Sleeping through the night is a pretty big win-win for parents and babies.
But what’s the secret to making it more than just a wish-wish?
According to a new review of research on sleep in babies younger than six months:
It’s not only possible but developmentally normal
A little parental help is usually needed to help our babies get there
Some techniques work way better
And here’s the best part: You don’t have to put your baby through hours and hours of howling to get there.
The researchers behind this study told me they’re keenly aware of how, um, fraught this topic is (“crying it out” being three words that incite as much fear and loathing in parents as the words “sleeping through the night” evoke bliss and joy). None of us want our baby to experience unnecessary distress, after all. Not while learning how to sleep. Not ever.
At the same time, sleep problems are one of the biggest reasons for doctor visits in the first year. When babies don’t sleep well, everybody suffers. A few weeks of night feedings go with the territory. But month after month of sleep deprivation can turn anyone into a zombie—or worse. Moms of infants with sleeping problems have higher rates of postpartum depression. The quality of our relationships also tends to tank, other research has shown.
No kidding…that magic milestone is really, really important.
The secret to baby sleep
But how to get there?
The researchers looked at 11 past studies in the U.S., the U.K., and Australia that had examined how parents approached infant sleep during the first 6 months after birth. (Most studies have been done on older babies.) Their goal was to find an answer to this question: What works for younger babies?
The clear winner: what the researchers awkwardly call “active preventive interventions” in the February/March 2016 issue of The Journal of Developmental and Behavioral Pediatrics.
Think of it as parent-training.
Basically, it’s educating parents about how to do two things:
Put the baby down awake to self-settle.
Keep interactions with the baby to a minimum during the night (minimize rocking, patting, feeding to sleep—all sleep cues involving parents’ attention that a baby can become dependent on).
It’s a “parent-lite settling approach,” says study co-author Brian Symon, an Australian family doctor who has treated more than 10,000 families and specializes in infant sleep. His philosophy: “Love your baby to the full, but beware of rewarding negative behaviors.”
The studies also showed that parents who knew what to expect during normal infant sleep—and how to respond—did better. The key point here: Sleep runs through cycles, with multiple points of rousing and then returning to sleep.
For babies, falling back to sleep on their own is a matter of learning how to respond to the right cues, Symon says. The successful approaches taught parents to distinguish between independent sleep cues—things like being tired, not overtired; a dark room; and a bedtime routine—and things a parent has to rush in and provide. Because a full belly is another independent sleep cue, some studies also recommended a scheduled feeding between 10 pm and midnight (even if the baby was asleep then) to help increase feeding intervals at night.
Right from the start
And here’s a game-changer: You can start practically from birth.
Obviously, no newborn is developmentally ready to sleep through the night. They need to eat at least every few hours for the first four to six weeks. But putting your fed baby down before he’s zonked out? Not rocking to sleep? Helping distinguish between day and night? You can definitely begin those habits early, the studies showed. Many of the education programs reviewed actually began before birth.
The goal, according to Symon: a baby who sleeps well—up to 12 hours at night and 4 to 6 hours during the day—by about 12 weeks.
But uh-oh, what if you already have a baby who doesn’t sleep well?
More good news: Parent-training works just as well helping babies who have already developed trouble sleeping as it does preventing problems, the review found.
It’s a matter of the baby learning to replace his old sleep cues (you) with new ones. And yes, Symon acknowledges, it can lead to a short-term uptick in crying for a couple of nights. That’s the part many parents dread, Symon told me. But it’s short-lived, he was quick to add. In his own practice, he’s found that 9 out of 10 babies who’ve had trouble sleeping learn to sleep well within two to four nights.
For parents who don’t want to trade even short-term pain for long-term gain, two modified versions can work, the review showed:
Responding at timed intervals: Where the parent waits to respond to crying for 5 minutes, then 10 minutes, and so on. “The downfall of this approach is that the baby can quickly learn ‘crying skills,’” says Georgina Crichton, a research fellow in psychology at the University of South Australia and the study’s co-author. “That is, they learn that as long as they keep crying, Mum or Dad will eventually come.”
Camping out: Where the parent sits next to the baby until she falls asleep, gradually increasing the physical distance between them.
Neither tactic works any better for the baby, Symon told me. Both run the risk of dragging out the process. But some parents, he’s found, prefer them—even though it can mean they end up in the very place they’re trying to leave: prolonged night-waking.
What didn’t work so well:
The researchers found no study in which repeatedly responding to a crying baby in the middle of the night improves sleep. In other words, if you keep getting up to soothe and settle your 4-month-old, you’ve succeeded in avoiding crying—but neither of you is getting great sleep. And you’ll probably still be getting up all night at 6 months, 12 months, 18+ months….
But what about the crying?
When done right, the studies show, learning the skill of how to sleep doesn’t mean much, if any, crying. “One of the cruel ironies is that this teaching is incorrectly labeled as ‘letting babies cry,’ when in fact they cry very little, as they are not given a reason to cry,” Symon told me.
“Babies cry very, very little if they aren’t hungry or overtired or both.”
For all of our justifiable aversion to crying (whether a lot or a little), the review turned up no data showing that crying hurts a baby, either physically or psychologically. “We did not find any evidence for short- or long-term harm,” Crichton told me. Poor sleep, she added, has far bigger consequences for kids—and parents.
Making everybody happy
Long-term follow-up studies of the “parent-training” approaches found no negatives and lots of positives. “Once a baby or child has great sleeping skills, either by being taught from birth or after resolving an established problem, the child functions at a superior level,” Symon told me. “They eat better, learn faster, are better company, function with more logic, and play more constructively.”
Then there’s the rest of the household. In his own practice, almost one-third of new moms come to him with some degree of depression at their first visit, he told me. Earlier research he published showed that those depression scores dropped by 85 percent within two weeks after parent-training. Anxiety and stress scores also dropped.
A good night’s sleep is that powerful. And, fortunately, that possible.