Sleep Handout: Dr. Todd Wolynn

the
Sleep Handout
( for Ages 6 Months to 2+ years )
Dr. Todd Wolynn
Copyright © 2011 Kids Plus Pediatrics

2
INTRODUCTION
June 10, 2010
Just as children learn how to walk, they also learn how to fall asleep.
FewDear Mr. Smith

moments are as precious as rocking a baby to sleep. But equally precious is the ability of a baby,
without difficulty, to settle itself to sleep.
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Understanding the concept and learning how you can teach your child to “self-soothe” is thetakimata
focus, and
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this handout.
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more about the child, the family, and their sleep history.
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cultural beliefs? Does the family want a change in the child’s consectetuer adipiscing elit, sed diam nonummy nibh
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sleep? If so, why? Does the sleep history reveal a potential sleep
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subject throughout this handout.
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professional experience, but still an opinion. It’s not The Answer, The Right Way, or The Only Way. It’s
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An Opinion.
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TheLorem
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establish self-settling-to-sleep behavior. This clearly structured technique allows your child to Stethow
learn clita
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independently.
When we say No to children at this age, when we don’t let them do whatever they want to do, we’re not
Sincerely,
surprised if they cry. Self-settling to sleep is no different. In fact, it may be the first big No they
experience, so it’s completely reasonable for them to cry. On average, crying associated with this
technique is much less then you might imagine. The vast majority of kids “get it” within 2-5 days, and a
Chad
good Hermann of our Kids Plus patients complete the process within 1-2 days.
percentage
Communications Director
The majority of the world’s children co-sleep in a family bed. I respect a parent’s decision on the
approach they wish to take regarding their children’s sleep habits when based on cultural/social beliefs.
There are risks and benefits to this practice, and I refer parents to the AAP guidelines on co-sleeping.
Pleasant Hills 850 Clairton Blvd., Suite 1200 ■ Pittsburgh, PA 15236 ■ 412 466-5004
Squirrel Hill/Greenfield 4070 Beechwood Blvd. ■ Pittsburgh, PA 15217 ■ 412 521-6511 www.kidspluspgh.com
3
June 10, 2010

If you, as a parent, have a separate room and crib/bed for your child, then you probably want your child
to feel comfortable and sleep soundly in that place. This handout is intended to have your infant-toddler
Dearconfidence,
gain Mr. Smith security, and success in the “going-to-sleep” and “staying asleep” phases.
LEARNING & CONDITIONING
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on conditioning herenonumy
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process of going to sleep.
By 6 months, the vast majority of infants no longer require feedings throughout the night. They’ve
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to be greatly improved, in both overnight sleep and napping. Medical disorders such as neurologic or diam nonummy nibh
gastroenterologic conditions can impact sleep, but they’re not typically the cause of early childhood
Ut wisi
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problems.
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Soillum
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4 months)?
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spoiling your young infant by picking her up; you’re providing the care and love that your child needs. ex ea commodo
consequat.
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month-old infant crying in the crib is not going to “learn a lesson” by “crying it out.” A 6-month-old
infant crying because you’ve just placed him in the crib to go sleep is a different situation. So is the 7-
Sincerely, who’s placed in the crib asleep but awakens in the middle of the night crying.
month-old
Infants 6 months and older frequently are conditioned to wake and alert us that they want a parent
Chad Hermann
present to go back to sleep. (They don’t need a parent; they want a parent. That’s an important difference
toCommunications Director
remember.) This pattern can be easily modified, or reconditioned, to allow the baby to gain the skill
set necessary to fall back to sleep without assistance.
A 6-month-old infant understands much more than a 1 or 2 month old. After 6 months of age, infants
4
June 10, 2010

crying in their crib are often stopped merely by the sight or sound of you approaching their crib. This is
because they’re anticipating that your next action is something they want: to be picked up, held, or fed.
Dear have,
They Mr. Smith
in short, been conditioned.
Specifically, they’ve learned: CRY, and someone will immediately come to the crib, pick me up, and
hold/rock/feed/give me what I want.
With sleep problems, think of crying as the child’s attempt to call for Room Service. It’s appropriate for
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your child
sanctus est to expect
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sit to be attended
amet. to right
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away. There’s nothing wrong with that expectation,
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asjusto duo dolores
there’s nothingetwrong
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when we call for room service in a hotel, someone will
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answer our call. But…
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dolore te feugait nulla facilisi. Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh
…after
euismod6 tincidunt
months ut of laoreet
age, this pattern
dolore can
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awakenings to persist and even to worsen. And those
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endless room service calls are ones no parent wants to
keep answering.
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By approximately
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and tonisl ut aliquip
stay asleep ex ea commodo
without parental
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intervention. In other words: she may call for room service, but she really doesn’t need it. consequat, vel illum dolore
Consetetur
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instantaneously become independent in the process of falling asleep. Each time your (non-ill, older-than-
five-months) child cries (during typical sleep hours) in the crib, he’s pushing the Room Service button.
And as long as he keeps getting room service delivered, he’s going to keep pushing the button.
Sincerely,
Infants come to expect the rocking, holding, feeding when they cry to help them get back to sleep. This
is usually a result of the child being conditioned to fall asleep outside of their crib (in the arms of their
Chad Hermann
parents, or in their parent’s beds or TV rooms with the TV on, or while being fed, rocked, etc).
Therefore, whenDirector
Communications they awaken, they expect and desire the same conditions to go back to sleep. Children
who require parental assistance almost every time they go to sleep are dependent on someone other than
themselves to get them to go to sleep.
The primary problem, then, is simple:
5
June 10, 2010

The child is dependent on his parents to help them to sleep. And so the child is unwilling to self-settle.
Dear Mr.you
As adults, Smith
should be independent of this process of going to sleep.
LOCATION / SLEEP-ONSET ASSOCIATIONS
We all have our own sleep-onset associations. What are they? Whatever it is that makes you feel
comfortable so you can fall asleep. Since you’re independent, you can recreate these associations every
timejusto
youduo
go dolores
to sleep: flipping your pillow over, turning on music, pulling your covers up or down, and
et ea rebum. Stet clita kasd gubergren, no sea takimata sanctus est Lorem ipsum dolor sit amet.
getting your body into a comfortable position. Imagine if you were DEPENDENT on someone else to
get Duis autem vel eumtoiriure
you comfortable fall dolor in hendrerit
asleep. Imagine in vulputate
ringing velitcalling
a bell, esse molestie consequat,
out until someone vel came
illum dolore eu feugiat
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to flip yourat pillow,
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To fall tincidunt
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independently, magna
a child aliquam
has to learnerat
howvolutpat.
to recreate their OWN sleep-onset associations.
commodo
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holding Duis autem
and feeding vel eum iriure
interventions candolor
becomein hendrerit in vulputate
problematic. Othervelit esse molestie
possible consequat, vel
interventions
illum
which candolore eu feugiat
become nulla facilisis
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include eros etpatting,
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stroking odiobaby,
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for himself.
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keepveniam, quisenvironment
the sleep nostrud exercisimple.
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consequat. Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse molestie consequat, vel illum dolore
eu feugiat
Often nulla facilisis.
SLEEP-ONSET ASSOCIATIONS problems involve where (location) the child falls asleep. If a
child almost always falls asleep on a parent’s shoulder, or in the TV room on the couch with the TV on,
or while being driven around in a car, then the child comes to expect and “require” this setting to fall
asleep regularly. It is unreasonable, in one night, to place your child awake in her crib and expect her to
happily fall asleep.
What about
Lorem the child
ipsum that
dolor sit fallsconsetetur
amet, asleep outside the elitr,
sadipscing crib and is then
sed diam put ineirmod
nonumy his crib already
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invidunt If this
ut labore et
child
dolore magna aliquyam erat, sed diam voluptua. At vero eos et accusam et justo duo dolores et ea rebum. Stet on
awakens (not sick, and not requiring food) is it really a surprise that he won’t fall back to sleep clita
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a bit unsettling to go to sleep in one place and wake up
in another.
Sincerely,
Imagine if you went to sleep in your bed every night, then woke up every morning on your kitchen floor.
You’d be freaking out! You’d be calling your friends and saying, “I’m telling you, it’s the same thing,
every night! I go to sleep there, but I wake up here! What’s going on here??!!”
Chad Hermann
ThisCommunications Director
comparison really isn’t far off from the experience of an infant who falls asleep while rocked on a
caretaker’s shoulder and then wakes in her crib. Unless a child is conditioned to learn to fall asleep
independently in her own crib, it’s unreasonable for parents to expect that she will easily fall back to
sleep if she awakens in the middle of the night.
6
June 10, 2010

Infants are completely dependent on someone, other than themselves, to recreate a SLEEP-ONSET
ASSOCIATION that is impossible for them to do for themselves. So it makes sense that they cry until
Dear Mr. helps
someone Smith to recreate the going-to-sleep process for them.
FEEDING / SLEEP-ONSET ASSOCIATIONS
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Duis
At whatautem
agevel
is eum iriure dolor
this pattern in hendrerit
considered as in
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unnecessary
barrier to self settling? 6 months, 9 months, 12
dolore teor
months, feugait nulla facilisi. Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh
2 years?
It really depends on your philosophy and parenting style.
There is no right answer here. But if you want your
infant/child to self-settle, it’s not likely to happen if the
baby requires a feeding to fall asleep. For the reasons I
listed above, I believe 6 months is a reasonable time to
let the child learn self-soothing techniques.
enim ad minim veniam, quis nostrud exerci tation ullamcorper suscipit lobortis nisl ut aliquip ex ea commodo
Here, I want to address a BIG NO-NO regarding
Feeding and Sleep. Some parents take huge risks by giving an infant a bottleful of milk to drink in his
crib while falling asleep. This can lead to severe dental disease requiring extensive oral surgery. “Bottle
Consetetur
Tooth” sadipscing
Caries elitr,result
(cavities) sed diam
when nonumy
infantseirmod tempor
typically invidunt
drink ut labore
formula et dolore
or juice frommagna aliquyam
a bottle as theyerat,
fallsed
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asleep. These liquids have sugars in them, and since the infant/child is groggy and headed into sleep gubergren, no sea takimata
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awake
(thanks to decreased swallowing and mouth cleansing). Thus, the liquids coat the teeth, allowing et
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justo duotodolores
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child’s stomach is actively digesting
when it should be resting. This leads to increased pooping and peeing, which causes your child to wake.
Sincerely,
So, bottom line: No bottles in bed.
Chad Hermann
Feeding Your Child to Get Her to Go Back to Sleep in the Middle of the Night
Feeding your infant when she awakens in the late evening and early morning (usually between 10pm &
5am) is a problem typically related to making Feeding-to-Sleep a part of the bedtime routine. When
parents discuss this concern, they tell me, My child is HUNGRY, and that’s why she’s awake and eating.
7
June 10,
Some 2010 tell me, Look, he eats two 8 ounce bottles through the night; he MUST be hungry.
parents
But if I wake up in the middle of the night and someone gives me two cuts of Mineo’s Pizza, with the
Dear Mr. Smith
cheese bubbling and slightly browned and the crust toasty warm and crisp, a cold cup of Pepsi sitting
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eating it! I consetetur
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without
eating. This also includes breastfeeding babies (yes, including the ad lib/feed-on-demand babies).
I’m a Lactation Consultant and a huge breastfeeding advocate. I’m passionate about promoting and
supporting breastfeeding. But in spite of this, I have sometimes found myself at odds with other
breastfeeding advocates who clearly support breastfeeding on demand. The mantra is that babies don’t
know from a schedule, so you should breastfeed them on demand. And I agree.
That said, depending on your parenting style and sleep philosophy, I don’t feel that “on demand”
breastfeeding has to continue through the night for a child past 6 months of age when a family wants the
child to learn self-settling. If you plan to practice an Attachment Parenting style, then you most surely
will be breastfeeding and co-sleeping. If your culture or belief is sleeping in a “Family Bed,” I don’t try
toConsetetur sadipscing
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sleep approach nonumy
(though I doeirmod
reviewtempor inviduntrisks
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and benefits magna aliquyam
discuss howerat,
to sed
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avoid co-sleeping risks related to adult bedding and adult characteristics during an office visit). no sea takimata
SELF- SETTLING
kasd gubergren,
There are manyno sea takimata
different wayssanctus est Lorem
to approach ipsum
this. Youdolor
may sit amet. another way, and that’s fine. But the
choose
way I’m describing here works almost 100% of the time – IF you carry it out as instructed.
Sincerely,
This approach is all about helping your child develop SELF-SETTLING sleep skills.
Some people describe this parenting sleep approach as the cry it out method. The intent is certainly not
Chad Hermann
toCommunications
make your baby cry, of course, but most 6-+-month-old infants will cry when not given what they
Director
want. This is normal and should absolutely be expected. It’s the exception, not the rule, for the 6+month-
old who is not given what he is demanding to sit quietly rather than protest.
Sometimes, this crying makes parents feel guilty. But should it? If a child wants to play with a sharp toy,
or run into the street, or stick a finger in an electrical outlet, his parents stop them from doing these
8
June 10, 2010

things. When the child cries because he didn’t get his way, do the parents feel guilty? Of course not. And
they shouldn’t – because they’re doing what’s best for the child at the time, and they’re also teaching the
Dear important
child Mr. Smith lessons in safety that will condition him for later in life.
ALorem
child ipsum
who isdolor sit amet, consetetur sadipscing elitr, sed diam nonumy eirmod tempor invidunt ut labore et
completely dependent on his parents to fall asleep will cry if placed in the crib awake and
left alone. We don’t like to hear crying, of course, but we need to remember that all crying does not
mean children are in pain, in fear, or suffering an illness. Taking a toy from a 6-month-old infant may
result in crying, but that’s fairly easy to figure out. If a 6-24 month-old child who expects you to rock/
hold/cuddled her to sleep is placed into crib wide awake without these desired behaviors, she will cry.
Many parents feel uncomfortable withdrawing this
assistance that the child “needs” get to sleep. The crying is
Duis autem
often vel eum
perceived iriurepain,
as fear, dolororin some
hendrerit in vulputate
other negativevelit esse molestie consequat, vel illum dolore eu feugiat
nulla facilisis
condition. at verofeel
Parents erosguilty
et accumsan
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crying, and because they’ve abruptly removed something dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh
euismod
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into enimroutine.
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consider nostrud exerci
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crying from the healthy, well-fed 8-month-old with a clean
illum dolore
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any nulla from
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onset of cryinget iusto odio dignissim qui blandit praesent luptatum
zzril delenit augue duis dolore te feugait nulla facilisi. Nam
from an 8-month-old from whom you’ve just taken liberatempor cum soluta nobis eleifend option congue
away
nihil imperdiet
sharp or dangerousdoming id quod mazim placerat facer possim assum. Lorem ipsum dolor sit amet, consectetuer
object?
enimreally.
Not ad minim veniam, quis nostrud exerci tation ullamcorper suscipit lobortis nisl ut aliquip ex ea commodo
eu feugiat
The nulla facilisis.
child cries and protests, because he wants what you’ve taken away. Whether you’re withholding the
sharp object or the rocking-to-sleep, you’re child is upset and therefore cries. But either way, you’re
doing the right thing.
Despite this reasoning, many parents feel so uncomfortable or guilty about not meeting their child’s
going-to-sleep demands that they continue to do so even though it repeats the cycle, and even though it
continues to make the child dependent on them to fall asleep.
You don’t want to hear your child cry, just as you don’t want to see your child fall. But when your child
is learning to walk, he will fall. And fall again. We don’t like it, but we accept it as an unavoidable part
of the learning process. The child gets up, on his own, over and over again until he masters the skill and
Sincerely,
learns to walk independently.
Crying while learning to self-settle is the same thing.

Chad Hermann
Communications
When Director
children learn how to sooth themselves to sleep, it’s often the first time they learn about
boundaries. In fact, it’s often the first No they really learn from: NO, I am not going to take you out of
the crib. You have to go back to sleep on your own.
Consider this analogy: Do you give your child candy or cookies every time they ask? No. What if they
9
June 10, 2010

cry? No again. (I hope.) Say your child loves Elmo, and she already has several Elmo dolls in her room
at home. While walking through a store, your child sees Elmo on the display shelf and cries because she
Dear Mr.
wants THATSmith
Elmo. Do you buy another Elmo just to calm her down and get her to stop crying? If you
do, we have a lot more to talk about than just sleep.
Many parents tell me about the difficulties they have getting their child to sleep while admitting that
other caretakers or daycare centers seem to have no trouble getting the child to sleep independently.
This example demonstrates how a child can be conditioned to respond to different people differently.
I eirmod
once worked with the parent of a 22-month-old who “required” a two-hour bedtime routine involving
tempor invidunt ut labore et dolore magna aliquyam erat, sed diam voluptua. At vero eos et accusam et
reading books, soft music, massage, cuddling, and being rocked to sleep before being able to be placed
in a crib for bedtime. I asked how the child napped. The parent told me that naps were equally tough and
Duison
long autem
the vel eum iriure
weekends at dolor
home.inWhen
I asked about velit esse molestie
weekdays, consequat,
the parent admittedvel illum
that dolore
those eu feugiat
naps were
nulla facilisis
handled by theat child’s
day et iusto
care, where napsodio
camedignissim qui blanditatpraesent
like clockwork 12:30PMluptatum
everyzzrilday,delenit
with augue duis
no book,
dolore te feugait nulla facilisi. Lorem ipsum dolor sit amet, consectetuer adipiscing elit,
no rocking, no massage, music or cuddling. The parent was at a loss to explain why this occurred. sed diam nonummy nibh
I Ut wisi enim
couldn’t ad myself.
help minim veniam, quis nostrud exerci tation ullamcorper suscipit lobortis nisl ut aliquip ex ea
illum dolore
“Well, eu feugiat
clearly,” I said,nulla
“thefacilisis
daycareat has
verothe
erosMagic
et accumsan
Cot.” et iusto odio dignissim qui blandit praesent luptatum
nihilparent’s
The imperdieteyes
doming id quod
widened mazim
with placerat facer possim assum. Lorem ipsum dolor sit amet, consectetuer
excitement.
enim ad minim
“What’s veniam,
a Magic Cot?!”quis nostrud exerci tation ullamcorper suscipit lobortis nisl ut aliquip ex ea commodo
I eu feugiat nulla
laughed, facilisis.
and then explained the joke.
There are, of course, no Magic Cots. But there are regular, predictable, consistent routines. The kinds of
routines, and prevailing nap rules, that kids are more than willing to comply with when they learn that
they have no other choice. Without those routines, and without the enforcement of those rules, kids
know thatdolores
justo duo they’reetthe ones calling
ea rebum. thekasd
Stet clita shots.
gubergren, no sea takimata sanctus est Lorem ipsum dolor sit amet.
Day cares
dolore understand
magna aliquyam this, anddiam
erat, sed theyvoluptua.
create anAtatmosphere that allows
vero eos et accusam – and
et justo duoexpects – ea
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home.
Sincerely,
TRAINING & RE-CONDITIONING
Chad
We allHermann
condition our children. Sometimes, we have to recondition them.
When your 9-month-old crawls toward the electrical outlet, you move her away and say, No. When she
immediately starts to crawl back toward the outlet, you pick her up, move her, and say No even louder.
The baby looks at you, the boo-boo lip comes out, and she begins to wail – as she heads back toward the
outlet. At no point, no matter how often or loudly she cries, do you consider letting her make it to the
10
June 10, 2010

outlet. And you never, not even for a moment, no matter how often or loudly she cries, consider letting
her stick her finger in that outlet. To you, it’s clear: Outlet=Electricity, Electricity=Danger, and
Dear Mr. Smith
Danger=No. Even if she cries more, you resist. Your stance is as firm and unyielding as a brick wall. She
learns that no matter what she does, no matter how often or loudly she cries, she will not be allowed to
touch the outlet. Eventually she learns that if she tries again, she will fail. Eventually she just stops
trying.
Conditioning works best when the process is clear and consistent. You know that, and you provide that
clarity and consistency, when your child is crawling toward an electrical outlet. You need to know it, and
you need to do the same thing, when she’s not self-settling in bed.
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to Sleep iriure dolor
is Tough. And in Learned.
hendrerit in vulputate velit esse molestie consequat, vel illum dolore eu feugiat
doloreabout
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it. Going to sleepLorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh
is tough!
Sure, a nice cozy bed or crib seems like a fine place to relax and drift off. But don’t forget that the
Ut wisi enim
primitive ad minim veniam,
predecessors quis nostrud
from which we’veexerci tation
evolved ullamcorper
lived in muchsuscipit lobortis
less safe nisl ut aliquip
surroundings. ex eato sleep
Going
meant – and still, in some ways, means – putting down ALL your defenses. If an invading tribe or vel
commodo consequat. Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse molestie consequat,
illum dolore
hungry bear eu feugiat
came nullayour
across facilisis at verobehind,
sleeping eros et accumsan et iusto
you weren’t odiotodignissim
likely fare veryqui blandit
well. Wepraesent
mammals luptatum
are
hard-wired this way.
Ever see a dog prepare to go to sleep? Watch the
genetically programmed instinct. The dog chooses a
strategic spot, typically with a good view of the area,
then circles round and round and plops down, curled
inConsetetur
a ball, itssadipscing elitr, ased
back against walldiam
or nonumy eirmodOnly
other barrier. tempor invidunt ut labore et dolore magna aliquyam erat, sed
diam voluptua. At vero eos et accusam et justo
then does it slowly drift off to sleep, with one eye duo dolores et ea rebum. Stet clita kasd gubergren, no sea takimata
sanctus
never est Lorem
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Lorem ipsum dolor sit amet, consetetur sadipscing
mode when we go to sleep – though some maladapted elitr, sed diam nonumy eirmod tempor invidunt ut labore et
doloreroutines
sleep magna aliquyam
can retain erat, sedon-guard
this diam voluptua. At vero eos et accusam et justo duo dolores et ea rebum. Stet clita
characteristic.
kasd gubergren, no sea takimata
Modern humans in safe settings have sanctus est Lorem ipsum dolor sit amet.
learned to suppress this vigilance. But this ability to
loosen up and let it all hang is not necessarily the Default mode in our Genetic Factory Setting.
Sincerely,
Some infants while appropriately nursed, rocked, held, kissed and cuddled to sleep don’t spontaneously
transition to self-sufficient sleep automatically. Sometimes as a parent, you have to move your cursor to
Chad Hermann
the lower left corner of the screen, click on the Start button, open the Control Panel, and manually click
off the “On Guard” mode and click on the “Self-Settle” mode.
Of course, it isn’t that easy. But would you be surprised if I told you it’s almost that easy? And that it’s
almost always much easier than parents thought it would be?
11
June 10, 2010

My thought is that sleep has a genetic/nature piece and learned/nurture piece. You may be naturally
hard-wired to be a Night Owl (like me) – able to watch Letterman, read a couple of chapters of a book,
Dearcomplete
and Mr. Smithall sorts of paperwork ‘til 3AM without any problems. Or you might be one of those 6am
Bright Eyes (like my wife) who’s up and excited and ready to shine before the sun is.
Some of our genetic programming is more easily modified than others. Ten years of parenting has
reluctantly shifted my sorry Night Owl butt out of bed before 7AM pretty regularly. I don’t even grunt or
growl first thing in the morning any more. But don’t get the idea it’s my first choice. Messing with those
Night Owl-Bright Eyes settings is a lot tougher than altering the “Go To Sleep” settings.
Going to sleep is much more easily conditioned or taught.
Duis autem
Because vel eum
going iriureisdolor
to sleep in hendrerit
a vulnerable in vulputate
time, velit esse
and because we molestie
may notconsequat, vel illum
innately chose to dolore
go fromeu full
feugiat
nulla facilisis to
wakefulness at sleep
without et iusto
help and odio dignissim
reassurance, qui blandit
children praesent luptatum
in a tumultuous settingzzril
maydelenit
have augue duis
a difficult
time switching out of vigilance mode at bedtime. Most infants and children, however, are not typicallysed diam nonummy nibh
ineuismod tincidunt
a stressful ut laoreet dolore
environment. After magna aliquam
6 or more erat volutpat.
months of being assisted to sleep, many children readily
Ut wisi
make theenim ad minim
switch veniam, quis
to self-settle mode nostrud exerciatation
with only gentleullamcorper
nudge. suscipit lobortis nisl ut aliquip ex ea
illum
(By thedolore
way:euiffeugiat
you’renulla facilisisof
the parent at one
veroof
eros et accumsan
those et iusto
babies who fromodio dignissim
the qui after
first night blandit praesent
birth couldluptatum
self-
settle and sleep through the night, I have a question and a recommendation. First: why the heck are you
nihil imperdiet
reading doming id
this? Second: quodtell
don’t mazim placerat
anyone elsefacer
howpossim assum.
well your Lorem
child ipsum
sleeps, dolor sitother
because amet,people
consectetuer
with kids
ofadipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat volutpat. Ut wisi
similar ages will probably hate you!)
Why They Failed: Just Do It (Correctly)
Consetetur
Parents sadipscing
often tell me elitr,
they sed
havediam nonumy
“tried” eirmod
to let theirtempor invidunt
child fall ut on
asleep labore et dolore
their magna
own prior to aliquyam
seeing me,erat,but
sed
diamit voluptua.
that At work.
just didn’t vero eos et accusam et justo duo dolores et ea rebum. Stet clita kasd gubergren, no sea takimata
eirmodfamilies
Many tempor invidunt
that do ut labore
fail, fail et
fordolore
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two aliquyam
reasons: erat, sed diam voluptua. At vero eos et accusam et
1)Lorem
Theiripsum dolor is
approach sit sound,
amet, consetetur
but they sadipscing
don’t stickelitr,
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it diam
long nonumy
enough eirmod
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et
2)kasd gubergren,
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don’t recognize sanctus
a critical flawestinLorem
their ipsum dolor sit amet.
approach.
In the first example, the infants have not been given ample opportunity to learn that there are new rules
inSincerely,
place to support self-settling. In the immortal words of Yoda, the grandest of all Jedi Masters: Do or
do not; there is no “try.”
Chad
So Hermann
Jimmy is 6 months old, and his parents agree tonight Friday night is the night. They feed, clean, and
Communications
cuddle Director
Jimmy prior to bedtime, and place him in his crib wide awake. They follow a reasonable
approach, but at some point, Jimmy’s crying reaches his parents’ threshold, they say enough is enough,
and they go in to hold and rock him to sleep.
If Sleep Self-Settling is followed as outlined later in this handout, it’s extremely rare for a child to fail if
conditioning is followed and appropriately completed.
12
The Flaw in the System: Groggy, But Awake?!

June 10, 2010
Remember that time when you were sitting in the back of class, or in a meeting, with your eyes closing
and opening, your head bobbing, obviously falling asleep yet still able to hear the teacher or speaker? To
Dear Mr. Smith
your amazement, you were even able recall some of the words the speaker said while you were drifting
inLorem ipsum
and out. dolor
This sit amet, consetetur
is because even thoughsadipscing elitr,sitting
you were sed diam nonumy
in class eirmodkind
looking tempor invidunt utyou
of ‘awake,’ labore
hadet
dolore magna
already startedaliquyam
enteringerat,
intosedstages
diam 1voluptua.
and 2 ofAtsleep!
vero eosIf et accusamsensors
I slapped et justo duo
fromdolores
an EEGet eamachine
rebum. Stet clita
to your
kasd in
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yoursanctus
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categorized LoremAnd
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yet, sit in
even amet, consetetur
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“light” elitr,you
sleep, sedcan
diam nonumy
still commit eirmod tempor
things invidunt (That’s
to memory. ut laborepretty
et dolore magna
cool, aliquyam erat, sed diam
huh?)
sanctus
Why tellestthis
Lorem ipsum
story? dolor sit
Because theamet.
mostLorem ipsum
critical partdolor sit amet, consetetur
of conditioning sadipscing
self-settling elitr, sed
is letting thediam
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eirmodherself.”
“settle tempor invidunt
Even ifutthe
labore
baby et dolore magna aliquyam
looks awake: eyes openerat,(but
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diam voluptua. At vero (but
head turning eos etslowly),
accusam she
et has
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conditioned dolor
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asleep where
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Whether molestie
it was consequat,
in the TV room velwith
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& eu feugiat
Order
nulla facilisis at vero eros et accumsan et iusto odio dignissim qui blandit praesent luptatum zzril delenit augue
(dun-dum!) playing in the background, or on her parent’s shoulder swaying back and forth – can youduis
guess what happens she wakes up not in that same place?
She cries. (This isn’t rocket science, folks.)
Iscommodo
it really consequat.
shocking Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse molestie consequat, vel
that she should cry? First, she was likely freaked out by the fact that she woke in a
place different from where she went to sleep (the Bedroom-to-Kitchen Phenomenon). Second, she didn’t
self-settle in the first place! We can’t expect her to awaken in the middle of the night, find herself alone
in a dark and room with out any soothing motion, and just roll over and go back to sleep.
Another parental misconception: when a child is run ragged or skips naps or in some way becomes very
tired and “worn out” by evening, then they’ll sleep better. This usually is not the case. In general, an
overly-tired child will sleep worse than usual.
diam teach
Why voluptua. At vero
a child eos et accusam
self-settling skillsettojusto
fallduo dolores
asleep et ea rebum. Stet
independently? Manyclitareasons:
kasd gubergren, no sea takimata
1)eirmod tempor
The child invidunt
gains ut labore
security andetconfidence
dolore magna aliquyam erat, sed diam voluptua. At vero eos et accusam et
related
justo
to duo dolores
sleep et ea rebum.
with each Stet clita
successful kasd gubergren, no sea takimata sanctus est Lorem ipsum dolor sit amet.
night.
2)dolore magnaenjoys
The child aliquyam erat, sed
greater diam of
quality voluptua.
sleep. At vero eos et accusam et justo duo dolores et ea rebum. Stet clita
3) The child does not develop fears associated with
going to sleep alone.
Sincerely,
4) The family unit does not suffer from the stress
of an unnecessary sleep problem.
Chad Hermann
5)Communications Director
Most lousy adult sleepers were lousy sleepers
as kids.
13
June 10, 2010

While certainly not a primary reason for teaching a child self-settling, the chance for parents to regain
normal patterns of sleep and intimacy does provide a significant benefit – both for the parents AND for
Dear
the Mr. Smith
child. The parents’ reward is self-evident. The child’s reward comes from having well-rested parents.
Tired parents are bad parents. Well-rested parents have more patience, better senses of humor, and a
greater willingness to engage their children in play. Overall, they’re happier people. And better parents.
Reconditioning is not difficult. At 6 to 12 months, infants respond to recurring patterns AND learn
rapidly. If you and ALL caretakers are consistent with your sleep conditioning routine, your child will
likely learn within a week how to fall asleep on his or her own. Your child will also learn how to put
him- or herself back to sleep when waking in the night. Most children, in fact, will complete the
majority of this learning process within 2-3 days!
Duis autem
Now. I mustvel eum the
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CONSISTENT consequat, vel illum reason
The primary dolore eu
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with conditioning is dignissim qui blandit
that the child praesent
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caregivers. I’ve had many parents come back to me and state that they carried out the plan I reviewed sed diam nonummy nibh
euismod
with them, tincidunt
and thatut laoreet dolore
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But, excepteratinvolutpat.
the rarest of cases, the failure almost always results
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caretakers part. suscipit lobortis nisl ut aliquip ex ea
illum
So howdolore eu feugiat
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vero eros et accumsan et iusto odio dignissim qui blandit praesent luptatum
nihil we
Here imperdiet
go… doming id quod mazim placerat facer possim assum. Lorem ipsum dolor sit amet, consectetuer
Establish a Regular Bedtime Routine.
eu feugiat
Infants andnulla facilisis.
children learn through repetition. A clear bedtime routine will let them learn to anticipate
Consetetur
that bedtimesadipscing elitr, sed diam nonumy eirmod tempor invidunt ut labore et dolore magna aliquyam erat, sed
has arrived.
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at different magna aliquyam erat, sed diam voluptua. At vero eos et accusam et
times.
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thenonumy
time you eirmod tempor
choose invidunt
is greater ut labore
than one toettwo
doloredifferent
hours magna aliquyam
from the erat,
timesedyour
diamchild
voluptua. At verofalls
currently eos et accusam
asleep, youret justo
childduo
may dolores
need ettoeahave
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the Stet clita
bedtime
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gradually no sea
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this approach, Lorem ipsumtalk
should dolor
to sit amet.
your doctor first.)
The idea behind the routine is to calm, or wind-down, your child. Obviously you want to avoid
Sincerely, your child. This means avoiding loud noise, bright lights, rough play, and drinks with
stimulating
caffeine for at least 30-60 minutes prior to bedtime. The routine doesn’t need to last very long. 5 to 30
minutes is typical. Common bedtime routines can include: snack, bath, bedtime story, cuddling, talking,
Chad Hermann
praying, and toothbrushing.
The routine is NOT meant to get your child tired or to sleep. Your child must be awake and alert enough
to recognize she is being placed in her crib. If she falls asleep during the routine, then she must be gently
awakened prior to being put in the crib.
14
June 10, 2010

I recommend the use of a Transitional Object to put in the crib with the baby. The child will typically
bond with this object – a small teddy bear/teething toy, for example. Since this process usually occurs
Dearthe
during Mr.time
Smitha child goes through teething, it’s helpful if the object can easily be chewed and
withstand teething. Since your child will be presented with a new object for the sleep process, this is also
an ideal time to eliminate a pacifier or bottle.
Once the bedtime routine is complete, your infant should be placed in his crib, with his transitional
object, awake in the room with a dim nightlight, and the door closed. As I’ve previously discussed, if
your child has become conditioned to falling asleep
outside of the crib or to requiring your presence, then
youjusto
canduo
expect your child to become upset and cry. If
dolores et ea rebum. Stet clita kasd gubergren, no sea takimata sanctus est Lorem ipsum dolor sit amet.
he could talk, he might say things like, Get me out of
thisDuis
crib,autem vel want
I don’t eum iriure
to godolor in hendrerit
to sleep, or I’minreally
vulputate
mad.velit esse molestie consequat, vel illum dolore eu feugiat
nullainterpretations
These facilisis at vero are
erosmuch
et accumsan et iusto odio
more accurate thandignissim
the qui blandit praesent luptatum zzril delenit augue duis
dolore te feugait nulla facilisi. Lorem ipsum
ones you’re inclined to make, like You’re abandoning dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh
euismod tincidunt ut laoreet dolore magna
me, You’re causing me harm, or You don’t love me. aliquam erat volutpat.
Yourcommodo consequat.response
first instinctive Duis autem
to vel
his eum
cry isiriure dolor intohendrerit in vulputate velit esse molestie consequat, vel
to attend
illum
it and dolorethe
soothe eu feugiat
crying.nulla facilisis
That’s at vero eros et accumsan et iusto odio dignissim qui blandit praesent luptatum
the conditioned
zzril delenit augue duis dolore te feugait
response expected by the infant (and nullaby
often facilisi.
the Nam liber tempor cum soluta nobis eleifend option congue
nihil imperdiet
parent). doming id
But remember: thequod mazim
entire pointplacerat
of thisfacer possim assum. Lorem ipsum dolor sit amet, consectetuer
adipiscing elit, sed diam nonummy nibh euismod tincidunt
approach is to recondition the infant’s response to beingut placed
laoreet dolore
in the magna
crib. aliquam erat volutpat. Ut wisi
Theconsequat.
caretakerDuis autem
should vel immediately
then eum iriure dolor in hendrerit
leave in vulputate
the infant’s bedroom.velitOften
esse molestie consequat,
the infant will bevel illum and
crying dolore
eu standing.
even feugiat nulla
Youfacilisis.
should still leave the room. Staying to “calm” the infant or laying her back down is
likely to condition her to expect these actions every time you put her in the crib.
This is also why I don’t recommend the use of a pacifier; if the pacifier falls out of the infant’s mouth,
she’ll cry until you come back to put it back in her mouth. Some caretakers try to avert this problem by
buying
justo several pacifiers
duo dolores and sprinkling
et ea rebum. themgubergren,
Stet clita kasd inside thenocrib, so if one
sea takimata falls out
sanctus the infant
est Lorem ipsummight
dolor easily
sit amet.
findLorem
another on dolor
ipsum their sit
own. (It’s
amet, true.) That
consetetur approach,
sadipscing elitr, however, just continues,
sed diam nonumy and perhaps
eirmod tempor invidunteven worsens,
ut labore et
thedolore
problem. It’s much easier to recondition the infant to self-sooth without additional items.
magna aliquyam erat, sed diam voluptua. At vero eos et accusam et justo duo dolores et ea rebum. Stet clita
So you’ve left the infant in the crib awake and alone. If he cries what do you do?
Sincerely,
I suggest waiting 5 minutes, giving him time to possibly soothe himself to sleep. You must time this
process with a watch or clock, because 30 seconds of crying will seem like an hour.
Chad
After Hermannof crying, you can go to the baby’s crib and briefly, verbally reassure him. This does not
5 minutes
Communications
involve Director
picking, lying down, or even touching the infant. If the baby was happy and pleasant five
minutes ago when you placed him in the crib, and he’s only crying since you left, it doesn’t take a
specialist, or a rocket scientist (I told you!) to figure out what upset him.
He’s angry. He’s almost certainly NOT ill or in pain. (He was just fine five minutes ago; it’s not like he
15
June 10, 2010

suddenly developed tuberculosis after you left him!) So your brief visit at the 5-minute point is to
condition him to expect that his crying will bring you to check on him. If he’s ok except for the
Dear Mr.
crying, Smith
you leave the room again.
So, what is the message you’re giving (conditioning) him?
If I check on you in the crib and everything is ok, but you are upset at being put in the crib, I’m going to
leave after verbally reassuring you, because I expect you to soothe yourself to sleep.
That’s a long message. But your baby will get it. And understand it.
The question I most often get is: How long (after the 5 minute visit) do I let my child cry? The answer I
Duis autem
typically velis:
give eumAsiriure
longdolor
as it in hendrerit in vulputate velit esse molestie consequat, vel illum dolore eu feugiat
takes.
dolorecaretakers
Some te feugait nulla facilisi.
tell me theyLorem
thinkipsum
this isdolor sit Once
harsh. amet, consectetuer adipiscing
again, my method is elit,
not sed
the diam
only nonummy
approachnibh
– but
whatever you do is going to condition your child to expect the response again. Dr. Richard Ferber,
Ut wisi enim
probably the ad minim
most veniam,
famous quis nostrud
pediatric sleepexerci tation offers
specialist, ullamcorper suscipit
a method lobortis nisl
essentially theutsame
aliquip
asex
theeaone I’ve
commodo consequat. Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse molestie consequat, after
described so far, but differs here. He suggests going back to a crying infant (older than 6 months) vel
illum
10 moredolore eu feugiat
minutes, and nulla
then facilisis at vero
again after 15eros
moreet accumsan
minutes –eteach
iustotime
odio briefly,
dignissimverbally
qui blandit praesent luptatum
reassuring the
zzril delenit
infant. I feel,augue duis dolore
however, te feugait
that each timenulla
you facilisi.
go backNam intoliber
the tempor cum disrupt
room, you soluta nobis eleifenddelay
or further optionthe
congue
self-
nihil imperdiet
soothing doming id quod mazim placerat facer possim assum. Lorem ipsum dolor sit amet, consectetuer
process.
enim ad minim
(There’s nothing veniam,
wrongquis nostrud
with exerci tation
Dr. Ferber’s ullamcorper
approach; suscipit
it’s just lobortisIfnisl
different. ut aliquip
you’re ex ea commodo
interested in learning
consequat.
more, Duis autem
it’s clearly vel eumalong
explained, iriure dolor in hendrerit
with some in vulputate
excellent velit esse
information molestie
about consequat,
pediatric sleep,vel
in illum dolore
Dr. Ferber’s
eu feugiat
book, nullaYour
Solving facilisis.
Child’s Sleep Problems.)
So… As long as it takes is my professional opinion. But why?
Ifeirmod
the child discovers that you will come back into the room and maybe even pick him up if he cries
longer than 20 minutes,
justo duo dolores thenStet
et ea rebum. youclita
have justgubergren,
kasd conditioned him
no sea to a new
takimata process.
sanctus To get
est Lorem youdolor
ipsum backsitinto his
amet.
room,
Loremall he has
ipsum to sit
dolor doamet,
is cryconsetetur
for moresadipscing
than 20 minutes.
elitr, sed And
diam so he’ll eirmod
nonumy do it. Just as he
tempor will ifutyou
invidunt come
labore et
back after 30, 40, or 60 minutes. Or longer.
A child will often cry for 30 minutes or longer. But she will almost always self-soothe and go to sleep if
you don’t interfere. (Of course, if there’s a sudden change in the crying, or if something seems out of the
Sincerely,you should immediately go and check on her.) The worst effects of this long crying may be a
ordinary,
hoarse voice, sore throat, or occasionally (if head-banging) a bruised head. None of these are serious.
Chad Hermann
Some parents have asked me if the crying could cause a hernia, heart attack, or stroke. Unless the child
Communications
has Director medical problem, the answer is No. The most troublesome issue for parents is
a severe underlying
usually when their babies cry to the point that they gag and vomit. (Vomiting typically doesn’t occur in
this process, with the exception of children with Gastroesophogeal Reflux, but it’s still worth mentioning
here. Also worth mentioning: keep an extra pair of sheets and PJs handy in case they do vomit.)
How you respond to this is very important.
16
June 10, 2010

To the child whose parent picks him up, apologizes, holds, rocks, and/or feeds him, there is likely to be a
new conditioning: that if he’s awake in the crib, he should cry; if he cries and no one comes, he should
Dear
cry Mr. Smith
harder; if he cries long and hard enough, to the point of vomiting, then that Room Service response
is finally going to come. (It may be bad room service, and it may be late, but it’s still room service.)
On the other hand, if you go to him and calmly, verbally reassure him while you clean him, his clothes,
and his linens, then immediately put him back into the crib, you’ve given a clear and consistent
message, conditioning him in a way you want: I will always check on you when something has
happened, but once I address the problem, I expect you to soothe yourself and go to sleep in your crib.
Once the child has fallen asleep, you do not need to go back in his room.
IfDuis autem vel later

he awakens eum iriure
in thedolor
nightinor
early morning – velit esse molestie consequat, vel illum dolore eu feugiat
nulla facilisis
typically beforeat vero
6ameros et accumsan
– then you shouldet iusto odiothe
repeat dignissim qui blandit praesent luptatum zzril delenit augue duis
approach described above. The one difference is amet,
dolore te feugait nulla facilisi. Lorem ipsum dolor sit that consectetuer adipiscing elit, sed diam nonummy nibh
you may not have seen the child for hours, and thevolutpat.
euismod tincidunt ut laoreet dolore magna aliquam erat
Ut wisi enimmay
awakening ad minim
have an veniam,
obviousquissource
nostrudthat
exerci tation ullamcorper suscipit lobortis nisl ut aliquip ex ea
requires
acommodo consequat. Duis autem vel eum iriure dolor inor
brief physical evaluation. Problems like teething hendrerit in vulputate velit esse molestie consequat, vel
aillum
“dirty”dolore eu feugiat
diaper can benulla facilisis within
addressed at vero 2-3
eros minutes,
et accumsan et iusto odio dignissim qui blandit praesent luptatum
zzril delenit
allowing youaugue duis dolore
to quickly leavete the
feugait nulla(Iffacilisi.
room. Nam liber tempor cum soluta nobis eleifend option congue
your child
nihila imperdiet
has fever, you’ll doming
haveid to
quod mazim placerat
approach facer possim assum. Lorem ipsum dolor sit amet, consectetuer
that differently.)
adipiscing
So, in essence,elit, sed diam
after nonummyofnibh
5 minutes euismod
crying, youtincidunt
make a ut laoreet dolore magna aliquam erat volutpat. Ut wisi
enimappearance,
brief ad minim veniam, then quis
leavenostrud
and letexerci
themtation
go asullamcorper
long suscipit lobortis nisl ut aliquip ex ea commodo
asconsequat.
it takes. Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse molestie consequat, vel illum dolore
Beware of the slippery slope here: 6am can become 5:50, which can become 5:35, which can become
5:15. Pick a time. Draw a line. And then stick to it.
Naps should be similar. Infants 6-12 months old typically take about 2 naps per day. From 12 months to
about 4 years
justo duo old,etthey
dolores usually
ea rebum. Stettake
clitaone
kasdnap. You should
gubergren, no seaestablish a pre-nap
takimata sanctus routine,
est Lorem justdolor
ipsum as you sit would
amet.
establish a pre-bedtime
Lorem ipsum routine
dolor sit amet, at night.
consetetur You should
sadipscing putdiam
elitr, sed the child
nonumy in eirmod
her cribtempor
– ideally, withut the
invidunt same
labore et
setting as bedtime
dolore magna – awake,
aliquyam then
erat, sed diamleave. (YouAtmight
voluptua. consider
vero eos usingetroom-darkening
et accusam shades
justo duo dolores et for naps.)
ea rebum. If
Stet clita
kasd child
your gubergren,
criesno
forsea takimata
more than sanctus est Lorem
five minutes, youipsum dolor
should sit amet.
briefly return to check, then leave again. If the
crying lasts longer than an hour, then you should abort the nap attempt. (This, however, very rarely
happens).
Sincerely,
I strongly suggest you begin the process with bedtime, not naps.
Chad than
More Hermann
95% of children will learn to self-soothe within 7 days.
The majority of children will learn to self-soothe within 3-4 days.
The first 1-3 days are the worst.
17
June 10, 2010

Days 1 & 2 can typically have 30-90 minutes of crying and disruptions.
Dear Mr.on
Starting Smith
a weekend or holiday helps.
If you have neighbors with a shared, thin wall, you might want to explain what you’re doing in advance
of starting the sleep training.
If someone shares the infant’s room, you should temporarily move her out for a couple days.
Ifeirmod
you feel that this process should take place, but you honestly recognize you’re not able to do it, you
should get close friends or family to help and leave for a few hours.
Duis autem
Perhaps velimportantly...
most eum iriure dolor in hendrerit in vulputate velit esse molestie consequat, vel illum dolore eu feugiat
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...If youtestart
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process, Lorem ipsum IT!
COMPLETE dolor sit amet, and
Stopping consectetuer
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sed diamwhich
nonummy nibh
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euismod tincidunt ut laoreet
and greatly prolong, the process. dolore magna aliquam erat volutpat.
Ifcommodo consequat.
the process doesn’tDuis autem
seem velwhat
to fit eum I’ve
iriuredescribed,
dolor in hendrerit
call ourin office.
vulputate velitasesse
And, molestie
always, consequat,
if you vel
have any
illum dolore
questions at eu
all feugiat
about nulla facilisis
the health andat vero eros etofaccumsan
wellness et iusto
your child, odioletdignissim
please us know. quiWe’re
blandithere
praesent luptatum
to help.
enim
Dr. Toddad minim
Wolynn,veniam, quis nostrud
the President of exerci tationPediatrics,
Kids Plus ullamcorperhas
suscipit
beenlobortis nisl ut
a general aliquip ex ea(Board
pediatrician commodo
consequat.since
Certified) Duis autem
1995.velIn eum
1997,iriure dolor in hendrerit
he became interestedin in
vulputate velitsleep
pediatric esse molestie
disorders consequat, vel illum dolore
and subsequently
eu feugiat nulla
completed facilisis. courses at The School of Sleep Medicine in Palo Alto (which is associated with
two intensive
Stanford University). After completing the course in 1999, he helped to open the Mercy Hospital
Pediatric Sleep Disorder Program. He was the Medical Director of the program from 1998-2007.
Sincerely,
Chad Hermann Copyright © 2011


Sleep Handout: Dr. Todd Wolynn

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Dr. Todd Wolynn

Copyright © 2011 Kids Plus Pediatrics

FewDear Mr. Smith

June 10, 2010

June 10, 2010

The primary problem, then, is simple:

June 10, 2010

June 10, 2010

June 10, 2010

Crying while learning to self-settle is the same thing.

June 10, 2010

June 10, 2010

June 10, 2010

The Flaw in the System: Groggy, But Awake?!

June 10, 2010

June 10, 2010

June 10, 2010

How you respond to this is very important.

June 10, 2010

IfDuis autem vel later

The first 1-3 days are the worst.

June 10, 2010

Chad Hermann Copyright © 2011

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