am, your infant is typically only missing one feeding if you assume a feeding schedule every 3 to 4 hours. Remember that you can always stay up later to give your last feeding at midnight and/or wake up earlier to give your first morning feeding at 5:00 am or earlier. The luxury of being able to sleep for 5 to 6 hours without awakening can be really appreciated after these first several months with your baby.
If you wait until your infant is older, there may be other problems that you must deal with. For example, a 9 month old infant can cry much louder and longer than a 4 month old. Older infants will not limit their discontent to crying. They can stand up in the crib and bounce up and down while holding onto the crib railings. Older infants will often attempt to climb over the crib railings. I know of many instances when older infants have climbed out of the crib only to fall 4 feet onto the floor. Head injuries and fractures can sometimes occur in these accidents. Other infants have gotten their feet caught in the crib railing as they climbed over it to get out.
If you decide to train your infant to sleep through the night at an older age, may I suggest that you place an air mattress or other soft padding below the crib railing. The other side of the crib should be up against a wall. Another suggestion is to place a couch or bed next to the crib. To minimize the chance that your infant will climb over the railing, raise the railing to its maximum height and lower the mattress in the crib as low as possible. As you can probably tell, once your child is able to crawl out of the crib, it will be very difficult to train him/her to sleep through the night. Even if you close the door on his/her room, once your child is out of the crib, he/she will bang on the door. This can be so noisy and disruptive, that you will have to respond. Once the door is open, your child will now want to sleep in your bed and will not sleep through the night unless he/she sleeps in your bed.
Wouldn't it be better to train my infant to sleep through the night more slowly, over a month, rather than all of a sudden?
While this idea sounds attractive, it may actually be more difficult. A slow training process may result in partial reinforcement. This gives your infant inconsistent signals of what is rewarded and what isn't. If on some nights, crying is rewarded by feeding, but on other nights it is not rewarded, this confuses the infant and further reinforces crying.
Some child development experts have recommended a slower approach and there is no doubt that such methods can work. I am an advocate of a more rapid approach because my experience indicates that infants learn very quickly and most will sleep through the night within a few days if all goes well. Some parents and experts are concerned that excessive crying might lead to psychological stress in later life. This would be very difficult to prove or disprove, although it sounds like it could possibly be a concern. All I can say is that my three children were all trained this way and they all seem to be psychologically normal today. There are many pediatricians who recommend this more rapid approach. You as a parent can decide on your own approach by discussing this further with your pediatrician or family physician.
Why do I need to train my infant to sleep through the night? I'm willing to wake up during the night to feed him/her. What would happen if I didn't do this training?
If you eventually plan on returning to work, it is important to get a good night's sleep. Most careers realistically only allow several months at the most to get back to work. If your career allows you a longer leave of absence, you are lucky. However, many young families will need income which has stopped if you are on a leave of absence.
You might get lucky and your child may learn to sleep through the night on his/her own. In many instances, parents are not this lucky.
Eventually, you will get tired of waking up in the middle of the night. For an older child, you can resort to bottle feeding. When your child wakes up crying, it only takes 5 minutes to prepare a bottle of formula (for infants) or milk (for older babies). With bottle in hand, your child will generally quietly feed and fall asleep until the desire for another bottle awakens him/her again. This practice promotes dental erosion and decay (described in the chapter on Using a Bottle to Fall Asleep).
Eventually, you will need to stop using the bottle. You will now have to deal with the tantrum that will result. Your older child is more physically mature and usually by this age, is capable of crying very loud, screaming, jumping, climbing out of the crib, banging on the wall, throwing objects, vomiting, etc. At least one of these will get your attention. Remember, children are incredibly smart. They will figure out which one gets your attention and they will do it until you deliver the attention to them. Vomiting is a particularly good attention getter that many children learn to use to get their way.
Your child will eventually learn that the best way to get your attention during the night is to sleep in your bed. This sounds kind of nice and cozy at first. But realize that children are not dolls. Your child will still wake up during the night. He/she will roll over, cry, hit you and/or kick you in the middle of the night. You and your spouse will not be able to spend private time together at night. Is this situation temporary? No, it is not. Actually, it is temporary for about three years. Until your child can be effectively reasoned with or disciplined, you will not be able to convince your child to go back to sleeping in his/her crib. Your child will find ways to get out of the crib, get out of the room, and get into your bed.
Your child needs to have his/her own place to sleep. Ideally, this should be their own crib in their own room. If an extra room is not available, then it should be their own crib in a room other than yours. When we lived in a two bedroom apartment, my oldest child would sleep in the second bedroom and my younger child would sleep in her own crib in the living room which was just outside our bedroom. Most couples will have a second child within three years of their first child. Sibling rivalry issues will occur, but these conflicts will be worse if both children are sleeping in them same room with you.
In many other cultures, raising a family in a crowded dwelling is a fact of life. They manage to raise their children without the need for separate bedrooms. Some experts believe that this type of close knit sleeping arrangement may have some psychological benefits. You must judge this for yourself and determine how you would like to proceed. Many homes may be too crowded and it may not be possible for each child to have their own room.
What if I prefer to have my infant sleep in the same bed with us (parents). What’s wrong with this?
This practice of infants sleeping in the same bed as parents is called co-sleeping (no crib). Co-sleeping is a necessity in crowded homes. Many families in many other countries prefer co-sleeping. Co-sleeping is less common in this country because Americans value privacy more so than in other countries. Families with a large enough home, have a choice of whether to sleep baby in a crib or co-sleep. If you prefer co-sleeping, then training your infant to sleep through the night using the method described will be very difficult. Co-sleeping sounds cozy and it promotes breast feeding. The major disadvantage of co-sleeping is that there is no separate time for privacy and getting a good night’s sleep is more difficult. A rare problem which occurs with co-sleeping is an adult who rolls over and smothers their infant during the night. While some doubt that this actually occurs, there are actual cases described in the medical literature. As an emergency room pediatrician, I had the grim task of pronouncing an infant deceased after being accidentally smothered by an adult during an afternoon nap. Adults who are heavy deep sleepers should not co-sleep.
Most parents prefer to have their infant sleep in a crib. Prior to training your infant to sleep through the night, it would be preferable to have their crib in a separate room.
What would happen if I want to train my infant to sleep through the night, but others in the household won't tolerate the crying?
This situation results in failure to train your infant to sleep through the night. It is very important that everyone in the household and your neighbors understand and agree with this plan. Everyone needs to understand that for the first two nights, there will be a lot of crying. This understanding must be done ahead of time. Do not attempt to start this plan until everyone agrees with it.
What often happens is, after a long period of crying during the night, someone will give in. This is usually a father or a grandfather. One of them will indicate that this much crying is too much. Emotional comments will usually follow such as; You are making the baby suffer!! In the middle of the night, it will be impossible to reason with such a person. Don't get into a fight over this. They will usually convince mom to nurse the infant, or they will get a bottle of formula and feed baby themselves. Realize that when this happens, your infant has just experienced partial reinforcement. This substantially strengthens their desire to wake up at night since they were rewarded for crying loud and long in the strongest way possible (partial reinforcement). When emotions have calmed and everyone is ready to try the plan again, it will now be harder to train your child to sleep through the night. Instead of two intense nights of crying, expect more.
Hopefully, by understanding the consequences of this, everyone in the household will understand how important it is to have a strong will and get this plan accomplished correctly on the first attempt.
Thank you for reading this chapter in its entirety. Initially, this plan may have sounded cruel. But after reading this entire chapter, I hope you will agree that this is the best way to train your infant to sleep through the night. When it comes to sleeping through the night, you basically have three choices:
1) Get lucky and your child will sleep through the night without any special effort.
2) Keep feeding your infant through the night for 15 to 20 months, at which time your child will begin sleeping with you for the next 2 years or more.
3) Follow the plan you just reviewed. It makes sense and is the best choice. I did this for all of my children and I have recommended this to other parents who have been very happy with its results. Other pediatricians have recommended this method as well.