By Centre for Community Child Health, Royal Children’s Hospital, Melbourne
Pinterest
Print Email
 

A step-by-step guide to using controlled comforting.

Sleeping baby credit iStockphoto.com/Mustafa Arican
 

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.

Is controlled comforting harmful?
Despite concerns about potential harms to the baby, no studies published in peer-reviewed journals have shown any psychological or physical harm from using controlled comforting (or other behaviour management techniques described on this site). In fact, recent research has 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 in terms of behaviour and sleep in the long-term. A recent study also found that parents who used these techniques with their babies reported fewer symptoms of depression in both the short and long term than parents who didn’t.

Before you start

Parents dealing with sleep and settling problems can become very tired and stressed, particularly if they’re 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’re 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?

Ensure your baby is well before you start, and discontinue controlled comforting if your baby becomes ill during the program.

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’s 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 (for example, two minutes at first).
  6. Leave your baby for a sequence of set time intervals (for example, 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’s still crying. Talk to your baby or pat him for one minute, or continue talking or patting until he’s 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’s soiled, change him under low light and with minimal fuss.
  9. As soon as he’s quiet (or after one minute), but before he’s asleep, leave the room again and wait for the next set time interval. What you’re 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.

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 your baby’s bedroom. Go into another room and distract yourself, perhaps making a cup of tea and turning on the TV. Only go back to check on your baby when the set time is up.
  • Talk to your partner first to make sure that you both agree with what’s going on. Work out what role each of you will play (for example, helping with resettling or timing the intervals). Consider taking turns each night.
  • Avoid important commitments for the first few days after you start controlled comforting. You need to be able to see it through without a major change to the baby’s routine.
  • Remember to leave your baby’s room before she falls asleep.
Use this 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 hasn’t gone back to sleep, get him out of bed and try again later.

Common pitfalls

Implementing a sleeping behaviour strategy doesn’t 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 might 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 I’ve had enough?
If you’re too tired, or feeling too distressed or upset, pick up your baby, calm her in any way you wish (for example, with a small drink or a cuddle) and try again next time.

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

What if my baby is in pain?
Many parents are concerned about teething causing pain. If you pick up your baby and she settles almost immediately, it’s very unlikely she was in pain – she just wanted to be picked up. You can give paracetamol (Panadol) if you’re concerned. Paracetamol takes about 20 minutes to work, so babies who settle after that might 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 doesn’t appear to be working.

Are you using the strategy correctly?
To check, re-read the steps described here. Is there anything you’re 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 you can do to help you cope during the intervals?

Are you going in when your baby is only grizzling, not crying?
If so, you might be inadvertently interrupting your 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’re convinced that learning to sleep independently through the night is in your baby’s best interests, then it’s easier to find the motivation to carry on through the few nights needed to help her adjust to the change. If not, returning to the status quo might be 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 your baby has more time to go to sleep by himself, and less time to get upset by your return.

Is your support network actually supportive?
Not everyone agrees with controlled crying. Disapproving relatives or acquaintances are one thing, but if your partner or other close support people aren’t in agreement, 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? 

When it seems too hard

  • Consider breaking down controlled comforting into a series of steps. For example, you could rock your baby until she’s quiet and put her 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’s 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.

Research suggests that working with a trusted child health professional increases the chance of success. Consider getting this support before you begin using controlled comforting. Read Getting help with settling babies for more information.

 

  • Add to favourites
  • Create pdf
  • Print
  • Email
 
 
 
 
  • Content supplied by Centre for Community Child Health
  • Last Updated 17-06-2011
  • Last Reviewed 12-08-2009
  • Acknowledgements

    Adapted from: Centre for Community Child Health (2004). The Infant Sleep Study: Managing Sleep Problems in Babies: A Training Manual. Royal Children’s Hospital: Melbourne.

  • Hiscock, H., & Wake, M. (2002). Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. British Medical Journal, 324(7345), 1062-1068.

    Hiscock, H., Bayer, J.K., Hampton, A., Ukoumunne, O.C., & Wake, M. (2008). Long-term mother and child mental health effects of a population-based infant sleep intervention: cluster-randomized, controlled trial [Electornic version]. Pediatrics, 122(3), e621-627.