Amazing Baby Sleep Secrets

You are strongly encouraged to print this book out immediately and then read it.
Most of us just dont have the patience to read through something on the
screen, and its much easier to pick it back up later if youve already printed it.
The Baby Sandmans

Amazing Baby Sleep Secrets:
The Ultimate Guide to getting your infant or toddler
to go to sleep and stay asleep every night
By Michael F. Quarles, Sr.,

The Baby Sandman
2001 Franklin Miami Publishing, LLC
Introductory
Materials
Copyright Notice
2001 Franklin Miami Publishing, LLC
All rights reserved.
Any unauthorized use, sharing, reproduction or distribution of these materials by any means, electronic,
mechanical or otherwise is strictly prohibited. No portion of these materials may be reproduced in any
manner whatsoever without the express, written consent of the publisher.
Published under the Copyright Laws of the Library of Congress of the United States of America, by:
Franklin Miami Publishing, LLC
7548 Preston Road, Suite 141-222
Frisco, TX 75034
Phone (972) 335-6677
Fax (214) 335-6677
Email babysandman@fmpllc.com
Website: www.fmpllc.com/babysandman/
Office phones are answered live only Wednesday morning from 8:00 a.m. to 12:00 p.m. Texas time.
All other times, calls are routed to voice mail. You can FAX anytime to (214) 853-5648. Routine
customer service calls, faxes and emails are usually handled within 72 hours. When we respond to you by
FAX, we try connecting three times, then resort to mail, so if you dont have a dedicated FAX line or you
turn your machine off, you probably will not get a response by FAX.
Legal Notice
While all attempts have been made to verify information provided in this publication, neither the author
nor the publisher assumes any responsibility for errors, omissions or contradictory interpretation of the
subject matter herein.
This publication is not intended to be used in place of proper medical advice. Often, pediatric sleep
disorders are caused by medical problems, and appropriate medical advice from a licensed doctor should
be sought for any medical problem or perceived medical problem.
The purchaser or reader of this publication assumes responsibility for the use of these materials and
information.
While this publication does provide analysis and opinion regarding the sleep methods of other sleep
experts, this analysis is designed to be informational only. Any perceived negative remarks about any
individuals or organizations are unintentional.
Amazing Baby Sleep Secrets Page 3 Available at

http://www.fmpllc.com/babysandman.html
Additional Information
Amazing Baby Sleep Secrets:
The Ultimate Guide to Baby Sleep
Latest Update - March 1st, 2001 - Version ABBS103
Thank you for ordering Amazing Baby Sleep Secrets. If you paid for this
book by credit card, your statement will show a charge from FRANKLIN
MIAMI PUBLISHING, LLC please make a note of this.
I welcome any comments (or questions) you might have. I can be reached
by email at BabySandman@fmpllc.com. If you would like to find out how you can make
hundreds (or even thousands) of dollars a month with almost no effort by helping to promote this
book, simply send an email to the same address and mention affiliate programs.

Contents
INTRODUCTORY MATERIALS
Copyright Notice ...............................................................................................................3
Legal Notice .......................................................................................................................3
Additional Information ....................................................................................................4
Contents ...............................................................................................................................5
SECTION I: AN INTRODUCTION TO INFANT AND

TODDLER SLEEP PATTERNS AND ISSUES
Chapter One: Infant and Toddler Sleep An Introduction
He/She Issues ......................................................................................................................9
How to Use This Book........................................................................................................9
Whats Normal? ..............................................................................................................10
The Non-Controversial Sleep Suggestions .........................................................................12
SECTION II: THE EXPERTS ANALYZED

Chapter Two: Dr. Richard Ferber
Background on Dr. Ferber ..................................................................................................16
Introduction to Dr. Ferbers Ideas.......................................................................................17
Bedtime Routines and Going to Sleep ................................................................................17
Sleep Patterns and Staying Asleep......................................................................................19
Cosleeping...........................................................................................................................20
Feeding as a Cause of Sleep Problems ...............................................................................21
Daytime Routines................................................................................................................21
Medical Issues.....................................................................................................................22
Summary/Diagnosing Sleep Problems ...............................................................................23
Chapter Three: Dr. William Sears

Background on Dr. Sears ....................................................................................................25
Introduction to Dr. Searss Ideas ........................................................................................26
Facts About Infant Sleep.....................................................................................................26
Step-by-Step Approach to Nighttime Parenting .................................................................27
Cosleeping (aka sharing sleep)........................................................................................29
Summary of Dr. Searss Sleep Program .............................................................................30

Chapter Four: Dr. T. Berry Brazelton

Background on Dr. Brazelton .............................................................................................31
Introduction to Dr. Brazeltons Ideas..................................................................................32
Statistics and Independence Issues .....................................................................................32
Three Personality Types Who Dont Sleep Well................................................................33
Miscellaneous Extras ..........................................................................................................34
Chapter Five: The American Academy of Pediatrics and Dr. George J. Cohen
Background on Dr. Cohen and the AAP.............................................................................35
Introduction to the AAPs Ideas .........................................................................................36
A Little More Sleep Science ...............................................................................................36
Newborns Through Three Months......................................................................................37
Three to Six Months............................................................................................................38
After Six Months.................................................................................................................38
How to Deal With Nighttime Crying in Infants and Toddlers............................................39
Other Sleep Issues and Suggestions....................................................................................40
Chapter Six: Joanne Cuthbertson & Susie Schevill

Background on the Authors ................................................................................................43
Introduction to the Authors Ideas ......................................................................................43
Book Introduction ...............................................................................................................44
Getting Your Child to Go Back to Sleep on Her Own .......................................................45
How to Get Your Baby to Fall Asleep on Her Own ...........................................................47
Situations and Developmental Factors That Can Disrupt Sleep.........................................48
Other Age-Specific Advice.................................................................................................49
Chapter Seven: Gary Ezzo

Background on Mr. Ezzo ....................................................................................................50
Introduction to Mr. Ezzos Ideas ........................................................................................51
Parent-Directed Feeding (PDF) ..........................................................................................52
Babies and Sleep .................................................................................................................53
Scheduling and How to Drop a Feeding .............................................................................54
Chapter Eight: Dr. Paul M. Fleiss

Background on Dr. Fleiss ...................................................................................................55
Introduction to Dr. Fleisss Ideas........................................................................................56
The Problem is One of Expectations ..................................................................................56
A Few Miscellaneous Points of Interest .............................................................................57
Chapter Nine: Dr. Jeffrey Hull

Background on Dr. Hull......................................................................................................59
Introduction to Dr. Hulls Ideas ..........................................................................................59
Whats This Disappearing Chair Thing All About?........................................................60
A Few Other Thoughts........................................................................................................61
Chapter Ten: Jodi A. Mindell

Background on Dr. Mindell ................................................................................................62
Introduction to Dr. Mindells Ideas ....................................................................................63
The Basic Method ...........................................................................................................63
Miscellaneous Advice from Dr. Mindell ............................................................................64

Chapter Eleven: Dr. Benjamin Spock

Background on Dr. Spock...................................................................................................66
Points From Dr. Spocks Book ...........................................................................................67
Chapter Twelve: Dr. Marc Weissbluth

Background on Dr. Weissbluth...........................................................................................68
Introduction to Dr. Weissbluths Ideas ...............................................................................69
How Much Day and Night Sleep ........................................................................................70
The Newborn Up to Four Months.......................................................................................72
Months Four and Beyond....................................................................................................72
Other Thoughts from Dr. Weissbluth .................................................................................73
SECTION III: PUTTING IT ALL TOGETHER

Chapter Thirteen: The Baby Sandman
The Short Version (I Need Help Now) ...........................................................................75
What You Can Learn from Each of the Authors ................................................................76
Putting It All Together ........................................................................................................78
Checklist for the Basics ......................................................................................................84

Section I:
An Introduction to
Infant and Toddler
Sleep Patterns
and Issues

Chapter One:
Infant and Toddler Sleep An Introduction
He/She Issues
Every author nowadays faces the question

of what to call people. Is it his, hers, his or
hers, or should I struggle to work in a
generic form? In this book, I have
universally adopted the feminine version. I
find the flipping back and forth that many
authors have adopted lately to be contrived
and awkward. Traditionally (until the last
couple of decades), books have used the
masculine as the inclusive version.
Therefore, to even it out a bit, I have simply

chosen the feminine version.
There are only one or two places where
gender even comes up in this book, and
what I mean should be readily apparent in
those sections. Everywhere else, she means
he and hers means his and so on if you have
a baby boy.
How to Use This Book
This book is designed to be thorough, yet
The three ways you can use the book are I

Need Help Now, a complete reading taking
my suggestions, or using it as a review of
whats out there so you know where to go
next.
concise. At the same time, you may have a

need to start making changes immediately.
Maybe you just cant wait until youve read
this all the way through.
Therefore, I have designed
If you are in I Need
this book so that you can
use it any of three ways.
Help Now mode, I
If you are in I Need Help Now

mode, I suggest you read
Chapter One, then Chapter
Thirteen. As you find the time,
you should then come back and
read the rest of the book
beginning at Chapter Two.
No matter which of the

suggest you read
ways you choose, I
Chapter One, then
strongly suggest you print
this entire book out, rather
The Short Version in
than trying to read it on a
If you think you might want to
computer screen. As much
Chapter Thirteen. You
take my suggestions (which of
as I would like to
course I think are valuable, but
encourage conservation, I
can come back to the
you have to read them to find
know that none of us has
out), and youre not in critical
rest later.
the same attention span for
emergency mode, I suggest
reading on a computer
reading, or at least skimming,
monitor as we do for reading in print.
straight through from Chapter One through
Thirteen. I have tried to make the text
succinct and readable, and an average reader

should be able to get through the whole
book in about two to four hours.
The last method, which is for those who
think Im probably full of hot air, is to use
this as a resource for further research. Even
if you decide my method, which combines
what I consider to be the best of the other
authors ideas, is wrong for you, this book is
well worth your time and money. After
reading this, especially Chapter Two
through Chapter Twelve, you will have
gained enough knowledge about what else is
out there to decide whose program you want
to adopt.
If its not mine, I have provided links to the
materials from each author so that you can
purchase the one or two that make the most
sense. By using this as a book review of the
baby sleep literature, you can save the
hundreds of dollars it would have cost to

buy all the authors materials and review
them on your own. If you choose this
approach, note that I have actively attempted
to prevent repetition of information in the
middle eleven chapters. Therefore, you
should not assume that a failure on my part
to mention an authors coverage of a topic
means that they skipped it. If their
information was especially enlightening, I
have highlighted it, but if its pretty generic
and covered elsewhere, I have not.
If you skim the table of contents, you will
see that the chapters that review the various
authors methods start with Ferber and
Sears, and then proceed alphabetically with
the others. Ferber and Sears represent the
two most commonly discussed schools of
thought
(progressive
waiting
and
attachment parenting), so I put them first.
Whats Normal?
Although
the question of how to handle

sleep problems results in dramatically
different responses, there is general
agreement on many of the standards for
normal. Everyone agrees that what you
should be doing depends on your childs
age.
For the first six weeks or so of a newborns
life, sleep is just plain disorganized. There is
a sort of a cycle that has three elements:
waking, sleeping and feeding. As some
parents have said, at this age babies dont do
much other than sleep, feed and eliminate.
The cycle typically lasts around three or four
hours around the clock, and night is not
much different than daytime.
Sometime around the four to six week
period, your infants system will begin
recognizing day and night. Biological
rhythms will start forming, and these

rhythms will, as your baby ages, control the
release of various hormones, including those
that govern the sleep cycle. By the time your
baby is around four to six months old, her
neurological system will be pretty fully
developed in its ability to regulate these
rhythms.
While science still has not really discovered
exactly why we need to sleep, many studies
have shown that it is important. Similarly,
we dont know exactly how much sleep we
need, but we can obtain some guidance by
looking at typical sleep patterns. The
following table, which I built by combining
the numbers from several sources, shows the
approximate amount of sleep required by
children at various ages.

The ranges are for the middle eighty percent,

so if your child falls outside of the range,
she is at the extreme ten percent on one end
or the other. Although your child may be
into one extreme or the other, she may still
be getting just the right amount of sleep for
her. If she is in one of the extremes,
however, it is probably worth pointing out to
your pediatrician. Similarly, the fact that
your child is in the range, or even dead on

average, does not necessarily mean she is
getting the right amount of sleep for her.
Watch for signs of overtiredness, especially
late in the day. As sleep deficits have
somewhat of a cumulative effect, it may take
days, weeks or even months before the signs
appear, so always listen to your babys
signals.
Night Sleep:
Mid 80% Range and Midpoint
Typical Number of Naps
Total (including naps):

13-20 hours (avg. 16)
6-8 Sleep Periods
Night Only (here and below):

11-16 hours (avg. 14)
3 (2-3 hours each)
At Six Months
9-12 hours (avg. 10)
3 (1-2 hours each)
At One Year
10-13 hours (avg. 11)
2 (1-1 hours each)
At Two Years
9-12 hours (avg. 11)
1 (1-2 hours)
9 - 12 hours (avg. 11)
Typical Sleep at Various Ages

In Early Postpartum Period
At Three Months
At Three Years
You will notice that, at certain ages,

particularly when children drop naps,
sometimes their requirements for nighttime
sleep go up for a while.
to help your child go back to sleep when she

experiences these wakings. How to
accomplish this objective is where the
authors disagree.
The sleep cycle for children is also different

than that for adults. While all humans cycle
through different sleep states during the
night, infants have a cycle that involves
shorter and more frequent cycles, with a
larger percentage of their time spent in light
sleep states. For this reason, slight wakings
during the night are not only acceptable, but
also perfectly normal and unavoidable.
A newborn will take about twenty minutes

after first falling asleep to enter a deeper
state of sleep, and this time comes down to
around ten minutes by three months of age.
For this reason, if your child has fallen
asleep and you want to move her, you are
less likely to wake her if you wait until she
has entered this deeper sleep state.
Therefore, the question is not how to prevent

these wakings, as you cant, but rather how
Beyond what Ive gone over above, we

simply dont know a lot about what works
best or the long-term impact of various sleep

methodologies, and there is not much

general agreement. Although our knowledge
is scanty, it is growing. Much of the advice
is based on anecdotal experience, rather than

careful research.
The Non-Controversial Sleep Suggestions
have purposely avoided controversial

subjects in this opening chapter. This section
reviews suggestions that are agreed upon by
almost all those giving infant and toddler
sleep advice. The controversial issues are
addressed both in the individual chapters
and in the final chapter.
Circadian Rhythms. As mentioned in the
previous chapter, biological rhythms called
circadian rhythms govern the sleep-wake
cycle in humans. These rhythms control the
release of hormones including human
growth hormone, melatonin and serotonin.
The single biggest factor influencing
circadian rhythms is light, but eating times,
routines we associate with bedtime, and
even clocks themselves can make a
difference.
In studies where all external time clues were
removed, sleep researchers have determined
that the natural human clock, on average, is
closer to twenty-five than twenty-four hours.
For this reason, it is often easier to adjust
your babys schedule, or your own schedule,
in the direction of later times, rather than
earlier times.
Additionally, it is helpful in regulating your
childs biological rhythms to make sure that
she is exposed to light in the morning and to
dim the lights as sleep time approaches.
According to one study cited by Dr. Fleiss
(Chapter Eight), a 100-watt light bulb ten
feet away shed sufficient light to disrupt
sleep patterns in some people.
Maintaining a relatively stable, although not

necessarily rigid, daily schedule for eating,
playtime, naptime, and other major
activities, should also help to regulate your
childs biological rhythms. Many authors
encourage a reasonably stable routine,
especially for toddlers, as an aid to sleep. A
bedtime routine is an important element of
this stable routine, and the pieces that make
up the bedtime routine may be less
important than keeping it consistent.
Consistent Sleeping Environment. Like
adults, children sleep better when they are in
the same environment each night. If your
baby sees the same things each time she
wakes in the night, she will not have to try
to figure out what a particular piece of her
environment means. The more consistent
you can make the sights, sounds and smells
she experiences upon waking, the more
likely it is that she will easily go back to
sleep.
Consistent Sleep Practices. While there is a
lot of disagreement over which method is
the best for encouraging your child to sleep,
virtually all of the authors suggest that you
adopt a consistent approach. Going to sleep
and going back to sleep after night wakings
are largely habitual, and consistency on your
part will help your child learn these skills
more rapidly. You should make sure that
you, your spouse, and any others who put
your child to bed are all using the same
basic routines and methods.
Sleeping with a Bottle. You may find that
younger babies fall asleep more easily while

nursing or taking a bottle. This is very

common and normal, and all of the authors
recognize that it happens. Some feel that you
should try to discourage falling asleep while
feeding, and others do not, but all agree you
should not let your baby sleep with a bottle.
If the bottle has something other than water,
it can promote tooth decay, and even water
may promote ear infections. So, if your baby
does fall asleep with a bottle, dont leave it
with her through the night.
age, and they may help comfort your child

while she goes to sleep or in the middle of
the night. Even Dr. Sears, who does not
encourage what he calls parental substitutes,
says that a familiar warm fuzzy object
may help your child sleep once shes in her
own bed.
Temperature. Your baby is probably best
off sleeping in a room that is about 65 to 70
degrees Fahrenheit. At this temperature, she
will probably need some covers, a warm
sleeper or a sleep sack to keep warm.
Feeding and Attention in the Early

Morning. Children learn very quickly about
Dirty Diapers. Although you will not want
getting what they want. If you are giving
to let them go too long, most babies do not
them a bottle, or a chance to nurse, or,
really care about dirty diapers. The most
especially for an older infant or toddler,
important reason to keep your baby clean
attention, in the early morning, you may be
will be the prevention of diaper rash, not
encouraging an early waking time. The
helping her sleep.
authors disagree about whether you should
use an earlier bedtime, a later bedtime, or
some other method to discourage your child
Permanence
and
Developmental
Milestones. Even the best of
from waking too early in the
sleepers will go through
morning. They all agree,
It is thought that
times when they do not sleep
however, that giving them
well. For instance, your six
something they enjoy when
swaddling may emulate
month-old baby may be
they first wake can encourage
the tight conditions of
sleeping perfectly, only to
them to wake up a little earlier
start experiencing sleep
each day in anticipation of
the womb.
problems at nine months.
receiving that pleasure.
This is perfectly normal, and
these new sleep problems often coincide
Swaddling. Swaddling newborns can
with developmental milestones such as
comfort them, but as they age, your children
learning to crawl, learning to walk, or
are more likely to be hampered than helped
understanding separation and return
by tight swaddling. It is thought that
(separation anxiety).
swaddling may emulate the tight conditions
of the womb. As children start to move
Problems Do Not Disappear on Their Own.
about more, however, they feel confined by
If your child is experiencing sleep problems
swaddling. By three months of age, and
on a regular basis, it is very unlikely that
often much earlier, your baby will probably
these problems will get better if you just
prefer a less confining blanket or sleeper.
keep doing whatever youve been doing.
You will have to take a more active role in
Transitional Object. This is the generic term
helping your child develop the skills she
for a favorite blanket, stuffed animal, or
needs to sleep well.
other comforting object. Transitional objects
are commonly adopted after six months of
SIDS: Back to Sleep. Newborns should

sleep on their backs to minimize the risk of
SIDS. Once she can roll over on her own,
your baby can sleep however she chooses.
The highest risk of SIDS is the time before
she has learned to roll over.
Need to Feed. Exactly how long your child
can sleep without a feeding before six
months of age is a matter of some
contention. By six months, however, she no
longer has a nutritional need for middle of
the night feedings. Continuing them beyond
this age is usually for comforting, not out of
need.
Premature Babies. For developing sleep
habits and evaluating recommendations for
various ages, use your babys adjusted
age, which begins on her original due date.
Sleep Diary. By keeping track of what you
have done and how your baby has slept, you
may spot patterns that are easy to miss if
you dont keep track. If you decide to seek
help from your pediatrician or others, this
diary will also provide them with some
useful background information.
Solids to Help Your Baby Sleep Through

the Night. With the exception of Dr. Hull,
all of the authors that I have read, including
all of those reviewed in this book, agree that
feeding solids before bedtime (or including
cereal in her bottle) does not help your baby
sleep longer into the morning. By the time
she is old enough for solids, she has passed
the time when she needs to feed during the
night.
Teething. While my anecdotal experience
seems to argue against this point, the authors
are pretty universal in agreeing that teething
should not cause night wakings. They imply
that teething causes more discomfort than
sharp pain, and that the discomfort is not
substantial enough to cause wakings.
Medical Issues. The different authors each
had their own list of medical issues and
remedies. They all agree that you should not
try to change sleep habits while your child is
suffering from a medical problem. You will
have more success if you wait until she is
healed first. I have not designed this book to
be an authoritative medical reference, as you
are better off consulting with your
pediatrician on medical issues.

Section II:
The
Experts Analyzed

Chapter Two:
Dr. Richard Ferber, M.D.
Background on Dr. Ferber
Dr.
Richard Ferber is perhaps the best

known of the baby sleep doctors. According
to the biographical information in his book
Solve Your Childs Sleep Problems, Dr.
Ferber is widely recognized as the nation's
leading authority in the field of children's
sleep problems. Director of the Sleep Lab
and the Center for Pediatric Sleep Disorders
at Children's Hospital in Boston (Harvard's
pediatric teaching hospital), Dr. Ferber also
teaches at Harvard Medical School and is a
pediatrician.
To my knowledge, Dr. Ferber has published
two books on baby sleep issues. The most
well known, Solve Your Childs Sleep
Problems, at about $13, is targeted towards

the needs of parents who are trying to handle
their own childrens sleep issues. The
second book, Principles and Practices of
Sleep Medicine in the Child, is a much more
expensive ($60) and technical resource
designed primarily for use by pediatricians,
neurologists, and psychiatrists.
If you are interested in finding out more
about either book or in purchasing them,
click on the appropriate link below (if you
are logged in) or cut and paste or type it into
your browser manually (if you are not
logged in).
Solve Your Childs Sleep Problems is available at:

http://www.amazon.com/exec/obidos/ASIN/0671620991/franklinmiamipub
Principles and Practice of Sleep Medicine in the Child is available at:
To the best of my knowledge, Dr. Ferber

does not have a personal presence on the
web. The closest I could find was a link to
the Center for Pediatric Sleep Disorders at

Childrens Hospital in Boston, which is at
http://www.childrenshospital.org/neurology/sleep.html.
If you find any other links to Dr. Ferber, or if you find contact information that he would like to
make publicly available, please drop me an email at babysandman@fmpllc.com.

Introduction to Dr. Ferbers Ideas
The first comment that I feel I need to make

about Dr. Ferbers book is that it has been
oversimplified. As others have pointed out,
it makes a quick and easy magazine article,
newspaper article, or television story to just
explain the progressive waiting aspect of
Dr. Ferbers work, but there is much more to
it than just that aspect.
In the beginning of his book, Ferber gives
some interesting background, including a
chart of typical sleep requirements for
children of various ages (see my table in
Chapter One, which is a compilation of
Ferber and others numbers).
Dr. Ferber points out that, although it is
normal for babies to wake briefly at night
as it is for adults most babies should be
able to sleep through the night by the time
they are three of four months old. He also
states that, past around five or six months of
age, a total inability to fall asleep and stay

asleep is NOT normal. He believes parents
with children older than this age should be
more proactive, not just waiting for the stage
to pass.
Ever the researcher, Dr. Ferber includes a lot
of interesting information about sleep
patterns in adults and children. While
interesting, I have not included a summary
of this information here, as I do not believe
most of it will directly help you with getting
your infant or toddler to sleep. If you are
interested in this subject, I would encourage
you to buy Ferbers books.
Lastly, in terms of introduction, at several
points in the book he offers a strong ray of
hope. According to Ferber, most sleep
problems can be corrected in a few days to,
at the most, two weeks.
Bedtime Routines and Going to Sleep
As many of you may know, humans have a

natural body clock that has, on average,
around twenty-five hours in a day. Sleep
researchers have determined this by putting
people in controlled environments where
there were no external signals regarding
time.
So how do we know when to fall asleep?
Our bodys sleep is controlled largely by
hormones, and those hormones are triggered
by a variety of environmental factors. Light
sources, eating times, and routines we
associate with sleep can all help trigger
these hormones. It is very important to
control these factors when getting your baby
to sleep, as sleep time will otherwise tend to

drift later and later each day.
In addition to helping stimulate sleep
hormones, as Ferber points out, a good
bedtime routine will help a childs emotional
state at bedtime. If she enjoys the routine,
shell look forward to getting it started, and
shell ease into sleep. If she dreads it, the
whole process can be a daily battle.
Dr. Ferber also points to the importance of
keeping the environment before your baby
goes to sleep consistent with what she will
see when she wakes up. For instance, if a
totally different set of lights is on when she
wakes in the middle of the night, she may

become disoriented and are more likely to

cry out. The next section discusses this issue
more fully.
According to Dr. Ferber, associations with
falling asleep are formed early, so you
should start to lay the groundwork as soon
as possible. He points out that you must
choose the associations very carefully as
well. If you choose associations that require
you to be there, then your child will have
difficulty going back to sleep when she
wakes up in the middle of the night without
you there. Ferber has found that difficulty
settling to sleep alone because of problems
with associations is a common problem up
to four years of age.
If youre having difficulty
appreciating the importance
of associations, think of your
own sleep patterns. As
explained in the book,
having all your normal
associations in place fells
right, and if they are not
there, it feels wrong. For
example, imagine Ferbers
illustration
using
your
pillow. If it was missing, and
you had to sleep without it, it
would be harder to go to
sleep.
night, your sleep would be extremely

disrupted. If you fell asleep each night with
it there, but it wasnt there when you awoke
in the middle of the night, your sleep would
probably suffer mightily. If you are letting
your child fall asleep in your arms in the
living room, but she wakes up alone in her
crib in the night, its like someone stealing
her pillow.
When you are building your childs sleep

associations, Dr. Ferber states that a
transitional object can be very helpful. For
instance, if your child has a stuffed animal
that can be in view as she falls asleep and
there when she awakes, it can help her settle.
He recommends that you let
your child pick this item by
As the name
showing what she likes. Of
course, he also emphasizes the
progressive waiting
importance of this object being
something other than you, or
implies, the basic
else your child will need your
concept is to
presence to go back to sleep
when waking at night.
gradually increase
the time that you wait

before responding to
It is for this reason that Ferber

says that your child must learn to
fall asleep on her own.
your babys cries.
Even worse, if you woke up in the middle of

the night, and it was missing, you might be
very disoriented. If it had just fallen to the
floor, you could adjust quickly and go back
to sleep (although your baby might not have
this luxury). But if someone had taken it,
you might not be able to go back to sleep. If
you were a baby, you might cry out in
frustration.
And it is this fact that leads to

the
Ferberizing,
or
progressive waiting, approach to getting
your baby to sleep. As the name progressive
waiting implies, the basic concept is to
gradually increase the time that you wait
before responding to your babys cries.
For instance, you might start out by letting
your baby cry for five minutes before going
in to comfort her. Then you go in, sooth
your child a bit, and leave again for five
minutes or until she falls asleep. Your
number the next day might be six minutes.
To take the example even farther, imagine if

someone started stealing your pillow every
Dr. Ferber describes this as a five-step approach:

1. When its time for her to go to sleep, put your child in her crib.
2. Leave the room while she is awake.
3. Stay out of the room for your number of minutes (five in the above
paragraph).
4. If your child is still crying at the end of the time, return briefly to assure her
that she is not abandoned, but leave while she is still awake.
5. Gradually increase the time each day until your child is sleeping on her own.
The specific time is really designed more to

help the parent than the child, since it is very
hard on most parents to not respond to their
crying baby.
probably have some difficulty the first night

or two. But, as you become used to sleeping
without your pillow, you would return to
your normal sleep patterns.
Dr. Ferber recommends the same basic

approach for getting your child back to sleep
when she wakes in the middle of the night
and is crying out (see the next section).
Dr. Ferber also points out that certain

changes, like moving a child from a crib to a
bed, involve substantial changes in
environment, you may have to go through
the process again when these occur. Keeping
your babys environment and bedtime
routine as stable as possible will minimize
these factors.
Returning to the pillow example above,

Ferber puts it on the parents level again.
For instance, if you had to give up your
pillow for orthopedic reasons, you would
Sleep Patterns and Staying Asleep
Although I dont advocate spending a lot of

your time learning everything there is to
know about sleep research, I do believe its
important to understand a few basics. Most
importantly, you need to know that there are
different levels (called stages) of sleep,
including one you have probably heard
before called REM (for Rapid Eye
Movement) sleep.
As a parent, there are really two things you
need to know. If you are interested in more,
I would again encourage you to consult Dr.
Ferbers shorter book, or even the technical
one if youre really interested.
The first relates to getting your baby to go to

sleep. When you or your baby is going to
sleep, you descend through various levels of
sleep until you reach Stage IV, at which
time you are deeply asleep and very hard to
wake. According to Ferber, by about three
months of age your baby will take about ten
minutes to enter Stage IV from when she is
first asleep.
This is important whenever your baby falls
asleep somewhere other than her crib, as
moving her before this time is likely to wake
her. In the next chapter we discuss this issue
further and apply it to newborns (under three
months) with Dr. Sears advice.

The second part of sleep that you should

understand relates to the way sleep cycles
work. As Dr. Ferber explains, during the
night, adults and children are cycling
through various stages of sleep, some of
which are deeper and some of which are
near waking. In an infant, or even in a
toddler, these cycles are shorter, and a baby
may go through ten to twelve cycles in a
night.
At the light sleep end of the
cycle, a baby is most likely to
awaken. In fact, despite your
best efforts, Ferber explains
that your child is almost
certain to awaken several times
a night. He explains that this is
perfectly normal, but that your
reactions to it (going in to
comfort your child) can result
in
abnormal
behavior
involving difficulty going back
to sleep.
If your child is having problems with

waking and crying out in the middle of the
night, Ferber recommends the same
progressive waiting approach described
above to condition her to falling back asleep
on her own. He further emphasizes that the
two work best together, as youre
consistently reinforcing associations that do
not require your presence. In other words,
both are helping your baby learn to sleep on
her own.
If you quickly pick your

child up and rock her in
the middle of the night
whenever she cries out,
you will prevent her from
learning to go back to
sleep on her own.
If you quickly pick your child up and rock

her in the middle of the night whenever she
cries out, Ferber states that you will both
mess up her sleep rhythm and prevent her
from learning to go back to sleep on her
own.
One situation in which Ferber does say you
may want to respond is if you know that you
know that your baby is having difficulty
finding her associations or transitional
object. In this case, you may want to help
her find it quickly and then leave.
This method will not stop

the normal nighttime
wakings. In progressive
waiting, Dr. Ferber says
that, rather than stopping
the wakings, the crying
will become whimpering,
and the whimpering will
become silence during
those wakings.
In
explaining
the
importance of sticking with a consistent
plan, Ferber points out a common mistake
and easy trap for new parents. Many parents
will let a child cry for a period of time, but
then go in to rock her to sleep (following
only steps 1-3 and part of 4, but not the rest
of 4 and 5). In this case, he says you have
just caused her needless trauma, as she has
not learned anything about falling asleep on
her own.
In other words, you and your baby will be
better off sticking to one method than
bouncing around.
Cosleeping
Dr. Ferbers advice on cosleeping is as

succinct as Dr. Searss advice (next chapter)
on crying it out.
Simply put, he says that it is a fact that

people sleep better in their own beds.

Others movements, sounds, or wakings

unnaturally wake others in their bed. This
happens to both the parents and the children.
Dr. Ferber encourages having children sleep
in their own bed as a way to help them learn
to be separate from their parents without

anxiety.
As he makes clear when addressing this
issue, Ferber believes that parents often
choose cosleeping for their own needs, not
for their childs needs.
Feeding as a Cause of Sleep Problems
Dr.
Ferber points to three potential

problems related to feeding that can cause
difficulty with sleeping.
One of these problems is experienced by
parents who let their baby fall asleep while
nursing or taking a bottle at night. As most
parents know, this is a very easy thing to do.
Most babies are very relaxed while feeding.
This state seems to help them fall asleep.
The problem is that children who fall asleep
feeding will develop associations between
feeding and falling asleep, with all the
problems discussed above as a result.
The next problem Ferber identifies is
feeding too much too late in the day. He
primarily focuses on the problem of excess
fluid and very wet, uncomfortable diapers
that result from too much fluid closer to
bedtime. His answer? Progressive changes
(have we seen this theme before?). In this
case, he is talking about progressively

lessening the fluid in late feedings and
progressively making feedings earlier.
He points out that day feedings may need to
increase to make up for less at night, but that
this should not prove too difficult, as most
children will naturally want more then
anyway.
The last problem that Ferber mentions that
can cause sleep problems is nighttime
feedings. While younger infants require a
certain number of regular feedings, he
believes that many parents deliver an
excessive number of feedings during the
night and fail to scale back on them as early
as they should.
In many cases, the desire to feed at night is
more a result of habit or hunger brought on
by a regular pattern of night feedings than
by a genuine need.
Daytime Routines
In
order to maintain the proper, regular

nighttime schedule, Dr. Ferber stresses the
importance of a proper, regular daytime
schedule.
The components of a daytime schedule that
may influence the bodys natural rhythms
include meal times, timing of naps, timing

for the start and end of night sleep, active
times, exposure to light and dark, and
bedtime routines.
With meals, naps and active times, Ferber
recommends not having them too late in the
day.

The start and end of night sleep are the best

indication of the current schedule. Regular
times that do not fit a proper schedule
indicate a need for progressive change.
As bedtime approaches, a gradual dimming
of the lights and entering into the bedtime
routine will trigger the sleep hormones,
making the onset of sleep easier.
Regular daytime schedules must be
maintained in order to keep biological
rhythms in order and stabilized. If the
schedule is too irregular in the daytime, the
bodys rhythms are disturbed. In this case,
your child may be simply unable to fall back
asleep at times.
She may act as if she has just woken up
from a nap, although its the middle of the
night. When the body is out of rhythm, and
it is producing the wrong hormones at the
wrong times, it may be impossible for your

child to go back to sleep.
Some children will have difficulty accepting
whatever it is (nap, food, active time) at the
appropriate times. In this case, Ferber
suggests offering the item only at the
scheduled time, and then taking it away if
she doesnt accept it. Do not reoffer the item
at other times.
For naps, he recommends using the same
progressive waiting approach as you would
use at night. As mentioned earlier, Ferber
feels that a child who has learned to fall
asleep on her own at any one time will more
easily learn to do so at other times.
Similarly, you should not let your child use
you to fall asleep at certain times, while
trying to get her to do it on her own at other
times. In this case, she may receive mixed
messages and have difficulty fully changing
over to a self-sleeper.
Medical Issues
Although neither Dr. Ferbers book nor this
as much a result of the intense crying as a

symptom of some other problem.
one is designed to be a medical reference,

both of us feel it is helpful to at least touch
Dr. Ferber discusses one possible reason for
on a few medical problems that may
colic. This analysis is largely
interfere with your babys
based on the fact that episodes
The good news is that
sleep.
tend to occur later in the day.
Ferber thinks that it may
most
symptoms
of
colic
Most importantly, perhaps, is
simply be a problem of
Ferbers discussion about
disappear by about
overload. That is, an infant
colic. According to Ferber,
may accumulate experiences
in the early months this is
three months of age.
and sensations over the day
probably the most common
until his or her system has had
cause of significant sleep problems.
about as much as it can handle. This may
result in a need to cry.
As Ferber points out, the actual causes of
colic are not really known, but many people
Ferber points out that, if this is the cause,
think it is related in some way to intestinal
soothing the child may not be helping her
distress. The difficulty in looking to
out. If she needs to let it out for a while, then
symptoms such as gassiness is that it can be
perhaps you should let her do so. Not

surprisingly, he suggests a progressive
approach to doing this. This progressive
approach might be used when other methods
are not quieting the outbursts.
As support for this claim, Dr. Ferber points
to the fact that babies often quickly become
quieter when hospitalized. He feels this is
probably a result of nurses letting the infant
cry it out when comforting doesnt work.
Lastly, Ferber mentions that most symptoms
of colic disappear by about three months of
age. He cautions parents to try to develop
good sleep habits in their babies as soon as
they are ready, and not to blame it on colic

for too long.
In addition to colic, Ferbers chapter also
discusses chronic illness, middle ear disease,
medications and brain damage as possible
medical causes of poor sleep. His advice on
these issues can be summarized as saying if
its one of these, you probably know it.
Of course, Ferber is realistic enough to note
that medical causes may prevent good sleep
patterns no matter how good the methods
implemented. He does, however, take a
pretty aggressive stance on returning to his
basic five-step method as soon as your child
might be ready.
Summary/Diagnosing Sleep Problems
Dr. Ferber offers a list of general points to keep in mind when determining the causes of your
childs sleep problems. Here are some highlights from his analysis:
If your child cries out at night but quickly quiets when you return and provide the same
associations that were there when she went to sleep, she has learned sleep associations
that require your presence. To resolve this, make sure your baby is falling asleep on her
own, not with you there all the time.
If you are using things like rocking to put your baby to sleep, and she is not waking up in
the middle of the night, then its okay to continue. Probably your child has learned
different associations for returning to sleep than she had for going to sleep.
If your child cries so hard that she throws up, respond immediately. Clean it up, but then
leave so as not to encourage this as purposeful behavior.
Even once your child has learned proper associations, there will be disruptions. These can
span the spectrum including travel, visitors, teething, medical problems or something like
moving from crib to bed. In these cases, you may need to work a bit to reestablish the
patterns
If your child is falling asleep at nap time on her own but needs you at night, the process
will probably go more quickly, as she already knows how to fall asleep on her own.
It is very important that you follow through consistently with your program if you want
consistent results.
If your child is sleeping normally, but at the wrong times, it may be necessary to modify
daytime routines (see section below on this) and to gradually shift her over to the right
time. If the times are close, remember the twenty-five hour natural schedule and adjust
the schedule by shifting your babys sleep time later until it reaches the desired time.
Early waking can be caused by too early of a nap in the daytime. It may also be caused by
a habit of feeding immediately upon waking. Sometimes, it is just a problem with getting
back to sleep for that one last cycle, in which case you need to pay careful attention to
environmental conditions (light and noise in particular).
If your child is sleepy long before bedtime, she is probably overtired. She may not be
getting enough or long enough naps, or she may need more sleep at night. He
recommends starting by consulting his table of sleep requirements for some guidelines.
As you can see, Ferber has a lot more to offer than just the progressive waiting approach, but
this is a key element of his discussion. He has many followers, and I believe has some valuable
lessons, but read the next chapter for the other side of the story.

Chapter Three:
Dr. William Sears, M.D.
Background on Dr. Sears
William
Sears, M.D., and Martha Sears,

R.N., are the pediatrics experts to whom
American parents are increasingly turning
for advice and information on all aspects of
pregnancy, birth, childcare, and family
nutrition. Dr. Sears was trained at Harvard
Medical School's Children's Hospital and
Toronto's Hospital for Sick Children, the
largest children's hospital in the world. He
has practiced pediatrics for nearly thirty
years. Martha Sears is a registered nurse,
certified
childbirth
educator,
and
breastfeeding consultant (from the back
cover of The Baby Book).
Dr. Sears has published a number of books
related to the full spectrum of parenting
from pregnancy on through discipline and
other child development issues. As far as I

know, only two of these books have
extensive sections relating to infant and
toddler sleep.
These two are The Baby Book, which is
designed to be a pretty thorough guide to
issues for children under two years of age,
and Nighttime Parenting: How to Get Your
Baby and Child to Sleep.
logged in).
The Baby Book is available at:

Nighttime Parenting: How to Get Your Baby and Child to Sleep
is available at:
Dr. Sears has an extensive set of web pages at http://www.askdrsears.com. If you would like to
take a quick jump to his resources related to sleep problems in infants and children, go here:
http://www.askdrsears.com/html/7/T070100.asp.

Introduction to Dr. Sears Ideas
You
can tell a lot about Dr. Sears

perspective right up front. For instance, he is
not an advocate of goals like how to get
your baby to sleep. Instead, he prefers to
encourage a concept he calls nighttime
parenting.
By nighttime parenting, Sears means
developing a good sleep attitude so that you
and your baby all sleep better as a result. He
points out that you cannot force a baby to
sleep, and that you are better off working in
a caring, supportive environment.
Not surprisingly, Dr. Sears is no fan of Dr.
Ferbers approach. While never mentioning
him by name, Dr. Sears often makes
references to advocates of the cry it out
approach. The references are never positive
ones. Sears has been quoted as saying that
the cry it out system is a method that
trains babies with less sensitivity than we
train pets. The Baby Book, p. 293.
His whole philosophy is based on the
principle that the goal is not just to get

baby to fall asleep and stay asleep, we want
[him] to regard sleep as a pleasant state to
enter and a fearless state to stay in. The
Baby Book, p. 293.
In reading Dr. Sears book, it is clear that it
is as much a book about attitudes towards
sleep (especially parental attitudes) as it is
about how-to advice. The implication is that
the how-to piece will evolve naturally if the
right beliefs are instilled first.
Lastly, please note that, as discussed in the
first chapter of this book, I have purposely
avoided repeating the same material over
and over again if an author repeats
information covered earlier in this book,
unless I believe the author being covered
offers substantially different insights into an
issue. Therefore, you should not assume that
my lack of coverage of a particular issue in
one of the chapters analyzing the experts
necessarily means that they did not discuss
the topic.
Facts About Infant Sleep
As was touched upon in the analysis of Dr.

Ferbers work, Dr. Sears emphasizes that
sleep is not a single, continual state. Rather,
sleep represents various stages from very
deep sleep to a light, near-waking state, and
these stages progress cyclically through the
night.
If sleep is a cycling through various stages
of awareness, there will be times when a
sleeper, adult or child, is nearly awake. The
natural lesson that evolves from this fact is
that, during the lighter sleep times, your
baby is easier to awaken.
In fact, Dr. Sears points out that childrens

sleep is more sensitive than that of adults for
two reasons. One is that they have shorter
sleep cycles than adults, and therefore have
a higher number of times during which they
are vulnerable to outside influences that
might awaken them. The other is that, on the
whole, babies have more light sleep and less
deep sleep than adults.
Sears points to the combination of these two
factors as the reason that most parental
complaints about their childrens sleep

habits relate to wakings during the night, not

to problems getting them to go to sleep.
Dr. Sears also mentions a point made by
Ferber infants have a light sleep period
that lasts for many minutes before they are
fully (deeply) asleep. As you read in the
previous chapter, this is why Dr. Ferber
states that waiting at least ten minutes from
the time a child goes to sleep before doing
anything that might disturb her is more
effective.
In addition to the analysis offered by Ferber,
however, Sears points out that this number is
even longer for newborns. In fact, he says

the light sleep period can be as long as
around twenty minutes in a newborn,
quickly decreasing to around ten minutes for
a three month-old baby.
If you are interested in reading more about
the reasons Sears cites for the different sleep
patterns of infants, his books offer some
interesting information. I did not include this
information here in order to keep our focus
on how to get things done, given that things
are the way they are, rather than spending
time wondering why they are the way they
are.
Step-by-Step Approach to Nighttime Parenting
The heart of Dr. Sears nighttime parenting

method is a three-step approach to handling
One.
Two.
Three.
sleep issues. The steps, outlined in more

detail below, are:
Give your baby the best sleep start

Condition your baby to sleep, and
Lessen conditions that cause night waking.
These steps are discussed in detail below.

STEP ONE: Give Your Baby the Best Sleep Start
The first step is where Dr. Sears lays the
groundwork for his sleep method. First of
all, Sears encourages that parents develop
the right mindset. By this, he means you
should not just be on a mission to get your
baby to sleep, but that you should work to
understand your babys needs as well.
cry it out approach (i.e. Ferber).

The last element of Step One is to
implement what Sears calls attachment
style parenting. Attachment style parenting
requires close attention to your babys cues
so that you can best address her needs.
Dr. Sears also offers encouragement and

good advice about developing your personal
style of parenting. He advises parents not to
be too swayed by experts, but rather to
remain open-minded and form your own
opinions. Obviously, he is most of all
encouraging you not to put too much weight
in the opinions of experts advocating the
During the daytime, elements of attachment

style parenting include feeding on cue (not
on schedule) and wearing your baby in a
baby sling or carrying her for much of the
day. Sears offers more details on these
aspects of parenting, as well as other
suggestions for putting yourself more in
touch with your babys needs, in The Baby

Book. Sears believes that a parent who is

physically close to his or her baby for much
of the day will be much more aware of and
attuned to the needs of that child.
Dr. Sears also recommends physical

closeness at night. That is, he encourages
sleeping in the same bed or next to your
babys bed. The reasons for this are
discussed further in the Cosleeping
section below.
STEP TWO: Condition Your Baby to Sleep

Sears also offers a list of suggestions for
providing a nurturing environment that will
help your baby stay asleep or return to sleep
quickly if she wakes up in the middle of the
night. This list includes swaddling (for
newborns), beds that move or rock (like a
In providing the right environment for your
cradle), putting your baby in her best sleep
baby to fall asleep, Dr. Sears provides a list
position (which you can
of suggestions. All of these
determine
by
are pretty self-explanatory or
You cant force your
experimentation), using a
have
been
discussed
familiar warm fuzzy object
elsewhere in this book,
baby to sleep; you can
(if shes on her own),
although Sears does provide
only
set
up
the
right
touching and caressing,
more details in his book.
leaving something belonging
These suggestions include:
conditions
that
will
make
to a parent with the baby if
daytime
mellowing,
she is sleeping on her own, a
consistent bedtimes, calming
it easier for her to sleep.
relatively quiet environment,
down,
wearing
down,
reacting quickly when she
nursing down, fathering
starts to fuss, and a full but not too full
down, nestling down, rocking down, using
tummy.
the car and gadgets.
As Dr. Sears points out, you cant force your
baby to sleep; you can only set up the right
conditions that will make it easier for her to
sleep.
Dr. Sears prefers more natural approaches

and encourages the use of the car and
gadgets only very sparingly. Similarly, he
does not believe in using substitutes for a
parent (such as the transitional object
Ferber recommends).
Obviously, Sears has a very different

opinion about how to react to your babys
crying. Ferber believes in conditioning for
independence
through
a
disciplined
approach, while Sears encourages quickly
reacting in a nurturing manner.
STEP THREE: Lessen Conditions that Cause Night Waking
As
discussed before, it is inevitable that

your baby will have times during the night
when she is less deeply asleep. If you want
your child to stay sleeping, it is, therefore,
very important to provide the best conditions
for remaining asleep during these times that
you reasonably can.
Dr. Sears analysis of these issues is largely

based on physical/environmental factors
combined with an awareness of medical
issues.
In discussing the environmental factors,
Sears offers self-apparent advice on many of
the issues (like consider giving her some
pain killers if she is teething). His list is

worth checking through, however, to see if

any of these factors might be contributing to
night wakings.
Specifically, it is worth checking for wet or
soiled diapers, skin irritations from
sleepwear or detergents, hunger, temperature
(room and sheets/mattress), and unfamiliar
sounds. His advice on each of these is pretty
much common sense; he mostly focuses on
the importance of parents awareness of
their babys needs.
In addition to the physical/environmental
causes, Dr. Sears addresses some medical
issues. Unlike Ferber, whose advice was
pretty much if your child has one of these
you know it, Sears offers some more
specific advice on how to tell if certain
medical issues are causing sleep problems.
The Baby Book, and to some degree
Nighttime Parenting, also offer remedies
and symptom relief suggestions for many
medical causes.
A couple of the more useful suggestions for

two very common problems include:
Using vaporizers (better than
humidifiers) for thinning cold
secretions and loosening coughs.
Sears has detailed information on
when and how to use vaporizers, and
why they are superior to humidifiers.
Using a combination of pain
relievers, positioning your baby with
the infected ear up, and a warm
mixture of vegetable oil and water in
the ear for ear infections.
For more information on Dr. Sears
suggestions for treating medical problems, I
would suggest purchasing The Baby Book,
which devotes over fifty pages to self-help
medical care. If you have a real need for a
more thorough analysis of medical issues
and treatments for babies, I am considering a
separate publication on these issues. I would
welcome
your
thoughts
at
BabySandman@fmpllc.com.
Cosleeping (aka Sharing Sleep)
Dr.
Sears answer to whether or not you

should share your sleeping area with your
baby is perhaps what he is best known for
discussing. Sears clearly advocates parents
consider what is often called cosleeping,
although he prefers the term sharing sleep.
Sears offers several compelling reasons for
sharing sleep, but even he agrees it is not
right for everyone. His list of reasons for
advocating sharing sleep:
1. Its easier to get your baby to go to
sleep because she trusts that you will
be there when she wakes up.
2. Your baby can more easily stay
asleep, knowing youre there during
those vulnerable times. Although

Sears
doesnt
mention
this
specifically, Im sure if asked he
would point out how much crying
can be saved here for an eight to
twelve month old, as this is the age
when they are most likely to
experience separation anxiety.
3. You will be in nighttime harmony
with your baby, and you will
therefore also sleep better.
4. Breastfeeding is easier.
5. This fits with the busy lifestyle most
of us have today. If you dont have
enough time to be with your baby
during the day, at least you can be
with her more at night.

6. Sharing sleep allows a parent to bond

with their baby. This additional
nighttime bonding may be especially
important to parents whose children
could not be with them as much
during the time just after birth
because
of
medical
reasons,
including a premature birth.
7. Babies thrive in this environment.
Sears does point out that sleep sharing may
not work if it is started later in a babys life,
rather than being a habit from the beginning.
He also states that, if one or the other parent
doesnt really buy in to the concept, it is far
less likely to work out.
Dr. Sears also discusses some arrangements
where space needs can cause problems.
Everyone has a certain amount of critical
distance where they are more comfortable. If
your baby is too close to you all the time, he
recommends putting some sort of soft
barrier or bolster between you and the baby.
If your bed is just too small, he suggests
considering a sidecar arrangement, where
the babys bed is pushed up against the
parents bed. If a crib is used for this, you
can probably remove the side of the crib
where it meets the bed, as long as there is no
crevice between the babys mattress and
yours.
If you are interested in the sidecar

arrangement,
http://www.armsreach.com
offers several product choices.
In both of his books, Sears offers a lot of
encouragement for parents who are
considering a shared sleep arrangement. His
advice demonstrates that he appreciates that,
at least in the United States, this is not a
common arrangement. At the same time, he
offers common sense advice about how to
handle criticisms and worries about the
arrangement.
Dr. Sears does say that, at some point,
babies must learn to sleep on their own. He
emphasizes that this should only occur,
however, after an appropriate period of time
during which she has been parented to sleep.
Unfortunately, his advice is noticeably
vague about when your child will be ready
to make this transition.
Basically, the final word from Dr. Sears on
cosleeping/shared sleep is about trust and
sensitivity. He believes that crying it out
builds mistrust and makes you insensitive to
your babys needs, and therefore less likely
to see certain causes of sleep problems. He
feels that shared sleep arrangements, on the
other hand, will build an environment of
love and awareness that will make you a
better parent.
Summary of Dr. Sears Sleep Program
As you can see, Dr. Sears sleep method is

essentially one of responsiveness. Like most
practitioners, he first encourages the right
environment. In looking at daytime
schedules and routines, however, he
promotes responsiveness to your baby rather
than the strict adherence that Dr. Ferber
advocates.
Similarly, his nighttime philosophy is much
more laid back. Rather than battling with

your baby, he believes in giving her a
certain amount of what she is looking for.
He does not view this as excessive
permissiveness, but rather as nurturing.
The philosophies are clearly at odds. Before
I give my thoughts on combining the two,
lets see what some other authors can
contribute to the solution.

Chapter Four:
Dr. T. Berry Brazelton, M.D.
Background on Dr. Brazelton
T.
Berry Brazelton, M.D., "the beloved

dean of American pediatricians, is an
internationally known expert on child
development. At Children's Hospital in
Boston and at Harvard Medical School,
which has recently named a chair in
pediatrics in his honor, he has taught, trained
pediatricians, and carried out his influential
research. His books have been translated
into eighteen languages." (from back cover
of touchpoints).
Dr. Brazeltons philosophy is based on a
good deal of guidance from his trained
practitioners. If you are looking for someone
to tell you what to do at each stage, this
approach may make sense for you. If you
are more of a self-learner, it probably does
not.
Like Dr. Sears, Dr. Brazelton has published

and been involved with a number of books
related to the full spectrum of parenting. As
far as I know, only two of these books have
much relating to infant and toddler sleep.
These two are touchpoints: The Essential
Reference, which is designed to be a pretty
thorough guide to issues for children under
three years of age (there is another
touchpoints book for three to six year-olds
as well), and, writing the foreword, The SelfCalmed Baby.
logged in).
Touchpoints: The Essential Reference is available at:

http://www.amazon.com/exec/obidos/ASIN/020162690X/franklinmiamipub
The Self-Calmed Baby is available at:
Dr. Brazelton has an organization called the

Brazelton Touchpoints Center, which is
available
on
the
web
at
http://www.touchpoints.org. He describes
this center as a training organization at the
Child Development Unit of Childrens

Hospital in Boston. In reviewing the site, I
found that it is targeted primarily towards
childcare professionals, not towards the
needs of individual parents.

If you are looking for professionals who

follow the Brazelton philosophy, you could
try
contacting
the
center
at
touchpoints@hub.tch.harvard.edu.
In addition, you can find out more about the
Brazelton Institute, which is a site geared
towards healthcare professionals, at
http://www.brazelton-institute.com/. This is
a unit at Childrens Hospital in Boston.
If you didnt notice, yes, this is the same
hospital that employs Dr. Ferber. I cant
help but think that Dr. Ferber has been a
major influence on Dr. Brazelton, especially
in recent years.
Introduction to Dr. Brazeltons Ideas
Before
beginning the introduction to Dr.

Brazeltons ideas, I think it is worth noting
that the following is derived almost entirely
from touchpoints, and not from The SelfCalmed Baby. There are two reasons for
this. First, although Dr. Brazelton seems to
have had some input into The Self-Calmed
Baby, his contribution was mostly limited to
writing the foreword. Secondly, The SelfCalmed Baby is really a book about
understanding your babys language and
signals, not about getting her to sleep.
If you are looking for a reference about
understanding your babys own way of
communicating, The Self-Calmed Baby is an
excellent reference. It is far more detailed
than Tracy Hoggs book Secrets of The Baby
Whisperer, and falls short perhaps only in
Dr. Sammons failure to adopt as catchy a

name as The Baby Whisperer (or The
Baby Sandman, for that matter ). In
reality, Dr. Sammons may be the original,
but unaccredited, baby whisperer.
Also, it is worth noting that sleep problems
only make up one chapter, or ten pages, of
the touchpoints book, although there are
tidbits, and even some more substantive
material,
about
sleeping,
scattered
throughout the book, especially in the agespecific chapters that make up the first of the
three main sections of touchpoints. So why
did I include Dr. Brazelton at all? Well, like
Dr. Spock, he is so universally recognized as
a general childcare expert that a lot of
people want to know what hes got to say.
Statistics and Independence Issues
The
research that Dr. Brazelton refers to

(probably from Dr. Ferbers sleep center,
although Brazelton does not provide a
citation) states that 70% of children are
sleeping through the night (for eight hours)
by three months of age, that 83% are by six
months of age, and that 90% are by one year
of age.
He points out a fact that is often not stated

clearly, but that is abundantly clear when
deciding which side of the Ferber-Sears
battle you want to take. Sleep issues largely
come down to a question of how parents feel
about the issues of autonomy and
independence.
As decisions about how parents feel about
autonomy and independence at various ages

demonstrates
an
understanding
and
is so vital to the decisions they will make
sympathy for the Sears side as well. Part of
about not just sleep problems, but all
this, he admits, is driven by the fact that we
childcare issues, Dr. Brazelton urges parents
most of us (i.e. most of the people who
to start by analyzing their feelings about
would be reading his book) live in a society
independence. He emphasizes that, in many
that fosters the idea that
cases, it is better for
A
good
relationship
between
self-reliance is necessary to
parents to be unified in
self-esteem.
an imperfect set of
her
parents
is
probably
more
beliefs than for them to
Lastly, he, at least in part,
be divided, even if one of
critical to a childs
addresses one question that
the parents beliefs are
Dr. Sears does not seem to
more helpful in getting
development than her
fully answer. If you are
baby to sleep. As he
sleeping arrangements.
going
to
choose
a
states it, A good
cosleeping arrangement, at
relationship between her
what age should you
parents is probably more
-Dr. T. Berry Brazelton, M.D. transition your child to her
critical to a childs
own room and bed?
development than her
According to Dr. Brazelton, in cultures that
sleeping arrangements. touchpoints, p. 387.
encourage cosleeping, such as India and
Mexico, this typically occurs when the child
In the end, Brazelton comes out on the
is two or three years old.
Ferber side of the argument, but he
Three Personality Types Who Dont Sleep Well
Dr.
Brazelton identifies three different

types of temperaments that children who
dont sleep well tend to exhibit: the driven
child, the low motor expender, and the
sensitive child.
For the driven, or extremely active child,
Brazelton suggests that the very intensity
with which she pursues new skills disrupts
sleep. Not content to merely work on
improving a new physical skill during the
daytime, this child will wake at night to
practice some more. For this type of child,
periods of nighttime waking will often
coincide with developmental milestones
such as standing or walking. Dr. Brazelton
suggests that parents of the driven child be
especially cautious about nighttime visits, as
their already stimulated child will only
become more awake with her parents added

presence.
The low motor expender is a quiet, alert,
and watchful child during the day. She tends
towards the cerebral, rather than the
physical, world. As she is not as active in
the day, she will not be as worn out when
nighttime comes around. For this child,
encouraging somewhat more independence
and activity during the day may help with
sleep problems.
Lastly, the sensitive child is likely to be
easily upset and rather clingy. Her sleeping
problems will probably revolve around new
situations, whether they be developmental
milestones, new social situations or new
environmental conditions. Because of her
sensitivity, her parents may tend to be

somewhat overprotective. The best way to

help this child is to encourage independence
during the daytime in measured steps so that

she does not become overwhelmed.
Miscellaneous Extras
Beyond that mentioned above, and the two

ideas below, Brazeltons sleep advice
largely mirrors that already discussed in
other authors chapters.
One unique suggestion he offers is
especially useful for parents who have
worries wondering if their baby is okay. If
you wake your child before you go to sleep,
and repeat some or all of the bedtime
routine, you may be able to more easily go
to sleep yourself. You will have alleviated
most of your concerns about her, such as
whether or not she needs to be changed, to

be fed, and so on. I havent tried this one
myself, as around my house were all asleep
by nine oclock or earlier most nights.
Another interesting suggestion applies to
comforting your child. If you find your child
is too stimulated by your going into her
room, you can try just calling to her from
outside of the room. Dr. Brazelton states that
he has been amazed by how willing a child
can begin to accept a parents voice for their
actual presence.

Chapter Five:
Dr. George J. Cohen, M.D., F.A.A.P.,
as Editor-in-Chief
for the American Academy of Pediatrics
Background on Dr. Cohen and the AAP
George
J. Cohen, M.D., F.A.A.P., as

Editor-in-Chief for the American Academy
of Pediatrics. George Cohen is attending
pediatrician at Children's National Medical
Center and a professor of pediatrics in
Washington, D.C. The American Academy
of Pediatrics is an organization of more than
55,000 primary-care pediatricians, pediatric
medical subspecialists, and pediatric
surgical specialists dedicated to the health,
safety, and well being of infants, children,
adolescents, and young adults (from back
cover of the American Academy of
Pediatrics Guide to Your Child's Sleep).
Although I could make a strong argument
against putting too much weight in medical
science in this area, I also cannot think of
any more objective source than the
professional medical community. This book
is the result of input from a committee of

many doctors, with both the inherent
problems and inherent benefits of input from
many different places.
The one concern I always have with
anything authored by the medical
community is that it tends to be dominated
by doctors in the over fifty crowd. Since
doctors, unlike lawyers, accountants, and
most other professions, do not have any
ongoing education requirements, these older
doctors are often relying on very outdated
information.
about the AAP book or in purchasing it,
click on the link below (if you are logged in)
or cut and paste or type the address into your
browser manually when you log in (if you
are not logged in now).
The American Academy of Pediatrics

Guide to Your Child's Sleep: Birth Through Adolescence
is available at:
The American Academy of Pediatrics has a

web presence at www.aap.org. They offer
several additional publications on topics
such as nutrition, allergies and medical

symptoms.

If you are interested in really learning what

the doctors are hearing, they also offer
extensive information through the
professional education section at

http://www.aap.org/profed/.
Lastly, they also offer a link over to the

National Library of Medicine, where you
can perform free research on Medline, the
most comprehensive medical research site

that I know about. The Medline free links
are at:
http://www.nlm.nih.gov/databases/freemedl.html.
Introduction to the AAPs Ideas

do is help her learn that nighttime is for
sleeping and daytime is for play, and to
advice is by considering how the book was
develop regular sleep habits. Guide to
put together. It is written and reviewed by
Your Childs Sleep, p.
pediatricians. It is the result of
76.
Even today, very little
a whole bunch of different
reviewers and writers from
In terms of timing, the
teaching regarding sleep
various parts of the AAP
basic idea is that,
combining their results.
(only about five hours) takes
sometime in the three
Therefore, it is, not
to six month old
surprisingly, pretty middle-ofplace during the three-year
period, you should be
the-road.
able to get your baby to
pediatric residency
sleep at least five to six
It does not offer extremist
hours straight through
program.
advice in any direction; instead
during the night. They
it is kind of a consensus book.
do not recommend
The tone of the book is, more
-Dr. Marc Weissbluth, M.D. allowing a child to cry
than any others I have read,
unattended for longer
one of objective analysis and
than ten minutes, but they recognize a
advice, not one of partiality and advocacy.
certain amount of crying as normal.
You can pretty well guess what the AAP
The basic philosophy is as follows: You

cant force your child to sleep; what you can
A Little More Sleep Science
Although Im not going to review it in too

much detail here, as much of it would be
repetitive this book probably has the best
section on sleep science of those I have
reviewed. If youre really interested in this
subject, I would suggest reading this book

first.
According to the AAP, the circadian
rhythms that govern sleep/wake cycles do
not even begin to develop until around six

weeks of age. This is one of the reasons why

young babies have such irregular sleep/wake
cycles. The ability to maintain a regular
cycle is pretty much fully developed by the
time a baby is four to six months old.
This guide also emphasizes the importance

of getting enough sleep. Children who are
regularly short on sleep do not learn as well
as those who get enough, and they are also
more likely to have behavioral problems as
they get older.
Newborns Through Three Months
During
to the first few weeks, the AAP

suggests you pretty much demand feed
every two to four hours. By four weeks, they
say sleep will begin to show more of a day
and night pattern, as the biological rhythms
(circadian rhythms) are starting to show up.
From the beginning, there are some things
you can do under the AAP guidelines. For
instance, you should make sure your house
is more well lit in the day (even during
naptimes) and becomes darker at night, so
that your babys clock will start to recognize
the natural cues from light and dark. To
further strengthen the concept of daytime as
awake time and night as sleep time, you can
encourage play and activity a bit more in the
daytime, even if it keeps your baby awake
for longer periods.
The AAP also recommends that you expose
your baby to normal levels of noise, rather
than teaching her to sleep only in absolute
quiet. A constant state of absolute quiet
during sleep can make her very sensitive to
noise, which may cause problems later.
By around two or three months, the AAP is
comfortable with babies sleeping up to
around five or six hours in a night. In fact,
by around six weeks you should begin
teaching your baby to go to sleep on her
own in her crib. You can encourage this at
naptime by putting her into the crib while
she is tired but still awake.
At this same time, around six to eight weeks,

you should also start to work a bit at keeping
your baby awake through feedings so that
she can be placed in her crib while still
awake at night. Remember to put her on her
back in the crib, as that is safer for the
prevention of SIDS. In fact, if youre able to
keep your newborn awake, the AAP
recommends you put her in her crib while
shes drowsy but awake from the very
beginning. This helps her build positive
associations between her crib and a good
sleep.
You can also start to build pieces of a goingto-bed routine from the beginning. The AAP
uses the term routine, rather than ritual or
schedule, in order to emphasize the fact that,
while it should be reasonably consistent, its
okay to bend the rules at times. Part of the
early bedtime routine might include washing
your babys face, hands, and bottom;
changing her into her fire-retardant sleeping
clothes, and rocking or cuddling with some
singing or listening to music before putting
her in bed. As discussed above, once she
starts to get pretty tired, but before she goes
to sleep, you should put her down in her
crib.
If your child cries when you put her in the
crib at this age, the AAP suggests you
should try to let her do so for a few minutes
before going in to comfort her. Keep in
mind, though, that they never (at any age)
recommend that you let her cry longer than
ten minutes without going in to check on
her.

Three to Six Months
This
is the time frame during which the

By this age, you are encouraged to let your
AAP says you can really start teaching your
baby cry a few minutes before going to her,
baby to sleep through the night. As they say
unless the cry is clearly
on page 31, Babies dont
one of distress. As they
Babies dont need to be
need to be taught how to
point out, by this point
sleep. Like the other vital
taught how to sleep. Like the
you
have
probably
functions, it just comes
learned the different
naturally. But good sleep
other vital functions, it just
types of cries that your
habits are something else.
baby uses for different
comes naturally. But good
They must be learned and
needs.
nurtured, and the earlier
sleep habits are something
the better. Guide to Your
In addition, if your child
Childs Sleep.
else. They must be learned
is not sleeping for five or
more hours at one stretch
According to the AAP, by
and nurtured, and the earlier
by the age of three
the age of three months,
months,
the
AAP
the better.
about ninety percent of all
encourages you to work
babies sleep through the
on your late afternoon
night (at least five hours at one stretch), and
routine. Try to keep her awake a little longer
by six months, almost all babies should be
before bedtime, and make sure youre
able to sleep through the night. Even by
following the suggestions on putting her into
three to four months old, they should be able
her crib while shes still awake.
to sleep for five to six hours at one stretch
during the night.
After Six Months
Sometime after six months, your child will

start to experience separation anxiety, and
this anxiety may not fully disappear until
around her second birthday. The AAP points
to separation anxiety as one of the reasons
you are better off trying to get your child to
sleep through the night by six months of
age.
If your child is experiencing separation
anxiety, the AAP recommends, among other
things, playing various types of peek-a-boo
to build her confidence that you will return

when you disappear from sight.
In addition, the use of transitional objects
may help during this time period. Children
often become attached to transitional objects
during the onset of separation anxiety, and
you might want to encourage such an
attachment at this age to ease the fear of
separation.
The AAP also suggests that, if your child
does adopt a transitional object that is also
around a lot during the day, you may want to

consider buying a duplicate so that you can

have one in the wash while the other is in
use. I have not tried this, but I do wonder if
different wear patterns and smells might
have an effect on the usefulness of this
strategy.
By this age, the AAP says that your child
should be able to go a full night without a
feeding. She should also be able to sooth
herself back to sleep when she awakens, so
you need not respond to whimpers or other
similar sounds.
At around eighteen months, your toddler
may return to a clingy stage, which may be a
sign of further understanding of separation.
If this has become a major problem, you
may wish to introduce a transitional object if
your child has not already claimed one.
The AAP states that a toddler, especially
beginning around the second birthday, will
be happiest with a pretty stable routine. This
should include not only a bedtime routine,
but also a daytime routine where eating,
walks, naps and regular activities occur at
pretty much the same time each day.
Although you need not be rigid, the stability
of a routine seems to add needed
predictability to a toddlers disordered
world. As stated before, the idea of a
routine, rather than a schedule or
regimen, is that it is reasonably consistent

while still allowing for a certain amount of
bending of the rules to meet different
circumstances.
For an older child or preschooler, the AAP
suggests you might utilize a neutral
timekeeper such as a clock, clock radio or
egg timer to help her understand the
appropriate time for getting up. This concept
can also be used for establishing bedtime if
your child is old enough to tell time or if you
use an egg timer, which many toddlers love
because of the fascinating way the sand
drops through the hourglass.
Dr. Hull (see below) suggests using Mr.
Sun for waketime, but, unless your childs
window faces to the East, it is often hard to
tell exactly when Mr. Sun is really up. In
addition, this will result in a schedule that
varies dramatically over the course of the
year, especially in more Northern areas.
In Chapter Six below, Cuthbertson and
Schevill offer a more detailed suggestion for
using a clock radio as part of an older
toddlers wake-up routine. I have no idea
whether this neutral timekeeper concept
originated with the AAP, Dr. Hull,
Cuthbertson/Schevill, or somewhere else,
but they all depend on it to some degree.
How to Deal With Nighttime Crying in Infants and Toddlers
Although
I have included a few of their

suggestions in the age-specific sections
above, I think it is worth reviewing the
AAPs guidelines on dealing with crying.
How you deal with this issue remains a
central part of any decision about how you
will deal with your childs sleep problems.
The AAP states that, typically, newborns

and young babies cry an average of two anda-half to three hours a day. As mentioned in
Dr. Sears Rule of Threes, a colicky baby
will not only cry more than that, but she
would typically cry inconsolably for at least
three hours/day, three days/wk, for at least
three weeks, beginning within the first three
weeks of life, and seldom lasting longer than

three months. The Baby Book, pp. 353-54. In

terms of general rules, the AAP says that
about one in five babies has colic, and that it
is somewhat more common in first babies
and in boys.
The AAP approach recognizes that a certain
amount of crying is normal, but that it is also
perfectly normal for you to want the crying
to stop both out of concern for your baby
and for your own sanity.
some brief comforting without picking her

up. The book is rather negative about both
the attachment parenting (Dr. Sears) extreme
and the Weissbluth extreme (see chapter
twelve below for more on Weissbluth, who
says let em cry as long as it takes unless
there is an emergency).
If your child has legitimate needs that are

causing the crying, such as a wet diaper, you
should
fix
the
Letting your baby go to sleep
problem as quickly
with a bottle in her crib is always and simply as you
can. Ideally, you
should leave the
a bad idea. If the bottle has
room
lighting
formula or juice in it, it may
alone, or at least
keep it low, and try
promote tooth decay. Even if it
to disturb your
child as minimally
just has water, it may foster ear
as possible.
As any parent quickly learns,

their new baby is focused on
getting what she wants. She
will try any and every tactic
available to her to get what
she wants, including crying.
During the first few months,
the AAP suggests that the
best thing to do is to respond
to those cries quickly. This
infections.
book states that, contrary to
what Ferber and others have suggested,
babies whose calls are answered quickly will
tend to cry less overall.
Although they recommend responding pretty
quickly at first, the AAP book suggests that,
once your child is a few months old, you
should start to manage the crying a bit,
especially when putting her down to sleep at
night and when she wakes in the middle of
the night. They suggest a centrist program
where, at this age, you let your baby cry for
up to five or ten minutes, then return for
The AAP suggests,

much the same as Dr. Ferber and some
others have suggested, that babies need to
cry a certain amount. This may result from a
need to sort of let it out, or an attempt to
sort out a confused world. They also state
that the extremely loud but typically rather
brief crying when a parent leaves the room
is a perfectly normal way for your baby to
say that she doesnt necessarily like what
youre doing. This should not cause you to
rush back in to see whats wrong.
Other Sleep Issues and Suggestions
In
no particular order, I have included

below some miscellaneous issues and
suggestions from the American Academy of
Pediatrics.
Going to sleep with a bottle. Some other

authors have mentioned this in their books
as well, but this is pretty universally
discouraged nowadays. If the bottle has
formula, milk or sugar water, it can promote
tooth decay. Even if its just water, it may

back up into the tubes connecting to the ears

and foster ear infections.
How long to breastfeed. The AAP
encourages mothers to feed their babies
nothing other than breast milk for the first
six months of life, and to continue
breastfeeding for at least twelve months or
for as long as baby and mother want to
continue. These guidelines have been
subject to change in the last few years, so if
% of Mothers Breastfeeding
you hear conflicting information, check the

date. The AAPs most recent (1997) policy
statement on breastfeeding is available at
http://www.aap.org/policy/re9729.html. The
U.S. Public Health Service, in line with this
policy statement, in January 2000 set forth a
program called Healthy People 2010
(available
at
http://www.health.gov/healthypeople/) that
includes breastfeeding guidelines. Their
statistics and goals by 2010 are as follows:
1998 (Actual)
2010 (Goal)
In Early Postpartum Period
64%
75%
At Six Months
29%
50%
At One Year
16%
25%
Premature babies. The AAP points out that

premature babies will, and should, take
longer to learn to sleep through the night. If
you use her adjusted age, or the time
elapsed since her original due date, you
should be pretty close for the AAP
guidelines.
Sudden Infant Death Syndrome (SIDS). In
order to prevent SIDS, you should place
your baby on her back when you put her
down to sleep. Once she is old enough to
roll over on her own (around four to seven
months of age), she should be past the
highest-risk time, so you probably dont
need to worry about rolling her back over.
The other most important measure is to
make sure that your baby is sleeping on a
firm surface with no soft bedding or other
such soft items. In addition, the AAP book
notes that children exposed to tobacco
smoke have a higher risk of SIDS, have
more colds, and have more upper respiratory
infections. If youre a smoker and are
looking for a reason to quit, here it is.
Medical Issues. Not surprisingly, the AAP

book offers one of the most extensive
sections on medical issues of the books on
the market. If you are interested in reading
more about sleep-related medical issues, I
would recommend this book and Dr. Sears
The Baby Book, along with perhaps Dr.
Spocks Baby and Child Care, although
some of its information is a little outdated.
Babys Door Open or Closed? Both Dr.
Ferber and Dr. Hull specifically recommend
that you keep your babys door open at
night. The AAP states that you should keep
it closed at night, as this is safer in the event
of a fire. It is worth noting, for any
cosleeping advocates who think I am at all
unfair regarding their point of view, that the
safest place for your child in a fire is
probably right next to you in bed.
Bad Habits. As several other authors have
stated, the AAP believes that allowing your
baby to fall asleep while feeding, rocking
her to sleep, and sharing a bed with her are

all bad habits that should be discouraged or

eliminated.
Sleep Diary. The AAP has an excellent,
common sense suggestion for parents whose
children are experiencing ongoing sleep
problems. By keeping a diary, you can better
evaluate what has and has not worked
yourself, and you can take this information
to your pediatrician or others for advice. The
sleep diary should include information on
the content and duration of the bedtime
routine, the time at which your child went to
sleep and woke up (including middle of the
night wakings as well as morning), and
exactly what you did in response to your
childs cries when going to sleep or waking.
In my experience, just recording the
information will often reveal the problem

and answer for sleep problems, or, for that
matter, for many different kinds of
problems.
Disappearing Chair. Dr. Hull is perhaps the
most widely known advocate of this
approach (see Chapter Nine). In the
disappearing chair routine, which is
generally used for children at the separation
anxiety phase from around eight months to
two years of age, you sit in the childs room
to give her comfort regarding her separation
fears. Each night, you move your chair a
little closer to the door, then out the door
and into the hall. With a slow enough
progression, you can help your child relieve
her fears without unnecessary crying.

Chapter Six:
Joanne Cuthbertson and Susie Schevill
Background on the Authors
Joanne Cuthbertson and Susie Schevill live

in Berkeley, California. They are both
mothers (with five children between them),
and both are married to pediatricians (from
back cover of Helping Your Child Sleep
Through the Night).
This book was written in 1985, and a couple
of the ideas are out-of-date, but it is
generally as applicable as when it was

written.
about their book or in purchasing it, click on
the link below (if you are logged in) or cut
and paste or type the address into your
browser manually when you log in (if you
are not logged in now).
Helping Your Child Sleep Through the Night is available at:

To the best of my knowledge, the authors do

not have a personal presence on the web. If
you find any links to the authors, or if you
find contact information that they would like

to make publicly available, please drop me
an email at babysandman@fmpllc.com.
Introduction to the Authors Ideas
This book is a good example of the rule that

you dont have to be an M.D. to offer good
advice. In fact, I feel that the doctors advice
can be less useful than a laymans at times,
as their substantial egos can prevent them
from recognizing the validity of any ideas
not their own.
The book is structured with an introductory

section and five age-specific sections. It is
designed so that a reader will read only the
introduction and the age-specific section that
applies to their child.
Because of the design, the majority of the
information in the age sections repeats itself
with only minor changes. Therefore, rather
than structuring my review the same way as

the book is structured, I have addressed the

issues only once. Age-specific comments are
included and noted as such.
The authors are basically cry it out
advocates, but they offer useful suggestions
for parents who are not comfortable totally
adopting the Ferber method. In addition, the
book is jammed with little tips and tidbits of
information that might prove useful in
particular circumstances.
These authors are the only ones I have seen
who break the issues out into such small age
ranges. In viewing the content of the various
chapters, however, I find that the breaks

may be too small. I have not done a word
count, but I suspect each chapter is about
90% borrowed, almost word-for-word, from
its predecessor.
Lastly, it is worth noting that these authors
advocate beginning sleep training as early as
five to seven weeks. This is certainly
controversial, and its the earliest age Ive
seen recommended. Dr. Ferber himself does
not really address issues pertaining to
children younger than three or four months
old.
Book Introduction
The
introduction to Helping Your Child

Sleep Through the Night includes some
interesting statistics on various aspects of
sleep. One study they cite by Dr. Thomas F.
Anders found that parents thought their
children were sleeping better than they
actually were. In that study, while almost
50% of parents of two month-old babies and
around 75% of parents of nine month-old
babies thought they slept through the night,
video taping of the babies found that the real
numbers were more like 16% and 33%
respectively.
Another study cited by the authors found
that nearly 90% of healthy, normal children
of preschool age had, at one age or another,
required more than thirty minutes to fall
asleep. This extended bedtime, and delay
tactics utilized by children trying to stretch
the bedtime routine, were much more
prevalent in older children (five years old)
than in younger ones (one year old).
The authors also refer to a study by Drs.
Beltramini and Hertzig that found that, not
only did 95% of children go through a
period of nighttime crying or calling for

parents at least once a week during the first
five years of their lives, but 70% had a stage
of awakening every night during those five
years. Unlike the above study, in which it
was found that older children were more
likely to stretch out bedtimes, this study
found that it was younger children who were
more likely to wake up during the night.
Early in their introduction, the authors of
this book make their goal clear: to help
children develop good sleep habits early, as
the later they are formed the harder it is to
form them. They emphasize that regular
schedules are important to keeping
biological rhythms in line, and that the
sleep-wake cycle is one of the most
important and powerful of these rhythms.
Citing Dr. Brazelton, the authors clearly
state that they are against cosleeping, as they
feel it interferes with the growth of daytime
independence and may interfere with a
childs self-esteem.

In addition, they have a few miscellaneous

disposable diapers and putting a
pointers and tips:
small slit in the plastic coating of the
inside one so it can leak some into
Putting interesting pictures on the
the outside one.
walls of your
Putting your baby with an
childs room may
The authors encourage
talking to other parents
make
the
older sibling is not likely
bedroom
more
as one of the best ways
to share good advice.
appealing,
and
to disturb the older childs
therefore
They
strongly
encourage good
sleep much, but it will
encourage the use of a
sleep habits.
transitional object that
probably
help
the
baby
your child can become
Putting your baby
with an older
attached to in order to
sleep better.
help with going to
sibling is not
likely to disturb
sleep and returning to
sleep during night wakings.
the older childs sleep much, but it
will probably help the baby sleep
In addition, they repeat the
better.
importance of bedtime routines,
standard times and such that we have
If your child is still having overly
gone over in previous chapters.
wet diapers even with the nighttime
style of diapers, try layering two
Getting Your Child to Go Back to Sleep on Her Own
The
advice from these authors is to start

this process early. They say that, at a
minimum, a child should be nine pounds,
five to seven weeks old, free of health
problems and not in a high-risk category.
Beyond that, they encourage you to start as
soon as you can.
According to the authors, the earlier you
start children learning to fall asleep on their
own, the easier it will be. This means that
your baby should fall asleep in her own bed,
not in your bed, and not in your arms.
Even before the five to seven week period,
the authors encourage certain behavior.
Whenever possible, your baby should fall
asleep in bed, not in your arms. As early as
three days old, they encourage what they
call a focal feeding, which is a scheduled
feeding in the late evening (around four
hours after your baby falls asleep). They

recommend that for this first feeding of the
night, you should wake your child if she has
not already awoken on her own. They do
not, however, recommend waking your baby
for other feedings during the night. Instead,
other feedings should be on a demand basis
for a newborn and should be phased out
beginning around five months of age.
So how do these authors recommend you get
your baby to learn to go to sleep on her
own? They outline a four-night routine.
They suggest doing this over a weekend, as
you may also lose some sleep these four
nights. If mom has been breastfeeding, the
authors also suggest using someone other
than mom for parts of the routine, as
outlined below.

The first night, you should remove the baby

from your room. Have your baby fall asleep
in her own room, or at least remove her to
her own room if she fell asleep somewhere
else. Wake your baby for the focal
feeding, as they recommend you doing for
a few nights before starting this routine.
Make this a quick feeding, and put the baby
back in her bed. Go back to sleep. Note that
the authors were kind of thin on what to do
if your baby doesnt go back to sleep at this
point on her ownthey leave this question
unanswered, just saying to [g]et [her] back
to sleep as promptly as possible. Helping
Your Child Sleep Through the Night, p. 35.
therefore removing the desire to wake up in

the middle of the night. For a younger baby,
nighttime wakings are more food-related
than attention-related.
Only after dad has really tried everything for
a while should he finally resort to letting
your baby feed. The authors estimate the
whole process might be stretched out as long
as an hour and-a-half or so.
In nights two to four, youre basically doing
the same thing, but pushing the envelope a
little more each night, trying to stretch the
time even more. They say that most babies
will respond by the third night, and almost
all will by the fourth night.
How much your child feeds at the focal

feeding is not all that important; just
offering her enough of an
The next time the baby
opportunity to feed is all you
need.
For an infant or toddler older

than about four months, the
authors state that there is no
wakes up, its time for
longer a need to feed at
night. Rather, they say any
The next time the baby
someone else to get
nighttime
feedings
are
wakes up, its time for
conditioned habits. The
someone else to get involved
involved (probably Dad).
authors suggest you first
(probably Dad). The authors
break the nighttime feeding habit with the
stress that this not be mom so that the baby
same basic method described above.
does not try to root for food, which they
point out is pretty much inevitable if Mom is
If your otherwise healthy child is still not
there. Dad should change the baby, swaddle
sleeping through the night beginning at five
the baby if she is a younger baby, and then
months of age, but they are not feeding at
put her into the crib. Dad can do about
night, the authors recommend what is
anything other than picking up the baby or
basically a Ferber approach of progressive
feeding her to get her to go back to sleep.
waiting (with longer intervals than Ferber
recommends) with short returns for comfort.
If Dad hasnt gotten baby to go back to sleep
They are not afraid to push the issue pretty
after ten to twenty minutes, he can then pick
far, stating that you can expect a five-toher up. You can then walk, cuddle, or rock
nine-month-old who has never slept through
your baby back to sleep, and then put her
the night will cry up to an hour or two
back in her crib.
before falling off to sleep. Helping Your
Child Sleep Through the Night, p. 73,
If, after around ten to forty-five minutes
emphasis added.
more (as much as you can stand), your child
is still not asleep, its okay to give water or
For a five to nine month-old baby, the
sweetened water in a bottle. The goal is to
authors say that it should only take about
break the nighttime wake : feed cycle,
three nights to Ferberize your baby (they

do not use that term). For a ten to eighteen
month-old, they say it can take five to ten
nights plus another month or two to
consolidate the pattern. For a toddler who is
two or older, they offer a twist on the regular
approach.
By the time they are two years old, children
understand pretty sophisticated concepts.
Therefore, at this age, the authors
recommend using a neutral factor to help
establish the appropriate time to get up: a
clock radio, as described in the AAP book.
When your two year-old goes to sleep, show
her the special new purchase (the clock
radio) and what it sounds like with music.
Explain to her that she can get out of bed
when the music comes on in the morning,
but that she should not get out of bed or cry
out until then.
If she wakes and cries out or leaves her bed
in the middle of the night, gently return her
to bed, communicate the same message, and
go back to your own room. If she is
wandering too much, you can gate her
doorway, explaining it will keep her safe in
her own room.
Maintain this firm but consistent approach
until she is sleeping on her own and not
calling out to you.
Additionally, the authors emphasize selfesteem building and verbal encouragement
during the daytime, especially for older

children. They also emphasize not using
your breasts as pacifiers at any time during
the day and dissociating feeding with falling
asleep by feeding earlier.
Lastly, after your child has successfully
broken her nighttime feeding habits and
successfully started to sleep on her own, the
authors suggest continuing the focal feeding
for an additional two to four weeks, and then
eliminating it cold turkey. If the two to four
weeks would end before the child is three to
five months old (depending on your babys
needs), you should continue the focal
feeding until that time.
They also do not recommend letting a child
under five months of age cry a long time
without coming to them, although they say
its okay for older children.
Lastly, in order to help your child sleep a
full night, they recommend that you not feed
her immediately upon waking in the
morning. If your child continues to wake too
early, make sure there is not too much light
in her room.
Also consider pushing bedtime later and
shortening her nap. If your child is napping
late in the afternoon, you might also
consider pushing naptime earlier. Typically
a child will transition to one nap per day by
around twelve to fourteen months and
eliminate her naps by around three years of
age.
How to Get Your Baby to Fall Asleep on Her Own
Again, the
authors of this book state that

they feel it is best to move a child into her
own bed and get her to learn to fall asleep on
her own as early as possible after five to
seven weeks.
In order to get her to fall asleep, they offer

several points in an approach that is sort of a
modified Ferber approach. First, they
recommend making your childs sleep
environment as pleasant as you possibly can.
In fact, for an older toddler they recommend

that you coincide the move with a few

positive changes to the room or bed area.
Next, they are big advocates of the
transitional object idea. Although they use
several different words to describe this item,
its basically a blanket, stuffed animal, or
other crib-safe item that they really like.
This item should be with her when she is in
your arms for her last feeding and in the crib
with her at night and at naps to comfort her.
If your child does not have such an item, the
authors recommend introducing one at this
time.
As in the Ferber approach, these authors
recommend that you leave the room while
your child is still awake. They say its okay
to return to your child at reasonable intervals
to comfort her, even stroking her, but that

you should not pick her up. As a last resort,
you can stay in the room without picking her
up.
If your baby has been sleeping in your bed,
the authors also suggest letting her get used
to napping in her crib for some time before
trying to get her to sleep through the night
there.
For those of you reading this who are
fortunate enough to have a child under eight
months of age, the authors suggest that it is
much easier to start her sleeping on her own
at this point. As discussed previously,
separation anxiety begins around eight
months of age and peaks between ten and
eighteen months.
Situations and Developmental Factors That Can Disrupt Sleep
In no particular order, I have compiled some

additional advice offered by the authors that
did not fit neatly into one of the above
sections.
Stranger and Separation Anxiety. Basically,
the authors say that this is a phase, and that
you can help your baby through it by being
sympathetic but not overly protective. They
also say that you should not let your baby
cry alone for more than a minute or two if
she is crying because of separation fears.
They offer no advice, however, for how to
tell if this is the real problem other than
saying that your child will be in great
distress.
Motor Development. As several authors
point out, motor development, especially
times of learning new skills, can disrupt
sleep patterns. In Helping Your Child Sleep
Through the Night, the authors suggest that
helping your child work on these skills
during the day may help lessen the adverse

sleep impact.
Teething. In short, they say this is a shortterm issue and not to make too big a deal
about it. Because teething is a short-term
issue, if your child has chronic sleep
problems, they suggest you look elsewhere.
When teething, offer physical comfort and
reassurance, and then continue as you
otherwise would.
Illness. The authors suggest not trying to
push the sleep issue too much if your child
is sick, and not to begin adapting her sleep
patterns during this time. They also suggest
trying, as much as you reasonably can,
keeping good sleep habits going during this
time, and returning to good sleep habits
quickly when the illness is gone.
Travel. The authors suggest trying pretty
hard to keep up good sleep habits while

traveling, rather than letting them slip, as

many parents are prone to do. Even if your
child cannot have her own room, you may
be able to put her in an isolated area of the
room, and you can certainly bring along her
transitional object and try to stick to your
normal schedule.
seriously and help her calm down. You

should not belittle her dreams, but you also
should not go to extremes because of them
(such as searching the room for hidden
dangers or monsters). If your child is
especially prone to frightening dreams, a
night-light and leaving the door open may
help.
Nightmares. If your child wakes up and cries

out from nightmares, you should take her
Other Age-Specific Advice
With older children, beginning in the ten to

eighteen month range and growing in
importance during the eighteen to thirty-six
month range, you should make sure to
reinforce your childs confidence during the
day. Self-esteem and confidence issues are
highly related to your childs ability to be
independent. The more you can do to build
self-esteem while she is awake, the easier
time your child will have adopting good
sleep habits. Even when your child has not
followed the routine too perfectly, the
authors stress putting the best face on what
has happened to encourage future
cooperative behavior.
Typically, children will move from crib to
bed in the two to three year-old range, or
earlier if a new sibling arrives. The authors
suggest easing this transition by starting
with naps in the bed. They also feel you
should really work at making the bed a fun,
interesting place so that they will have more
incentive to stay there. A night table can
hold some items, and getting your child
involved with picking out the bed, sheets,
and other items will help.
You should not wait until the arrival of your
second baby to transition the first one into a
bed. My mother likes to tell about my older

brother physically throwing me out of the
crib several times after this happened to him.
Of course, my wife gave a knowing smile
when she first heard this story, and I could
almost see her thinking Well that explains a
lot. While it makes an amusing story now,
this is probably not the best route for either
child.
In addition, as your child ages she will
become more adept at finding ways to get
what she wants. For this reason, it is
important to keep a reasonably strict
bedtime routine and to not be too
entertaining during this time. The authors
emphasize not giving your child choices at
bedtime. In dealing with questions or issues,
they recommend deferring your answers to
the morning or saying you will handle it
after she is asleep.
When your child is toilet training, the
authors do not feel you should put too much
stress on her at night or during the bedtime
routine. This is more important if you are
trying to change sleep habits, but they
suggest it even for children who have pretty
good sleep habits.

Chapter Seven:
Gary Ezzo
Background on Mr. Ezzo
Gary
Ezzo, the author of On Becoming

Babywise, is the Executive Director of
Growing Families International. He is a
graduate of Talbot Theological Seminary
and served ten years as Pastor to Family
Ministries in Sun Valley, California. Along
with his wife, Anne Marie, Gary has
authored a number of biblically based
parenting curriculums and books used by
more than 1,500,000 parents throughout the
world (from the Growing Families
International web page).
Mr. Ezzos philosophy is based around the
concept of controlling feedings and the
sequence of sleeping, awake time and
feedings. Much of the commentary about
Mr. Ezzos work has focused on his attitudes
towards dealing with crying, but this
occupies only one chapter, or about 9%, of
his book.
The other most commonly cited criticism I
have heard is that his system starts babies
sleeping on their own too early. Like the
authors of Helping Your Child Sleep
Through the Night, Ezzo recommends
starting children sleeping on their own in the
seven to nine week range. Note that this

represents a change in the 1998 version of
his book; in its original incarnation in 1995,
he recommended starting in the five to eight
week range.
Mr. Ezzo has published several books
associated with different age ranges, right on
up through the teen years. Only two of these
books have much relating to infant and
toddler sleep, and most of that is in On
Becoming Babywise: Learn How Over
500,000 babies were trained to sleep
through the night the natural way, which is
focused on infants, with some material for
toddlers up to around twenty months of age.
The other of Ezzos books that I reviewed in
coming up with the following material is On
Becoming Babywise: Book Two: Parenting
Your Pre-Toddler Five to Fifteen Months.
your browser manually when you later log
in (if you are not logged in now).
On Becoming Babywise is available at:

On Becoming Babywise: Book Two is available at:

Mr. Ezzo, and his faith-based ministry called

Growing Families International, maintains a
web site at www.gfi.org. They call this
organization an international parenting

ministry. For additional background on the
Ezzo family, you can check out
.
http://www.gfi.org/GFI/about/ezzo.html.
In addition, it is worth noting that,
presumably in response to some criticism of
their works, they have posted a web page
specifically comparing the recommendations
of the American Academy of Pediatrics

(AAP) to their own. This page (for the On
Becoming Babywise comparison) can be
found at
.
http://www.gfi.org/GFI/articles/babywise.html.
The comparisons shown reveal that most of
Ezzos recommendations are very similar to
the AAPs. Notably absent from this page,
however, is a comparison of the issue about
when to start sleeping through the night. In
my latest version of the AAPs Guide to
Your Childs Sleep, the 1999 version, they
suggest starting to work on getting your
child to sleep through the night only if they
are not sleeping five to six hours by three
months of age. AAP Guide to Your Childs
Sleep, p. 77. Although it is not exactly clear
what Ezzo recommends here, it appears that
he is suggesting that a child three to five
months old should sleep ten to twelve hours
without a feeding. On Becoming Babywise,
p. 132. But on page 182 of On Becoming
Babywise, he states that, at thirteen weeks,
a breast-fed baby can extend his nighttime
sleep to nine to ten hours. On page 43, he
says that [h]ealthy, full-term babies
typically are born with the capacity to
achieve seven to eight hours of continuous
nighttime sleep between seven and nine

weeks. On Becoming Babywise.
In any case, there is quite a difference
between sleeping five to six hours between
feedings and sleeping nine to ten hours
straight through.
If the Ezzos or Growing Families
International disagree with my comparison, I
would welcome their comments and will
make any corrections necessary in order to
more accurately reflect the truth.
In any case, even if Mr. Ezzo is a bit
aggressive on starting long sleep periods
early and responding to crying, there is a lot
of valuable information in his books.
Among other aspects, he does a better job of
emphasizing the importance of feedings to
the sleep cycle than any other author I have
seen, and his advice on using a feed-wakesleep cycle rather than a wake-feed-sleep
cycle is worth strong consideration.
Introduction to Mr. Ezzos Ideas
Although
the subtitle of On Becoming

Babywise is Learn How Over 500,000
babies were trained to sleep through the
night the natural way, only Chapter 3 of the
book is dedicated solely to Babies and

Sleep.
There is a good reason for this, as the real
focus of Ezzos work is the interrelations

between feeding and sleep cycles. Because

he sees these as inextricably intertwined, he
spends much more of the book discussing
feeding issues.
In the first chapter of the book, he also
emphasizes the need for a healthy
relationship between the two parents as the
most important thing they can do to help
nurture their child. As he rightly points out,
even very small infants are closely attuned
to the emotional states of others, especially
their primary caregivers.
Arising naturally from the importance of the

relationship between a babys parents, Ezzo
gives his philosophy on how a family should
be focused. He decries Dr. Sears attachment
parenting methods as resulting in childcentered, not family-centered, families. The
result, according to Mr. Ezzo, is selfcentered children who do not understand the
give-and-take of the real world. If you were
to read his later books, it is obvious that he
views this self-centeredness to be at the root
of many problems for older children and
even adults.
Parent-Directed Feeding (PDF)
The
feeding philosophy that Ezzo derives

from
his
non-child-centered
family
philosophy is called parent-directed
feeding, or PDF. He starts here, because, in
his words, [a] feeding philosophy
represents more than just passing on
nourishment to a baby; it represents a
complex value system with its own set of
expectations and beliefs about what is best
for a child. On Becoming Babywise, p. 43.
Although he never gives an outright
definition for PDF, what it comes down to is
a sort of flexible schedule for feeding. Best I
can tell, there are two parts to PDF.
The first part, which Ezzo recommends
starting to encourage as early as you can, is
to make sure your newborn is following a
feed/wake/sleep routine rather than a
wake/feed/sleep routine. The reason for
making sure your baby has a waking period
after feeding but before sleeping is so that
she can begin to learn to fall asleep on her
own. As several authors reviewed in earlier
chapters point out, a child who falls asleep
in her parents arms while feeding is likely
to have sleep problems.
Mr. Ezzo carries this a bit further than the

other authors. He recommends starting to
lay the groundwork for this by beginning a
proper cycle during the first week of life. In
addition, he makes it clear that this routine
should be followed for naps, and not just for
nighttime sleep.
The second part of PDF is the flexible
schedule part. What this means is that you
have an approximate target amount of time
in mind between the beginning of one
feeding and the beginning of the next, but it
need not be too precise. For instance, for a
newborn (less than eight weeks), the target
might be around two and-a-half to three
hours for breast-fed babies and three to four
hours for formula fed babies.
If your baby demands food a long time
before the beginning of the period (say, at
the one hour mark), you should, as a general
rule, not give in to her demand. If she is still
asleep or not demanding food by the end of
the time (three hours in this example for a
breast-fed baby), you should wake her and
feed her anyway.

Other authors have extensively discussed the

motivation behind the waking period after
feeding but before sleep, and Mr. Ezzos
extension of this philosophy to napping
seems reasonable. The motivation for the
flexible scheduling piece is to begin to
control both your babys biological rhythms
and those of her mother. This relies on the
assertion that infants are not capable of

adequately establishing their own cycles, but
that they will benefit from a regular routine.
In Ezzos words, erratic feeding periods
confuse an infants young memory . . . [and]
there is no chance for the hunger/wake/sleep
mechanism to stabilize. On Becoming
Babywise, p. 48.
Babies and Sleep
Although there is a little more to it, Mr.

Ezzo seems to imply that babies who are
part of a PDF routine will, for the most part,
naturally fall into a pattern of sleeping
through the night. He offers some interesting
statistics drawn from a sampling of 520
% Sleeping Through the Night
infants who used PDF. The following table

summarizes the percentages that were
sleeping through the night (defined as seven
to eight hours of continuous sleep) at
different ages:
7 to 9 Weeks Old
12 Weeks Old
Breast-Fed
86.9% of girls, 76.8% of boys
97% of girls, 96% of boys
Formula-Fed
As you can see, these are impressive

numbers, but its worth noting that they are
his own studies and have not been reviewed.
In addition, he points out that of the 10%
that had medical conditions, all slept
through the night (eight to nine hours) by the
time they were sixteen weeks old. He also
states that 80% of the babies began sleeping
through the night on their own, with only
PDF to guide them.
In describing the importance of sleep, Mr.
Ezzo discusses the findings of research on
intelligence and sleep, referencing Dr.
Weissbluths book (see Chapter 12 below
for a review of Dr. Weissbluths book). The
most important fact that he points out is that
children whose test scores demonstrated

superior intelligence all experienced healthy
sleep at night. In describing why this might
be, Ezzo states that children with good sleep
habits are more able to interact with their
environment, as they are more awake and
alert.
Although he is pretty much neutral on the
subject of transitional objects, Ezzo is
strongly against the use of rocking chairs,
car rides, mechanical devices, shared sleep,
or nursing your baby as methods to get your
child to sleep. He refers to these as sleep
props, and calls them addictive. He is very
strongly against parents sleeping with their
babies, in particular.

Scheduling and How to Drop a Feeding
Mr. Ezzo breaks up the babys first year into four phases, describing typical feeding patterns
during each of these phases.
Phase 1. Stabilization. Birth through week eight. During this time, Ezzo recommends a
two and-a-half to three-hour cycle from the beginning of one feeding to the beginning of
the next. About the first half-hour would be taken by the feeding, followed by about an
hour of wake time and then an hour to an hour and-a-half of sleep. For late evening and
middle of the night feedings, there would, of course, be no wake time.
Although it is easy for sleepy newborns to go to sleep while feeding, Ezzo
suggests using talking, rubbing his feet, or whatever else works to keep her awake. Once
your baby gets past her fourth week, Ezzo says she can sleep as long as she wants after
her late evening feeding. During the first four weeks, he recommends a maximum of five
hours until the next feeding.
Phase 2. Extended Night. Weeks nine through fifteen. During this time, you would
begin to stretch time between feedings, and perhaps drop some. You would also drop the
nighttime feedings by around nine weeks. Ezzo says a breast-fed baby can sleep nine to
ten hours at this age, and a bottle-fed baby can sleep up to eleven. Naps at this point may
come down to two, with a duration of around an hour and-a-half to two hours each.
Phase 3. Extended Day. Weeks sixteen through twenty-four. Somewhere during this
time you will typically begin to introduce solid foods, but you will probably still maintain
four to six liquid feedings. If your child has not dropped her third nap before now, she
will probably do so during this time period.
Phase 4. Extended Routine. Weeks twenty-five through fifty-two. This stage is pretty
much more of the same as Phase 3, but you may drop one more daytime feeding,
typically bringing the total down to four or five.
When you have decided to drop a feeding,
Ezzo suggests three different methods,
depending upon which feeding you are
planning to drop.
If you are dropping one of the daytime
feedings, he suggests you just do it,
adjusting the time between feedings
accordingly so that they are still evenly
spaced.
If you are dropping middle of the night
feedings, which Ezzo says some babies will
do on their own between the seventh and

ninth weeks, he recommends just letting
your baby cry it out. He states that [a]ny
crying will be temporary, lasting from five
to forty-five minutes. On Becoming
Babywise, p. 123. He states it will take about
three nights to fully drop these feedings.
Mr. Ezzo states that the late-evening feeding
is the most difficult to drop, but that it
should be dropped around two months of
age.

Chapter Eight:
Dr. Paul M. Fleiss, M.D., M.P.H., F.A.A.P.
Background on Dr. Fleiss
Paul M. Fleiss, M.D., M.P.H., F.A.A.P., is a

well-respected pediatrician who has been in
practice for over thirty-five years. He has
published articles ranging from the Journal
of the American Medical Association to
Mothering magazine, and has given
numerous presentations on topics including
breast-feeding and the use of herbal
remedies. He has also received several
research grants to study the excretion of
pharmaceutical drugs in human milk.
Dr. Fleiss was the subject of the 1996 film
The Good Doctor (he is the father of the
Hollywood Madam, Heidi Fleiss). He
maintains an active medical practice in Los
Angeles, California (from the back cover of

Sweet Dreams).
Dr. Fleiss has published one book, which is
on sleep issues for children. This book is
titled Sweet Dreams: A pediatricians
secrets for your childs good nights sleep.
In addition, he has a book on issues faced by
parents of premature babies that is slated for
release in August of 2001. This book will be
titled Your Premature Baby Comes Home :
A Pediatrician's Guide to Caring, Feeding,
and Development, and it can be preordered
by going to:
about Sweet Dreams or in purchasing this
book, click on the link below (if you are
logged in) or cut and paste or type it into

your browser manually when you later log
in (if you are not logged in now).
Sweet Dreams is available at:

I was unable to find a web presence for Dr. Fleiss, but I did find a listing with contact
information at:
http://www.breastfeedingtaskforla.org/DirData2001.htm#Miracle%20Mile%20/%20Downtown
The listing is from the Breastfeeding Task Force of Greater Los Angeles Resource Directory.
Introduction to Dr. Fleisss Ideas
Dr. Fleisss philosophy is one of immediate

response. Essentially, there are two elements
to his sleep method. First is cosleeping.
Second is the immediate response part,
which means that you should, without
hesitation, go to your child whenever she is
crying out. When you go to her, you should
do whatever it takes to soothe her.
According to Dr. Fleiss, the very goal of
most parents and sleep practitioners is
wrong. You should not viewing successful
parenting as having a baby who quietly
sleeps through the night. Rather, success
would be a baby who has learned that her
mother will come to her whenever she cries
out for her, as Fleiss says this child will
more likely develop into a self-reliant and
self-assured child.
Dr. Fleiss makes rather a big deal in his
introduction about the fact that this book is
based on a well-documented and rigorous
review of the latest scientific literature . . .
[with] supporting references from the
medical literature . . . [and] [f]ew childcare
books make this commitment to scientific
honesty. Sweet Dreams, p. xiii.
While it is true that he has done a better job

than most of documenting supporting
studies, I would hardly call a book that only
cites supporting references, and no
detractors, as accurate and unbiased
scientific information. Sweet Dreams, p.
xiii. Three years in law school taught me the
importance of objective and thorough
research on both sides of the issue, and
Fleiss only cites the studies that support his
viewpoint even where those that contradict
him vastly outnumber those that support
him. In fact, if one were to look exclusively
at the studies conducted by major sleep
centers, they would probably end up near to
Ferber or the AAP in parenting style.
At the same time, while his claimed
objectivity is ludicrous, his opinions are
worth consideration. Studies, especially
where subjective criteria abound as in this
topic, are always highly suspect and subject
to manipulation. I merely mean to say that I
take offense at the claim of objective and
scientific analysis by one who is so clearly
an advocate of a minority point of viewthat
is, immediate response.
The Problem Is One of Expectations
Dr. Fleiss distinguishes himself from other

authors quickly by his description of the real
problem: unrealistic expectations. Rather
than starting with a babys sleep problems
and how to correct them, he starts with the
parents expectations.
In his mind, parents are misled into
believing that babies can and should sleep
like adults. As he and other authors have
pointed out, babies sleep differently than
adults. Even after three months of age, when

they are capable of maintaining a relatively
stable twenty-four hour cycle, the content
and duration of their sleep is different than
that of adults.
Dr. Fleiss would, in fact, consider many
children who had been successfully taught
to sleep through the night as parenting
failures. While the Ferber method or other
cry it out methods may stop your child from
crying out in the middle of the night, this

For nighttime wakings, he suggests that the

may
not
be
such
a
wonderful
best answer is to quickly go to your child.
accomplishment. In fact, if it results in longAccording to Dr. Fleiss, a child whose cries
term psychological damage, as Fleiss
are ignored will resort to
implies it will, it would be
Babies are not adults,
using any behavior that will
considered a failure.
get them attention. They will
and
there
is
nothing
you
react this way because their
As Dr. Fleiss states on page
emotional need is far
5 of Sweet Dreams, Babies
can do to turn them into
stronger than the limited
are not adults, and there is
amount of rationality that fits
nothing you can do to turn
adults overnight . . . Let
into their decision-making.
them into adults overnight . .
your baby be a baby, and
. Let your baby be a baby,
Dr. Fleiss does not believe
and both you and the baby
both you and the baby
that immediate response will
will be much happier.
spoil your child. In fact, he
will be much happier.
states that [c]hildren are
The corollary to this is
spoiled by being ignored.
making sure that parents
Sweet Dreams, p. 27. In other words, hes
dont blame their child for sleep problems.
saying that ignoring your child will mess her
Fleiss states that problems with resistance to
up, not keep her from being spoiled. As
bedtime are typically due to a failure by the
additional evidence of the reasonableness of
parents to establish good bedtime rituals,
his immediate response method, he points
and that middle of the night wakings are just
out that humans are the only mammals that
plain normal, and not a problem at all.
will ignore their infants cries. All other
mammals will respond immediately.
A Few Miscellaneous Points of Interest
The book, in general, offers more platitudes

than concrete suggestions, but Fleiss does
have some advice that is a little different
than the authors analyzed so far. He also
offers a lot of support for the concept of
cosleeping, but the analysis on this issue is
very similar to Sears analysis, so its not
worth repeating here.
One suggestion he has for encouraging a
good nights sleep is avoiding circumcision.
Dr. Fleiss makes a substantial leap of faith
in saying that this is a major cause of longterm sleep problems. He points to a study
that says that circumcision is a stressful
event. He then points to a sleep study that
shows that, when they have been placed
under massive stress, infants sleep is

negatively effected. Combining these two,
he makes a small leap of faith to say that
infants sleep is negatively affected by
circumcision, and a major leap of faith to
imply that this has any long-term impact.
At the same time, he is in line with the
medical community in stating that
circumcision is not medically necessary.
Probably most of you reading this book have
already made the decision one way or the
other by now anyway, so I wont dwell on
this issue any further.
Other suggestions from Dr. Fleiss for
relaxing your baby include massage, early

morning or afternoon exercise, and exposure

to sunlight. All of these are good, healthy
habits at any age, and you may benefit from
them as much as your child does.
Lastly, while other authors have correctly
identified the critical role of light and dark
in regulating the bodys circadian rhythms,
Fleiss offers an interesting number that I

have not seen elsewhere. He cites a study
that says that the light from a 100-watt light
bulb at ten feet is sufficient to disrupt the
bodys internal clock. In other words, if
youre not sure if the lights youre using at
night are too bright, they probably are.

Chapter Nine:
Dr. Jeffrey W. Hull, M.D., F.A.A.P.
Background on Dr. Hull
Jeffrey
W. Hull, M.D., F.A.A.P. is a

graduate of the University of Texas at
Austin and the University of Texas Medical
Branch at Galveston. He completed
internship and residency training in
pediatrics at the Child Health Center,
UTMB Galveston, and served for an
additional year on the faculty as Chief
Resident in Pediatrics. Following that time
he served for three years as a U.S. Navy
pediatrician at the Naval Regional Medical
Center, Camp Lejeune, North Carolina,
before entering private pediatric practice
(from biographical information supplied
with his Sleep Tight Video - registered
trademark of Jeffrey Hull Productions, Inc.).
produced in 1996 and that he sells over the

Internet. Although I have not actually typed
it out, its important to keep in mind how
much information a sixty-five minute video
contains. By my estimate, it is roughly the
equivalent of three or four single-spaced,
typed pages on 8 x 11 paper in a twelvepoint font. In other words, it wouldnt make
much of a book.
Hull is also not the only one who offers
infant sleep training on video. A quick
search on Amazon.com revealed four others,
and I am sure there are plenty more. Hulls
work is distinguished in that he has done a
better job of marketing it, and I feel its
popularity requires me to include a review.
Dr. Hulls contribution to the field is made

through a sixty-five minute video that he
Dr. Hulls ego does not allow him to have anyone else (like Amazon or Barnes & Noble) sell his
video, as he is firmly convinced that the personal support he offers represent much of the value
in the video. I can tell you from experience with similar programs that 99% of the purchasers do
not ever contact him, but Im sure he could never admit this to himself. In any case, theres only
one place you can find his video, which is on his website, at www.drhull.com. If you want to
jump right to the page to order, go to http://www.drhull.com/cgi-local/shop.pl/page=Order.html.
Introduction to Dr. Hulls Ideas
Dr. Hulls biggest claim is that his method

is a no tears method. While true, this
hardly makes him unique. His video starts
off with some sleep science and information
about bedtime rituals, all of which is the
standard stuff.
He then moves into the five types of sleep

problems that he says he sees in his practice.
Dr. Hull claims that any other sleep problem
is probably just a variation on one of these
five. The five are:

1. Wrong Bedtime for a Baby

2. Newborn Not Sleeping Through the
Night
3. Wrong Bedtime for an Older Child
4. Night Crying in an Older Infant or
Toddler
5. Child Sleeping in Your Bed
His section on the wrong bedtime for a baby
involves two steps. First, make sure that you
have a good bedtime routine in place, and
that the bedtime routine is taking place at
your babys natural bedtime (whenever her
longest sleep segment typically occurs), no
matter when in the day that is. Then, you
can start to adjust the time for the bedtime
routine.
Citing the studies stating that humans have a
natural cycle closer to twenty-five hours,
rather than twenty-four, he suggests
different adjustments for moving the cycle
forward than backward. If pushing the time
later, he suggests two hour daily changes,
and if pushing it earlier, twenty to thirty
minutes.
His wrong bedtime for an older child
solution is the same as for a baby, plus
potentially altering afternoon nap and
feeding times.
feeding issues, especially on stretching out

the intervals between feedings (see my
comments in the A Few Other Thoughts
section below). He also suggests, contrary to
virtually every piece of advice written in the
last fifteen years, that you use solids at
bedtime to increase sleep.
This recommendation was common at the
time Dr. Hull went through medical school,
but it also represents the danger of listening
too carefully to the advice of someone who
is relying on outdated training. As I
mentioned in the AAP section, doctors are
not required to undergo ongoing training,
unlike most other professions, and if they
have a substantial enough ego, they may
decide that they already know all they need
to know and stop learning about more recent
research. There are great doctors who do
make the effort to keep their knowledge
current, but be very cautious in choosing a
provider.
For the older infant or toddler who cries out
in the night, Hull suggests a tactic that the
AAP refers to as the disappearing chair
trick. This method is described in the next
section below.
For the child that insists on sleeping in your
bed, Dr. Hull suggests the disappearing chair
method, but applied at bedtime as well as in
the middle of the night.
For a newborn who is not sleeping through

the night, Dr. Hull focuses primarily on
Whats This Disappearing Chair Thing All About?
While the AAP gave brief mention to this

technique, Dr. Hull is the only one Ive seen
that makes it the heart of his program.
First of all, the idea arises from trying to
find a solution that does not require one to
go all the way into either the Ferber or the

Sears camp. Most of the plan is in the
mainstream of baby sleep science: dont
rock or nurse the baby to sleep, put her into
her crib while shes still awake but pretty
tired, maintain a good bedtime routine.

Whats different is how you respond to, and

in many cases prevent, your baby from
crying. This approach is designed for the
child between six months and two years of
age. It assumes that crying during this age
range is primarily the result of separation
anxiety.
If your child is suffering from a fear of
separation, the only solution that will
address her fears is to know youre there. At
the same time, if you make your appearance
too appealing, you may be training her to
call for you even when shes not really
suffering, but just bored.
Therefore, you must be there for comfort,
but your presence must not be all that
interesting. When putting your child to sleep
at night, you sit in a chair near her crib. If
she has woken in the middle of the night,
you should go to her and sit in the chair.
You should not sing to her, talk to her, or
pick her up. Rub her back or touch her only
if you think it is absolutely necessary. If the
problem is separation anxiety, your presence

should suffice.
Each night, you will respond in the same
way. If you respond quickly, she will not get
as worked up, and she will probably go back
to sleep more easily.
Over the course of several nights, you will
make only one change. Each night you will
move your chair farther and farther away
from her crib, until you slowly move it out
the door and out of sight. If this is done
slowly enough, your child should not object.
You might only move the chair a foot or a
few inches per night, depending upon your
childs tolerance.
Lastly, it is important when using the
disappearing chair method to make sure that
everything else is just right. You are only
providing the minimal comfort she needs.
Therefore, all of her other needs must be
taken care of in advance (dirty diaper,
temperature, etc.), and the daytime schedule
and bedtime routine should be consistently
used
before
using
this
method.
A Few Other Thoughts
First
of all, if you need some lessons in

double talk, listen to Dr. Hull discuss how
the medical community has it all wrong, but
that you should listen to him because hes a
doctor. Hmmm.
Now, lets talk about some specific cautions.
First, lets talk about feedings. All of the
criticism aimed at Gary Ezzo for spreading
out feedings too far in newborns should
apply doubly to Dr. Hull, as he has even
more aggressive standards. He suggests that,
as soon as possible, you should get the
feeding interval to be at least four hours,
and that the real goal is to maximize this
time. He also states that a baby should sleep

an uninterrupted ten to eleven hours by eight
to ten weeks. Mr. Ezzo does not recommend
this long of an interval until a child is at
least three to five months old.
Second, the open bedroom door again. Your
fire marshal and the AAP tell you that a
child is safest with the door closed, as in a
fire there is some protection from smoke and
the spread of the fire. Dr. Hull says you
should leave it open so you can hear your
childs cries. Personally, I think a baby
monitor turned low can solve the hearing
problem while addressing the fire issue.

Chapter Ten:
Jodi A. Mindell, Ph.D.
Background on Dr. Mindell
Jodi A. Mindell, Ph.D., is a Pediatric Clinical Director of the Sleep Disorders Clinic at Allegheny
University of the Health Sciences in Philadelphia. She holds M.S. and Ph.D. degrees in clinical
psychology, is associate professor of psychology at St. Joseph's University, and is the author of
numerous publications on the subject of pediatric sleep disorders (from the back cover of
Sleeping Through the Night).
Dr. Mindell is often quoted and interviewed in various online and offline publications, mostly
those in the parenting genre. She is the author of two books and many articles, but only one of
the books is currently in print. This book, Sleeping Through the Night, is the one she is best
known for authoring.
If you are interested in finding out more about Sleeping Through the Night, or in purchasing this
book, click on the link below (if you are logged in) or cut and paste or type it into your browser
manually when you later log in (if you are not logged in now).
Sleeping Through the Night is available at:

The web presence I found for Dr. Mindell is

through St. Josephs University in
Philadelphia, where she teaches. For her

resume, you can check out:
http://psychology.sju.edu/faculty/mindell/web_page.html#F
and for some interesting information about her in a more conversational form, see:
http://www.sju.edu/SLEEPING_THROUGH_THE_NIGHT/about_the_author.htm.
Introduction to Dr. Mindells Ideas
Dr. Mindells book is a thorough and sound

analysis of whats available, and she is
pretty much in the Ferber camp in terms of
general
philosophy,
with
a
few
improvements. As you will see in the
following paragraphs, however, she has
many gems of additional wisdom.
Mindell is also a bit more open to allowing
parents to pursue alternatives styles, and
much of her advice is useful whether or not

you plan to Ferberize.
In the wake of reading Dr. Fleisss book, I
cannot help but note the lack of research
citations in her work. These may not be as
important in a book written for the general
public as in an academic paper, but it there
were a couple of things she said about which
I would like to have read more.
The Basic Method
In Sleeping Through the Night, Dr. Mindell

describes a four-step Basic Bedtime
Method for dealing with sleep issues.
If you read a little further, youll find that
she recommends a certain order for
implementing this method. The place to start
implementing the basic bedtime method is
naptime. You should then use it at bedtime
after naptime has become easier, and,
according to Mindell, you may never need to
worry about middle of the night wakings if
you get naptime and bedtime working well
enough.
The first step of Dr. Mindells routine is to
have a set time for bedtime or naptime. This
step keeps your babys internal clock set,
and it should be the same time each day.
The second step is the often-discussed
bedtime routine. As discussed in earlier
chapters, this helps set the stage for easily
falling asleep. A good bedtime routine will
be enjoyable, and the end of it should occur
in your childs room in order to build
positive associations.
The third step should actually come first.

This step involves going into your childs
room and imagining it both at bedtime and
in the middle of the night. In order to
minimize sleep disruptions, Dr. Mindell
emphasizes that everything about the
environment, from sounds to lighting to
whats in the crib, should be as exactly the
same at bedtime as in the middle of the night
as possible. Although she does not
specifically address carrying this step over
to naptime, her naptime advice does suggest
that you [m]ake everyone and everything
consistent with your evening routine.
Sleeping Through the Night, p. 100.
The fourth and last step is the Ferber step.
At the end of the bedtime routine, put your
baby in her crib and leave the room. Then
you can return in a brief checking routine
under Ferbers principles, then leave again,
and so on.
The absence of the fifth step is a major
deviation from Dr. Ferbers approach. For
nighttime wakings, Dr. Mindell suggests
that its perfectly fine to rock your baby
back to sleep or do whatever youve
normally done in your middle of the night

successfully implementing the bedtime

wakings. According to Dr. Mindell (and this
routine for several weeks and are still being
is one of the places I would like to have seen
regularly woken up at night. In this
a citation to some authority), Studies show
circumstance, you would
that teaching your baby
Dr. Mindell suggests that, if
pretty much do a classic
to fall asleep on his own
nighttime Ferber method.
at bedtime is all that is
your
six
week-old
or
older
baby
required to teach him to
By the way, Dr. Mindell,
sleep through the night.
has fallen asleep while nursing,
like
several
other
Sleeping Through the
authors, suggests starting
Night, p. 90.
you should wake her up before
to build some good
putting her into her crib so that
habits beginning around
In other words, if you get
six weeks of age by
the bedtime issue solved,
she begins to learn to fall
putting your baby down
the nighttime problem
to sleep while shes still
will go away on its own
asleep in the same environment
awake and beginning
over a period of a few
bedtime routines. In fact,
weeks. The theory is that
in which she will awaken.
Dr. Mindell suggests
your baby has learned to
that, if your baby has fallen asleep while
fall asleep on her own, and she will naturally
nursing, you should actually wake her up
use this same skill during the night if her
before putting her into her crib so that she
environment is identical.
begins to learn to fall asleep in the same
environment in which she will awaken.
Dr. Mindell suggests Ferberizing for
nighttime wakings only if you have been
Miscellaneous Advice from Dr. Mindell
As
I stated in the introductory section

above, Dr. Mindell offers several gems of
wisdom that are not easily categorized.
While many of these duplicate those listed
above, there are still a few that do not, as
follows.
Crib or bedroom for punishment. While it
makes perfect sense, I havent seen other
authors point out this important principle.
Dr. Mindell says its a mistake that many
parents make to use either their childs crib
or her bedroom as a place to put her when
she misbehaves. It is very important to build
only positive associations with the sleeping
environment, so this is strongly discouraged.
Early risers and night owls. While Dr.

Mindell says that a typical baby bedtime is
between 7:00 and 8:30 p.m., she has specific
advice for parents of children who habitually
wake up early or stay up late. For a child
who stays up late, she states that you cannot
move her bedtime earlier, as she just wont
go to sleep. For the early riser, on the other
hand, she suggests you may be able to keep
her up later in order to get a little more sleep
in the morning. Her willingness to change an
early riser but not a night owl may represent
Mindells own bias, however, as I suspect
she is more the night owl based on this
advice.
Moms t-shirt as transitional object. If
youre looking for a transitional object that

your child will really like, Dr. Mindell refers

to one study (again with no citation) that had
babies sleep with a t-shirt that their mothers
had worn all day. Apparently, this shirt,
loaded with Moms scent, was a significant
calming influence that helped the babies
sleep better.
Other methods. Mindell includes a section
where she discusses some other methods for
getting children to sleep through the night.

She describes, along with some others, both
the disappearing chair, or gradual parent
removal as she calls it, method, as well as
the concept of scheduled awakenings as
advocated by Cuthbertson and Shevill. In
addition, she offers some good analysis for
each of these other methods this is worth a
read if youre considering those ideas.

Chapter Eleven:
Dr. Benjamin Spock, M.D.
Background on Dr. Spock
Benjamin
Spock, M.D. ("Dr. Spock"),

practiced pediatrics in New York City from
1933 to 1947. Then he became a medical
teacher and researcher at the Mayo Clinic,
the University of Pittsburgh, and Case
Western University in Cleveland. The author
of eleven books, he had two sons, a
stepdaughter, and four grandchildren, and
was married to Mary Morgan. Dr. Spock
died March 15, 1998, at age 94, shortly after
completing work on the seventh edition of
Dr. Spock's Baby and Child Care (from
which this information is obtained).
As most anyone who hasnt been living in a
closet knows, Dr. Spock was probably the
most well-known and often quoted
pediatrician of the twentieth century. While
getting good publicity does not make your
ideas any more or less sound, one can hardly
ignore the influence of Dr. Spock on parents
and pediatricians alike.
The paperback 7th edition of Dr. Spocks

Baby and Child Care that I have is 939
pages of power points for baby and
childcare. In other words, this book is not
written like a traditional book. Rather, it is
designed more as a reference, broken up into
chapters, sections, and numbered points.
With 1,193 points in the 833 pages that
make up the meat of the book, every couple
of paragraphs is a new power point.
As such, it is hard to easily review Dr.
Spocks sleep advice in a traditional writing
style. Therefore, I have chosen to identify
the most relevant or unique points in more
of a list format below.
about Dr. Spocks Baby and Child Care, or
in purchasing this book, click on the link
below (if you are logged in) or cut and paste
or type it into your browser manually when
you later log in (if you are not logged in
now).
Dr. Spocks Baby and Child Care is available at:

I have been unable to find any web presence for Dr. Spock. If you are aware of any, please email
me at BabySandman@fmpllc.com.
Points from Dr. Spocks Book

When to start sleep training. Start having
your baby learn to go to sleep on her own
around three or four months old by putting
her in her crib while shes still awake. If
shes been sleeping in your bed, move her
out by this time if not a month or so earlier.
Middle-of-the-night feedings. Dont wake
your baby for feedings, but for the first six
weeks feed her when she needs it in the
middle of the night. She will probably give
these feedings up on her own around six to
twelve weeks of age. If she is at least twelve
pounds and two months old, and is still
feeding in the middle of the night, influence
her to give it up. Let her fuss for a minute or
two instead of responding immediately. If
she doesnt quiet down, go to her.
Feedings at your bedtime. For a newborn,
you can probably time this for your
convenience. The two considerations for
giving this up are whether or not she is
sleeping through the night and whether she
is sucking her thumb a lot. If she wakes later
in the night, its probably easier for you to
wake her when you go to bed than to be
woken up later in the night. According to
Spock, thumb sucking can be a sign that she
is not sucking as much as shed like from
the breast or bottle.
At first, its the only means of

communication. Later, its usually for
attention, or at least you have learned how to
identify the meaning of the cry. In the first
few months, you cant spoil your baby.
Something is bothering her. According to
Dr. Spock, you dont have to worry about
spoiling until your baby is around six to nine
months of age. Until then, you should
generally respond, as youre building a basic
sense of trust.
Generally speaking, Spock is not an
advocate of letting babies cry it out. If you
end up with a baby who is chronically
resistant to going to or staying asleep, and
that child is over a year old, he feels you
may have no other choice. In this case, he
suggests that you must leave the room and
not go back unless there is an emergency.
He says the crying will not last more than a
few days, and never more than a few weeks.
Spock also feels it is important that your
baby not see you when she wakes up if
using this method, so if youre in the same
room, put some sort of a screen up.
Bedtime. At some point, and certainly by the
age of two, Spock emphasizes that parents
need to enforce a bedtime. Many children by
this age will not want to go to bed even
when they need more sleep.
How to deal with crying. It doesnt mean the

same thing in an infant as in an older child.

Chapter Twelve:
Dr. Marc Weissbluth, M.D.
Background on Dr. Weissbluth
Marc
Weissbluth, M.D., has been a

pediatrician for twenty-five years and is also
a leading researcher on sleep and children.
He founded the Sleep Disorders Center at
Chicago's Children's Memorial Hospital in
1982. In addition to his own research, he has
written chapters in textbooks for
pediatricians on sleep problems, has lectured
extensively to parent groups, and has
appeared on Oprah. Dr. Weissbluth is the
father of four children - and they are all
good sleepers (from Healthy Sleep Habits,
Happy Child).
Dr. Weissbluths philosophy for most babies
and toddlers who wont sleep is something
akin to let em cry as long as it takes. On the
other hand, he has an awful lot in this book
that is designed to keep you from getting to
that point.
Perhaps the most unique aspect of

Weissbluths book is the focus on naps. He
spends a lot of time explaining the problems
and symptoms that result from inadequate
napping, as will be discussed below.
Weissbluth is the author of two other books
in addition to Healthy Sleep Habits, Happy
Child. These two are not part of this review,
but they are called Crybabies: Coping with
Colic: What to Do When Your Baby Wont
Stop Crying and Sweet Baby: How to Soothe
Your Newborn.
about Healthy Sleep Habits, Happy Child, or
in purchasing this book, click on the link
below (if you are logged in) or cut and paste
or type it into your browser manually when
you later log in (if you are not logged in
now).
Healthy Sleep Habits, Happy Baby is available at:

The only web presence I could find for Dr.

Weissbluth is at www.sweetbabies.com.
This is a sort of multipurpose site for giving
a little bit of biographical information about
Dr. Weissbluth, a little bit of information
about his practice (The Northwestern

Childrens Practice), and a commercial pitch
for the Sweet Baby book along with a CD
for soothing newborns.

Introduction to Dr. Weissbluths Ideas
Dr.
Weissbluth brings a very different

perspective to infant sleep science. As
anyone who has read much about him
knows, he is best known for advocating
letting your baby cry as long as necessary
once a certain age is reached, if that is
necessary to get her to sleep.
is causation. He does not cite any studies

that say that if your child sleeps more, she
will be smarter. In fact, your child may be
sleeping plenty, and extra sleep may cause
more problems.
There may be altogether unrelated factors

causing both the diminished mental capacity
and the sleep problems. They may even be
His book does not start with the crying
totally unrelated, although there is a
issue, but rather with a
correlation. If I found data
lot of information on
If I found data that proved that
that proved that there was a
the
importance
of
significantly
higher
sleep.
The
basic
there was a significantly higher
percentage of automobile
principle he advocates
accidents
the
month
percentage of automobile
is that your child
preceding heavy rainfall
should get as much
months,
would
you
accidents the month just before
sleep
as
possible,
therefore
assume
that
especially at naptime.
heavy rainfall months, would
automobile accidents cause
rain?
If
you read the
you therefore assume that
beginning of his book,
Now, that said, I do think
automobile accidents cause
you will probably be
parents can pay more
scared silly about sleep
attention to naptime and
rain?
issues, as he points to a
can
consider
earlier
lack of adequate sleep
bedtimes as possible tools in helping their
as causing a host of childhood maladies,
children sleep better. I am merely cautioning
from behavioral problems to a lack of
the reader to not go overboard.
intelligence. Be careful reading this
information, however, as he is taking some
What about this crying for hours on end
huge leaps of logic in reaching some of his
thing? Well, this is what many have
conclusions.
discussed most critically. This method may
be best in certain cases, and Weissbluth
The basic logic is as follows, and it applies
makes a point of giving lots of parent
in any area, but lets look at intelligence as
success stories, but there are three problems
an example. Studies have shown that more
I have with the concept.
intelligent children sleep more, and that less
intelligent children sleep less. Therefore, if
One: children who are forced to spend
you can get your child to sleep more, she
endless hours in their bedrooms crying may
will be smarter.
(and according to some parents have)
become very dissatisfied with the bedroom
The problem with this logic is that Dr.
environment at all times. In other words,
Weissbluth
is
taking
studies
that
they may form negative associations with
demonstrate correlation, or the fact that two
the crib and bedroom that are the exact
things go together, and assuming that there
opposite of what Dr. Mindell and others

would have you build.
Two: trust, once lost, is very difficult to
replace. Parents who have unsuccessfully
tried Weissbluths method have reported
that they have lost a special part of their
relationship with their child that may never
return.
Three: Its not one size fits all when were
talking about baby sleep problems. In other
words, the best solution for one baby may
not be the best for another. If you are

working through a sequence of alternative
methods to see what works best for your
child, I think this method must come last
(see the next chapter for more on this).
That said, I have, as stated for other authors,
included a review of Dr. Weissbluths book
for a reason. And that reason is not to trash
the book or his ideas, but to pull out the
more valuable parts to fit into my overall
plan. So lets learn a little more about
Weissbluths ideas.
How Much Day and Night Sleep?
Although
he points to many examples of

problems resulting from too little sleep, Dr.
Weissbluth does not cite any examples of
too much sleep causing problems.
He does, however, offer some interesting
charts of actual sleep for 2,019 of his
patients and others in northern Illinois and
northern Indiana. As Weissbluth points out,
most books only show the average, and not
how wide of a range typical sleep patterns
might occupy. Therefore, his charts show
the 90th percentile and 10th percentile along
with the 50th percentile. This should help
parents develop a better idea of whether or
not their child fits within the middle,
presumably normal, 80%.
For instance, a mid-range one year-old
might sleep about eleven and-a-half hours at
night and a little over two hours in the day,
but the range of normal (middle 80%) is
much wider. On the high end of this range,
children at one year slept almost thirteen
hours at night and over three hours in the
day. On the low end the number was less
than ten hours at night and under one and-ahalf hours in the day.
While there is a range of normal, Dr.

Weissbluth believes that there are more
undersleepers than oversleepers. While
nighttime undersleep can be a problem in
some circumstances, he highlights the time
spent napping as especially important.
Weissbluth points to various studies at
various ages showing that children who nap
more are more adaptable, had longer
attention spans, were considered easier to
manage by their parents, and were more
likely to have high IQs.
At the same time as he emphasizes the need
for daytime sleep, Dr. Weissbluth states that,
up until about twenty-one months of age, the
amount babies and toddlers can nap is
largely beyond the control of parents. On the
other hand, he argues that many children nap
less than they otherwise would because
parents are somehow messing up their
childs natural schedule.
Among the things that parents most often do
that interferes with their childrens naptime,
Weissbluth refers to allowing your baby to
sleep outside his crib after four months of
age, not fitting your schedule around your

babys naptime, and not following through

In addition to focusing more attention on the
on early signs of sleepiness before your
importance of naps, Dr. Weissbluth states
baby becomes overtired. When children
that many parents put
become overtired, they are
In young children, lack of
their children to bed too
not likely to yawn or nod off;
late. Interestingly, he
instead they get grumpy,
sleep
leads
to
the
release
of
suggests that too late of a
active and excitable.
bedtime is often a cause
stimulating hormones, such
of nighttime or early
Dr. Weissbluth believes that
morning
waking.
nap deprivation is a major
as adrenaline. These
Although it appears
factor in sleep problems for
stimulating hormones then
contrary
to
logic,
the nine to twelve month old
Weissbluth says that,
child. He describes the
promote activity and make it
because of the way sleep
response alluded to in the
works, an earlier bedtime
previous paragraph, where
harder to go to sleep, as a
can often result in a later
lack of sleep leads to the
time for waking up.
release
of
stimulating
vicious cycle builds.
hormones,
such
as
According to Weissbluth, one of the primary
adrenaline. These stimulating hormones then
reasons parents keep children up too late is
promote activity and make it harder to go to
out of a desire to spend time with them
sleep, as a vicious cycle builds.
when they get home from work. While this
time is important, he feels that your childs
In terms of the number of naps, Weissbluth
sleep is more important. Therefore, even if
says that around four months of age, as sleep
you miss some evening playtime, you
becomes more organized, three naps is
should get her to bed at an early hour,
typical. The third nap is typically dropped
typically between 6 and 8 p.m.
around nine months of age, and the second
by twenty-one months, although there may
If you are unsure about whether or not your
be a transition time when one nap is not
child should or could be going to sleep
enough and two is too much (try an earlier
earlier, the question to ask is Looking at
bedtime to help this problem).
your child twenty or thirty minutes before
bedtime, do you think she could go to sleep
If your child is not going to sleep at her
at that earlier time? Healthy Sleep Habits,
naptime, Dr. Weissbluth recommends that
Happy Child, p. 48. If the answer is yes, you
you still leave her alone, in her crib, for an
should probably consider an earlier bedtime.
hour or so, at the normal time. If she still
He uses the analogy of surfing, where your
hasnt napped, keep her up until the next
goal is to time the sleep wave so that your
naptime.
child eases right into sleep. Look for a slight
calming or distant look in your child as a
The last nap is typically dropped by around
sign.
the third birthday, although Weissbluth
would encourage you to keep it going as
long as your child will take it.

The Newborn Up to Four Months
Dr.
Weissbluth doesnt think there is too

much you can do to cause sleep problems
during the first four months. If you want
your baby in bed or in the bassinet at your
bedside at this age, thats fine (as long as
you move her out after four months).
Especially for the first six to eight weeks,
just try to keep her waking times from
exceeding two hours or so, and maybe keep
a sleeping and feeding diary.
If you prefer to hold your baby while putting
her to sleep, Weissbluth says thats fine, but
you should be consistent about it. In the
same way, if you put her down so she can
fall asleep on her own, be consistent.
In fact, contrary to the advice from several
of the other authors discussed above, Dr.
Weissbluth has no problem with you nursing
your baby to sleep. You can even maintain
this habit as long as your baby does not

develop a sleep problem (like night waking).
Beyond the first six or eight weeks, and for
the rest of your childs life, Weissbluth
encourages sleeping in bed. He does not
believe that sleep in the car seat, in a
vibrating chair, or elsewhere, is as good as
sleep in a calm, still, crib.
For the time after the initial six or eight
weeks, and up to around four months, he
recommends you start nibbling around the
edges of good sleep habits. Start trying to
find that magic moment when you can catch
the sleep wave for an easy transition. Pay
attention to your babys language, so you
can learn what her different cries mean and
when shes ready to sleep. Lastly, start
testing her ability to fall asleep on her own,
but dont worry too much about this yet.
Month Four and Beyond
Once the fourth month starts, [o]ur goal is

to establish sleep habits, so we dont want to
get sidetracked by worrying too much about
crying. Healthy Sleep Habits, Happy Child,
p. 128. Dr. Weissbluth states that sleep
problems arise not in the first three or four
months, but from a failure by parents to
change their techniques for coping with
crying after that time. Until that time, a
babys system is not really capable of
maintaining a very structured sleep pattern.
During this age, Weissbluth feels you should
start to make more of an effort to keep your
baby on a regular schedule. For most of this
time, that will mean three naps plus
nighttime sleep. If your baby is waking
before 6 a.m., he recommends that you not
go in to her, as she will enjoy your company

and start waking earlier each day.
If your child is waking early at night, he
says that there are three things that will not
work, although they are still reasonably
common. Feeding solids, keeping your baby
up later, and awakening your baby for a
feeding (see Cuthbertson), according to Dr.
Weissbluth, will not help. Putting her to bed
earlier may help.
As discussed above, Dr. Weissbluth says
you should put your baby through her nap
ritual and into bed roughly at the scheduled
times whether or not she sleeps. If she cries,
let her cry, but leave her completely alone
for one hour.

At the end of that hour, you can go to her,

soothe her, hold her, and whatever you want
to do for her crying. If she looks like she
wants to go to sleep at this time, you should
put her back down at the right time. If not,
shes up until the next naptime. Weissbluth
does admit it may be a little hard to get a
four month old into a regular schedule, but
by five or six months it should be no
problem.
So thats napping. Bedtime is pretty

straightforward. Dr. Weissbluth says she
should now start to sleep on her own. Put
her down and leave the room, ideally at the
magic moment, but when shes not yet
asleep. Leave the room and dont go back.
The process of extinction, or going cold
turkey on going to her after shes in bed, is
his recommended method. The main reason
he claims for advocating this method over
more gradual methods is that it works more
quickly.
Other Thoughts from Dr. Weissbluth
Teething. Dr. Weissbluth, like many other

authors, feels that teething is overstated as a
cause of sleep problems. He says quite
clearly that teething does not cause night
wakings. Blaming teething for sleep
problems, according to Weissbluth, is
probably a holdover from the days when
teething was blamed for everything from ear
infections to even death (he states that, in
England at the end of the 19th century,
teething was blamed for five percent of
childrens deaths).
Separation anxiety. Weissbluth does not
really see this as an issue. Again, he is
taking a position contrary to most of the
authors above, but it is very consistent with
the rest of his advice. Most of the concern
with letting a baby cry for a long time is that
she will develop a sense of aloneness and
lose faith in the consistency of her parents.
If separation anxiety isnt really a big deal,

then letting her cry alone, likewise, may not
cause any harm.
Fading. This is a process that Dr.
Weissbluth refers to on pages 170-71 of his
book, but he doesnt really seem to make it
part of his basic method. The idea is that you
take a list of everything you do, and then
find ways to scale back each item to zero.
For instance, for feeding, it might be starting
with the breast, then a bottle of breast milk,
then formula, then juice, then water, and
finally no bottle. In fading, you gradually
wean your child from the complex contact,
first simplifying the contact, and then
eventually eliminating it. I discuss this
concept, although in a somewhat different
incarnation, in the next chapter.

Section III:
Putting It
All Together

Chapter Thirteen:
The Baby Sandman
The Short Version (I Need Help Now)
Okay, here goes. If youre just plain desperate for help now, heres where you start. This is
organized in a few quick steps, by age. Ages are under three months old, three to eight months
old, and over eight months old. Dont forget to read Chapter One as well, no matter how old your
child is. It has the basics that are necessary for any of this to work well. They are also
summarized in a checklist at the end of this chapter.
Under Three Months Old
Theres
only so much you can do about

sleep habits in a child who is under three
months old. At this age, she hasnt yet fully
developed her neurological systems and
biological rhythms. It is perfectly normal for
a young baby to cry two and-a-half to three
hours a day, and some of this will happen at
night.
If your baby has colic, she will probably be
crying for three or more hours, three or more
days a week, for three or more weeks in a
row. The good news is the last three colic
is typically gone or on the way out by three
months of age. Hang in there.
Given the limited development of such a
young baby, set your expectations low. For
the first six weeks, she will need to feed
every two to four hours, including during the
night. By three months of age, you can
probably get away with one feeding about
three or four hours after she first drops off at
night, followed by five or six hours of peace.
If youre just going crazy, dont be afraid to

ask for help. Others can share the
responsibilities at nighttime and in the
daytime. If you have to, you can even step
outside for a few minutes to cool off. If your
child is under six weeks old, she may sleep
better if she is tightly swaddled.
There may not be much you can do now, but
youre actually lucky if you are starting
now. It is much easier to develop good sleep
habits early in your babys life than it is to
change the bad sleep habits in the terrible
twos.
You can start to lay the groundwork now
with a simple bedtime routine, making sure
your house is light in the day and dark at
night, and encouraging fun time and activity
in day. If your baby will accept it, you may
want to start trying to lay her in her crib
while shes still awake by two to three
months of age. These simple steps will make
a big difference later.

Three to Eight Months Old
If
you picked this age to start developing

good sleep habits in your child, you hit it
just right. There is not too much you can do
with a child who is younger than three
months old, and building sleep habits

becomes harder with older children.
If you are in I Need Help Now mode, just
skip right to putting it all together on page
78.
Eight Months to Three Years Old
Parents
with children older than eight

months old who still have bad sleep habits
face a slightly bigger challenge. The system
still works, and for most parents the positive
results will start almost immediately. You
can expect your child to be sleeping on their
own within two weeks in most cases, and
many parents see results within two or three

days.
If you are in I Need Help Now mode, just
skip right to putting it all together on page
78.
What You Can Learn from Each of the Authors
While I strongly encourage you to read this book cover to cover, the following list will give you
some highlights of the most important takeaways from the authors that were reviewed in
Chapters Two through Twelve.
Dr. Richard Ferber, M.D.
By using a methodical, progressive approach to changing behavior, you will end up with
a result that is tolerable where a cold turkey change might prove unbearable.
Your baby needs to fall asleep on her own, not in your arms. If she falls asleep in your
arms, and later wakes up in her crib, she will be confused and disoriented, which will
cause her to cry out.
In changing bad sleep habits, it doesnt have to be all or noneyou can take baby steps
towards reaching your objective.
Dr. William Sears, M.D.
Dont be too strongly influenced by any sleep expert. Make up your own mind based on
your values and what feels comfortable to you.
If you are considering cosleeping, this book offers a long list of the benefits you might
realize and of ways to handle possible criticism from others
If your childs sleep problems may be caused in whole or in part by medical problems,
The Baby Book has a lot of good, self-help medical advice. The advice is useful for some
basic diagnosis as well as for symptom relief.

Dr. T. Berry Brazelton, M.D.

How you will handle sleep issues largely comes down to your attitudes about autonomy
and independence. You should first address these issues and come to a consensus, as a
couple, before undertaking any sleep program.
In cultures that practice cosleeping, children typically transition out of the parents bed at
around two to three years old.
Dr. George J. Cohen, M.D., F.A.A.P., as Editor for the American Academy of Pediatrics
This text offers a good, objective summary of the consensus opinion of the medical
community. Theres a pretty good chance that this will reflect your pediatricians advice,
so this gives you some idea about what to expect.
As a book built on consensus, this guide serves as a starting point for analysis. If youre
going to deviate dramatically from the AAP guidelines, make sure you have a good
reason.
Use a sleep diary to help you spot trends or to take to a sleep expert if you need more
help.
Joanne Cuthbertson and Susie Schevill
Feeding schedules play a very important role in controlling sleep patterns for younger
babies
When weaning from the middle of the night feedings, use Dad or someone else other than
Mom
Use an older sibling to calm the baby by having them both sleep in the same room, as the
older sibling will provide a good example of what your baby should be doing. Although
many parents are concerned the baby will keep the older child up, this rarely happens.
For an older toddler, a neutral object like a clock radio can help provide the boundaries
for the appropriate time to get up.
Gary Ezzo
The earlier you start, the easier sleep training will become
If you follow a Feed/Wake/Sleep cycle rather than a Wake/Feed/Sleep cycle, your baby
will naturally fall into a better sleep pattern. This allows you to put your child into her
crib while still awake, so that she learns to settle herself to sleep. When she wakes in the
middle of the night, she will use this same skill to settle herself back to sleep.
Dr. Paul M. Fleiss, M.D., M.P.H., F.A.A.P.
Let your baby be a baby. Managing your own expectations may be the best sleep training,
as we dont really know the potential long-term effects of cry it out methods.
Dr. Jeffrey W. Hull, M.D., F.A.A.P.
The use of the disappearing chair to teach your child to sleep on her own while
(hopefully) not being forced to cry out for you.
Finding, using, and changing the natural bedtime for younger babies.
Dr. Jodi A. Mindell, Ph.D.
Understanding the importance of consistency and routine.
Good bedtime habits may eliminate the need for worrying about middle of the night
issues.
Work on helping your baby go to sleep at naptime first, then bedtime second, and during
the middle of the night third.

Dr. Benjamin Spock, M.D.

Understanding the different reasons for crying in infants and toddlers, and therefore the
different ways you should respond.
Dr. Marc Weissbluth, M.D.
The importance of naps, and sleep in general.
The principle of extinction as the fastest way to change sleep habits.
The concept of fading, or making small, consistent changes to work towards the final
goal.
Catching the sleep wave at the right time, not too early nor too late.
Putting it All Together

As both Drs Brazelton and Fleiss pointed out, the best place to start your sleep program is with a
core set of beliefs. For most of the authors, you can quickly discover their beliefs by evaluating
their recommendations, but the beliefs are rarely stated as such.
The beliefs that go into my sleep system are in the following list. If you disagree with these core
beliefs, you will most likely disagree with parts of the system. If you are generally in agreement
with them, I believe you will agree with most parts of this system. I hope you will try it, because
the system works. You should set down a list of core beliefs for yourself and your spouse, and
make sure that all other caregivers buy into them and follow your system. Beware the wellmeaning relative who tries to help your baby out by doing it their own way when youre not
around.
Core Beliefs for the Baby Sandman Sleep System
1. First, do no harm. The goal of this sleep system is to help your child learn to sleep better
without causing any unnecessary trauma that may result in broken trust or emotional
issues. While some trauma may be necessary, it is important to keep it limited to them
minimal amount possible. This limited trauma is still in a childs best interest, as
cumulative, long-term sleep deficits have a more strongly negative effects on a child.
2. Sleep problems do not go away on their own. You should start to gently build a
foundation for sleep habits by around six to eight weeks of age, but you should not worry
too much about results before three months of age. From three to eight months of age is a
critical time for building sleep habits, as you can lay the proper foundation before
separation anxiety becomes an issue. If your child is older than this age and still having
problems going to sleep or sleeping through the night, you must not wait to start building
good sleep habits.
3. While there is a balance between your childs needs and your own, parenting is and
should be an inherently selfless act. No good sleep system should run the risk of
sacrificing your childs well being for your own sleep. Similarly, if you are considering
cosleeping, make sure you are doing this because you believe it is in the best interest of
your child, not because you think its easier on you.
4. Try to incorporate as many of the non-controversial sleep suggestions from Chapter
One as you can. Almost everyone is in agreement about the merits of these ideas, and
any sleep system will be much more effective if built on the proper foundation. While
many of these seem basic, it is important to stick to them, as the fundamentals can often
make the difference between success or failure in sleep training or in many other areas of
life.
5. If your child is experiencing a temporary medical problem or other significant
temporary trauma, try not to change too much until the problem or trauma has
passed. If the medical problem is permanent, you must make some adjustments, but try
to treat your child as normally as you can. Sleep is just as important, if not more
important, to children with medical conditions.
6. Children are not all the same. A good sleep system, therefore, should recognize that
different children will react differently to different methods. The best way to find out
what works is to start with the least traumatic method and slowly work down the list
towards the methods that require more discipline. Methods that require extensive time
crying it out should only be used as a last resort, not as the starting point. Most parents
will not need to use these methods if they start off the right way early enough in their
babys life.
7. Feeding plays an important role in sleep, especially for children under six months of
age. While there may be some ways to use this in sleep training, your childs nutritional
needs should never be jeopardized for a good nights sleep.
8. Trust is much easier to break than to build. Never use methods that can damage your
bond with your child as anything other than a last resort.
9. Helping your child learn to sleep on her own by six to eight months of age is a
desirable goal. While it is never a good idea to force children to grow up too quickly, it
is not unreasonable to expect your child to sleep through the night in her own crib by this
age.
10. Consistency is extremely important to any sleep system. Although some authors
condemn others for training their children like pets, any psychologist will tell you that
all of us try to get more of what we perceive as pleasurable and avoid that which we view
as painful or unpleasant. In order to build associations with pleasure or pain, more
consistency results in a quicker learning curve. Extremely inconsistent responses to our
efforts (such as crying) cause jumbled signals in the brain, and, at the extreme, mental
illness.
11. Children are resilient. While it is important to do the least harm, it is comforting to
know that imperfect parenting still results in good kids. Strive to do your best, and learn
from your mistakes, but dont get too uptight about them. Children from all kinds of
environments have grown up to be perfectly healthy and normal.
As I state above, you may disagree one or more of these beliefs. If you do, you may decide not to
adopt part or all of my system. What I can tell you is that the system works, so consider the
impact different beliefs may have on your decisions. Weigh the pros and cons of any deviations
thoroughly before rejecting any part of the system.
Remember that this system assumes youre already doing the basics as described in Chapter One.
For your convenience, the page following this section includes a checklist for some of the basics
that you can review.

Newborns to Three Months Old
The best advice I can give during this time

is not to worry too much about your babys
sleep habits. For the first six to eight weeks,
there is almost nothing you should do but
feed her when she needs it. A compromise
between demand and scheduled feeding is
the best approach. Be responsive if she is
hungry, but keep an eye out for signs that
she is feeding for comfort rather than
nutritional value, especially if the time
between the start of any two feedings is less
than two hours, or if it is consistently less
than three hours.
Trying to encourage your child to remain
awake through the feeding so that you can
lay her down on her own before she falls
asleep can help build the grounding for
sleeping on her own later, but dont push too
hard on this. If your child just wont stay
awake until the end of the feeding, even if
you try feeding her after a shorter interval,
dont worry about it for the first six to eight
weeks.
After the first six to eight weeks, you can
start to ease into building more of the basics
for good sleep habits. You should start to
work a little harder at keeping your baby
awake after the bedtime feeding so that you
can put her into her crib while she is still
awake.
Start working in a bedtime routine as well.
While this may not include the bath and
story time that you will incorporate later, it

can include a gradual dimming of the lights,
a feeding, perhaps washing her face, a
diaper change, and trying to lay her down on
her own to sleep. At first, you might want to
sing or talk to her to help her settle on her
own, but you dont want her to become too
dependent on your presence for falling
asleep.
By three months of age, she is probably
going to sleep around 6 to 8 p.m., and she
will probably need another feeding around
three or four hours after bedtime. If she is
not able to sleep another five or six hours
after this feeding by three months of age,
start keeping careful track of the timing of
events with a sleep diary. If your baby is
going longer than four hours before the first
nighttime feeding, you may want to try
waking her for this feeding in the
Cuthbertson approach. Typically a baby will
go back to sleep for another two to four
hours immediately after the morning feeding
before fully waking.
During these nighttime feedings, try to do as
little as possible to disturb your baby. Dont
try to keep her awake too long, keep the
lights low, and keep the environment quiet.
Ideally, she will feed in a half sleeping state
that will make it easy for her to return to a
fully sleeping state when the feeding is
done.
After Three Months of Age
This is when your childs first sleep habits

are formed. You should work through this
system from top to bottom. If a piece of the
system applies only to certain ages, it is so
identified. If there is no particular age
mentioned, the advice is applicable for every

age.
If you are starting this at three to six months
of age, you can implement this system at
naptime and at bedtime simultaneously. If

your child is older than six months of age, I

would suggest first locking in the system for
naptime, then working it into bedtime. In
either case, the middle-of-the-night system
should follow the implementation of the
bedtime system by three or four weeks, or
longer if things still seem to be improving.
Naptime should occur at roughly the same
time of day. Typically, your child will be
napping three times a day up to around nine

months to a year old, two times a day until
around eighteen months to two years, and
once a day until she is about three. You
should use this routine for each nap. As the
age approaches during which children
typically drop a nap, be aware of signs that
your child is trying to drop a nap, and follow
her cues rather than leading her.
The system for naptime involves four to seven steps, depending upon how your child reacts. If
you are like most parents, your hope is that you will not have to ever go past step 4. The better
you handle the fundamentals, and the younger your child is, the more likely it is that you will not
have to get past step 4. If your child is older than twelve months, and if you have not been
following most of the fundamentals from Chapter One, you should implement them for two to
four weeks before starting this system:
1. Make sure that, if your child is going to feed/eat, this occurs before you begin the
naptime routine in step 2.
2. Use a short, consistent routine to let your child know its naptime. This routine should
occur in her bedroom, and it may involve reading a book or two, playing with a lowactivity toy, or whatever you want that doesnt take too long.
3. Put her into her crib while she is still awake. Ideally, you will learn to catch the sleep
wave that Dr. Weissbluth describes, when she is sleepy but not yet overtired. Look for a
lull in her activity or a distant look in her eyes.
4. For the first two or three days, stay in the room, but be quiet. She should be able to see
you, but try not to touch her or make any sounds. If she is going to sleep easily, you may
find that after the two or three days you can just leave the room when you first put her
down. If you try that, and she screams, return immediately and stay in the room until she
falls asleep. Proceed to step 5. If she doesnt need you there to fall asleep, youre done
with naptime training and can proceed to bedtime. Skip steps 5, 6 and 7.
If your baby cries even with you in the room, you can try caressing her a bit or speaking
to her. If this does not comfort her, and she is consistently unable to go to sleep with you
in the room, skip step 5 and go right to step 6. If this does comfort her, try to slowly
diminish the amount of this comforting that she requires, and when she no longer needs
your touch or voice, proceed to step 5.
5. If you didnt have to return in step 4, she should sleep for a normal amount of naptime
(see table on page 11 for naptime at various ages). If you had to return, you should next
try the disappearing chair trick. Each day, you will continue to stay in the room.
However, you will move your chair a little farther from your child each day. Use your
best judgment to determine how far you should move the chair, but you probably want to
be out the door within one to two weeks. Once you are out the door and out of sight, she
should be able to sleep on her own.

If she will not let you move the chair beyond a certain point, try moving in a bit and then
slowing down the moves. If this doesnt work, go on to step 6. If youve gotten out the
door, youre done with naptime for now, and you can skip steps 6 and 7.
6. In this step, you first have to let her cry a bit. When you put her down, leave the room
rather than sitting with her. If youve gotten to this step, she will probably cry when you
leave the room. Let her cry for three minutes, then return and comfort her briefly (for less
than a minute) without picking her up. Leave again. This time, wait for five minutes, and
if shes still crying, go back in. Comfort her briefly, and leave again. Wait for up to ten
minutes for her to go back to sleep. Keep returning every ten minutes until she sleeps or
until an hour has elapsed. If an hour has elapsed without her going to sleep, get her up
and do not let her sleep until her next nap time. Obviously, if she goes to sleep, let her
sleep.
The next day, start with five minutes, and then ten. The third day, start with seven. The
fourth day, start with ten. Never wait longer than ten minutes before going to your child
at this stage. Ten minutes is a long time when your child is crying.
If you have been trying this routine for two weeks with no improvement, you will have to
move to step 7. Hopefully, she has started to learn to go to sleep on her own. If she seems
to be making improvements, keep trying this step before going on to step 7. If she is
sleeping, skip step 7 and proceed to the bedtime routine.
7. This step is the end. It is almost never necessary for children under twelve to eighteen
months old, and you should not try it if your child is younger than six months. It is simple
to implement. At the end of the naptime routine, put your child down. Leave the room.
Dont go back in unless you think that something is wrong with her (other than being
upset that youre not there). Respond quickly if you think there is an emergency. If she
makes it an hour without going to sleep, get her up and do not let her sleep until her next
naptime.
The system for bedtime is the same basic system, but you should have a more extended bedtime
routine. Do not begin the bedtime routine until your child has been going to sleep on her own at
naptime for two to four weeks, unless she is under six months old. If she is over six months old,
let her attain full mastery of the naptime sleep skill before you get to the bedtime system.
Most children will adopt to sleeping on their own reasonably quickly once they have it down for
naptime. If your child had to go through steps 6 or 7 at naptime, however, you should be
somewhat more willing to get to those steps more quickly at bedtime.
Once your child is asleep, if she wakes in the middle of the night, go to her quickly and meet her
needs. Do what you need to do to get her back to sleep quickly, including holding her if
necessary. Once she locks in the ability to go to sleep on her own at bedtime, she will probably
go to sleep on her own when she wakes in the middle of the night with little effort. If she has
been consistently going to sleep on her own for three or four weeks at naptime and bedtime, but
she is still waking in the middle of the night, you will need to implement the system for the
middle of the night.
The system for the middle of the night assumes that your child is waking for something other
than an appropriately timed feeding in the middle of the night. If she is waking for twice for
feedings until about three months or once until about six months, it is perfectly normal. You
should be able to drop the feedings as she grows.
If she is waking for attention, and not for a feeding, you will need to work through steps 5 to 7 of
the naptime routine at the waking time. Go in, briefly calm your baby, but do not pick her up.
Progressively work through steps 5 to 7 until she is sleeping on her own.
Thats the complete system. It involves up to seven steps in three different stages. It requires that
you first put the fundamentals in place. It is not complicated, but it works. Nothing is a
permanent fix, however, and dropping feedings, dropping naps, medical issues, developmental
changes or environmental changes (moving to a bed, travel, new siblings, guests) may cause
temporary sleep problems.
At these times, try to keep things as normal as possible. Return to your regular routine as quickly
as possible after the change has passed. You may need to do a mini-repeat of the system to return
her to good sleep habits, but it should be much, much easier for her to return to her good habits
than it was to form them the first time.

Checklist for the Basics

" Are you exposing your child to lots of light in the daytime, beginning from
the time she first gets out of bed?
" Are you dimming the lights at night so that she is exposed to nothing as
strong as a 100-watt bulb at ten feet after sundown?
" Have you encouraged physical activity early in the day, before your childs
first nap?
" Is your childs daytime routine reasonably consistent each day, with naps,
meals, activity and bedtime occurring around the same time each day?
" Is your childs bedroom environment pleasant for her? Is her crib a
comfortable place for her to be when shes awake or asleep?
" Have you tried swaddling your newborn to help her sleep at night (under six
weeks of age)?
" If your child is waking early in the morning, have you tried delaying her
bottle and being a little boring for the first half hour or so after she wakes?
" Is your childs bedroom between sixty-five and seventy degrees Fahrenheit
when she is sleeping? Is she properly dressed for the temperature?
" If your childs sleep has been disrupted by travel, guests, or medical issues,
have you quickly returned to what was working when the event passed?
" Have you considered introducing a transitional object if your child has not
already adopted one?


Amazing Baby Sleep Secrets

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Amazing Baby Sleep Secrets

Uploaded by

Copyright:

Available Formats

You are strongly encouraged to print this book out immediately and then read it.

The Baby Sandmans

By Michael F. Quarles, Sr.,

2001 Franklin Miami Publishing, LLC

Amazing Baby Sleep Secrets Page 3 Available at

Amazing Baby Sleep Secrets Page 4 Available at

SECTION I: AN INTRODUCTION TO INFANT AND

SECTION II: THE EXPERTS ANALYZED

Chapter Three: Dr. William Sears

Amazing Baby Sleep Secrets Page 5 Available at

Chapter Four: Dr. T. Berry Brazelton

Chapter Six: Joanne Cuthbertson & Susie Schevill

Chapter Seven: Gary Ezzo

Chapter Eight: Dr. Paul M. Fleiss

Chapter Nine: Dr. Jeffrey Hull

Chapter Ten: Jodi A. Mindell

Amazing Baby Sleep Secrets Page 6 Available at

Chapter Eleven: Dr. Benjamin Spock

Chapter Twelve: Dr. Marc Weissbluth

SECTION III: PUTTING IT ALL TOGETHER

Amazing Baby Sleep Secrets Page 7 Available at

Amazing Baby Sleep Secrets Page 8 Available at

Every author nowadays faces the question

Therefore, to even it out a bit, I have simply

How to Use This Book

This book is designed to be thorough, yet

The three ways you can use the book are I

concise. At the same time, you may have a

If you are in I Need Help Now

No matter which of the

succinct and readable, and an average reader

hundreds of dollars it would have cost to

the question of how to handle

rhythms will start forming, and these

Amazing Baby Sleep Secrets Page 10 Available at

The ranges are for the middle eighty percent,

your child is in the range, or even dead on

Typical Number of Naps

Total (including naps):

6-8 Sleep Periods

Night Only (here and below):

3 (2-3 hours each)

9-12 hours (avg. 10)

3 (1-2 hours each)

10-13 hours (avg. 11)

2 (1-1 hours each)

9-12 hours (avg. 11)

9 - 12 hours (avg. 11)

Typical Sleep at Various Ages

You will notice that, at certain ages,

to help your child go back to sleep when she

The sleep cycle for children is also different

A newborn will take about twenty minutes

Therefore, the question is not how to prevent

Beyond what Ive gone over above, we

Amazing Baby Sleep Secrets Page 11 Available at

methodologies, and there is not much

is based on anecdotal experience, rather than

The Non-Controversial Sleep Suggestions

have purposely avoided controversial

Maintaining a relatively stable, although not

Amazing Baby Sleep Secrets Page 12 Available at

nursing or taking a bottle. This is very

age, and they may help comfort your child