Blog Post 25-‘Let Cry’ Sleep Solutions: Graduated Extinction & Extinction (Sleep Solutions #3)

Healthy Sleep Habits, Happy Child
by Marc Weissbluth, M.D.

A Healthy Child Needs a Healthy Brain,
A Healthy Brain Needs Healthy Sleep.

If you have not already done so, please read Blog Posts 1 through 5 that describe how sleep is important and beneficial. 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. This is a reference book. Read only the topic of interest to you.

     

SLEEP PROBLEMS:
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.  Also, all of the items listed below in “WHAT A PARENT CAN DO” also contribute to the treatment of sleep problems, but they might not be sufficient.  Specific family circumstances (Blog Posts 14 and 17) and individual differences in babies (Blog Post 20) might make this difficult to accomplish and a sleep problem (difficulty falling asleep or staying asleep) might develop in your child. 

Two safe and effective treatment strategies that do not involve letting your child cry are ‘Fading’ and ‘Check and Console’ (Blog post 19). 

Two safe (Blog Post 24) and effective treatment strategies that do involve letting your child cry are ‘Graduated Extinction’ and ‘Extinction’.

            Because of differences in specific family circumstances and individual differences among babies, it is difficult to give specific advice regarding which method best suits a particular family.  Nevertheless, here are some general observations that might help you:

                        · If there is moderate or severe marital distress or perhaps if either one or both parents have symptoms of anxiety or depression, consider starting with ‘Fading’ or ‘Check and Console’.

                        · If there is mild marital distress or perhaps only one parent has symptoms of anxiety or depression, consider starting with ‘Graduated Extinction’.

                        · If there is minimal marital distress and neither parent has symptoms of anxiety or depression, consider starting with ‘Extinction’.

GRADUATED EXTINCTION

            Graduated extinction means that after a bedtime routine including soothing, at sleep onset and in the middle of the night, you let your baby fuss or cry for a predetermined brief period, say five minutes.  It may be a little less or more.  Then you pick up your baby, talk to him, feed him if hungry, and do whatever is necessary to calm him down.  You might either calm him to a drowsy state or to a deep sleep state and then you put him down and possibly leave the room. On a given night, you might keep the interval constant, say five minutes, or progressively increase the delay interval by, say five minutes, with each episode.  Or, on a given night, keep the interval constant, but on each subsequent night, progressively increase the delay interval.  During one of these delays, your child learns to fall asleep unassisted because he is learning self-soothing skills.

EXTINCTION

            Extinction (you are extinguishing the habit expectation that crying out always brings parental attention) means that after a bedtime routine that includes soothing, at sleep onset and in the middle of the night, except for feeding, changing, and any suspicion of medical distress, you let your baby fuss or cry without time limit until the morning.

                        · Extinction with a cap: Some parents put a cap on the number of minutes of ignoring their child, so they know they are not committing to endless fussing and crying, for example 45 minutes.  Too brief a cap might allow your child to learn to cry to the time of the cap for the reward of parental soothing.

                        · Extinction with parental presence: Some parents remain in the room until their child falls asleep. 

Your child learns to fall asleep unassisted because he is learning self-soothing skills.

CAUTION

            Neither Graduated Extinction nor Extinction will work if:

                        · Parents are inconsistent, for example, “just once” take the child back to their bed for nursing.

                        · The bedtime is too late.

                        · Naps are not going well.

(To be continued.)

QUESTION

Have you tried Graduated Extinction or Extinction? If so, please share your experience in Comments.

DO I HARM MY CHILD IF I LET HIM CRY AT NIGHT TO LEARN SELF-SOOTHING?           

• Studies show that children are not harmed (Blog Post 24) when extinction or graduated extinction is used.

IT IS NOT NECESSARY TO MAKE YOUR CHILD CRY TO HAVE A GOOD NIGHT’S SLEEP

WHAT A PARENT CAN DO

• It may be difficult to begin or choose a sleep solution. Blog Posts 23.

• No television or digital electronic devices in child’s bedroom (Blog Post 21), if possible. Blog Post 22.

• Some babies sleep better than other babies. Develop coping strategies to reduce stress if your baby has extreme fussiness or crying.  Plan to encourage self-soothing skills at 2 to 4 months of age. Blog Posts 20.

•  ‘No Cry’ sleep solutions (‘Fading’ and ‘Check and Console’) may solve sleep problems. Blog Post 19

•  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 Post 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 Post 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 Post 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.

·  Encourage an early or earlier bedtime (even a slightly earlier bedtime may produce better sleep.  Blog Post 6) especially at 6 weeks.  Blog Post 7.

∙ Recognize that a healthy brain requires healthy sleep. Blog Posts 1, 2, 3, 4, and 5.

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