How to train your baby (to sleep)

Many sleep coaches suggest a range of interventions including addressing the bedroom setting as well as the infant's nutrition and nap schedule. (Photo: iStock)

By Jennifer Smout

22 Nov 2022

As societies have changed to require parents to return to the workforce soon after their children’s birth, the pressure is on for babies to sleep through the night. But is this a fair expectation, and can you actually train your baby to sleep?

Among the many questions new parents are asked in the early months, one of the most common is, “Are they sleeping through yet?” Some lucky parents may be able to respond in the affirmative, but for many the answer is a resounding no.

Sleeping through the night isn’t a paediatric milestone that clinics measure, and there are no South African Department of Health guidelines or medical recommendations around the ages at which this can be expected. This suggests that there is a wide variance between infants, and parents need not feel there is something wrong with them or their baby if their baby still wakes often.

Although babies’ sleep processes change significantly over the first years of their life, what doesn’t change is that babies wake up at night, often in order to meet their needs (food, a nappy change, or comfort) but sometimes just because it is the end of one sleep cycle, and they’ve woken out of a light sleep.

“It’s not that [some babies] are sleeping through, it’s that their parents just don’t know that they’ve woken up,” explains Meg Faure, occupational therapist and co-author of Sleep Sense and creator of the Parent Sense app.

Studies have shown that the number of night wakings varies across babies, with some suggesting three times is average, and others showing an average waking of almost five times per night for certain age groups. This is true for between 25–50% of children over the age of six months. So, babies waking up often at night is a common occurrence and this might make some parents feel comforted that they’re not alone.

What differs between babies is what happens when they wake up. Research in the 1970s and 1980s by Dr Thomas Anders found that some infants signalled that they were awake by crying out whereas others did not and were able to return to sleep quietly. When babies do cry out in the night, it’s often the case that parents respond to these cries by trying to get the baby to go back to sleep using a variety of strategies. This seems to be normal — in a 2005 study, roughly 50% of 12-month-old infants required parental intervention to get back to sleep after waking. That of course means the parents needed to be awake as often as their infants were.

What happens when babies don’t sleep through

For the parents of infants who don’t “sleep through” or who have disruptive bedtime routines that result in a lack of sleep, the impact can be severe. Sleep deprivation has been linked to poor mental and physical health outcomes, including exacerbating postnatal depression and anxiety. Many parents of wakeful babies are concerned that their baby is waking up too much, struggles to fall asleep fast enough, and might not be getting the recommended amount of sleep that they need. Some studies show that ongoing sleep problems in children can negatively affect children’s development, mood, behaviour and health. Others suggest that infant sleep problems are poor predictors of long-term sleep outcomes. Nonetheless, having a wakeful baby can make early parenthood a trying and emotional time for the whole family.

But although infants’ sleep and the number of times they wake up probably haven’t changed over many centuries, what has changed are some cultural norms around it.

“It’s a lot around expectation,” says Faure. “If your expectation is that your baby needs to sleep through the night (for instance if you’re going back to work and need to get the sleep), then you’re going to have a higher sense of urgency around your baby sleeping. There is also a cultural veneer around sleeping and sleep hygiene. In some cultures, it’s going to be fine for babies to wake during the night and for the mom to respond. In our culture, we need for babies to sleep.”

When babies don’t sleep then, some parents may believe that they are doing something wrong or that their baby has a problem that needs to be solved. What happens next depends on the parents.

Can you train a baby to sleep? Evidence suggests you can

Although Anders’ 1980s research didn’t suggest that returning to sleep quietly was a skill that babies had to learn, he called the ones that didn’t cry out when they woke up “self-soothers” and this term would come to have a serious influence in popular culture, shaping our expectations of how to get babies to sleep.

“Where parents go wrong, is that when our babies make a noise in the night we rush in and we think if we’ll settle them quickly, they’ll go back to sleep quickly, but then they become dependent on us to go back to sleep. A better strategy is to help them to learn to self-soothe. The very important thing is to understand self-soothing as a skill,” argues Faure.

“Babies can do this independently without parents there, so what the parents need to do is to help the little one to find a strategy. The second thing [for parents to understand] is not to over-respond. If you’re always doing it for them, they won’t learn. They need to have time to fuss or niggle or find their way themselves.”

If your baby doesn’t go back to sleep on their own, wakes frequently, or struggles to go to sleep (for naps or for bedtime), you might have heard that you need to “sleep train”.

Importantly, many sleep scientists and sleep courses (including Faure’s Sleep Sense coaching course) only recommend sleep training from six months of age onwards. This has to do with babies having met nutritional requirements during the day and having developed object permanence (ie, being able to understand that even when their parents are not with them, they still exist). Sleep training is also not recommended for any infants who are ill or have other physiological issues (like teething) or developmental issues. In addition, research shows that sleep training before six months is not effective and risks unintended outcomes including an increased risk of sudden infant death syndrome.

Extinction isn’t a word that has many positive connotations, yet when it comes to sleep training it’s a word that’s used often. Extinction-based behavioural sleep interventions assume that a parent or caregiver’s behaviour or attention reinforces an infant’s crying at night. Extinction methods aim to improve infant sleep by removing or reducing caregiver attention during sleep times to eliminate crying, because they believe that this will encourage an infant to learn to self-soothe. The evidence shows that these methods can work for reducing bedtime problems and night wakings, at least in the short term. With all extinction-based methods, parental consistency is key to success.

Unmodified extinction (commonly known as “cry it out” or CIO) is perhaps the most extreme. In this method, a child is put to bed and all cries or noises from the child are ignored until a set wake time. Of 19 studies where this was the method of sleep training, 17 showed that it led to improvements in sleep, and was “effective in eliminating bedtime problems and night wakings, and improving sleep continuity”.

Many sleep coaches suggest a range of interventions including addressing the bedroom setting as well as the infant's nutrition and nap schedule. Image: iStock)

Graduated extinction is colloquially known as “controlled crying”, and it is where the caregivers ignore the child’s crying for set periods of time before returning to settle them using limited techniques (generally no rocking or picking them up) and repeating this in cycles until the infant has fallen asleep. Some methods recommend a fixed scale of intervals; for example, you leave the child to cry for five minutes, return for a few minutes to settle them, and then leave again for five minutes. Others have an incremental scale, where you return after a short period (one or two minutes) and this period gets longer or doubles each time you leave the room. Of 14 studies of this method of sleep training, all 14 reduced bedtime problems and night wakings.

Though controlled crying is perceived by some as a gentler approach to CIO, it does not mean that all babies respond well to it. One mother interviewed for this piece forwarded an informational leaflet on controlled crying (called a “sleep programme”) they received from a Johannesburg private paediatric clinic. It took an incremental approach of doubling the time between check-ins with the baby and specified that if your baby vomits on itself from crying, you should simply return, clean up the baby and the bed, and then leave the infant again.

Finally, extinction with caregiver presence (sometimes called camping out) is where the caregiver remains near the child in the room but ignores the child’s crying or offers limited settling. Over a few nights, the caregiver gradually increases the physical distance from the child until they’re no longer in the room with them. Four studies have shown this to be effective.

There are also non-extinction-based methods of sleep training, which focus on getting a baby into a good bedtime routine, changing their bedtimes, waking them up on a schedule to hopefully disrupt a waking-up habit, and simply providing education to parents on normal baby sleep and sleep associations to shift their expectations and behaviour. Parental education “may set the standard as the most economical and time-efficient approach to behaviourally based paediatric sleep problems”. Prevention, as they say, is better than cure.

Some parents are able to pursue these techniques alone and address the concerns they have about their infant or child’s sleep. For others, the thought of going it alone is too much to bear. They might turn to a sleep consultant or coach for assistance.

Not doing it alone. Working with a sleep coach

For parents wanting some outside help, a simple search on Google or Instagram returns numerous results for baby sleep coaches who have made it their business to assist struggling parents.

“There is real benefit (and comfort!) in working with an actual person who can guide you every step of the way,” says Christine Bergh, baby sleep coach from The Sweetest Sleep. “I am regularly approached by parents who have tried to do [sleep training] on their own but it hasn’t worked.”

It’s often said that it takes a village to raise a child, and sleep consultants and trainers consider themselves part of this village.

“If what you’re doing is working for you, then there is no need to change it, no matter what the ‘experts’ say. But, if what you’re doing isn’t working for you any more and you are struggling, there is no need to feel guilty for seeking help.

“There is a lot of information out there, but not enough support. Parenthood is already one of the toughest things we’ll ever do — so less judgment about our choices and more support in parenting is much needed,” says Bergh.

For Jonel Basson, a consultant at Good Night Baby Sleep and a qualified paediatric occupational therapist, “Every baby is different. The success of sleep training is not so much dependent on the specific method that you apply, but how consistent you are in your approach. We use different methods, depending on a baby’s age, their temperament, the family dynamics, as well as the parents’ preferences.”

With the abundance of coaches out there, it can be hard to evaluate the quality of the services or know who to trust with such an important issue. South Africa doesn’t have its own association or certification for sleep coaches, but internationally there is the Association of Professional Sleep Consultants (APSC) whose members are governed by a code of ethics that specifies that their advice should not seek to replace the advice of a doctor or paediatrician. (In South Africa, only Good Night Baby is part of this association). There are many other sleep coaches who have done their training and qualified using overseas training programmes (such as Baby Sleep The Night). To evaluate these, reviews and referrals are probably a parent’s best source of information to make their decision.

Basson agrees. “Who better to tell you than the parents who have used these services themselves? If you are looking for a sleep consultant, go have a look at their website, Facebook and Instagram pages and see what clients who have used them before are saying about their service and success rate.”

What you can expect from a sleep consultant also varies. It is likely to involve completing a detailed questionnaire about your child’s sleep patterns, sleep habits and health, and following an assessment by a consultant you’ll have a one-on-one meeting with them to go through a plan for your child. Not all sleep consultants use extinction-based methods either, or at least not exclusively. Both The Sweetest Sleep and Good Night Baby create individualised plans for each child, that aim to take a holistic approach to the child’s wellness and sleep.

“Getting a child to sleep better is like building a house,” says Basson. “You need to start from the bottom, making sure that the foundation of healthy sleep is in place first. A hungry baby, a baby who is too cold or an overtired baby won’t sleep well. What we as sleep consultants do is so much more than just applying a method or only focusing on the ‘training’ part.

“No sleep training will work if you haven’t first made sure that all the building blocks of healthy sleep are in place. With some babies, no sleep training is even needed at all once you’ve sorted out the basics.”

Basson also clarified that not all parents have the goal of having their baby sleep through the night. Some are simply trying to navigate how to develop good sleep habits and improve their nighttime routine.

“You can still have independent sleep even if a baby still needs night feeds. If everything is in place, they will start pushing out those night feeds when they are ready.”

This need to focus on foundations is echoed by Bergh.

“There is a lot we can do to help our little ones sleep better. Without any kind of ‘training’, we can still create solid foundations for good sleep. That’s why it’s important to consider things like the bedroom setting, the daytime feeding routine, the nap schedule, and the journey to sleep at bedtime.

“When I work with a family, I create a plan that is very specific to their baby so that we can establish good sleeping habits and find their ’sweet spot’ for sleep.”

As the research that suggested that parental education is a cost-effective solution to baby sleep showed, working with a consultant may have the benefit of simply assisting parents to cut through the noise around baby sleep and sleep training by providing them with the information and support they need.

For Brigitta Annegarn, a mother who used a sleep consultant when her daughter was 10 months old, “Sleep training is as much about training the parents as it is about training the baby.” The support and information were helpful to them in making small changes for their child, with positive effects on their daughter’s sleep habits and duration.

“The change was radical and it’s still in place. It has been lasting. Five months down the line and we’re still going. I think sleep training is the right thing under the right circumstances.”

Although it might be comforting to have the support of a trained professional, it’s still worth noting that sleep training is not necessarily an easier or stress-free solution for parents because of it. Ultimately, parents must do the actual “training” part of the plan alone (with the virtual support of a consultant). Studies have shown that parental attrition (that is, parents stopping training or not being consistent), or resistance (refusing to start training) are common barriers to sleep training intervention success.

For Annegarn, “Going through it was one of the worst things I’ve ever done … certainly, the first few nights are horrific. I’m so glad we’re through it and I am happy we did it, but even our much gentler approach, which meant not leaving her on her own, was still pretty horrific.”

Experiencing a child crying can cause significant distress for parents and is one of the leading reasons given for parents not doing the training consistently or at all.

Bergh explains: “The biggest concern for parents is not knowing how their baby will respond and how much crying there will be. None of us like hearing our babies cry, even for a second. But I can never promise parents that their baby won’t cry during the process. The reality is that none of us like it when something related to our sleep changes, and babies are just the same and are very likely to notice the change.

“The big difference is that the only way they can communicate their irritation and perhaps confusion with us is by crying. What I can promise parents is that they will still be able to be near them, touch them, talk to them, and comfort them, but they’ll do this in a very specific way that still gives their baby room to learn.”

Several mothers who were interviewed for this piece describe sleep training with a consultant as having been extremely helpful in terms of support and a personalised approach.

For Rulleska Singh, “It was a very positive experience, but I also think it helps to find someone who is sensitive to your family structure and what is important to your unit.”

Similarly, for Tiffany Marx, it was “very positive”. Four months later, her son “still happily sleeps through the night without us having to go in to settle him at least 90% of the time. Emotionally there were a few nights that were hard, but I 100% put that down to the sleep-deprived state we were in at the time.”

Working with a consultant seems like a positive experience for parents, which is likely to increase their ability to stick with sleep training to achieve the results they want.

So, should you sleep train?

Testimonials from parents who’ve been through it and the research on sleep training shows that it can be effective in addressing infant and child sleep problems, at least in the short term. But, after reading all of this you might be wondering whether sleep training is good for babies — after all, there is almost always some crying involved in the process (whether it’s complete extinction or another form) and the demand to alter a baby’s sleep patterns could be seen to be more about parental needs and demands than their baby’s. This is a contentious question without clear answers.

Some studies, such as those covered by Emily Oster in her book Cribsheet, suggest that babies are no more stressed after sleep training than they were before, but their parents are often significantly less stressed. In addition, both a 2012 study and a 2016 small study found that there were no long-term negative impacts on children’s stress levels or on their relationship with their parents in the long term. That means that children didn’t develop negative attachment patterns or other behavioural problems.

In contrast, psychotherapists like Philippa Perry (The Book You Wish Your Parents Had Read) argue that sleep training is harmful and that when a baby is not held through its distress they disassociate and cut themselves off, perhaps stopping the crying but remaining physically and emotionally distressed. Trauma therapist, Dr Gabor Maté suggests that babies do not learn the “skill” of falling asleep or self-soothing after a period of controlled crying; instead, they simply give up on being helped, with potential long-term impacts on the child’s view of the world, emotional vulnerability and attachment to their parents.

In 2022 the Australian Association for Infant Mental Health issued an updated position paper on infant sleep which expressed concern that “the widely practised technique of controlled crying is not consistent with infants’ and toddlers’ needs for optimal emotional and psychological health and may have unintended negative consequences”.

This was Sophie’s* take. “My son has always been a wakeful baby and a sleep fighter. He is 15 months old and has never slept through the night. I consider an excellent night’s sleep to be two wake-ups overnight. He averages three to four wake-ups a night and when teething or sick this can be countless.

“Sleep training did not feel right for us as a family. I didn’t want my baby to cry and be distressed at night and not be supported or responded to by his parents. Babies who are sleep-trained still wake up at night, they just don’t signal to their parents, and I would hate for my son to be sick or scared and not call for me.

“It’s been really hard to parent a wakeful baby at night, but I know that eventually he will sleep through the night and then I will have no regrets about being responsive for each of his wake-ups.”

Ultimately, the decision to sleep train or not and how to go about that, is up to the family and probably linked to multiple cultural and financial factors. For those who choose not to sleep train, more patience, and more parental intervention may be required, but eventually sleep disruptions do pass.

Perhaps then, as research by Helen Ball suggests, “What we tell parents about normal infant sleep and how we provide support, requires reframing.”

South Africa doesn’t have guidelines, but nurses and healthcare providers who work in antenatal, postnatal and paediatric clinics could still provide information about normal infant sleep patterns and sleep management options to parents — particularly to first-time parents.

According to Ball, “When expectations don’t meet reality, and where culture suggests that there is something abnormal about infant waking, new parents may doubt their own caregiving competence or question whether their infant’s night-waking is normal.”

Our expectation that all babies can go to sleep in the same way, stay asleep for the same amount of time, and wake up at a set time of our choosing contributes to the demand for sleep training in the first place, and may also have a negative impact on parental perceptions of their own sleep disturbance.

Sophie also rightfully points out that it’s not babies but the economic system that’s the problem. If parents were better supported during the difficult transition to early parenthood, and through navigating disrupted sleep, they may not feel so pressured to “solve” their babies’ sleep challenges.

“South African work environments are in the dark ages in terms of support for parents, and the concept of the ‘village’ doesn’t exist. It’s you, or you and your partner doing it alone (for most people)” says Sophie.

“There is such an online social media battle about the decision to sleep train or not, but I wish we’d turn that energy to lobbying for better parental leave and supportive working conditions for parents — like flexible working hours and locations and phased-in work for primary caregivers, amongst other interventions.” DM/ML

* Pseudonym

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