Night-Time Sleep Interventions
When babies cry, parents rush to respond. The question parents face on a daily basis is not whether or not to respond, but how. Let’s stop insulting parents by educating them on the importance of responding to their child and start giving them the tools to respond effectively.
Parents are pretty confident about feeding their child when hungry, changing their diaper when wet, and calming their baby when crying, but many are most at a loss when it comes to getting their exhausted baby to sleep through the night. When it comes to baby sleep interventions, parents don’t need more ideas about things they can try, they need a framework to help make these decisions and guide their response.
Response to Intervention (RtI)
Imagine if your child is having difficulty with classroom behavior. The first intervention would not be to refer him or her therapy or special education services in a pull-out classroom. The first step would be to make sure the teacher was enforcing consistent routines, expectations, and reinforcements. Yet, when we hear our babies struggling to sleep, we often jump immediately to the most intensive intervention we have to offer.
While typically used in education, Response to Intervention (RtI) can be applied to baby sleep interventions as well. I used this 3-Tiered approach to get all three of my girls sleeping through the night by 3 months old. By following these two key principles, I was able to confidently match my child’s sleep needs to an appropriate response.
- Start with the least intensive intervention
- Give your child a opportunity to respond
Tier 1 Baby Sleep Interventions
Tier I includes research-based strategies and techniques that are beneficial for all children. They include universal things that parents can do every day to support good sleep habits. Implementing these “best practices” should help prevent sleep problems from occurring in the first place.
- Following developmentally appropriate amount of wake/sleep times
- Following a consistent daytime nap routine
- Following baby sleep cues
- Following a consistent bedtime routine
- Providing a calm, quiet environment before bed (preventing excessive stimulation)
- Providing consistent environmental sleep cues (e.g. dark, quiet room with noisemaker, swaddle, pacifier, and/or lovey)
- Laying baby down drowsy but awake
- Managing the level of stress in the home environment
- Providing a full feeding before bed
- Waiting at least 1-2 minutes before responding to night-time cries
Before jumping to the conclusion that there is something “wrong” with your child, you first need to evaluate your current practices and make sure you are providing the right Tier 1 interventions to support healthy sleep. Then, if your baby wakes up crying in the middle of the night, wait a few minutes to provide an opportunity for your child settle back to sleep. If your baby is unable to do so on his or her own, you can move on to the next tier of interventions by offering an additional level of support.
Tier 2 Baby Sleep Interventions
The next step is to provide more targeted interventions aimed to address a specific problem. Tier 2 includes low-level interventions that require minimal support and interaction. The purpose is to support your child in learning to sleep on his or her own, not to take over and interfere with the process. Start with a quick room check to see if there are any problems that need to be addressed.
- Changing baby’s diaper
- Providing gas drops
- Adjusting the temperature in the room if too hot or too cold
- Putting the pacifier back in baby’s mouth
- Adjusting the swaddle
- Readjusting baby’s positioning (side, stomach, back, etc.)
- Laying your hand on baby’s face or body
- Providing a gentle shake or vibration with your hand
- Making a loud shushing noise in baby’s ear
- Waiting at least 2 minutes between interventions
Whatever your response, it’s important to be quick and avoid smiling, playing, turning on the light, talking, or gazing into your baby’s eyes. When you withhold this reinforcement, your baby will soon get the message that night time is for sleeping, not getting attention from mom. Hopefully your child will respond to one of these interventions and settle quickly back to sleep. If not, wait a couple minutes before going back and trying again.
Tier 3 Baby Sleep Interventions
I know many moms who skip over Tier 2 and jump straight to Tier 3, especially when they’re tired in the middle of the night. While that may work in the short-term, it fails in the long-term. According to a longitudinal study of night-time sleep patterns, the biggest predictor of night-time sleep between 6 – 12 months was the length and intensity of parents night-time interventions between 0 – 6 months. However, if after several attempts at Tier 2, your child still does not respond, you may need to consider more intensive interventions.
- Picking up and burping your baby
- Holding, rocking, bouncing, and/or soothing your baby
- Offering a short feeding (or longer, if necessary) before switching in the pacifier
- Restarting a mini-version of your sleep routine (new diaper, pajamas, pacifier, and swaddle to bed)
- Letting your baby get up and play for awhile before trying again (if it’s clear they just aren’t tired and you got the timing wrong)
- Waiting 2 – 5 minutes between interventions
- Consulting with your doctor regarding possible gas, reflux, etc.
- Talking with a sleep consultant regarding possible sleep training options
From Tier 3 Back Down
If you are currently in a habit of providing Tier 3 support to get your child to sleep, you may have to start at Tier 3 and work your way back down. Your child will likely require a gradual release of support in order to get back to a place of being able to sleep on his or her own. For example, the first night after you child has been sick, he or she may still cry out for comfort. You may need to hold your baby for 30 seconds or so before laying him or her back down (Tier 3). The second night you may be able to offer the same level of comfort simply by leaning over the crib (Tier 2). The third night, your child may sleep through the night without additional support (Tier 1).
The best thing about this model is that it provides flexiblity in responding to baby’s needs. It assumes that the majority of baby’s CAN LEARN TO SLEEP ON THEIR OWN WITH A LITTLE HELP AND SUPPORT. It’s a simple, common sense approach that allows parents to monitor their baby’s progress and adjust (increase or decrease) their night-time sleep interventions as they see fit.
If you have more questions about sleep or schedules, please reach out or subscribe for more tips!