By Centre for Community Child Health, Royal Children’s Hospital, Melbourne
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You can solve baby sleep problems with controlled comforting. It involves comforting, settling and walking away so your baby learns to go to sleep without you. Here’s how to do it.
Sleeping baby credit iStockphoto.com/Mustafa Arican
 

What is controlled comforting?

Controlled comforting is a behaviour management strategy for dealing with persistent settling and waking problems in young children.

The idea behind controlled comforting is to help children learn how to settle themselves to sleep, rather than you feeding, patting or cuddling them to sleep.

Controlled comforting involves quickly checking and reassuring 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 with controlled comforting

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.

You should use controlled comforting only:

  • 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.
Ensure your baby is well before you start, and stop doing controlled comforting if your baby get sick during the program.

How to do controlled comforting

  1. Establish a consistent and positive bedtime routine.
  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 herself. 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 her nappy. If it’s dirty, change her 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. You’re trying to give your baby the opportunity to learn to go to sleep by himself. He is also learning that you are not far away and do eventually return.
  10. This process is continued until your baby falls asleep by herself.
  11. When your baby wakes overnight, follow the same routine.

Important tips for controlled comforting

  • Controlled comforting takes 3-14 days to work.
  • Use a clock or your mobile phone to time intervals – four minutes can seem like a very long time.
  • Turn baby monitors down or off. Make sure you can still hear your baby.
  • 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 your baby’s routine.
  • Remember to leave your baby’s room before he 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 her for another 15-20 minutes, again using controlled comforting. If, after that time, your baby hasn’t gone back to sleep, get her out of bed and try again later.

Common pitfalls with controlled comforting

Putting a sleeping behaviour strategy into practice doesn’t always go smoothly. Here are some common pitfalls with controlled comforting and practical tips for how to deal with them.

What if your 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 you. Try to calmly clean up any vomit from the bed and put a fitted mattress protector over the sheet. 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 you’ve had enough?
If you’re too tired, or feeling too distressed or upset, pick up your baby, calm him in any way you wish – for example, with a small drink or a cuddle – and try again next time.

What if your baby is unwell?
If your baby is unwell, you should stop controlled comforting start again when she’s better. If she has a slight runny nose and cough but no fever, you can still use controlled comforting if you’re happy to do so.

What if your baby is in pain?
Many parents are concerned about teething causing pain. If you pick up your baby and he settles almost immediately, it’s very unlikely he was in pain – he 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 controlled comforting isn’t working?

There can be several 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?
Many babies grizzle when drifting off to sleep and by going in you might be stopping your baby from falling asleep. Only return your baby is 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, 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 and 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 comforting. Disapproving family or friends 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.

When controlled comforting 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 comforting only at night, when it’s likely to be more successful.
  • Ask your partner to manage the controlled comforting (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 and family health nurse. They’ll be able to help you develop a program tailored to the needs of your child.

Working with a trusted child health professional can increase your chances of success in solving your baby’s sleep problems. You could think about getting this kind of support before you begin using controlled comforting. Read more about getting help with settling babies.
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  • Content supplied by Centre for Community Child Health
  • Last Updated 05-08-2014
  • Last Reviewed 19-05-2014
  • Acknowledgements This article was adapted from Centre Centre for Community Child Health, The Royal Children's Hospital, Melbourne (2012-2016). The Infant Sleep eLearning Program.
  • Centre for Community Child Health, The Royal Children's Hospital, Melbourne (2012-2016). The Infant Sleep eLearning Program. Retrieved July 28, 2014 from http://www.learninghub.org.au/course/category.php?id=10.

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