Sleep Schedules
Firstly, it’s important to understand what sleep training actually is. Sleep training can be defined in many ways – but in broad terms, it is the intentional changing of a child’s sleep behaviors by their caregivers. This can be done in multiple ways, using different sleep training methods and at different times. The goal of sleep training is to teach children how to fall asleep and ‘stay asleep’ (or at least sleep independently without needing their caregivers to put them back to sleep). Some methods focus more on short-term wins, while others aim to create long-term healthy sleep habits (1).
The most common versions of sleep training are the cry-it-out method, the Ferber Method, and more recently various renditions of “gentle sleep training methods” that have gained popularity in recent years. While each of them is similar in certain aspects (they are all trying to solve a child’s sleep problems), there are also a lot of differences. Sometimes, having everything under the ‘sleep training’ umbrella can therefore be unhelpful.
This article is divided into 4 sections. First we will address the most common misconceptions, questions and controversies around sleep training. Then we will look at when the best time to start sleep training, different sleep training methods, and lastly why some sleep training fails.
I’m not personally a big fan of the term ‘sleep training’. One of the reasons is that the word ‘training’ has a lot of negative connotations (and is very different from the verb to teach for example). It also implies that a caregiver “trains” a child, when in reality, a lot of sleep training techniques are actually about training the parent (or at least Batelle is). Especially in the first year, so much of a baby’s sleep is down the caregiver and how they interact with them (2).
Sleep training has also been largely synonymous with the somewhat controversial ‘cry-it-out’ method. Cry-it-out promotes that you let a baby cry so they can learn to self-soothe. However, this sleep training method is outdated when you look at all the other ways to sleep train your baby that have been developed more recently. Although, what is interesting is that pediatricians still recommend CIO as the go-to method – largely because it is the most well-known and often is free. This is even more understandable when you realize that pediatricians (still) learn almost nothing about children’s sleep at med school (3),(4).
If you have done any investigation into sleep training, you will have heard about sleep associations. Sleep associations put simply, are things your child associates with falling asleep, like being rocked, co-sleeping held, or co-sleeping (5). The aim of sleep training is to help children develop sleep associations that do not include the parents – ie. the baby falls asleep on their own. Sleep associations are often based on something in a child’s sleep environment – whether physical (a bassinet, white noise, or having a swaddle for example) or an action (eg. a bedtime routine, breastfeeding to sleep, or cuddles before bed). The great thing here is that sleep associations are transient and can therefore be changed.
At Batelle, our focus is on first understanding what sleep associations a child may have, and then training the parent to dissemble those associations in a way that doesn’t make them feel unsupported or unresponded to.
Sleep training and night weaning often go together, but they aren’t the same thing. While sleep training teaches a child to sleep independently, night weaning is the process of eliminating night-time feedings, typically from about 6 months of age (6). In certain situations, depending on your child’s weight and health, night feedings might continue even after sleep training begins. At Batelle we promote something called a dream feed, which allows a parent to feed a child while they are still sleeping, which allows them to get the calories they need without creating associations that lead to poor sleep habits (7).
A sleep regression is when a child starts to have disrupted sleep patterns due to either a developmental leap or a change in their external or sleep environment. The first regression is the 4-month sleep regression, which usually coincides with when pediatricians advise sleep training to start (9). What we see is that often a sleep regression begins the cycle of night wakings and poor sleep patterns, as parents unknowingly create detrimental sleep associations (such as a middle-of-the-night feed) in an attempt to get better sleep in the short term. These regressions are often what leads to the need to then sleep train.
Most sleep training methods (such as CIO, Ferber Method (aka graduated extinction), and the Chair Method) are such that when a child goes through a regression period of time, even after being sleep trained, they typically fall back into ‘bad habits’ and often need to sleep train again (10). The reason for this is that these methods are teaching a child the end result (ie. falling asleep/self-soothe independently) but not working on the foundation of creating predictability and trust in their sleep environments and sleep space. Methods that focus more on a gradual, trust-building approach – such as the camping out method and Batelle’s approach are much better equipped to deal with sleep regressions as they have worked through a process rather than focused on the end result.
According to research, it’s generally not recommended to start sleep training until the child is around 4 months old. The American Academy of Pediatrics recommends that sleep training starts at around four to six months, although at Batelle, we recommend waiting until closer to the 6-month mark.
However, if your baby is younger than 6 months of age, you can still work on their sleep and lay good sleep foundations so that you never need to sleep train to correct a sleep problem. If you understand the mechanics of baby sleep, you can work on the basics such as having a good sleep schedule, having a consistent bedtime routine, and making sure that you create the best sleep habits possible so as to create an independent sleeper from the get-go.
There are very few robust studies that have been done on sleep training, which leaves new parents in a bit of a quandary about whether to sleep train or not (at least from a data perspective). Most of the sleep studies out there are down on few participants and are down through surveys, which are notoriously open to bias and interpretation. While there have been a lot of studies showing that sleep training causes no harm (eg. a recent 2022 study shows that they also make no difference to the bond between child and caregiver). There are also a few on efficacy, a lot of studies showing the benefit on a child’s health to have good quality sleep (and the effect on mood, development, and cognition on not getting enough sleep), and other studies also show in the long term that sleep training makes no difference to the long-term sleep of a child (11),(12),(13),(14).
However, the sleep training methods being studied are usually cry-it-out or Ferber (extinction or graduated extinction) and there is little to no research on the methods that focus on the root sleep issue (a need for reassurance) such as the Batelle Method and their long term efficacy and impact. For this reason, we have been building the largest sleep training database and plan to publish a number of studies on how best parents can get a good night of sleep with their little ones, including how these effects last well into later childhood.
There’s no hard-and-fast rule on how long sleep training will take. It greatly depends on the method used, the child’s unique disposition, and crucially how a parent implements that method. For some, results may be visible within a few days, while for others, it may take a few weeks to see a significant improvement.
Some methods, like the ‘cry-it-out’ method, typically yield faster results but are significantly more difficult for parents to implement and stick with. Conversely, ‘gentle sleep training methods’ may take a bit longer – as they typically focus more on incremental changes. But as discussed in our blog on “Is Batelle sleep training gentle?”, how you define gentle in the context of a gentle sleep training method is somewhat opaque and therefore often misleading.
Sleep training comes in many different shapes and sizes, although CIO is the method that comes to mind when you heard the words ‘sleep training’. In reality, there are several methods available, that have been designed to suit various parenting styles and children’s temperaments. Let’s briefly explore some of the popular sleep training techniques.
The Cry It Out (CIO) method, also known as the extinction method dates back to 1894 in Emmett Holt’s book ‘The Care and Feeding of Children’ (15). There are various definitions of CIO, with some people saying CIO is any sleep-training method that allows a baby to cry for a specified period before the parent will offer comfort (which would include a Ferber Method), while others take the purest view and see CIO as specifically what is called “extinction”. On the purest definition, CIO is when you let your baby cry – with no response from you as the caregiver – until they fall asleep.
CIO is still one of the more commonly used methods by new parents as it is the simplest to understand and implement – and also free. The difficulty is that it requires parents to not respond to their child, which parents understandably find very difficult.
The Ferber method is one of the most used methods of sleep training, especially among sleep consultants. It was developed by Dr. Richard Ferber, this method involves allowing your child to cry for a predetermined amount of time (eg. 15 minutes) before offering comfort. This is similar to the CIO method, as involves letting the baby cry, but in graduated extinction, the parent returns to comfort the child at increasing time intervals (versus not at all in the case of Cry-it-out).
The pick-up put-down method is similar to Ferber method but allows a parent to pick up the child during “check-ins” rather than need to reassure them while leaving them in their crib.
While these methods (and various other permutations of Ferber) are said to be effective in teaching children to ‘self-soothe’ and fall asleep independently, they can still be challenging for parents, who are still required to not respond to their child when they cry.
Now we start to come to what is usually considered the more “gentle sleep training methods”. The Chair Method, also known as the Sleep Lady Shuffle or the camping out method, is a well-known one and involves the parent sitting in a chair next to the child’s bed as they fall asleep. Over time, the chair is moved further away until it’s eventually out of the room.
This method can be less stressful than the CIO or Ferber method as the parent is present throughout the process. However, not only does it take longer to see results than CIO or Ferber, but the caregiver is not actually providing any emotional responses to the child, and therefore it is arguable whether this method is more supportive than CIO/Ferber or just more confusing for the little one…
Batelle uses a more engaged and emotionally responsive approach than any of the other methods. What we mean by the words “engaged” and “responsive” is that while you are still working on changing sleep associations or behaviors that are detrimental, the goal for a parent is to remain emotionally present throughout. Depending on the age and developmental stage of a child, the ways to get a good night’s sleep will be different and based on the needs of that child.
A lot of the Batelle Sleep School program is based on teaching the parents how to change their behavior in a way that helps their child to learn to self-regulate with the caregiver nearby and fully engaged. This is based on the premise that a child requires a secure attachment with the caregiver in order to feel safe and secure, especially when it comes to sleep. Batelle helps parents understand and attune to their child’s needs while also working towards healthy sleep habits. It is probably most comparable to the camping out method but has far more emphasis on engagement and support.
While a CIO method represents the least engagement (you walk away, go into a different room and don’t respond to a baby’s cry), Ferber, pick up put down and various “check-in” methods are not that dissimilar. The only change is that you are selectively (and to a child arbitrarily) giving comfort and reassurance rather than not at all. The Chair method (or other camping out methods) is more engaging but still doesn’t provide validation to their child – they simply show them they are not alone by virtue of their presence. While you do work your way out of the room with the Batelle method, you remain engaged and responsive to your child at every step of the way.
Sleep training doesn’t always work. In fact, a 2018 study showed that the efficacy rates for most ‘studied’ sleep training (primarily Ferber and CIO), had only between a 10-25% chance of “improving” infant sleep (16). There is a variety of factors that come into play here, including starting too young, not having consistent bedtime routines, having incorrect sleep schedules, or underlying medical reasons causing poor sleep. Before beginning sleep training, it’s often very helpful to rule out any health issues with your pediatrician.
However, the other big reason we see for sleep training failing – which in our experience is the main reason – is actually not to do with the child at all; it’s to do with the parent. If you implemented these methods like a robot, most of them would probably have some degree of improvement, even if that is likely short-lived. But parents are not robots. They are humans who care deeply about the well-being of their children. They are humans who are biologically triggered when they hear their baby cry. They are humans who second-guess themselves and worry about if they are doing these methods correctly. And because of this, a lot of these methods, (and especially the ones that require more disengagement like Ferber or CIO), often fail because parents don’t feel comfortable following through with them. The difficulty with this is that the more things you try and don’t complete, the higher your child’s cry threshold can become, meaning that they learn that in order to get you to re-engage they need to cry longer, harder, or louder. So when thinking about what sleep training method you want to go with, make sure you feel able to fully commit to whatever method you feel aligns best with you and your family.
In conclusion, there are a lot of things you need to know about when thinking about whether to sleep train or not when to start, and what methods to use. If you want to learn more about whether sleep training is a good option for you and your family – you can do so by booking a consultation below.
