A Healthy Child Needs a Healthy Brain,
A Healthy Brain Needs Healthy Sleep.
“Sleep Readiness” is the title of Chapter 11 of the United States of America Department of the Army field manual (FM 7-22) that prepares young men and women to become soldiers. It is the official document that describes how all young recruits will acquire necessary skills during the process that is sometimes referred to as basic training or “boot camp.” Updated in 2020, it is based on empirical data using traditional scientific methods. Sleep is serious business.
If you have not already done so, please read Blog Posts 1 through 5 that describe how sleep is important and beneficial, from the point of view of the United States of America Department of the Army. I have lightly edited, added emphasis, and condensed Chapter 11 in order to show you how “Sleep Readiness” can also help parents help their child sleep better.
Initially, I posted Chapter 11 (Blog Posts 1 through 5) to emphasize the value of healthy sleep. Based on the material presented in Chapter 11 of the Army field manual, Blog Posts 6 through 15 show how basic principles of sleep apply, not only to military basic training, but also to parenting.
Going forward, I will post specific information for parents and children based on my book, “Healthy Sleep Habits, Happy Child.” Please do not be put off by my book’s length. For now, only read the single, age-appropriate Chapter for your child. Later, if you wish, read Chapters on What is Healthy Sleep, Why Healthy Sleep is Important, and Preventing Sleep problems. Finally, if needed, read the Chapter on Sleep Solutions.
PREVENTION VERSUS TREATMENT
All the items listed below in “WHAT A PARENT CAN DO” contribute to the prevention of sleep problems developing in the first place; the earlier you start, the more likely your success. All of these same items also contribute to the treatment of sleep problems, but they might not be sufficient. Specific family circumstances (Blog Posts 14 and 17) might make prevention difficult to accomplish and a sleep problem (difficulty falling asleep, staying asleep, or bedtime resistance) might develop in your child. Two treatment strategies that do not involve letting your child cry are ‘Fading’ and ‘Check and Console’.
Over a period of time, you gradually reduce your efforts at night to help your child fall asleep at bedtime and return to sleep after an awakening during the night, so that your child takes over for himself or herself and learns to fall sleep unassisted (self-soothing). Fading has also been called the ‘Chair Method’ when done with an older child in a crib or bed because you slowly move the chair farther from the child until you are just outside the door. Here is an example of a fade sequence designed to help an older child learn to return to sleep unassisted after a night awakening:
· Respond immediately; spend as much time as needed; do whatever works to soothe your child back to sleep.
· Father gives bottle or mother does not nurse.
· Change bottle from formula or milk to diluted juice and then to water.
· No bottle.
· No picking up.
· No singing, talking, verbal communication.
· Minimal contact, patting, or handholding.
· No eye contact; sober, unresponsive face.
· No physical contact; sit next to child
· Move chair away from crib or bed toward the door, slowly over several days.
· Reduce time with child.
·Delay your response.
In an English study of children about 3 years old, psychiatrists and parents established goals that included the child sleeping in his own bed and not disturbing his parents during the night. For one family, the parents gradually changed their behavior as follows:
· Father reads story to child in child’s bed for 15 minutes.
· Father reads newspaper in the child bedroom until child falls asleep.
· Child is placed back in bed with minimal interaction.
· Father gradually withdraws from bedroom before child is asleep.
For another family:
· Parents alternate but respond to child.
· Parent gives no drinks but provides holding and comforting.
· Parent only sits by the bedside until child is asleep.
· Parent provides less physical contact at bedtime.
In this English study, 84% of children improved. The two factors that most likely predicted success were the absence of marital discord and the attendance of both parents at the consultation sessions. Teamwork is important (Blog Post 18)! When one problem such as bedtime resistance was reduced or resolved, other problems such as night waking rapidly disappeared because the child had learned self-soothing skills. Half of the mothers in this study had current psychiatric problems requiring treatment, but this did not make treatment failure more likely. The focus is on the child’s behavior.
Another English study showed 90% improvement when families completed 4 or 5 treatment sessions with a therapist to identify target behaviors and an individual fading treatment program. The authors concluded that because the child’s nighttime behavior changed quickly and radically, it was the parental responses that maintained the problem, not anxiety in the child or lack of parental attention. Also, “Once some success was obtained, the morale and confidence of the parents rose, and they were more determined to persist for more peaceful nights.”
I have seen this over and over again, when parents see even partial improvement, parents gain confidence and no longer feel guilty or rejecting.
CHECK AND CONSOLE
When you first hear your baby cry at night, you immediately respond, unlike graduated extinction which involves ignoring crying for a predetermined number of minutes. Check and console has also been called ‘Pick Up, Put Down’. Because of your immediate response, your child is not crying full force and your first attempt is to minimally soothe your child back to sleep in darkness by stroking, petting, rubbing the tummy, making shushing sounds, or gently rocking the crib, but you try to not pick up or feed (for soothing) your child. However, if necessary, you do pick up, talk or sing, and offer breast or bottle but the goal is to do the least amount of parent-soothing in order to encourage self-soothing for your child. You soothe her preferably to a drowsy state, or if needed, a deep sleep, put your child down, and preferably leave the room, if possible. After 6 months of age, Check and Console might fail because your soothing attempts might stimulate your child and cause her to cry more in the hope that you will pick her up and play with her.
Fading and Check and Console often fail if the bedtime is too late, naps are not going well, or parents are inconsistent.
Have you tried Fading or Check and Console? If so, please share your experience in Comments.
IT IS NOT NECESSARY TO MAKE YOUR CHILD CRY TO HAVE A GOOD NIGHT’S SLEEP
WHAT A PARENT CAN DO
• ‘No Cry’ sleep solutions (‘Fading’ and ‘Check and Console’) may solve sleep problems.
• Communicate with each other and coordinate nighttime parenting practices. Consider delaying your response to nondistress sounds your baby makes at night by 5-10 seconds, especially after 3 months of age. Blog Post 18.
• Encourage partner to help care for baby daytime and nighttime. Be emotionally available at bedtime. Seek help if your child is not sleeping well and there are symptoms of anxiety or depression for yourself or partner. Blog Posts 17.
• Encourage self-soothing; the earlier the better. Consider leaving the room after putting your child down to sleep. Provide opportunity for naps based on drowsy signs. Encourage partner to help care for the baby daytime and nighttime. Blog Posts 16.
• Plan for healthy sleep by focusing on sleep quality, not just sleep quantity. Provide opportunities for naps. Blog Post 15
• Make a sleep plan that you are comfortable with; be flexible and tolerant. Blog Posts 14.
• Become more aware of the difference between how you feel when well-rested versus mildly sleepy. Blog Post 13.
• Try to maintain a regular sleep schedule. Blog Post 12.
• Try to not respond immediately to every quiet sound your baby makes at night. Blog Post 11.
• Practice soothing to sleep and bedtime routines, every night, if possible. Blog Post 10.
• Watch for drowsy signs. Blog Post 9.
• Respect your child’s natural sleep rhythms. Blog Post 8.