Dr. Kathleen Berchelmann, M.D. Sheds Some Light on Safe Sleep

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Some babies drift to Slumberland easily and blissfully, while for others, it's a fight through the night. Parents should choose the bedtime routine they feel most comfortable with — one that works for both them and their child. We asked Dr. Kathleen Berchelmann, M.D., Assistant Professor of Pediatrics at Washington University School of Medicine in St. Louis and spokesperson for the American Academy of Pediatrics, what her thoughts are on this popular topic.

{ MORE: Co-Sleeping: The Leading Risk Factor for Sleep-Related Infant Deaths }

Do you recommend co-sleeping? Why or why not?

Dr. Berchelmann says:

The only way for a baby to sleep safely is on his or her back in a crib. The only things in the crib should be the baby and a tightly fitting crib sheet. No sleep positioners, bumpers, blankets, stuffed animals, etc.

What about swaddling blankets, babies that roll over, “breathable bumpers,” and breastfeeding babies that like to co-sleep with mommy? I'm a breastfeeding mother of five, and I've lived these realities.

{ MORE: Tips to Help Your Baby Sleep on His Back }

My colleague and pediatric sleep medicine researcher Dr. James Kemp also wrote an excellent post about co-sleeping.

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Is crying it out a good option?

Dr. Berchelmann says:

I am not an advocate of just letting babies cry in their cribs until they fall asleep.

{ MORE: Does Crying It Out Hurt Your Baby? }

This isn't fair to the baby, who may not understand that parents will come back and are not gone forever. In psychological terms, infants may not yet have developed “object permanence.” This is why modern pediatricians and psychologists have developed sleep training methods, sometimes called “graduated extinction” or “controlled comforting.”

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Please explain sleep training.

Dr. Berchelmann says:

The Ferber method of sleep training, also known as “Ferberizing,” is an infant sleep training technique developed by Dr. Richard Ferber.

Dr. Ferber is currently the director of The Center for Pediatric Sleep Disorders at Children's Hospital Boston and Harvard Medical School. He has been researching sleep and sleep disorders in children for more than 20 years. The Ferber method is meant to be used for infants who are at least 4 months old, but Dr. Ferber recognizes that many babies have nutritional needs at night and cannot go six hours without feeding until about 6 months of age. For this reason, I usually don't recommend sleep training before babies are 6 months old.

{ MORE: Helping Your Newborn Fall Back to Sleep }

Here are the key points to the Ferber method:

  • Prepare your baby for sleep using nighttime routines such as rocking, reading, and singing. 
  • Put your baby in the crib when he or she is drowsy but not yet asleep. 
  • At bedtime, leave the infant in his or her crib and leave the room. 
  • Return at progressively increased time intervals to comfort the infant with soft words, but without picking him or her up or turning on the light. For example, on the first night, soothe the baby after three minutes of crying, then after five minutes, and then after ten minutes, until the baby is asleep. 
  • Each subsequent night, return at intervals longer than the night before. For example, the second night you might soothe your baby first after five minutes, then after ten minutes, and then each twelve minutes, until the baby is asleep.

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Image via Flickr/ Thorpe Obazee

The “camping out method” also called the “camp-it-out method,” or “adult fading,” is another commonly accepted form of sleep training.

In this method, parents sit or lie in their infants' room and may touch them while they are in their crib, but do not feed, rock, or cuddle them to sleep. Gradually, caretakers move back from the crib and eventually out of the room. Usually, parents use a chair or mattress on the floor and slowly move the chair or mattress away from the crib until they are out the door.

{ MORE: Help! My Baby Has Trouble Falling Asleep }

An essential element of any sleep training method is that babies are put in their cribs when they are drowsy but not yet asleep. Only then can babies learn to fall asleep.

Never try to sleep train an infant less than 4 months of age. 

As I mentioned before, it's probably best to wait until at least 6 months. If you are struggling with sleep for an infant under 6 months of age, my colleague and fellow mom-pediatrician Dr. Katie Bucklen has some great suggestions for solving your baby's sleep problems.

Please use safe sleep techniques such as a bedside infant bassinet or “co-sleeper,” rather than sleeping with your infant in bed with you. Although co-sleeping allows for easy breastfeeding for moms of newborns, co-sleeping has been associated with SIDS and infant suffocation. I use a “co-sleeper,” or three-sided crib that abuts the edge of my bed. My babies sleep just about six inches away from me but are safe from soft adult bedding. We no longer recommend sleep positioners.

{ MORE: Should You Allow Your Baby or Young Child to Sleep with You? }

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If your baby is sick, teething, out of his or her routine, or in a new environment, it's not a good time for sleep training. Always respond to the physical needs of your baby, such as clearing his or her nose of mucus when he or she wakes with a cold. If your baby is teething, try these techniques to sooth their painful gums and don't expect them to sleep well. If they are coughing a lot at night, be sure to see your pediatrician, as this can be a sign of wheezing, asthma, or reactive airway disease. If you've already sleep-trained your baby, you may need to retrain them if they get out of their routine due to sickness or other stressors. 

{ MORE: How to Deal with a Crying Baby Who Won't Sleep }

Sleep training works for naps, too, but most people start with nighttime sleeping. If you are struggling with nap schedules, or you have a little one who doesn't want to take naps, read this very practical article by my colleague Dr. Sarah Lenhardt.

Many have argued that infants who are permitted to cry in their cribs, even during sleep-training methods, are not capable of “self-soothing.” Critics say that infants don't really settle down, relax, and go to sleep; they just give up. But we know from other research that infants do have effective methods of self-soothing.

Sucking a pacifier, for example, releases calming hormones in the brain. Attachment objects, such as a blanket, doll, or plush toy, can have similar calming effects, especially in older infants and toddlers. Ask any parent who's tried to take a pacifier or favorite blanket away — removing attachment objects causes stress! And giving them to children helps them self-soothe.

{ MORE: The Pros and Cons of Pacifiers }

Consistent bedtime routines, rocking before bed, and singing or playing music for your infant can also reduce stress. 

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What is your advice to parents creating a sleep routine for their child?

Dr. Berchelmann says:

The trick to a good sleep routine is to start your routine about 30 minutes before your child's natural melatonin surge. The good news is that kids don't need melatonin supplements — their bodies make it naturally. A melatonin surge about 30 minutes before bedtime means toddlers stay in bed and sleep well. We can trick their bodies into producing a melatonin surge when we want it. Here's how:

  • Dim your house lights about 30 minutes before bedtime. Don't wait until bedtime to shut off the lights. If necessary, cover the windows to reduce natural light. 
  • During the 30 minutes between light dimming and bedtime, do quiet activities together. Tell stories, sing lullabies, rock, or snuggle with your children. Many families say prayers. If you need to read a book, use a small clip-on LED reading light. 
  • Make sure natural light enters your child's room in the morning. Natural-light exposure during wake-up time is important for melatonin regulation. If you've pulled down shades before bed, open them after your child falls asleep in order to allow the morning light to shine in. 
  • Never use screens, such as iPads, TVs, or smart phones during bedtime. There is good research to show that screen time before bed makes it take longer for kids to sleep. Kids should not have screen access for a full two hours before bed. 
  • Make sure you're not over-doing it with naps. If your toddler takes a nap from 1 p.m. to 3 p.m., they might not be ready for bed at 8 p.m. Before considering a supplement, consider setting a later bedtime or shortening nap time. This is how much napping your toddler needs, and this is how much sleep your toddler needs. 
  • Find a bedtime routine that you, as a parent, enjoy. Stick to it. Make sure that all caregivers are using the same bedtime routine. 
  • Kids need a regular bedtime and a regular wake-up time to keep their melatonin surges synchronized. This is the hardest part for parents. Getting kids to bed on time means sacrifices on our part, like not staying out too late at another child's activity. Sorry, no sleeping in on the weekends, either. 
  • Address anxiety, nutrition, illness, and anything else that is preventing your child from falling asleep. Kids can have anxiety over things we never imagined. They won't tell you unless you ask.

{ MORE: How Much Sleep Does Your Toddler Need? }

Sleep is a life skill that we, as parents, need to teach our children. When we teach our children healthy sleep routines, we give them so much more than a schedule. We give them health, energy, attention, and cheerfulness that will last a lifetime. We get a more peaceful home. And we get to sleep more, too. 

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Dr. Kathleen Berchelmann, M.D. Sheds Some Light on Safe Sleep

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