Taking back the bedroom
6/27/2024 by Joe Novak, M.D.
It's common for infants to have nighttime awakenings (also known as nocturnal wakefulness) during infancy. This is your baby's way of telling you that they need comfort — they are hungry, experiencing gas pains, need a diaper change, are feeling ill or want to be held.
During the first few months of life, a baby doesn't have "homeostatic pressure," which is the drive to sleep that most people have. At this early age, no circadian rhythm is established and your baby has metabolic needs which are crucial for organs to develop and grow.
Circadian rhythm utilizes environmental cues, such as the presence of light or dark, and even physical and mental cues to conserve energy. The circadian rhythm becomes stabilized around 3 to 6 months of age. Once this occurs, nighttime awakening will decrease. Your baby's growth has also established that they can maintain body temperature and energy without needing frequent feeding. Once your child can start maintaining nighttime sleep (around 4 to 6 months), they can move to their crib, in a separate room.
Isn't sleeping on their own risky?
Once your baby starts sleeping on their own, they still require supervision and "safe sleep" practices to reduce the risk of Sudden Infant Death Syndrome (SIDS).
Safe sleep entails:
- Lay your baby on their back on a flat, firm surface.
- Do not elevate the head of the bed, as this can cause the child to slouch down. Studies have shown that elevating the head of the bed has no decrease in the number of reflux events.
- Remove stuffed animals and loose blankets from the crib.
- Eliminate tobacco and vaping smoke. If you choose to smoke, do so outside and wear a "smoker's jacket" that can be removed and left outside the home. The best way to minimize second and third-hand smoke is to stop smoking completely.
- Install smoke and carbon monoxide detectors. They are not the same device, so having both types and keeping them in working order is important. Carbon monoxide is an odorless gas and cannot be detected by smell alone. Use your baby's birthday as a date reminder to check every detector in the house to ensure they are in working order.
- Do not "co-sleep" or sleep in the same bed together. This carries the risk of accidentally rolling onto your baby.
But my baby still wakes up at night.
From about 6 months, as many as 16% to 21% of infants still experience nighttime awakenings. Both the parent and baby need to have a good night's sleep. Help your child learn to soothe themself. Sometimes, the constant response to a crying child can promote wakefulness. It's normal for you to want to comfort your child, but learning to soothe themselves results in more restful sleep for you and your baby.
There are many ways to help build an infant's sleep endurance. No single method is right or wrong. The key is to implement a consistent routine and use a strategy that fits your parenting methods and environment. The Ferber Method utilizes gradual timing before a parental response occurs to the infant's cry.
What is a good bedtime routine?
The most important thing is to establish a familiar routine.
- Set a bedtime to help promote a biological clock.
- Ensure they have a clean diaper and sleeping clothes before starting the process.
- Shut off most if not all lights to mimic how they will sleep in darkness.
- Offer a feed before bedtime so they go to sleep on a full stomach.
- Utilize a sound machine for calming noises. Some have projectors that are not light-disruptive.
- Read a short story. Reading to your child every day is important for speech and language development. Infants respond well to their parents' voices.
- Rock together.
- Transition the bottle to a pacifier if needed.
- Minimize distractors in the room. Remove pets and other children from the room if possible.
- Promote a quiet environment.
Tell me more about the Ferber Method
Each night when the baby cries you will perform what is called a "check-in." Your baby should undergo a specific amount of time before you respond. You can utilize a phone timer if needed. It's normal for a child to wake up and "stir" or make babbling noises. This is a form of self-soothing. Only start the timer for crying that does not stop.
A "check-in" consists of entering the room to briefly comfort them. Use a calming voice or soft shushing sounds, combined with patting your child or rubbing their belly. You can turn on the light to have them see that a parent is present. You can also replace the pacifier if it has fallen out. This should only last a couple of minutes. What you should not do is pick up or feed the child. Then shut off the light, exit the room, and repeat the process as needed, adding a longer time to respond. The response length should increase by a couple of minutes per day. The hopeful outcome is that your child will then be able to either continue to sleep through the night or self-soothe on their own without parental intervention.
Ferber Method daily schedule:
- Day 1: First check-in at three minutes; second check-in five minutes later; third check-in 10 minutes later; subsequent check-ins at 10-minute increments.
- Day 2: First check-in at five minutes; second check-in 10 minutes later; third check-in 12 minutes later; subsequent check-ins at 12-minute increments.
- Day 3: First check-in at 10 minutes; second check-in 12 minutes later; third check-in 15 minutes later; subsequent check-ins at 15-minute increments.
- Continue increasing the check-in delay by a couple of minutes each day.
A child typically has a "honeymoon" phase where the first few nights go well and then they regress to old habits and it's perfectly normal for this to happen. If you feel this method is not working, it's okay to stop and try again in 1 to 2 weeks or to try something different. This is not a "one-size-fits-all" model.
It's also important to recognize that this process can feel stressful. It's a normal response to want to instantly comfort your child. Take turns with your partner to reduce this burden.
Find more information about sleep methods
Craig Canapari, M.D., is a pediatric sleep physician and father who shares resources and advice on childhood sleep and sleep training on his website.
Joe Novak, M.D., is a resident in his third and final year at Mayo Clinic in Rochester, Minnesota. He loves spending time with his wife and his infant son, and enjoys collecting antique comic books, working on vintage cars, basketball, and is an avid movie-goer. He will be working in full-scope primary care pediatrics in Wisconsin this coming year.