By Raising Children Network
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Sleeping baby credit iStockphoto.com/Mustafa Arican
 
You can solve baby sleep problems with controlled comforting, which is also called controlled crying. It involves comforting, settling and walking away so your baby learns to go to sleep without you. Here’s how to do it.

What is controlled comforting?

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

Controlled comforting involves quickly checking and reassuring your baby while he’s learning to settle.

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.

Is controlled comforting safe?
Controlled comforting has been found to be safe and effective. Babies whose parents have used controlled comforting are more likely to sleep better in the short term. In the long term they’re just as well-adjusted as other children their age in terms of behaviour and sleep.

Some parents worry that controlled comforting will hurt bonding and attachment, but when this settling strategy is used appropriately, there’s no evidence it harms babies or attachment. If you’re unsure or you’d like advice about your baby’s sleep, talk with your child and family health nurse or paediatrician.

Controlled comforting, controlled crying, crying it out: what’s the difference?

Controlled comforting is sometimes called controlled crying.

Controlled comforting or controlled crying is different from crying it out, where a baby is left to cry until she falls asleep. Crying it out isn’t recommended by child health professionals because it isn’t safe or effective in helping children learn to settle themselves to sleep.

Before you start with controlled comforting

Dealing with your baby’s sleep and settling problems can leave you very tired and stressed, especially if you’re losing sleep too. Controlled comforting is sometimes tried by parents who feel overwhelmed and unwell.

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, which also 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. Your baby might grizzle as she starts to settle.
  5. If your baby starts to 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 and your baby can manage.
  7. After each time interval has passed, return briefly to your baby if he’s upset. 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 your baby’s nappy. If it’s dirty, change her under low light and with minimal fuss.
  9. As soon as your baby is 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’s also learning that you’re not far away and you’ll eventually come back.
  10. Continue 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. 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 your baby hasn’t gone back to sleep after that time, get her out of bed and try again later.

Common problems with controlled comforting

Putting a sleeping behaviour strategy into practice doesn’t always go smoothly. Here are some common problems 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 keep the lights low, and to only change the baby if you need to – otherwise, some babies can learn to vomit each time they are put into the cot. If your baby vomits during controlled comforting you might prefer to choose a different sleep behaviour strategy – for example, camping out.

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 and 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?
You might be 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 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 seem 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. By going in when your baby is grizzling, you might be stopping your baby from falling asleep.

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.

Do your support network support controlled comforting?
Not everyone agrees with controlled comforting. You might be able to cope with disapproving family or friends, but if your partner or other close support people aren’t in agreement, it will be hard to carry through with the strategy. It’s best if at least the people in your home 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 instead.

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 help you to improve your baby’s sleep. You could think about getting this kind of support before you try controlled comforting. Read more about getting help with settling babies.
 
 
 
  • Last updated or reviewed 15-03-2016
  • Acknowledgements This article was adapted from the following source: Centre for Community Child Health, Royal Children’s Hospital (2012-2016). The Infant Sleep eLearning Program. Melbourne: RCH.