Welcoming a baby is a time of great joy for parents. It can also be one of the most challenging. One of the greatest difficulties many parents face is getting their baby to sleep and re-settling following night wakings.
Author
- Harriet Hiscock
Principal Fellow, Department of Paediatrics, The University of Melbourne
When these problems persist, parents' sleep can be disrupted, worsening their mental health and wellbeing.
At this stage, some parents might then turn to sleep strategies, previously known as sleep training. Sleep strategies aim to help a baby learn to settle themselves to sleep, without the help of an adult.
Others worry about claims these strategies might harm their baby.
So what does the evidence say?
Sleep is a learnt skill. While some babies learn to go to sleep easily, others need more help. If used properly, the evidence shows sleep strategies can help babies and parents sleep better, and don't harm the baby or their relationship with their parents.
But they can be hard to implement.
When might you use sleep strategies?
Sleep strategies are best suited to babies aged six months or older, once they can get enough food during the day to meet their nutritional needs. Younger babies may still need to wake for a night feed.
Only use sleep strategies if your baby's sleep is actually a problem for you - some parents are happy to get up multiple times overnight, and that's fine too.
A good bedtime routine is the foundation for success with any strategy - it helps a baby know that settling time is coming, and babies thrive on predictability. A good bedtime routine may include dinner, bath, PJs, a story and cuddle, then into bed.
How the 'checking method' works
The checking method is a common sleep strategy which used to be called controlled crying or controlled comforting. It's known as "graduated extinction" in scientific literature.
It involves parents putting their baby into their sleep space (such as a cot) drowsy but still awake, then leaving them to self-settle.
If the baby cries, the parent returns at increasing time intervals (for example, starting the night with two-minute intervals, then moving to four minutes, then six) and pats or rocks their baby until they are calm but still awake, then leaves. Parents repeat this until their baby falls asleep or the parent feels they have had enough, in which case they can pick them up, comfort them and try again the following night.
This doesn't mean parents leave their baby to "cry it out", as the parent returns at regular intervals to comfort the baby.
The checking method usually takes three to seven nights for a baby to learn to self-settle.
'Camping out' is another strategy
Another commonly used strategy is camping out, known in the clinic as "graduated extinction with parental presence".
This involves the parent putting a camp bed or chair next to the baby's sleep space.
For the first few nights, the parent pats their baby to sleep then leaves the room.
Once the baby is settling with this, the parent can sing or talk quietly until the baby falls asleep, rather than patting them.
After a few nights, the parent moves the chair or camp bed a couple of feet away from the sleep space.
Over ten to 14 nights, the parent gradually moves out of the bedroom altogether.
Can these strategies harm babies?
Some parents worry they may be causing harm to their baby. And misinformation has made it difficult for parents to weigh the pros and cons.
Some social media has conflated the outcomes of children from Romanian orphanages - who experienced prolonged deprivation in the 1980s - with the outcomes of sleep strategies.
Children from these orphanages were more likely to develop psychiatric disorders than peers raised in families. But it is the extreme circumstances of their upbringing that caused this, not sleep strategies.
We studied the impacts over five years
Our trials and follow-up of 328 Australian babies, starting in 2003, suggest sleep strategies are safe and effective.
We compared two groups of eight-month-olds: one (intervention) whose parents met with a trained nurse for advice on the strategies above, and one (usual care) who received no advice.
We followed these babies to ages ten and 12 months, and again at two and five years.
At ten and 12 months , mothers in the intervention group reported fewer baby sleep problems and better mental health than the usual care group.
By age two , mothers in the intervention group again reported better mental health, while parenting style and child mental health were similar between groups.
At age five , there were no group differences in child sleep, salivary cortisol (a stress marker), child emotional or behavioural scores, mother-child closeness, use of harsh parenting, or parent mental health.
In short, use of sleep strategies in babies was not associated with any evidence of harm to the child or the parent-child relationship.
Similarly, a 2016 study of 43 infants in Adelaide found that one month on from doing sleep strategies, babies' salivary cortisol decreased compared to those who did not do sleep strategies.
Twelve months later, there was no difference in child emotional or behavioural problems or in mother-child attachment between the groups.
I think I want to use sleep strategies, what next?
If your baby is aged six months or older and you want to try sleep strategies, agree on the approach with your partner, if you have one. This includes choosing which strategy you'll use and how it will work in your household. Some parents alternate nights so both get a better nights' sleep on alternate nights.
Strategies work best alongside a consistent bedtime routine and during a quiet one to two week stretch with few disruptions.
Only start when your baby is well - you can pause if they get sick and restart once they've recovered.
The evidence shows sleep strategies can work and you can be reassured there is no evidence of long-term harm to children.
If you need help with infant sleep, or if these strategies haven't worked, talk to your GP or child health nurse. They can refer you to an inpatient early parenting centre for more intensive support, if needed.
Harriet Hiscock received funding from National Health and Medical Research Council grants.
