Controlled comforting

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Controlled comforting (sometimes called ‘controlled crying’) is a behaviour management strategy for dealing with persistent settling and waking problems in young children.

The idea behind the strategy is to help children learn how to settle themselves to sleep, rather than parents feeding, patting or cuddling them to sleep. It’s not the only strategy parents have used. For information on alternatives, see Changing your baby’s sleep pattern

Controlled comforting involves brief checking and reassurance of your baby while he is learning to settle.

Before you start

Parents dealing with sleep and settling problems can become very tired and stressed, particularly if they are losing sleep themselves. Controlled comforting is sometimes tried by parents who feel overwhelmed or whose wellbeing is suffering.

Controlled comforting should only be used:

• with babies older than six months and less than two years
• as part of a total program for establishing healthy sleep patterns that includes a positive bedtime routine
• when you are confident your baby is getting lots of attention, time and affection during the day.

For information on what the research says is effective, see What works with persistent sleeping problems?

How to implement controlled comforting

1. Establish a consistent bedtime routine (see Positive bedtime routines).
2. When it's time to say goodnight, put your baby in his cot and tuck him in. Either talk to and/or pat your baby until he is quiet, or for one minute.
3. As soon as your baby is quiet, or after one minute, say goodnight and leave the room. Leave before your baby is asleep.
4. Stay out of the bedroom and give your baby a chance to settle by himself. Ignore grizzling.
5. If your baby starts to really cry, wait for the set amount of time before going back to your baby (e.g. two minutes at first).
6. Leave your baby for a sequence of set time intervals (e.g. 2, 4, 6, 8 and 10 minutes, or 5, 10 and 15 minutes). Set your own intervals of time based on how long you think you can manage.
7. After each time interval has passed, return briefly to your baby if he is still crying. Talk to your baby or pat him for one minute, or continue talking or patting until he is quiet (depending on your preference). Try to soothe him without picking him up if you can.
8. Keep an eye on his nappy. If it is soiled, change him under low light and with minimal fuss.
9. As soon as he is quiet (or after one minute), but before he is asleep, leave the room again and wait for the next set time interval. What you are trying to do here is give him the opportunity to learn to go to sleep by himself.
10. This process is continued until your baby falls asleep by himself.
11. When your baby wakes overnight, follow the same routine.

Some other important points about controlled comforting

• Controlled comforting takes between three and 14 days to work.
• Use a clock to time intervals; four minutes can seem like a very long time.
• Turn off all baby monitors.
• Don’t wait outside the baby’s bedroom. Go into another room. Distract yourself. Make a cup of tea and turn on the TV. Only go back to check the baby when the set time is up.
• Talk to your partner first to make sure that you both agree with what is going on. Work out what role each of you will play (e.g. helping with resettling, timing the intervals). Consider taking turns each night.
• Avoid important commitments for the first few days after you commence controlled comforting. You need to be able to see it through without a major change to the baby’s routine.
• Remember, leave the baby’s room before he falls asleep.

What about the day naps?

Use the strategy for daytime sleeps as well. This will lead to less confusion for you and baby. If your baby wakes up from a day sleep after less than an hour, try to re-settle him for another 15-20 minutes – again using controlled comforting. If, after that time, your baby has not gone back to sleep, get him out of bed and try again later.

Common pitfalls

Implementing a sleeping behaviour strategy does not always go smoothly. Here are some common pitfalls for parents putting a plan into action, and practical tips for how to deal with them.

What if my baby vomits? 
Some babies tend to vomit more often than others and about one in five may vomit during controlled comforting. If this happens it can be upsetting for baby and parent. Try to calmly clean up any vomit from the bed and put a clean nappy wrap under your baby’s head. It's best to avoid making a big fuss, turning on lights, or completely changing the baby unless absolutely necessary. Otherwise, some babies can learn to vomit each time they are put into the cot.

What if parents have had enough?
If you are too tired, or feeling too distressed or upset, pick up your baby, calm him in any way you wish (e.g. small drink, cuddle) and try again next time.

What if your baby is unwell?
If your baby is unwell, controlled comforting should be stopped and re-started when he is better again. If he has a slight runny nose and cough but no fever, controlled comforting can still be used if you are happy to do so.

What if the baby is in pain?
Many parents are concerned about teething causing pain. If you pick up your baby and he settles almost immediately, it is very unlikely that he was in pain. He just wanted to be picked up. You can give paracetamol (Panadol) if you are concerned. Paracetamol takes about 20 minutes to work, so babies who settle after that may have been in pain. If you have persistent concerns about your baby being in pain, talk to your doctor.

What if it’s not working?

There can be a number of reasons why a sleep program does not appear to be working.

Are you using the strategy correctly? To check, re-read the steps described here. Is there anything that you are not doing, or could do differently? Perhaps check with a professional who understands the use of this strategy.

Are you returning to your baby too soon? Are you following the time intervals exactly? Are you using a clock? Have you got something that you can do to help you cope during the intervals?

Are you going in when the baby is only grizzling, not crying? You might be inadvertently interrupting the baby from falling asleep. Only return if the baby is really crying.

Do you really want to carry through with this? Is the goal of uninterrupted sleep worth it for you and your baby? If you are convinced that learning to sleep independently through the night is in your baby’s best interests, then it is easier to find the motivation to carry on through the few nights needed to help your baby adjust to the change. If not, then perhaps returning to the status quo is your best choice.

Are the time intervals right for your baby? Some babies calm down when a parent enters the room. Other babies get more upset. If your baby is getting more upset, lengthen the time intervals to 5, 10 then 15 minutes.  This way the baby has more time to go to sleep by himself and less time to get upset by your return.

Is your support network supportive? Not everyone agrees with controlled crying. Disapproving relatives or acquaintances are one thing, but if your partner or other close support people are not in agreement, then it will be difficult to carry through with the strategy. It’s best if at least the people in your household can agree on a consistent approach. Perhaps another strategy like camping out may be more acceptable?

Is it just too hard?

• Consider breaking down controlled comforting into a series of steps. For example, you could rock your baby until he is quiet and put him down semi-asleep for a week. Then for the next week, put your baby in the cot fully awake.
• Try using controlled crying only at night when it is likely to be more successful.
• Ask your partner to manage the controlled crying (if he or she agrees to).
• Use camping out as an alternative.

If things haven’t improved after two weeks, talk to your doctor or child health nurse. They’ll be able to help you develop a program tailored to the needs of your child.

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