Treating Sleep Problems Once They Arise

Author: Ian St. James-Roberts, PhD, FBPsS

baby crying

When it has been confirmed that your infant is normal and healthy but continues to wake up at night after 6-12 months of age, there is strong evidence that changing parents’ behavior is effective in stopping infant night waking and signaling. There are two main ways to do this:

1. "Controlled Crying" Methods
The first step is for parents to agree on a realistic bedtime and length of sleeping for the infant or child. He/she is then settled in their crib at the agreed time, often following a set of pleasurable activities, such as bathing, designed to calm the baby and establish a bed-time routine.

The ‘standard’ approach involves ignoring the crying and other protests which occur during settling, waking or resettling during the night, so that these are not rewarded by parental attention. Parents should not pick the infant up or take the infant into bed with them. In effect, the infant is left to cry until the crying stops.

A gentler method - called ‘Checking’ - is preferred by many parents and works almost as well. Using this approach, the parents make regular checks on their infant after he/she is placed in a crib, to ensure safety and provide limited comforting and reassurance. The checks should be minimal in length and in the amount of interaction between the infant and the parent. These “checks” can initially take place every five minutes, but the time between them is often set following a discussion between parents of what the infant and parents can tolerate. The amount of time can then be gradually increased to 10 and 15 minutes, in the same or following nights. Another method allows parents to stay in the room with the infant, but having minimal interaction with the infant.

Parents who wish to use these methods should consult a healthcare professional for guidance and advice before doing so. An important consideration is that some parents are unable to leave an infant to cry because they find this stressful or cruel. Unfortunately, half-hearted use of these methods is likely to worsen the problem, so a full discussion of what parents can manage is an important first step before these strategies are tried. Parental resources, values and circumstances are also very important. For some parents, finding ways of tolerating and coping with their child’s night waking may prove less disruptive for the family as a whole than trying to impose some of these methods to stop the night waking. Parents can also be reassured that many children will eventually stop waking them in the night on their own.

2. Positive Behavior Methods
This term is used for methods which avoid the need to leave babies to cry. The word ‘positive’ refers to methods which involve active steps to support and reward infants who quiet down and go to sleep at night. The main methods are like those used to prevent infant sleeping problems, described above. The main difference is that these are added in response to sleeping problems and, usually, at an older age. The steps involve adding a nightly routine of pleasurable, calming activities before bed-time. Feeding or rocking to sleep is discouraged. These calming activities should occur in the same place at approximately the same time each evening. Lighting in the place where the baby sleeps is reduced at night and increased in the morning, to encourage the infant to link sleep to darkness and times they are awake to daylight. Unfortunately, there is far less evidence that these methods are effective in dealing with infant sleep problems once they have arisen, and they are not as effective as the controlled crying methods described above.

Finally, a different group of infants has been identified who have multiple problems (prolonged crying, night waking, feeding and other problems), and these multiple problems continue after four months of age. These infants seem to be quite different from those who just have sleeping problems on their own. There is evidence that infants who have multiple problems after four months of age are more likely to have continuing and serious difficulties that last up to school age. Cases of this kind are much rarer, only about 5% of infants have these multiple and continuing problems. Unfortunately, our understanding of this recently recognized group of infants is poor. Therefore, if parents believe that their infant or child fits into this category, they should contact a health professional for advice.

It is worth remembering that being woken by a child in the night can be stressful, but is usually a sign that the child is in good health. How much better to have a child who wakes in the night than one who is quiet and sick! It can help, too, to bear in mind that most children will eventually stop waking and signaling in the night as they get older.

This section of the website was revised in December 2013 to include recent research evidence.