7 questions to ask when you have literally tried everything to get your baby to sleep
The books make it sound so easy, don’t they?
A few nights of 10–15 minutes of crying and your child will be
sleeping through the night….
For many parents, sleep training is hard, but manageable. For others, not so much. And it’s not always for lack of trying. Your child isn’t sleeping well anytime, anywhere. Naps are hard, bedtime is hard, and nighttime? Don’t even ask. You’ve tried crying-it-out, pick-up-put-down, cosleeping, sleep suits, white noise, oils, lotions, massage….Nothing seems to work.
I often frequently work with frustrated, exhausted parents who have been trying so hard. The saddest part is that they think it’s all their fault; that somehow, they are doing something wrong.
Parents, you can relax your tired self for a moment. There are some good reasons why sleep training sometimes doesn’t work, and many of them have nothing to do with what you are or aren’t doing.
Sneaky sleep disruptors
If working on sleep has been a no-go, asking some of these questions might help you figure out why:
Does your child snore or mouth breathe (not associated with a cold), have a sweaty head when they sleep (not associated with a warm room), or are really restless when they sleep?
These symptoms can point to conditions that can indicate obstructed breathing. Tonsils and adenoids can grow at disproportionate rates and cause breathing during sleep to be difficult. A check-in with the pediatrician or a pediatric ear, nose, and throat doctor might be in order.
Has your child ever been diagnosed with anemia or low iron?
Though uncommon, low iron stores in children can directly affect sleep architecture (even when iron levels are back up). Low iron stores can also cause Restless Legs Syndrome, “itchy” or “tickly” feelings in the legs and an inability to get comfortable enough to sleep. Check with your pediatrician to check iron levels.
For children under a year (especially under 6-months), does it ever seem like they’re physically uncomfortable or in pain?
If your gut tells you that your child seems in pain when laid down flat, or they wake up screaming, or they sleep best when they are slightly on an incline (like in a seat), your child may have symptoms of silent reflux. Silent reflux does not involve “spitting up” and can cause pain as stomach acids bubble up. This kind of pain directly interferes with the ability to go to sleep or stay asleep. Other signs may be that they “nibble” instead of take in full feedings, or they feed best when partly drowsy. While it’s true that reflux rarely hits a child later in infancy, or those who never had reflux as a newborn, there are cases where reflux has not fully resolved, or teething/growth spurts cause symptoms to return. Food intolerance can also cause stomach distress or even itchiness that can make sleep difficult. If your child seems like they just aren’t comfortable, it’s worth consulting your pediatrician.
Is your baby alert, perceptive, sensitive, persistent?
Temperament is a major factor in sleep troubles. Sensitive babies who hear and notice everything are going to have a harder time disconnecting from the exciting world of awake time. These babies need a very consistent, very regular routine of naps with adequate wind-down time. Alert infants and children require a slightly different approach to sleep and may need more help than their mellower peers.
Is your baby younger than 6 months?
If your baby is younger than six months and you’re not seeing success with sleep training, it may be that your baby is too young. Infants under 6-months (and especially those in the throes of the 4-month regression) are going through a giant leap in brain growth. As a result, they have a limited capacity for managing distress or nightwaking.
It’s okay to take a break, do what you can to get sleep, and try after 6-months. The notion that sleep behaviors during this stage become “habits” that can’t be shifted, is just not supported by research. In fact, the majority of research on sleep training was conducted on infants older than 6-months (and mostly on toddlers and preschoolers). Sometimes waiting until the regression dust settles sets you up for a better chance to shift sleep behaviors.
Is your child (older than 4 months) going through a developmental leap?
During the first few years, children go through a fair number of developmental shifts that can throw everything out of whack. (You can find out more about these regression periods on wonderweeks.com). Generally, every time your child gains a new motor or cognitive skill, sleep will suffer: crawling (8–9 months), pulling to stand (10 months), walking (12-months) and then 15- and 18-months, and 2-years. You may find that even though your baby was sleeping well, these periods can get rocky…or rockier. Navigate these as best you can without instilling new habits that you don’t want to do in the long-term.
How is your child napping?
Make sure you know how much naptime your child needs for their age. An overtired baby/child will have more trouble going to sleep and staying asleep. Sometimes, just getting naps at the right time will help both daytime and nighttime sleep (Click here for guides on naps and timing). Kim West (aka The Sleep Lady) suggests that if your child is really nap-deprived, try to get naps in any way that works for a while and work on bedtime go-to-sleep skills. Once your child is sleeping like a champ at night, you can work on going back to crib sleep during the day.
West also suggests that you know how long your child can stay awake for their age. Before 6-months, it may only be 60–90 minutes. Even at a year, children can only manage about 3–4 hours before they need a nap. If you are waiting to see signs of fatigue, but not watching the clock, you may be missing those optimal sleep windows.
Things parents CAN do:
Don’t jump ship too soon
In their desperation, and lack of confidence, parents may try too many things too quickly, resulting in frustration and confusion. Pick something you can really commit to and don’t look back. It’s the waffling that throws children off. Stick with the new routine for at least 3 or 4 days. If there’s any improvement at all, you’re on the right track. Know that your child may really protest at first. That’s normal because they don’t know what’s changing or why. If you can stay consistent and supportive, they will get the hang of it.
Work on bedtime go-to-sleep skills
The best, easiest time to get the biggest bang for your sleep-training buck is at bedtime. Babies develop patterns for what it means to go to sleep (and therefore back to sleep). Gradually work on encouraging your baby/child to go to sleep without being rocked, nursed, held all the way to sleep. There are several approaches that work, so pick one that you can live with and stick with it.
It’s okay to go slowly.
For many people, crying-it-out works and works easily. For others…not so much. The good news is, it’s not the only approach. It’s okay to go more slowly and more gradually. As long as you are consistently moving forward, it’s okay to go at a pace that’s right for you. It’s also okay to help children calm down when they need it. We want to keep them in the zone of “challenge” not “overwhelm.”
The over-emphasis on behavior (both the child’s and the parent’s) sometimes causes important outside factors to be over-looked — and then the blame falls squarely onto parents. If any of these “sleep disruptors” are in the mix, sleep training will be hard, if not impossible. So, parents, take a breath. It’s definitely not all you.