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Getting to Sleep

Ask the parents of any baby or young child for their number one parenting concern and they'll probably roll their exhausted eyes and say "sleep."

Though getting little ones to nod off peacefully  -- and stay asleep  -- may be one of the biggest challenges parents face, it's also one of the most individual. Every child responds differently to different techniques, so an effective routine usually has to be tailored to your own needs. To help you do that, we asked some of the nation's pediatric experts, who represent a range of opinions, for their solutions to the top bedtime challenges. You'll find plenty of options to suit your family.

Cris Beam's last piece for Parenting was "Straight Talk on Strangers," in the September issue.

CRYING IN THE CRIB

Once an infant is 4 or 5 months old, what should you do if he cries when you leave the room? What's good and bad about letting him cry it out?

William Sears, M.D.: The "let your baby cry it out" approach comes from an old fear of spoiling kids. But that's a myth; when an infant cries, he's communicating a need, not being manipulative.

Martha Heineman Pieper, Ph.D.: You shouldn't leave your baby to cry, because it's harmful. Even if it gets him to go to sleep without crying, it's only because he's accepted the fact that although he's unhappy, you're not coming. He learns to fall asleep in hopelessness.

Richard Ferber, M.D.: There will always be situations where you have to let a child cry. If you take matches away from a child, he's going to cry. Does this mean he's learning not to use matches out of hopelessness? You're not removing love or care when you help your 5- or 6-month-old baby switch sleeping patterns. The goal is to give him the opportunity to learn to fall asleep in a new way.

For parents who decide to take the "cry it out" approach, one of the most popular methods is delayed-response, or the "Ferber Method." How should they start this?

Dr. Ferber: Well, I don't consider anything to be the "Ferber Method." But once a baby is 5 months old, my approach is to stay out of the room when she cries for the length of time you're comfortable with  -- anywhere from one to five minutes. Then go back in and soothe your baby without picking her up; leave again and stay out for a few minutes. For example: The first night stay out one minute, then three, then five, and continue to go in every five minutes if she is still crying. The next night try staying out for three minutes, then five, then seven, then seven again, until she stops crying. Some parents go in every two minutes night after night, and that doesn't really help.

If it takes longer than three days for the baby to stop crying, then something is wrong; for instance, it could be too much napping or a change in nighttime feeding patterns.

What are some alternatives to this method?

Claire Lerner: The approach I've developed is to put your baby down the first night when she's almost asleep and then leave the room; if she's still crying, come back in a few minutes. The next night put her down when she's a little more lucid and leave the room a bit longer. Stay away for a slightly longer time each night until the baby learns to fall asleep when you leave.

Jodi Mindell, Ph.D.: I don't think it makes any difference if you go in and check on your baby after 30 seconds, 5 minutes, or 30 minutes. To get him to sleep on his own, you just have to leave. If after 20 minutes he's still crying and you can't stand it, you can take him out and then start the whole process again the next night.

What should parents do if their baby has no trouble falling asleep but wakes up too early in the morning and cries for them to come?

Mindell: Try putting her to bed earlier. It's counterintuitive, but it works because sleep-deprived babies wake up more often. She may also be waking up because she's used to being fed. In this case cut down the early-morning feeding by one ounce (if you're bottle-feeding) or one minute (if you're breastfeeding) a day until you've completely eliminated it.

Dr. Ferber: When a baby awakens at a reasonable hour, you should go to him when he cries. But if he's waking up very early and seems to need more sleep, going to him can then become a habit. If that occurs, delay getting him for a few minutes. The next morning go to him a few minutes later. But be prepared  -- there's bound to be some crying.

Sharing a Bed

What are the pros and cons of the "family bed"?

Dr. Sears: I believe there's no right or wrong place for a baby to sleep; however everyone gets the best sleep is the right arrangement for that family. My personal belief is that in the first year babies belong snuggled next to their parents.

Patricia Henderson Shimm: Letting your kids sleep on their own starting in infancy gives them independence. Bedtime should be a happy, nurturing time for a child. If you think of their bed as a little nest and you treat it as a wonderful place to be, they'll like it.

Lerner: For some people the family bed is just not in sync with their personality. You have to give up a lot of space, time, and intimacy with your partner. Often, sleeping with their baby is a decision parents later regret  -- because the longer you keep the child in your bed, the harder it may be for her to adjust when you want her to stay in her own room.

The Consumer Product Safety Commission recently warned that sharing a bed with a baby can be dangerous. Should parents be concerned?

Arlene Eisenberg: Yes, they need to be extremely cautious. Babies can suffocate under soft comforters and pillows. And some beds have bars and cracks where an infant can get caught and be strangled.

Dr. Sears: Parents need to co-sleep in a safe way. That means no drugs or alcohol prior to bedtime, sleeping with only one child at a time, and not using soft or loose bedding.

If you do want your baby to sleep with you at first and then move him into his own bed, what's the best way to ease the transition?

Pieper: If you let the family bed go on after your baby is 6 months old, it can be hard to stop it without making him feel that it's arbitrary and mean. If you're willing to continue the family bed until he naturally gives it up, fine.

Mindell: You can move an older baby or toddler into his own bed. Tell him that if he's in bed and quiet, you'll check on him in five minutes. Or say that you have to do a chore and you'll be right back: The first night it's a quick chore like getting water; then advance to a longer chore, such as doing the dishes.

Dr. Ferber: If your child has always slept in your room, don't just suddenly put him in his room, shut the door, and leave. Stay in his room until he falls asleep to help get him used to the new space; then when you go to bed, sleep in his room. Over a period of a week to several weeks-depending on the child-you can start putting him down and then leaving the room.

Dr. Sears: First put a futon or toddler mattress at the foot of your bed, to get him used to sleeping on his own. For a few weeks, lie down with him there until he falls asleep and then climb into your own bed. When he's used to this, start having him fall asleep alone on the futon. After a few weeks, move the futon into his own room. If he wants to come back to your room, take it as a sign that he isn't ready for nighttime weaning.

Finding the Right Routine

How soon should you start bedtime rituals? And what's the best routine for a toddler?

Pieper: Even in the first months, babies respond to routines because there's a security in predictability. So it's good to do things in the same order each night: Give them a bottle, then burp them, then put them down.

With toddlers, make the transition as smooth as possible. Try to take care of the tasks your child doesn't enjoy before dinner. And if she's playing with something at bedtime, let her bring it along (as long as it's safe for her to have, of course). Going to bed shouldn't be a penal sentence.

Eisenberg: It's a good idea to slow your child down-a half hour to an hour before bedtime-by helping her do a puzzle or other quiet activity. TV can be too exciting at this time. Note what time she typically gets sleepy and then start the routine 30 minutes before that. If you begin too early (when she can't fall asleep) or too late (when she might throw a tantrum), you'll miss the boat.

Shimm: The simplest routines are the best. For instance, give her a bath, brush her teeth, read her a book or two, and then sing her a song. And if Mom wants to read a number of books and Dad can do it in just one, it doesn't matter; the child will get used to both styles.

Mindell: My daughter is 2½ , and we always read Goodnight Moon. I save the new stories for daytime because they take a lot more cognitive energy to listen to.

Ariel Gore: If you've gone through the ritual and your child still isn't going to sleep, try a book on tape. That way, she doesn't have to have you there, but she has some entertainment to help her wind down.

How should a parent handle kids' pleas -- for water or back rubs -- to get you to come into their rooms?

Eisenberg: Set limits. Say, "We're not getting any more water tonight, and we're not having this conversation again." Many parents think they're being kind when they give in to a child's demands, but kids want to know that there are rules and limits.

Shimm: Needing water is all part of the routine; if your child's asking for it every five minutes and you can stand getting it, fine. But if your threshold is lower, you're going to have to set boundaries.

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