By Centre for Community Child Health, Royal Children’s Hospital, Melbourne
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Baby awake in cot credit iStockphoto.com/barbaragibbons
 
What’s the secret to a good night’s sleep for the whole family? Your baby learning how to go to sleep without your help. This approach is for dealing with persistent sleep problems in children six months or older.

A new sleep pattern: in a nutshell

The first step to an uninterrupted night’s sleep is to help your baby learn to fall asleep independently at bedtime. This means creating a new sleep pattern.

  • Put your baby into the cot awake. This way, he can begin to learn self-soothing skills and how to fall asleep independently. Babies won’t learn to fall asleep by themselves if you do it for them.
  • Usually, when your baby has learned to fall asleep independently at the start of the night, he can get back to sleep without your help during the night.
  • It takes 3-14 days to change a baby’s sleep patterns, just as it takes a few days for grown-ups to get over changes to their sleep patterns (for example, when suffering from jet lag).
  • You can change your baby’s sleep pattern, but expect your baby to protest for the first few nights, until he gets used to the change. Sleep will then improve for everyone.
To learn more about the causes of common sleep problems, you might like to read these articles: Concerned about your baby’s sleep? and What causes sleep problems?

Four steps to better sleep

The key is to change habits associated with going to sleep, and to allow your baby to develop the ability to settle independently. Here are the steps:

  1. Identify the habit associated with the sleep problem.
  2. Gradually phase out this habit.
  3. Establish a positive bedtime routine.
  4. Teach your baby to settle to sleep independently. 
The support of a trusted child health professional can make all the difference to successfully changing your baby’s sleep pattern. Talk to your maternal and child health nurse or contact an early parenting centre in your area. You can also read more about getting help with settling babies.
Step 1: Identifying your baby’s sleep habits
Usually, the way your baby falls asleep at the start of the night is the way she’ll expect to go back to sleep after waking during the night – so if she’s rocked or fed to sleep at the start of the night, she’ll expect to be rocked or fed back to sleep later. This can become a problem when you have to interrupt your own sleep to help your baby resettle.

The first thing to do is work out what habits your baby is associating with going to sleep. The following table has some tips to help think through your baby’s sleep habits over the last 24 hours.

Sleep habits Your child
Where is your baby normally put down to sleep?

Is this the same place where baby wakes during the night? If your baby is in the habit of falling asleep in the family room, or in your arms, he might need this to get back to sleep after waking during the night.

Possible habit: falling asleep in a different place

If your baby cries when put in the cot, what do you do?

If you’re in the habit of picking up, cuddling or rocking your baby to sleep, he might have developed the habit of needing your presence to get to sleep. He’s likely to need this during the night as well as at bedtime.

Possible habit: being held or rocked to sleep

Is your baby put into the cot asleep or awake?

If your baby is awake, how do you settle him? The things you do when you settle him for the night are the things he’ll want after waking later.

Possible habit: being rocked, fed, patted or cuddled to sleep

Is a dummy used?

Can your baby replace the dummy without your help during the night? If not, he might call out to you for help.

Possible habit: falling asleep with a dummy that gets lost when it falls out

Is a mobile or music used?

Do you have to turn music on again when your baby wakes in the night? If so, it’s likely he’s developed the habit of needing it to settle.

Possible habit: needing music to fall asleep

Some other things to consider

  • Does your baby have a predictable bedtime routine? Do you do similar things together every night before bedtime? If not, introducing a routine will help your baby get ready for sleep.
  • Is your baby getting enough sleep during the day? If she’s not having regular daytime sleeps, she could be overtired – and overtired babies are more difficult to settle at night. That might sound strange, but settling is a learned behaviour. Like anything learned, settling is harder for your baby to do when exhausted. You might like to consider re-introducing daytime sleeps.
Step 2: Phasing out sleep habits associated with night waking
If your baby is falling asleep in another room, or you’re rocking, holding or cuddling him to sleep, you could try to develop a new habit of putting your baby in the cot drowsy but awake. This helps him learn a new sleep habit that doesn’t require you to be there. In rare circumstances, this might do the trick.
 
The following table includes tips to help you phase out existing sleep habits. 
Sleep habit How to phase it out
Night feeding

If your baby routinely falls asleep at the breast or with the bottle, she might now depend on feeding to help her get to sleep. Try to change this habit by:

  • trying to finish the last feed at least 20 minutes before bedtime
  • feeding her the last feed outside the bedroom – this helps weaken the link between feeding and sleeping
  • fading out night feeds altogether – this is an important step if you’re trying to consolidate your baby’s sleep during the night.

Babies six months and older who are developing well and putting on weight as expected can be taught to re-settle overnight without a feed.

Dummies If a dummy is causing problems (for example, your baby needs you to find and replace it overnight), you can try to help your younger baby give up the dummy. You can teach older babies to manage their own dummies during the night.
Music and mobiles In general, if your baby is having problems resettling overnight, it’s probably best to stop playing music at bedtime. This is especially the case if resettling means you have to get out of bed to turn the music back on during the night.
Baby monitor In general, you won’t need to use a baby monitor when carrying out settling techniques. If your baby is a long way from your room, a monitor can be used. But avoid responding when your baby is only grizzling.

Step 3: Establishing a positive bedtime routine
A positive bedtime routine helps prepare a baby for sleep. This means organising bedtime around a series of consistent activities and tasks, done roughly in the same order and at the same time each night. A positive routine is predictable and includes calming and soothing activities.

In addition, you need to make sure that your baby is getting enough sleep during the day. Babies who get overtired during the day can find it harder to settle to sleep at night.

A daytime bed routine and the two strategies described below can help you improve daytime sleeps for your baby. 

Step 4: Teaching your baby to settle back to sleep
A good bedtime routine sets your baby up for success. But you’ll need a strategy for managing crying out at bedtime or during the night when your baby wakes.

If you’re confident you’re giving your baby enough attention throughout the day, but you feel he’s become dependent on you to fall asleep, you can use a behaviour management technique, such as controlled comforting or camping out.

Research has shown that behaviour management techniques are the most effective in solving sleep problems. These techniques are based on the observation that babies who cry when waking overnight haven’t learned to self-soothe and fall asleep by themselves. These techniques aim to teach babies to fall asleep without the help of an adult.

Choose the approach you’re most comfortable with and try to use it consistently for a period of time:

  • Controlled comforting: Sometimes called ‘controlled crying’, controlled comforting has been practised since the 1970s. It’s a systematic way of gradually reducing your attention to crying and calling out.
  • Camping out: this is based on the idea that parental presence is reassuring to a baby. It involves the parent staying in the room, gradually reducing the amount of help the baby needs to settle. It’s a good option for a parent who wants to stay near, but might not be the best idea for a parent who is easily upset or frustrated when their baby cries. Research suggests that the process involves less crying than the controlled comforting strategy.
Research suggests that these two approaches are successful in 80% of cases. You can read more in our guides to controlled comforting and camping out.

Things to consider

  • Consider your timing before you begin. Both approaches can be demanding and tiring. If your child is ill or you’re going through a major upheaval, such as moving house, wait until later.
  • Stop using a behaviour management strategy if you or your child becomes ill during the program.
  • If you can’t take any time during the day to have a rest and catch up on some sleep, you might be better off waiting until you can.
  • Choose the approach you’re most comfortable with, and that fits best with your family and situation. We know this is an important part of success. Although we know that these approaches are successful 80% of the time, we don’t know why they don’t work with every baby.
Are sleep behaviour techniques harmful?
Studies have shown that babies who have undergone controlled comforting are more likely to sleep better in the short term – and are as well adjusted as their peers when it comes to behaviour and sleep in the long term. Despite some people’s concerns, no studies have shown any psychological or physical harm from using the techniques described here.

Older siblings

Parents are often concerned that a baby’s crying might wake a sibling during the night. There are a couple of possible approaches to this problem:

For settling

  • Tell your older child that you’re going to settle the baby five minutes before you do it. Make it clear to the sibling that they either need to stay out of the baby’s room or remain quiet if they’re going to go in.
  • Find something to keep the older child interested in while settling the baby. For example, give her a different toy or book, a snack or drink, or ask her to ‘settle’ a toy baby (these are all best done outside the baby’s room).
  • Reward the older child for staying out of the room or for remaining quiet in the baby’s room.

For waking overnight

  • Keep in mind that crying babies rarely wake older children overnight. If you’re concerned, you can pre-warn the older child that the baby might wake and cry. Tell your older child not to worry because mummy and/or daddy are taking care of it.
  • If crying does cause problems, it might be helpful for the older child to sleep in a room further from the baby (if possible), or to spend the night at a family or friend’s house. 

Sharing your room or bed with your baby

If you share a bed with your baby, you can pat him briefly to encourage settling. Turn away when your baby is quiet to allow him to settle to sleep. See Sharing your bed with baby for more information on safe co-sleeping.

Putting a screen up between your bed and the cot can be a good idea if you’re sharing your room with your baby and you want to use controlled comforting. This means she won’t be able to see you directly, and might not be as upset when you don’t offer a cuddle. Cardboard or a sheet will do for the screen.

Looking after yourself

Changing a baby’s sleep patterns is a challenging and tiring task. You need to look after yourself as you see it through:

  • Rest at least once a day. Even if you don’t go to sleep, resting can help restore your energy and ward off fatigue.
  • Go to bed at night soon after your baby has gone to sleep. This is to ensure at least 2-3 hours of unbroken sleep for yourself.
  • Accept offers of help. 

Relapses and other difficulties

About 20% of babies who learn to resettle during the night will begin to wake again for no apparent reason. If your baby is otherwise well, persist with your settling program. Usually babies will go back to their good habits after a couple of nights. A burst of night waking usually occurs two weeks after babies have learned to resettle during the night. 

If you’re still having problems after seven days of controlled comforting or two weeks of camping out, talk to your doctor or child health nurse. These health professionals might be able to help you tailor a program that will work better for your baby. You might also like to contact an early parenting centre in your state or territory where you can receive more support and help.

Contact a child health professional if at any time you feel things aren’t working, or you’re anxious, distressed or don’t know what to do next. You can also call a parenting hotline in your state or territory for help – some can be reached at any time of the day or night. 

Recapping on baby sleep

Here’s what you need to know about your baby’s sleep before starting out on a change program (for babies six months and over):

  • Your baby usually needs the same amount of sleep from one day to the next.
  • Babies differ in their sleep needs.
  • Both adults and babies cycle through ‘quiet’ and ‘active’ sleep during the night.
  • The first few hours of your baby’s sleep is usually quiet (deep) sleep. The rest of the night has more active (lighter) sleep – this is when babies usually wake up.
  • Waking during the night is normal, but it can cause problems if your baby can’t get back to sleep without your help.

Video Baby sleep stories

In this short video, parents talk about encouraging baby sleep. They share tips on:

  • identifying sleep cues
  • finding out what helps babies to sleep
  • being consistent with sleep and settling techniques.

As these mums and dads say, every baby is different. What works for one baby might not work for another. You might need to experiment to find out what’s right for you and your baby.

 
 
 
 
  • Content supplied by Centre for Community Child Health
  • Last updated or reviewed 30-08-2011
  • Acknowledgements Adapted from: Centre for Community Child Health (2004). The Infant Sleep Study: Managing Sleep Problems in Babies: A Training Manual. Melbourne: Royal Children’s Hospital.