Healthy Sleep Habits, Happy Child

Embrace Early Bedtimes

Prioritize Early Bedtimes Establishing an early bedtime is crucial for preventing overtiredness and promoting healthy sleep habits in children. An earlier bedtime encourages better sleep quality, which is essential for a child's mood, behavior, and overall health.

Many parents struggle with getting their children to bed on time, but the benefits of an early bedtime are clear. When children go to bed too late, they become overtired, which can lead to behavioral problems, difficulty learning, and even obesity. In contrast, an earlier bedtime allows children to get the sleep they need to thrive.

To implement an earlier bedtime, start by gradually shifting your child's schedule earlier, even by just 15 minutes per night. Pair this with a consistent bedtime routine that helps your child wind down and prepare for sleep. Over time, you'll see the positive impacts of this change on your child's well-being.

Here are some examples from the context that support the key insight about the importance of earlier bedtimes for children:

• The context states that "Earlier bedtimes usually help the child get through the transition to a single afternoon nap" during the 13-15 month age range.

• For children 16-21 months old, the context advises "If you have only a morning nap, try to delay its onset by shifting it slowly toward midday. Try a ten-to twenty-minute delay every few days." This gradual shift towards an earlier bedtime can help maintain healthy sleep.

• For 22-36 month old children, the context suggests "If your child refuses to nap but still needs to nap, experiment with earlier or later bedtimes to help him get more rest." Adjusting bedtimes can compensate for reduced napping.

• The context emphasizes that "day-in, day-out sleep deprivation at night or for naps, as a matter of habit, could be very damaging to your child." Maintaining regular, earlier bedtimes is crucial to prevent chronic sleep loss.

The key point is that embracing earlier bedtimes, even if it's inconvenient for parents, is essential for supporting children's healthy sleep patterns and avoiding the negative impacts of overtiredness on mood, behavior, and development. The context provides multiple examples of how adjusting bedtimes can help children transition through different sleep stage changes.

Consistent Sleep Schedules Foster Independence

Consistent sleep schedules are crucial for fostering a child's independence. When parents establish a regular sleep routine, it helps children learn to self-soothe and fall asleep on their own. This reduces nighttime disturbances and promotes healthy sleep habits.

The key is to be consistent with bedtimes, nap times, and other sleep-related activities. This allows a child's body to adapt and develop its own natural sleep-wake cycle. Over time, the child becomes better able to regulate their own sleep, rather than relying on parents to intervene every time they wake up.

Maintaining a consistent sleep schedule also prevents a child from becoming overtired, which can lead to more resistance at bedtime and more night wakings. By ensuring the child gets the right amount of sleep at the right times, parents set their child up for independent and restorative sleep.

Here are examples from the context that support the key insight that consistent sleep schedules foster independence:

• The context states that when parents "initially suffer through the process of establishing a good sleep schedule and their child is well rested, occasional irregularities and special occasions that disrupt sleep usually produce only minor and transient disturbed sleep. The recovery time is brief and the child responds to a prompt reestablishment of the routine." This shows that consistent sleep schedules help children learn to self-soothe and return to sleep easily after disruptions.

• The context describes how one mother said her child "now goes down like warm butter on toast!" after learning to fall asleep independently through a consistent sleep routine. This illustrates how consistent schedules promote self-soothing and independence.

• The context explains that "if you can learn to detach yourself from your baby's protests and not respond reflexively by rushing in to her at the slightest whimper, she will learn to fall asleep by herself." This demonstrates how consistent routines and not rushing to soothe the child help them develop independence.

• The context states that "simply locking the door solves nothing if your child is going to bed too late, getting up too late, not getting the nap he needs, taking a nap too late in the afternoon, having a very irregular bedtime." This shows that consistent, regular sleep schedules are key for promoting independence, not just physical barriers.

In summary, the context provides multiple examples of how consistent, structured sleep schedules and routines help children learn to self-soothe and become more independent at bedtime, rather than relying on parents' constant intervention.

Breastfeeding and Family Bed Controversy

The book critiques the idea of unrestricted breastfeeding and the family bed as a universal solution for sleep issues. Instead, it advocates for a more balanced approach that considers individual differences.

The book argues against the notion that "attachment parenting" through unrestricted breastfeeding and co-sleeping is the only way to be a good parent. It points out that this view ignores the diversity of children's temperaments and sleep patterns, as well as the unique needs and experiences of each family.

The book emphasizes the importance of developing healthy sleep habits through age-appropriate schedules and routines, rather than relying solely on breastfeeding and co-sleeping. It suggests that a one-size-fits-all approach can be problematic and may not address the underlying causes of sleep problems.

Overall, the book encourages a more nuanced understanding of sleep and parenting, where the "right" approach is tailored to the individual child and family, rather than dictated by a single, inflexible philosophy.

Here are the key examples from the context that support the insight about the critique of unrestricted breastfeeding and the family bed as a one-size-fits-all solution:

• The book criticizes authors like William Sears who advocate for "unrestricted breast-feeding and the family bed" as the way to get a baby to sleep, noting that this ignores "the enormous individuality of temperament differences, experience of the parents, and age-specific sleep patterns of children."

• The book states that the "family bed" can cause potential problems, especially when "someone is not getting enough sleep, either parent or child" and that the "family bed can make any future changes in sleep arrangements difficult to execute."

• The book notes that while the "family bed" is common in some cultures, the U.S. Consumer Product Safety Commission and American Academy of Pediatrics "actively discourage the family bed" due to safety risks like suffocation and entrapment.

• The book emphasizes the need for a more balanced approach, stating "Our goal is a well-rested family, and a family bed...may be right for your family" depending on the individual situation.

In summary, the book critiques the one-size-fits-all promotion of unrestricted breastfeeding and the family bed, and instead advocates for an approach that considers individual differences and needs to achieve a well-rested family.

Recognizing the Parent's Role in Sleep Problems

The key insight is that parental behavior plays a critical role in children's sleep problems. When parents are inconsistent or overly attentive at bedtime, it can disrupt healthy sleep habits in children.

Recognizing this parental influence is the first crucial step. Once parents acknowledge their own role, they can then develop effective solutions to address their child's sleep issues. This may involve establishing consistent bedtime routines, reducing excessive parental attention at night, and teaching children self-soothing skills.

By taking responsibility for their part in the problem, parents empower themselves to make positive changes. With the right approach, parents can help their children develop healthy, independent sleep patterns. This not only benefits the child, but also leads to more restful nights for the entire family.

Here are examples from the context that support the key insight that recognizing the parent's role in sleep problems is the first step toward developing effective solutions:

• The context states that "the rapid improvement of sleep patterns produced by reduced parental attention tells us that neither lack of parental attention nor anxiety in the child was causing the sleep difficulty." This suggests that parental overattentiveness can contribute to children's sleep problems.

• The context describes how "some parents bend over backward to appease their child" by avoiding limits, which "may lead to the absence of limits." This indicates that inconsistent parenting can contribute to sleep issues.

• The context explains how "some parents like their children to remain in one developmental stage because they themselves have certain needs that were never adequately met." This shows how a parent's own unmet needs can influence their child's sleep patterns.

• The context notes that "when children do not have their signals read, they are at risk to develop 'primitive strategies,' meaning that they tend to cry and become more unable to self-soothe." This illustrates how a parent's inability to properly read and respond to their child's needs can perpetuate sleep problems.

• The context states that "frustration tolerance may be harder to measure in these children" with certain developmental issues, and that "a gentle push toward competence must occur" - suggesting that parents need to find the right balance in their approach.

In summary, the context provides multiple examples of how parental behaviors, such as overattentiveness, inconsistency, and failure to properly read and respond to their child's needs, can contribute to and perpetuate children's sleep problems. Recognizing this parental role is the first step toward developing effective solutions.

Importance of Self-Regulation in Infants

Infants develop self-regulation - the ability to balance their impulses and emotions - through the consistent routines and structure provided by their environment. This is a critical skill for healthy emotional development and independence.

As infants experience the predictable patterns of their daily lives, they internalize the ability to manage their physiological needs like hunger, sleep, and touch. They learn to soothe themselves and wait patiently, rather than immediately crying out. This lays the foundation for them to eventually regulate their own emotions and behaviors.

Parents play a key role in nurturing this self-regulation. By setting gentle limits, responding sensitively to their child's cues, and gradually withdrawing support as the child gains competence, caregivers teach infants to navigate their internal states. This allows infants to explore the world with a sense of security and confidence.

The development of self-regulation is a gradual process, with both frustration and comfort playing important roles. Infants need opportunities to practice self-soothing and tolerate mild distress, which ultimately strengthens their ability to manage their impulses and emotions independently.

Here are examples from the context that support the key insight about the importance of self-regulation in infants:

• The wise mother of twenty-month-old Esme learned that she did not want to put her daughter down to say good night. She realized that her "loving her child 'too much' had gotten in the way of setting healthy limits." This shows how important it is for parents to help infants develop self-regulation, even when it's difficult for the parent.

• The context states that "Infants learn internal regulation, a balance between inhibitory and excitatory control, from the routines and regularity of their environment." This directly supports the key insight about the role of environment in developing self-regulation.

• The passage discusses how "Development and regulation of physiological needs such as hunger, thirst, sleep, elimination, and tactile stimulation happen almost intuitively" in infants. This illustrates how self-regulation develops in basic physical domains.

• It explains that "Each developmental milestone is subject to regulation from the environment, especially the family." This emphasizes the crucial role of the family environment in shaping an infant's self-regulation.

• The passage contrasts "difficult" infants who have "irregular schedules and short attention spans" with those who nap well and "spend more time in the quiet alert state and seem to learn faster." This shows how self-regulation, or lack thereof, impacts an infant's development and learning.

Setting Limits is an Act of Love

Setting limits for children is an act of love. It teaches them to tolerate frustration and develop self-control - crucial skills for navigating life's challenges.

When parents establish consistent bedtime routines and gently enforce them, even when the child protests, they are helping the child learn to self-soothe and sleep independently. This may be difficult in the moment, but it prepares the child for greater autonomy and resilience in the long run.

Limits provide a sense of security and structure that children crave. They learn that their needs will be met, but not on demand. This fosters the child's development of self-esteem - a genuine sense of their own worth and competence.

Parenting is not about avoiding all frustration, but about introducing it in manageable doses. Allowing a child to "cry it out" at bedtime, for example, teaches them to regulate their emotions and develop the ability to be alone. This is a sign of emotional maturity, not neglect.

The goal is "good-enough parenting" - not perfection, but a balance of meeting the child's needs while also allowing them to develop independence. Small "failures," like missing a dirty diaper, are normal and do not permanently damage a child. It's the overall pattern of responsive, attuned care that matters most.

Setting limits is an act of love because it prepares children to thrive, not just in the moment, but throughout their lives. It may be difficult, but it is essential for raising competent, self-assured individuals.

Here are examples from the context that support the key insight that setting limits is an act of love:

• The context states that "Loving our children includes introducing and teaching them to live with frustration. Saying no to a child becomes just as important as loving her unconditionally." This shows how setting limits helps children develop the ability to tolerate frustration, which is an important life skill.

• The story of the 13-year-old girl who had never been taught to sleep through the night illustrates how setting limits, even if it causes initial distress, can ultimately lead to positive outcomes like renewed energy and improved relationships. The treatment "consisted of education regarding sleep habits and then 'forcing' her to stay in her room" until she learned self-soothing techniques.

• The context discusses how "Babies need to learn to tolerate frustration and learn self-soothing techniques to calm themselves and prepare them for life's inevitable obstacles." Gentle limits are described as the way to do this, even though it can be difficult for both parents and children.

• The story of the mother of 2-year-old Esme shows how the mother's "loving her child 'too much' had gotten in the way of setting healthy limits." This highlights how setting appropriate limits, even when it feels challenging, is an act of love that supports the child's development.

In summary, the context provides multiple examples of how setting limits, even when it causes short-term distress, ultimately helps children develop important life skills and prepares them for the challenges they will face. This demonstrates how setting limits is an act of love, not harshness, on the part of parents.

Quotes

Let's take a look at some key quotes from "Healthy Sleep Habits, Happy Child" that resonated with readers.

...please remember that leaving your baby alone protesting for more fun with you while you get dressed is not the same things as abandonment. Similarly, leaving your baby alone protesting for more fun when she needs to sleep is not neglect.

The quote emphasizes the difference between being alone momentarily during playtime or sleep time and actual abandonment or neglect. It's essential to recognize that brief separations, such as parents dressing up or a baby's sleep time, do not equate to neglecting the child's needs or emotional well-being.

If the sleep disruption is repeated night after night, the actual measured impairments do not remain constant. Instead, there is an escalating accumulation of sleepiness that produces in adults continuing increases in headaches, gastrointestinal complaints, forgetfulness, reduced concentration, fatigue, emotional ups and downs, difficulty in staying awake during the daytime, irritability, and difficulty awakening. Not only do the adults describe themselves as more sleepy and mentally exhausted, they also feel more stressed. The stress may be a direct consequence of partial sleep deprivation or it may result from the challenge of coping with increasing amounts of daytime sleepiness. Think how hard it would be to concentrate or be motivated if you were struggling every day to stay awake. If children have

🌍: The quote discusses the negative effects of repeated sleep disruptions in adults. When people don't get enough sleep consistently, they experience increased daytime sleepiness, which leads to various physical issues like headaches and gastrointestinal problems, as well as cognitive impairments such as memory loss, reduced concentration, and irritability. Additionally, ongoing sleep deprivation can cause stress, either due to the exhaustion itself or from dealing with daily sleepiness challenges. In children, similar sleep issues might affect their behavior, learning, and overall well-being.

Remember, sleep training means starting to respect your baby’s need to sleep when he is a newborn by anticipating when he will need to sleep (within one to two hours of wakefulness), learning to recognize drowsy signs, and developing a bedtime routine. Then your baby will not become overtired.

1. Respecting a newborn's need to sleep means understanding their sleep patterns and ensuring they get enough rest.
2. Recognizing drowsy signs and creating a bedtime routine can help prevent overtiredness in babies.
3. By doing so, parents can foster healthy sleep habits and support their baby's overall well-being.

Chapter Notes

HOW TO USE THIS BOOK

• Read the Introduction and Chapters 1, 2, 4, and 5 before your baby is born: These chapters provide an understanding of the importance of healthy sleep, how to satisfy your baby's sleep needs, and how to cope with fussiness or crying in the evening.

• Husbands should read portions of the book and act as a coach for their wives: Even if the baby is not very fussy or crying much in the evenings, husbands should read Chapter 4 because all babies have some fussiness. They should also read the sections on sleep problems in Chapter 3 and the Action Plan for Exhausted Parents.

• Read the Action Plan for Exhausted Parents in the chapters before and after your child's age: Chronological age is only a rough guide for both sleep problems and their solutions, so it's important to consult the Action Plan for Exhausted Parents in the chapters surrounding your child's age.

• Read the appropriate sections in Chapter 10 or 11 if your child has snoring, mouth breathing during sleep, or very dry and itchy skin: These chapters provide information on these specific sleep-related issues.

• Understand that you may experience "baby brain" and feel exhausted and lost after the birth: This is a common experience, and it's important for husbands to be involved in reading and implementing the strategies in the book to help their wives.

INTRODUCTION

Here are the key takeaways from the chapter:

• Sleep Deprivation Harms Children: Sleep deprivation in children can have negative effects on their behavior, performance in school, and overall development. It is important to address and treat sleep problems in children.

• Healthy Sleep Habits: Healthy sleep habits involve establishing regular sleep patterns, including consistent bedtimes, nap schedules, and sleep durations. This requires understanding a child's natural sleep rhythms and synchronizing parental behaviors to support healthy sleep.

• Prevention vs. Treatment: Preventing the development of unhealthy sleep patterns is easier than treating established sleep problems. Prevention involves paying attention to a child's evolving sleep rhythms and using appropriate soothing techniques to help the child fall asleep. Treatment of existing sleep problems can be more difficult, as both the child and parents may be stressed from fatigue.

• Crying and Sleep Training: While some crying may occur during sleep training, the long-term benefits of healthy sleep habits outweigh the short-term discomfort. The author emphasizes that making children cry is not the goal, but rather, the goal is to help them learn to sleep well through appropriate techniques.

• Biological Differences in Sleep and Wakefulness: There are fundamental differences between the brain in a sleep state versus an awake state. Sleep problems, such as night terrors, occur during the sleep state, while behavioral issues, such as tantrums, occur during the awake state. Understanding these biological differences is important for addressing various sleep and behavioral concerns.

• Parental Involvement: Both mothers and fathers play an important role in helping children develop healthy sleep habits. Traditionally, mothers have borne the burden of sleep deprivation, and the author emphasizes the importance of fathers actively participating in the process of establishing healthy sleep routines.

• Detailed Guidance: The book provides detailed guidance on preventing and treating sleep problems, including discussions of different sleep training strategies, such as extinction, graduated extinction, scheduled awakenings, and relaxation techniques.

NEW INTRODUCTION TO FIRST HARDCOVER EDITION

Here are the key takeaways from the chapter:

• Ideal Soothing Support System: The chapter describes an ideal scenario where both parents are actively involved in parenting, have a strong marriage, no postpartum issues, only one child, easy breastfeeding, no medical problems, extra bedrooms, available help from relatives and friends, and financial resources for childcare and housekeeping. However, the author acknowledges that most families do not have such an ideal support system.

• Importance of Soothing and Sleep in the First Few Months: The greater the resources to soothe the baby during the first few months and the better the parents become attuned to the baby's changing sleep needs, the more likely the baby will sleep well during the first four months. This can help prevent sleep problems from developing after four months.

• Overtiredness and Dependence on Parents: If the baby becomes overtired due to lack of soothing resources, they are less likely to self-soothe and become more dependent on parents to be soothed to sleep.

• Four-Step Plan to Prevent Sleep Problems: The chapter outlines a four-step plan to prevent sleep problems, focusing on establishing routines, managing wakefulness, and gradually transitioning to independent sleep during the first 16 weeks.

• Barriers to Treating Sleep Problems: The chapter identifies several potential barriers to successfully treating sleep problems, including lack of information or tools, working parents' guilt or exhaustion, marital issues, abandonment or authority issues, family stress, and undiagnosed mental health problems in parents.

• Importance of Addressing Barriers: The author emphasizes that if parents recognize barriers to treating sleep problems, they should work extra hard to soothe the baby during the first four months to prevent sleep problems from developing in the first place.

Why Healthy Sleep Is So Important

Here are the key takeaways from the chapter:

• Healthy sleep habits do not develop automatically: Parents play a key role in shaping their child's natural sleep rhythms and patterns into healthy sleep habits.

• Extreme fatigue can interfere with normal development: While children will "crash" when totally exhausted, this is unhealthy as it interferes with social interactions and learning. Well-rested children do not exhibit peevish, irritable, or cranky behavior.

• Modern lifestyles can disrupt natural sleep patterns: Factors like urban stimulation, daycare, social isolation, and busy schedules can interfere with a child's ability to sleep well.

• The sleeping brain is not resting: The sleeping brain functions in a different manner than the waking brain, and its activity is purposeful in recharging the brain's "battery".

• Optimal wakefulness is important: Children need sufficient sleep to maintain optimal alertness and attention span, rather than being either drowsy or hyperalert.

• Early intervention is key: Starting early to help a child learn healthy sleep habits is more effective than trying to correct bad habits later on. The process of falling asleep unassisted is a skill that requires practice.

• Consistency is crucial: Inconsistent or oversolicitous parenting can contribute to sleep problems. Parents need the courage to be firm in establishing healthy sleep routines without feeling guilt or fear.

• Abrupt vs. gradual approaches: An abrupt, "cold-turkey" approach to sleep training is generally more successful in the long run than a gradual, "controlled crying" approach, as it is less susceptible to natural disruptions and "relapses".

Healthy Sleep

• Sleep Duration: The amount of sleep a child needs, both during the night and during the day, is an important element of healthy sleep. As the child's brain matures, the patterns and rhythm of sleep change, with key developmental milestones occurring at 6 weeks, 12-16 weeks, 9 months, 12-21 months, and 3-4 years.

• Naps: Naps are an essential part of a child's healthy sleep pattern. The number and timing of naps changes as the child grows, with the morning nap disappearing between 12-21 months and the afternoon nap becoming less common between 3-4 years.

• Sleep Consolidation: This refers to the process of a child's sleep becoming more consolidated, with longer periods of uninterrupted sleep at night and fewer night wakings. This is a key part of healthy sleep development.

• Sleep Schedule and Timing: The timing of a child's sleep, both at night and during naps, is important for healthy sleep. As the child's internal timing system matures, the optimal sleep schedule will change.

• Sleep Regularity: Maintaining a consistent sleep schedule and routine is crucial for healthy sleep. Irregular sleep patterns can lead to overtiredness and other sleep-related issues.

• Homeostatic Control Mechanism: This is the first regulatory system that controls the body's need for sleep. It works on the principle that the longer you go without sleep, the longer you will subsequently sleep, as the body tries to restore the lost sleep.

• Circadian Timing System: This is the secondary regulatory system that controls the body's internal clock and ensures that the body is sleeping at the right time and that the different stages and types of sleep are correct. This system is genetically specified and is set to the proper time by sunlight.

• Individual Variation: The internal timing system is under genetic control, so there is individual variation in how it expresses itself. It takes time for this system to fully develop and stabilize.

Sleep Duration: Night and Day

Here are the key takeaways from the chapter:

• Newborns and Young Infants Sleep Patterns: Newborns sleep about 16-17 hours per day, with the longest single sleep period being 4-5 hours. Between 1 week and 4 months, total daily sleep duration decreases to 15 hours, while the longest single sleep period increases to 9 hours. This development reflects neurological maturation and is not related to the start of solid foods.

• Parenting Practices Influence Sleep After 3-4 Months: After about 3-4 months, parenting practices can influence sleep duration and behavior. Parents can promote more calm, alert behaviors by being sensitive to their child's need for sleep and helping to maintain healthy sleep habits.

• Daytime Sleep and Attention Span: Infants who sleep longer during the day have longer attention spans and are better able to learn from their environment. They "soak up" information more easily compared to infants who sleep less during the day.

• Sleep Duration and Behavior: Infants and toddlers who sleep more are more adaptable, positive in mood, and less demanding, while those who sleep less are more fussy, irritable, and exhibit hyperactive-like behaviors.

• Napping and Total Sleep: Three-year-olds who nap are more adaptable than those who do not. Napping does not affect night sleep duration, but those who nap have a higher total daily sleep of 12.5 hours compared to 11 hours for non-nappers.

• Sleep Deprivation and Cognitive Development: Chronic sleep deprivation in infants and young children can impair cognitive development, particularly in complex problem-solving and abstract thinking, even if their performance on simpler tasks remains intact.

• Adolescent Sleep Patterns: During adolescence, there is a biological shift that encourages more evening wakefulness, combined with academic and social demands that pressure teenagers to stay up later, leading to chronic and cumulative sleep loss.

Naps

Here are the key takeaways from the chapter:

• Naps have their own function and are different from night sleep: Naps help adjust the alert/drowsy control for optimal daytime arousal, whereas night sleep is important for physical and emotional restoration. Naps have more REM sleep in the morning compared to the afternoon, which helps direct brain maturation in early life.

• Sleep and wake states are not opposites: While you can force wakefulness upon sleep, you cannot force sleep upon wakefulness. Parents can only permit the maximum amount of sleep their child needs, not make short nappers into long nappers.

• Nap patterns are largely an individual trait: Twins can have very different nap durations, suggesting a strong genetic component. By 21 months, social factors start to play a role in nap duration.

• Early bedtime is crucial: Putting a child to bed earlier, even as early as 6-7 PM, can help prevent overtiredness, bedtime battles, night wakings, and early morning awakenings, and regularize and prolong naps.

• Poor napping has consequences: Infants who don't nap well have shorter attention spans and appear less persistent. By 3 years old, they may be described as nonadaptable or hyperactive, which can impact school success.

• Naps should be protected: After 4 months, babies should nap in their cribs, as napping outside the crib can lead to nap deprivation. Short, out-of-sync naps are less restorative than longer, well-timed naps.

• Nap transitions are gradual: Babies typically transition from 2-3 naps to 1 nap between 15-21 months. An earlier bedtime can help ease this transition.

• Lost nap sleep cannot be made up at night: Cutting corners on naps and trying to compensate with an earlier bedtime leads to a cranky, demanding child in the late afternoon/evening.

Sleep Consolidation

• Consolidated Sleep: Uninterrupted, continuous sleep without disruptions or awakenings. Consolidated sleep is different from fragmented sleep, where awakenings or shifts to lighter sleep disrupt the sleep cycle.

• Effects of Sleep Fragmentation: Similar to reduced total sleep, sleep fragmentation can lead to increased daytime sleepiness, decreased mental flexibility, impaired mood, and decreased performance. Adults with fragmented sleep often use caffeine or alcohol to mask the effects.

• Protective Arousals: Awakenings that occur to prevent asphyxiation or sudden infant death syndrome (SIDS). These arousals are normal and necessary to maintain breathing during sleep.

• Harmful Arousals: After the first few months of life, frequent arousals that disrupt sleep continuity are usually harmful, as they can lead to sleep fragmentation and its associated negative effects.

• Nap Quality: Naps that are too brief or too light, such as those in a baby swing or stroller, may not be restorative. Stationary sleep is best for quality naps. Naps of less than 30 minutes are generally not considered "real" naps.

• Healthy Sleep Patterns: By 4-8 months of age, infants should have a midmorning and early afternoon nap, with a total nap duration of 2-4 hours, and 10-12 hours of consolidated night sleep with 1-2 interruptions for feeding.

• Night Waking: Night waking is often due to the child's inability to return to sleep unassisted after a normal arousal, rather than the arousals themselves. Teaching the child the process of "falling asleep" is important to address night waking.

Sleep Schedule, Timing of Sleep

Here are the key takeaways from the chapter:

• Importance of a Healthy Sleep Schedule: Just as junk food is unhealthy for the body, an irregular or "junk" sleep schedule is unhealthy for the brain. Maintaining a consistent sleep-wake cycle is crucial for attentiveness, vigilance, task performance, and mood.

• Sleep as "Food" for the Brain: Sleep should be viewed as essential "food" for the brain, just as breastmilk or formula is food for the body. Parents should prioritize and plan for their child's sleep needs, just as they do for their child's nutritional needs.

• Sleep Organization in Infants: Before 6 weeks of age, infants' longest sleep periods are randomly distributed throughout the day and night, often only 2-3 hours. By 6 weeks, the longest sleep period predictably occurs in the evening and lasts 3-5 hours.

• Daytime Sleep Organization: Around 3-4 months of age, infants' daytime sleep becomes organized into 2-3 longer naps, rather than many brief, irregular naps. Parents, especially nursing mothers, should try to nap when their baby naps.

• Avoiding Abnormal Sleep Schedules: Abnormal sleep schedules often develop when parents keep their children up too late at night, either due to enjoying playtime, difficulty putting the child to sleep, or late work/commute schedules.

• Flexible Bedtime: Bedtime should not be rigidly fixed, but should vary based on the child's age, previous nap duration, and wakeful period before bed. An earlier bedtime may be needed if the child missed an afternoon nap or was unusually active.

• Prioritizing Child's Sleep over Parent's Desires: If a parent arrives home late, the child should be put to bed as usual, rather than keeping them up to play. Maintaining the child's sleep schedule is more important than the parent having extra time with the child in the evening.

Sleep Regularity

Here are the key takeaways from the chapter:

• Consistent Bedtime: A consistent bedtime, even if it is later than ideal, is better for children than an irregular bedtime. Irregular bedtimes are associated with more daytime sleepiness, lower grades, more injuries, and more school absences in teenagers.

• Optimal Bedtime Window: The best time for a child to fall asleep is when they are just starting to become drowsy, before they become overtired. Putting a child to bed when they are overtired makes it harder for them to fall asleep.

• Biological Rhythms: Newborns and young infants have several interrelated biological rhythms that develop over the first few months of life, including sleep/wake patterns, body temperature, cortisol levels, and melatonin production. Disrupting these natural rhythms can lead to "disorganized sleep".

• Cumulative Sleep Loss: Small but constant deficits in sleep over time can have escalating and potentially long-term effects on a child's brain function, mood, and behavior. This can manifest as issues like headaches, gastrointestinal problems, forgetfulness, irritability, and difficulty concentrating.

• Twenty-Five Hour Cycles: Our basic biological clocks have a cycle of about 25 hours, not 24. This means children may naturally get "off schedule" every few weeks, and parents need to make efforts to reset their child's sleep/wake cycle to match the 24-hour day.

• Importance of Healthy Sleep: Healthy childhood sleep may be important for the development of creativity, empathy, and overall mental health, though these effects are difficult to measure directly.

• Overtiredness and Adaptability: Children who are slightly overtired are more easily thrown off balance by disruptions to their routine and take longer to recover. Well-rested children tend to be more adaptable to changes in their sleep schedule.

Sleep Positions, SIDS

• Sleeping Position Myths: The common myth that all children sleep better on their stomachs is not true. In fact, some babies sleep better and fuss or cry less when asleep on their backs, which is a healthier position as it helps prevent sudden infant death syndrome (SIDS).

• Skull Shaping: Contrary to many parents' fears, sleeping on the back does not cause a misshapen skull.

• Allowing Natural Sleep Positions: Parents should not intervene and roll the child back when they roll over to a different sleeping position. Leaving the child alone allows them to learn to sleep in different positions and to remember the next night not to roll in the first place.

• Letting Children Learn Independently: When an older child pulls themselves to a standing position in their crib, parents do not need to help them get down. The child will learn from the experience and be more careful next time.

• Avoiding Reinforcement of Attention-Seeking Behaviors: Parents who rush in to roll the baby over or help a child down run the risk of reinforcing this behavior, encouraging it to be repeated night after night. Children can learn to use these behaviors to get extra attention from their parents.

• Importance of Independent Learning: Depriving a child of the opportunity to learn how to roll over or sit down unassisted at night can hinder their development and learning process.

The Benefits of Healthy Sleep: Sleep Patterns, Intelligence, Learning, and School Performance

Here are the key takeaways from the chapter:

• Sleep patterns and infant development: Infants who spend more time in REM sleep and the "quiet alert" state tend to be more attentive and learn faster. Infants with irregular sleep schedules and short attention spans, such as those with colic or difficult temperaments, may have imbalances in internal chemicals like cortisol that can affect their sleep and learning.

• Importance of naps for infants: Infants who take longer naps tend to have longer attention spans and learn faster. Naps promote optimal alertness in children. Contrary to a common myth, long naps do not interfere with infant socialization or stimulation.

• Sleep patterns and preschool children: Preschool children who nap well are more adaptable, which is an important trait for school success. Those who do not nap tend to have more night wakings and be less adaptable.

• Sleep patterns and school-age children: Multiple studies have shown that children with higher IQ scores and better academic performance tend to sleep longer than their peers. Even small, chronic sleep deprivation can be harmful for learning and academic performance.

• Sleep difficulties and learning disabilities: Children with attention deficit hyperactivity disorder (ADHD) or learning disabilities often have sleep-related difficulties, though the causal relationship is not fully understood. Improving sleep can lead to improvements in peer relations and classroom performance.

• Sleep and creativity: Research on creative adults suggests that cutting back on sleep can negatively impact the originality of ideas and the quality of experiences.

Drowsy Signs

• Drowsy Signs: These are the signs that indicate your baby is becoming drowsy and ready for sleep. They include decreased activity, slower motions, less vocal, weaker or slower sucking, quieter, calmer, appearing disinterested in surroundings, less focused eyes, and drooping eyelids.

• Soothing-to-Sleep Routine: When you notice these drowsy signs, you should begin a soothing-to-sleep routine to help your baby transition into sleep. This routine should start within one or two hours of wakefulness.

• Colic and Drowsy Signs: About 20% of babies have colic, and they may not show the typical drowsy signs. In these cases, you need to watch the clock more carefully and start the soothing process about 20 minutes earlier.

• Putting Baby Down: It is not necessary for your child to be drowsy and awake when you put them down or lie down with them. Sometimes, babies can go from drowsy to sleepy very quickly, and there is no need to wake them up before putting them down.

• Fatigue Signs: These are the signs that indicate your baby is becoming overtired, such as fussing, rubbing eyes, irritability, and crankiness. If you notice these signs, it's important to start the soothing-to-sleep routine as soon as possible to help your baby transition into sleep.

Soothing to Sleep

• Soothing: Soothing is the process of restoring a peaceful state in a baby by reducing the intensity of fussiness or crying. It involves techniques like snuggling, cuddling, and using gentle rhythmic motions to bring comfort and a sense of tranquility.

• Synchronizing with Baby's Rhythms: Parents should try to synchronize their soothing actions with the baby's rhythms, such as gently rubbing the back in time with the baby's breathing pattern or using a ride on the shoulders to arrest a spell of tense, jerky movements.

• Importance of Father Involvement: Fathers should get involved in caring for the baby from the very beginning, including practicing baby care tasks like feeding, bathing, and putting the baby to sleep. This helps them gain confidence and become an active participant in soothing the baby.

• Sucking as a Soothing Mechanism: Sucking, whether at the breast, bottle, pacifier, or finger, is a powerful way to calm a baby. Parents should avoid deliberately interfering with sucking during soothing and sleep, as it is a natural and healthy way for babies to self-soothe.

• Rhythmic Motions and Gentle Pressure: Rhythmic rocking, swinging, or jiggling motions, as well as gentle pressure from swaddling or being held, can be effective in soothing babies, as they may mimic the sensations the baby experienced in the womb.

• Massage: Infant massage, performed gently by parents, can soothe babies and also help the parents develop a closer bond with their child.

• Respecting the Sleep Window: Babies have a natural one- to two-hour window of wakefulness, after which they become drowsy and need to be soothed to sleep. Respecting this window and soothing the baby during the early signs of drowsiness can help prevent the baby from becoming overtired and difficult to soothe.

• Skepticism Towards Unproven Remedies: Parents should be cautious about using unproven remedies, gimmicks, or home remedies to soothe their babies, as many of these have not been shown to be effective and may even be dangerous.

• Placebo Effect: The perception that a particular remedy or technique is effective in soothing a baby may often be due to the placebo effect, where the parent's emotional expectations and the natural day-to-day variability in infant crying create the illusion of a cure.

Bedtime Routines

• Bedtime Routines Promote Relaxation: Bedtime routines help children feel safe and secure, and calm down before falling asleep, as they are associated with the natural state of relaxed drowsiness.

• Timing of Bedtime Routines: Bedtime routines should be started early, before sleepy signs change into overtired fussy signs. Older children and more regular babies will develop predictable sleep times.

• Elements of Bedtime Routines: Bedtime routines can include reducing stimulation (less noise, dimmer lights, less handling, playing, and activity), creating a quiet, dark, and warm bedroom environment, bathing, massaging, dressing for sleep, swaddling, lullabies, favorite words or sounds, and feeding.

• Consistency in Bedtime Routines: It is important to be consistent in the sequence of bedtime routines to help children understand that it is time to sleep. Patience is also crucial, as it may take time for children to learn that it is not playtime.

• Avoiding Waking Sleeping Babies: Except for premature babies or when trying to correct a sleep problem, you should never wake a sleeping baby.

Breast-feeding versus Bottle-feeding and Family Bed versus Crib

Here are the key takeaways from the chapter:

• Colic vs. Common Fussiness: Babies can be categorized into two groups - 80% have "common fussiness" and 20% have "extreme fussiness/colic". Babies with colic require significantly more soothing effort from parents compared to those with common fussiness.

• Breast-feeding vs. Bottle-feeding: Breast-feeding is generally considered best, but bottle-feeding (either formula or expressed breast milk) can be beneficial for providing fathers and other family members the opportunity to feed the baby, giving the mother a break. Changing formulas does not reduce fussiness or improve sleep.

• Family Bed vs. Crib: Sleeping with the baby in a "family bed" can promote bonding, but also carries risks like suffocation and may lead to long-term sleep problems. Crib sleeping is safer, but may be more difficult for babies with colic. Transitioning from family bed to crib can be challenging.

• Temperament Development: Babies' temperaments at 4 months old can be categorized as "easy" (42%), "intermediate" (49%), or "difficult" (9%). Babies with colic are more likely to develop a "difficult" temperament, while those with common fussiness are more likely to be "easy".

• Soothing Effort and Sleep: The amount of soothing effort required by parents is a key factor in a baby's temperament development. Babies who require less soothing tend to become "easy" temperaments, while those requiring extensive soothing are more likely to become "difficult" temperaments.

• Breast-feeding and Family Bed for Colic: For babies with colic, breast-feeding in the family bed may be the most effective soothing strategy, even though it can lead to fragmented maternal sleep. Bottle-feeding and crib sleeping may be less effective for these babies.

• Coping with Colic: Mothers of colicky babies are at higher risk of postpartum depression and need strong support systems (e.g. dedicated partners, help with housework/childcare) to cope with the extreme fussiness.

Breast-feeding the Fussy Baby by Nancy Nelson, RN, IBCLC)

Here are the key takeaways from the chapter:

• Monitoring Baby's Output: After the 6th day of life, a baby should be producing 6 or more wet diapers and 1 or more stools per 24-hour period as a sign of adequate breast milk intake.

• Feeding Frequency: Babies usually need to feed 8-12 times in a 24-hour period during the first few weeks, and may cluster feed (frequent feedings followed by longer sleep stretches) before becoming more efficient.

• Assessing Milk Supply: A lactation consultant can do a feeding observation, including pre- and post-feeding weights, to assess if the baby is effectively transferring milk and if the mother's supply is adequate.

• Dealing with Engorgement: Use warm compresses, massage, and cold compresses to manage engorgement, but avoid over-pumping which can prolong the issue.

• Flat or Inverted Nipples: Breast shells, pumping before feeding, and nipple shields can help babies latch onto flat or inverted nipples, but a lactation consultant should be consulted.

• Positioning and Holds: The football or cross-cradle holds can help a fussy baby latch and feed effectively. Firm support and close contact with the breast is important.

• Gastroesophageal Reflux: Holding the baby upright during and after feedings can help manage reflux, and in severe cases, medication may be needed.

• Foremilk vs. Hindmilk: Ensuring the baby gets the higher-fat hindmilk by feeding for 12-15 minutes per breast can help prevent gas and fussiness from lactose overload.

• Letdown Reflex: Applying firm pressure to the breast for a minute before feeding can help manage a rapid letdown that may cause gagging and fussiness.

• Allergies and Infections: Cow's milk allergies, yeast infections, and skin irritants can all contribute to fussiness, and should be evaluated by a healthcare provider.

• Soothing Techniques: Swaddling, rocking, white noise, and pacifiers can help soothe an overstimulated or non-hungry fussy baby.

• Self-Care for the Mother: Staying hydrated, getting rest, and seeking support are crucial for managing the challenges of a fussy, high-needs baby.

• Persistence and Patience: Extreme fussiness/colic is temporary, and continuing to breastfeed can provide important benefits, even if the process is difficult.

Solid Foods and Feeding Habits

Here are the key takeaways from the chapter:

• Feeding Rhythms and Sleep Patterns: The method of feeding, whether breast or bottle, and the introduction of solid foods do not affect the infant's sleep-wake patterns. Studies have shown that infants fed on demand and those fed intravenously have similar sleep-wake cycles, indicating that feeding method does not influence sleep.

• Breast-feeding and Night Waking: While there is no difference in night waking between breast-fed and formula-fed infants at 4 months, by 6-12 months, breast-fed infants tend to wake more frequently at night. This is likely due to the mother's perception of the infant's need for nourishment, leading to more responsive nighttime feedings.

• Attitudes Towards Feeding and Infant Behavior: Mothers who prefer formula feeding tend to be more interested in controlling their infant's behavior and perceive night waking as a problem to be solved. In contrast, nursing mothers may be more sensitive to the health benefits of breast-feeding and respond more readily to their infant's nighttime needs.

• Weaning and Night Waking: Weaning the infant from breast-feeding to bottle-feeding or solid foods does not directly lead to longer sleep at night. However, the change in feeding method and attitudes towards it may indirectly influence the infant's sleep-wake habits.

• Maren's Sleep and Feeding Routine: The case study of Maren illustrates how breast-feeding became an integral part of her sleep routine, leading to frequent nighttime wakings. The transition to bottle-feeding and a new sleep routine eventually helped Maren learn to sleep through the night.

• Parental Responsiveness and Infant Development: The parents in the case study were attentive to Maren's needs and provided her with a nurturing environment, which contributed to her overall development and self-assurance. However, they may have waited too long before trying to put her to sleep independently, as suggested by their parents.

Solutions to Help Your Child Sleep Better: “No Cry,” “Maybe Cry,” or “Let Cry”

• "No Cry" Sleep Solutions: These are the gentlest sleep solutions, which involve soothing the baby to sleep without letting them cry. Key elements include:

  • Starting early, within 1-2 hours of wakefulness, to avoid the overtired state
  • Always holding, responding, and soothing the baby until they fall asleep
  • Sleeping with the baby
  • Respecting "drowsy signs" and putting the baby to sleep drowsy but awake
  • Establishing and consistently practicing bedtime routines
  • Practicing scheduled awakening (focal feeding)
  • Using white noise, room-darkening window shades, and relaxation techniques

• "Maybe Cry" Sleep Solutions: These solutions involve some crying, but less than the "Let Cry" approach. Examples include:

  • Having the father put the baby to sleep
  • Making the bedtime earlier
  • Focusing on the morning nap
  • Implementing "sleep rules"
  • Using "silent return to sleep" and "day correction of bedtime problems"

• "Let Cry" Sleep Solutions: These solutions involve the most crying, including:

  • Ignoring all crying or extinction
  • Ignoring some crying, also known as controlled crying or graduated extinction
  • Using the "check and console" method
  • Utilizing a crib tent

• Babies Need to Sleep After 1-2 Hours of Wakefulness: The chapter emphasizes that babies need to return to sleep after only 1-2 hours of wakefulness, as this pattern can help them avoid sleep problems in the first four months.

• Choosing the Right Solution: The chapter suggests that the "No Cry" solutions should be tried first, as the "Let Cry" approach may be the hardest for parents. However, the "Let Cry" solution may be the most effective for babies with extreme fussiness or colic.

Prevention versus Treatment of Sleep Problems

• Prevention of Sleep Problems for Common Fussy Babies: For 80% of babies with common fussiness, sleep solutions that involve no crying, such as the "one-to two-hour rule," can prevent sleep problems if parents have ample resources for soothing.

• Treatment of Sleep Problems for Common Fussy Babies: About 5% of common fussy babies become very overtired four-month-olds, and some crying might occur during treatment to correct the sleep problem. However, the improvement in sleep patterns and the child's well-being is often dramatic and rapid.

• Prevention of Sleep Problems for Extremely Fussy/Colicky Babies: For 20% of babies with extreme fussiness or colic, sleep solutions that involve no crying, such as "Always hold your baby, always respond and soothe your baby as long as needed to induce sleep, sleep with your baby," can prevent sleep problems if parents have enormous resources for soothing.

• Treatment of Sleep Problems for Extremely Fussy/Colicky Babies: About 27% of extremely fussy/colicky babies become very overtired four-month-olds, and treatment to correct the sleep problem might involve more crying. The improvement in sleep patterns and the child's well-being is often slow and not dramatic, which can be especially hard for parents who have already endured four months of sleep deprivation.

• Letting the Child Cry: Rarely, some parents may want to let their child cry to help them sleep after the peak of fussiness and crying has passed at six weeks of age, but the child is under four months of age. This might be done if the mother has to return to work or is becoming overwhelmed, depressed, or resentful towards the baby. The instructions are to give the child less attention at night, perhaps feeding only twice at night, and ignoring crying for either brief or long periods of time, for only four or five nights. This approach may work better for common fussy babies than for extremely fussy/colicky babies.

Action Plan for Exhausted Parents

Here are the key takeaways from the chapter:

• Elements of Healthy Sleep: Healthy sleep consists of 5 key elements:

  • Sleep Duration: Ensuring your child gets enough sleep at night and during naps, based on their age and temperament.
  • Naps: Maintaining a consistent nap schedule, waking from naps if needed to maintain the nighttime sleep rhythm.
  • Sleep Consolidation: Minimizing sleep interruptions and fragmentation to ensure uninterrupted, consolidated sleep.
  • Sleep Schedule: Putting your child down for naps and bedtime when they show signs of drowsiness, rather than strictly adhering to the clock.
  • Sleep Regularity: Maintaining consistent nap and bedtimes, even if the bedtime is a bit late.

• Back Sleeping for SIDS Prevention: Placing babies on their backs to sleep is the best way to prevent Sudden Infant Death Syndrome (SIDS).

• Soothing Techniques: Effective soothing techniques for fussy or colicky babies include:

  • Getting help from the father
  • Encouraging sucking (even if the baby falls asleep)
  • Rhythmic rocking motions
  • Swaddling
  • Massage

• Breast-feeding vs. Bottle-feeding: For common fussy babies, breast-feeding is usually easy, but for extremely fussy/colicky babies, breast-feeding may be more difficult due to the mother's fatigue and sleep deprivation.

• Family Bed vs. Crib: For common fussy babies, a family bed usually works well, but for extremely fussy/colicky babies, a family bed may lead to sleep-deprived parents, though the soothing power of physical contact can make it worthwhile.

• Sleep Solutions: There are three main approaches to helping your child sleep better: "No Cry," "Maybe Cry," or "Let Cry." The appropriate approach depends on the severity of your child's fussiness or colic.

Disturbed Sleep

Here are the key takeaways from the chapter:

• Disturbed Sleep in Infants and Young Children: When infants and young children do not sleep well, their behavior changes and they may feel worse, even though they cannot directly communicate their feelings. Observing how adults feel and behave when their sleep is disturbed can help us better understand and sympathize with our children.

• Symptoms of Disturbed Sleep in Adults: Daytime sleepiness from disturbed sleep in adults typically causes mild eye irritation, heavy eyelids and limbs, lethargy, loss of motivation and concentration, and a tendency to yawn and nod off.

• Symptoms of Disturbed Sleep in Infants and Young Children: In contrast to adults, chronically tired infants and young children often become "upcited" - a combination of upset and excited - rather than yawning and nodding off when sleepy.

• Mood and Performance Effects of Disturbed Sleep: Disturbed sleep is associated with increased levels of certain hormones (cortisol, noradrenaline, adrenaline, dopamine) that affect arousal, alertness, irritability, and tension. This can create a "vicious circle" where sleep loss leads to hyperarousal, which further disrupts sleep.

• Relationship Between Disturbed Sleep and Behavior: Disturbed sleep in infants and young children can directly cause fitful, fussy behaviors, and the effects can accumulate over time, leading to increasingly poor mood and performance. This relationship becomes more complex as children develop.

• Long-Term Effects of Disturbed Sleep: Chronically disturbed sleep in childhood may contribute to the development of adult insomnia and other mental health issues later in life.

• Elements of Healthy Sleep: Healthy sleep consists of five interrelated elements: sleep duration, naps, sleep consolidation, sleep schedule, and sleep regularity. All five elements must be present to ensure good-quality sleep.

• Approach to Solving Sleep Problems: When addressing a child's sleep problem, it's important to consider multiple potential causes and solutions, be patient, and monitor the effects of any changes over several days before trying something new.

Sleep Log

• Sleep Log: A sleep log is a graphical representation of a child's sleep patterns, showing when they were awake, asleep, quiet in bed/crib, and crying in bed/crib. It is a more effective way to track sleep patterns compared to a detailed diary.

• Sleep Begets Sleep: The more rested a person is, the easier it is for them to fall asleep and stay asleep. Conversely, the more tired a person is, the harder it is for them to sleep.

• Excessive Daytime Sleepiness: This refers to a state of impaired daytime alertness and wakefulness, which is a result of disturbed sleep. It can affect a person's task performance, attentiveness, vigilance, and mood.

• Stanford Sleepiness Scale: This is a self-rating instrument developed at Stanford University to describe different levels of daytime sleepiness, ranging from "Feeling active and vital; alert; wide awake" to "Almost in reverie; sleep onset soon; lost struggle to remain awake".

• Gradations of Wakefulness: There are gradations between being fully awake and fully asleep, and these gradations can influence a person's performance, attentiveness, and mood.

• Importance of Tracking Sleep Patterns: Monitoring a child's sleep patterns through a sleep log can help identify and address any issues related to sleep deprivation, which can lead to depression, irritability, and other behavioral problems.

Morning Wake-up Time Is Too Early

• Ensure a Dark and Quiet Bedroom: Use window-darkening shades and white noise machines or humidifiers to reduce the impact of external noises and create a conducive sleep environment.

• Maintain a Sleep Log: Keep a sleep log to help identify the optimal bedtime for your child.

• Adjust Bedtime Gradually: If the bedtime is too late, slowly move it earlier in 20-minute increments over 4 nights to find the right balance.

• Abrupt Bedtime Shift: If the child appears tired much earlier, move the bedtime much earlier immediately, even though this may cause some protest crying.

• Ignoring, Partial Ignoring, and Check-and-Console: Use these techniques to help younger children adjust to the earlier bedtime and sleep through the night.

• Sleep Rules and Silent Return to Sleep: Use these techniques to help older children adjust to the earlier bedtime and sleep through the night.

• Shifting the Entire Schedule: If the child is already going to bed very early (around 5:30 or 6:00 PM), move the bedtime a little later (20-30 minutes every 4 nights) and ignore them until 6:00 AM.

• Temporary Late Bedtime: For some older, persistent children, temporarily pushing the bedtime to a very late hour can cause them to sleep in later, which can then be gradually adjusted back to an earlier time.

• Patience and Flexibility: Finding the right bedtime for your child may require some back-and-forth adjustments, and it's important to be patient and flexible throughout the process.

Morning Nap Is Absent, Too Short, Too Long, or at the Wrong Time

• Morning Nap Development: The morning nap typically develops between 3-4 months of age in 80% of children, and a few months later in 20% of children who had colic.

• Short Nappers: About 20% of children between 6-21 months always have short naps in the morning and afternoon, regardless of what parents do. These children may appear tired, but by 9-12 months, they are taking fewer and longer naps.

• Causes of Absent or Short Morning Nap: The most common cause is an interval of wakefulness that is too long between wake-up time and the beginning of the nap. For younger children, starting the nap after only 1 hour of wakefulness can help. For older children, starting the nap at the wrong biological time can shorten or make the nap less restorative.

• Balancing Nap Timing: You want to start the nap when the biological nap time begins, but also avoid the overtired state. It's a balancing act to allow the child to become a little overtired but not too much.

• Interference from Older Siblings: An older sibling's scheduled activity can interfere with the morning nap. Options include having a relative or neighbor watch the younger child or allowing the child to nap in the car seat during the drive.

• Late Wake-up Time: A late wake-up time can be caused by a late bedtime, preventing the child from falling asleep at the optimal morning nap time (9-10 AM). Controlling the wake-up time around 7 AM and moving the bedtime earlier can help.

• Long or Late Morning Nap: A morning nap that is too long or too late can interfere with the ability to fall asleep for the second nap around 12-2 PM, leading to an overtired child in the late afternoon. Limiting the morning nap to 1-2 hours and moving the bedtime earlier can help.

• Nap Time Routine: Before naps, briefly but intensely stimulate the child with physical activity, then tone it down and spend extra time soothing the child, including a bath if it is calming, in a dark and quiet room.

Afternoon Nap Is Absent, Too Short, Too Long, or at the Wrong Time

Here are the key takeaways from the chapter:

• Afternoon Nap Disappearance: The afternoon nap usually disappears around the age of 3 years. If it disappears too soon, the child may become overtired in the late afternoon and have difficulty falling asleep at night. Reestablishing the afternoon nap (if the child is under 3) or moving the bedtime earlier (if the child is over 3) can help.

• Afternoon Nap Persistence: If the afternoon nap persists in much older children, the bedtime might progressively get later, causing bedtime battles. Eliminating the afternoon nap will permit an earlier bedtime and help erase bedtime battles.

• Nap Timing: Bad timing is a common cause of problems associated with the afternoon nap. If the nap is too early (before noon), it may not be as restorative, and the child might be overtired by late afternoon. If the nap is too late (after 2 PM), it may interfere with an early bedtime.

• Nap Conflicts with Activities: The afternoon nap may conflict with scheduled activities, such as preschool or activities for older siblings. Try to minimize these conflicts by using babysitters, carpools, or skipping some, but not all, of the classes. An earlier bedtime might be essential when the afternoon nap is shortened or skipped.

• Nap Quality in Daycare: Daycare may be associated with poor-quality naps due to bad timing, too much noise, not enough help for long soothing, or crying from other children. The morning nap usually goes easier in daycare because the child is already better rested from the previous night's sleep. An earlier bedtime can help these children.

• Protecting the Sleep Schedule: If the morning or afternoon nap is sometimes way too short or skipped, try to keep the child up and go to the next scheduled sleep time, but move it a little earlier. Protecting the sleep schedule is important.

Third Nap Is Absent, Too Short, Too Long, or at the Wrong Time

• The Third Nap: The third nap, occurring around 3:00 to 5:00 P.M., is variable and may be short, long, or absent. It usually disappears by nine months of age.

• Impact of a Long Third Nap: If the third nap is too long, it can lead to a very late bedtime, which may be associated with bedtime battles as the child is past their biological time for evening sleep.

• Addressing the Third Nap: If the child is under nine months, the third nap should be shortened. If the child is nine months or older, the third nap should be eliminated. Even a brief, late-afternoon or early-evening "power nap" can interfere with an early bedtime.

• Misinterpreting the Third Nap: Around nine to twelve months of age, a child may fall asleep around 5:30 P.M. and be up again around 7:30 or 8:00 P.M., playing with parents until 10:00 P.M. This is not a third nap, but rather a need for a very early bedtime (around 6:00 P.M.) and no playtime between 7:30 and 10:00 P.M.

• Flexibility for Special Events: Parents should not become slaves to their child's nap schedule. The more the regular sleep routine is protected, the less disruptive special events will be.

Needs a Nap but Refuses to Nap

Here are the key takeaways from the chapter:

• Causes of Nap Refusal: Changes in routine, such as holidays, trips, or illnesses, can cause a 2-3 year old child to give up napping and become overtired during the day. Another common cause is when the child drops the morning nap, but the parents do not adjust the bedtime to be earlier, leading to "cumulative sleepiness" over time.

• Establishing an Early Bedtime: If the child is substantially under 3 years old, trying a temporarily super-early bedtime (e.g., 5:00-5:30 PM) can help erase the child's sleep debt and make them more able to relax and take a nap. This may initially cause the child to wake up too early, in which case the parents should ignore the child until 6:00 AM.

• Reestablishing the Nap Habit: To help reestablish the nap habit, the parents can try intense morning stimulation and an extra long, soothing nap time ritual. Leaving the child alone in the crib for up to 1 hour, even if they cry, can sometimes allow the nap to occur. Alternatively, the parents may need to lie down with the child in their bed to help induce sleep, and then gradually transition the child back to their own crib.

• Older Children and Napping: If the child is substantially past their 3rd birthday, trying to reestablish the nap may not be effective, and the focus should be on establishing an earlier bedtime to help the child sleep better.

• Case Study: Henrik's Nap Struggles: The chapter provides a detailed case study of a family whose 8-month-old son, Henrik, was struggling with naps. The pediatrician recommended an earlier bedtime (5:30 PM) and a consistent wake-up time (7:00 AM) to help reestablish Henrik's nap schedule. This, combined with morning stimulation and a soothing nap routine, eventually helped Henrik regain his nap schedule and vibrant personality.

Bedtime Is Too Late: Sometimes or Always a Battle

Here are the key takeaways from the chapter:

• Biologically Driven Bedtimes: After 6 weeks of age, children tend to have biologically driven earlier bedtimes. If parents are unable or unwilling to accommodate these earlier bedtimes, the child can become overtired.

• Common Problematic Situations: Three common problematic situations are: (1) a postcolic child who relies on the family bed and breastfeeding to sleep but now wants to sleep much earlier than the parents, (2) families who use daycare and need extra time to get the child home at night, and (3) dual-career families with long commute times from work.

• Solutions: Solutions involve using others to help prepare the child for bed (bathing, dressing, feeding) and establishing a brief bedtime routine as early as possible. Parents may also need to go to sleep earlier themselves or alter their work schedules to come home earlier on some days.

• Enjoying Mornings: By having an earlier bedtime, parents can enjoy more quality time with their child in the mornings.

• Unavoidable Late Bedtimes: If circumstances make it impossible to have an early bedtime, parents should still aim for the earliest bedtime possible.

• Resources for Soothing: The chapter references a list of resources for soothing on page 74 that parents can review.

Afraid of the Dark or Being Alone

• Common Childhood Fears: Children between the ages of 2 and 4 often have fears of various stimuli, such as thunder, lightning, barking dogs, shadows, and other uncontrollable items.

• Nightlight Considerations: A sensitive baby may have difficulty sleeping well if the closet light or a conventional 7-watt nightlight is used. A quarter-watt guide light that produces a faint yellow glow is usually sufficient illumination.

• Soothing Bedtime Routines: Longer and more soothing bedtime routines can help children feel more secure and sleep better.

• Comfort Objects: Providing a new, protective teddy bear can help a child fight off fears and feel more secure.

• Parental Intervention: A father can walk around the room and "capture" the "monsters" in a bag or box to remove them from the room, which can help alleviate a child's fears.

• Symbolic Reassurance: Guardian angels, charms, or dream catchers can help a child feel more secure and protected.

• Controlled Attention: An older child can be given a bell to summon a parent, with the understanding that the parent will come to soothe the child for a predetermined period of time, using a kitchen timer to control the duration. This gives the child confidence and helps them sleep better without becoming a ploy to fight sleep.

• Goal of Parental Support: The goal is to provide extra attention and support at night without it becoming open-ended or a way for the child to avoid sleep.

Will Not Stay in His Crib or Bed

• Crib Tents: Crib tents can be used to prevent one- or two-year-olds from climbing out of their crib. While parents may be reluctant to use them, thinking the child will feel restricted, many children actually enjoy the comfort and security of the crib tent, like a teepee or fort.

• Latch Locks: Some parents prefer to use a latch lock on the door instead of a crib tent. It's important to have the child watch the lock being installed, so they understand the seriousness of the rule. If the child leaves the room, they should be immediately returned, and the door locked, which may result in protest crying but is usually only for one night, as the child learns to stay in the room.

• Attention-Seeking Behavior: One-or two-year-olds who climb out of their crib may be doing so to seek social interaction from their parents. Providing too much attention can reinforce this behavior, so it's important to use methods like crib tents or latch locks to protect the child's sleep and prevent the development of sleep problems.

• "Sleep Rules" and "Silent Return to Sleep": These techniques are used for older children who won't stay in bed. "Sleep Rules" and "silent return to sleep" involve consistently returning the child to their bed without interaction, which helps them learn to stay in their room.

• Consistency is Key: Regardless of the method used (crib tent, latch lock, or "Sleep Rules"), consistency is crucial. If parents are not consistent, the child will continue to test the boundaries and the sleep problems will persist.

Action Plan for Exhausted Parents

• Observing Child's Behavior: Parents need to observe their child's behavior to determine if they are active, alert, and wide awake or if they are fighting sleep and appear woozy.

• Junk Food vs. Junk Sleep: Just as junk food is bad for the body, junk sleep is bad for the brain. Healthy sleep patterns are essential for a child's growth and development, just like a balanced diet.

• Consistency and Patience: When making changes to address a child's sleep problem, parents should be consistent and allow 4-5 days before making another change to see the impact. Patience is key during this process.

• Sleep Log and Problem Identification: Parents should keep a sleep log as described in the book and identify the main sleep problem, such as issues with sleep duration, naps, sleep consolidation, or sleep schedule.

• Gradual Approach: Parents may not be able to make all the necessary changes at once, so they should do the best they can and focus on the elements of sleep that need the most improvement.

• Addressing Sleep Elements: The key elements of sleep that may need improvement or correction include sleep duration (night and day), naps (good vs. bad), sleep consolidation, and sleep schedule.

• Customized Approach: Parents should determine what changes they can and cannot make, such as controlling wake-up time, adjusting nap schedules, changing bedtime routines, or using tools like crib tents.

• Importance of Consistent Approach: Solving sleep problems requires a consistent approach, and there may be increased crying in the beginning, but the upside is that crying around sleep should be eliminated altogether.

• Sleep as a 24/7 Process: Sleeping well is not just about getting the child to go to bed at night without crying; it's a 24/7 process that requires a comprehensive approach.

How to Use This Chapter

• Approximately 5-10% of babies are at risk for developing severe sleeping problems: This chapter focuses on the necessary corrections to solve sleeping problems for this subset of babies.

• Reading the entire chapter is recommended for parents who have not yet had a child: This will help them identify if their baby is on the path to developing severe sleeping problems and enable them to prevent future issues.

• The chapter is divided into four main sections:

  • Detailed description of extreme fussiness/colic and its relation to difficulties in sleeping during the first 3-4 months
  • Explanation of temperament
  • Connection between fussiness/crying during months 3-4 and temperament at 4 months
  • Postcolic

• The section on postcolic is crucial: It helps prevent or solve sleep problems in 20% of children.

• Parents with a child already experiencing sleeping problems may benefit more from reading the summary and action plan: They may be too exhausted to go through the entire chapter.

• The chapter provides data that connects the two ages (3-4 months and 4 months) and tells parents how likely it is that their baby will develop on one path or another: This information can be skipped by parents whose child already has or had colic.

Introduction

• Colic affects 20% of all babies: Colic is a mysterious condition that affects a significant portion of infants, leading to excessive crying and fussiness during the first few months of life.

• Unexplained fussiness and crying are common in newborns: All babies, regardless of their ethnic background, birthing method, or family lifestyle, experience periods of unexplained fussiness and crying in their first weeks of life.

• Parents use similar techniques to cope with infant crying: Parents tend to employ the same strategies and techniques to manage the crying and fussiness of their newborns, whether their baby's experience is relatively smooth or turbulent.

• Unhealthy sleep habits can develop after 3-4 months: If parents do not adjust their coping techniques as their baby matures, around 3-4 months of age, it can lead to the development of unhealthy sleep habits and associated problems.

• Colic can set the stage for future sleep issues: A baby's experience with colic during the early months of life can potentially contribute to the development of unhealthy sleep habits and the child becoming a "crybaby" later on.

Sleep and Extreme Fussiness/Colic

Here are the key takeaways from the chapter:

• Extreme Fussiness/Colic Definition: Extreme fussiness/colic is defined as an infant who, otherwise healthy and well-fed, has paroxysms of irritability, fussing or crying lasting for a total of more than three hours a day and occurring on more than three days in any one week, and the paroxysms continue to recur for more than three weeks.

• Characteristics of Extreme Fussiness/Colic: The attacks are absent during the first few days but present in 80% of affected infants by two weeks and 100% by three weeks. The attacks occur predominantly in the evening hours, starting between 5-8 PM and ending by midnight. The attacks disappear by two months in 50% of infants, three months in 30%, and four months in 10%.

• Causes of Extreme Fussiness/Colic: Potential causes include an imbalance between serotonin and melatonin, leading to painful gastrointestinal cramps, as well as blunted cortisol rhythms in colicky infants.

• Crying vs. Fussing: Persistent low-intensity fussing, rather than intense crying, characterizes infants with extreme fussiness/colic. Fussing is an unsettled, agitated, wakeful state that may not lead to crying if parents intervene.

• Sleep Patterns in Extreme Fussiness/Colic: Diary data shows extremely fussy/colicky infants sleep less than non-colicky infants, especially during the day and evening. However, sleep lab data shows no differences by 9 weeks. Extreme fussiness/colic may be a disorder of excessive wakefulness rather than impaired sleep.

• Temperament and Extreme Fussiness/Colic: Infants with extreme fussiness/colic are more likely to have a difficult temperament when assessed at 4 months, but not at 12 months. Difficult temperament is associated with shorter sleep durations.

• Postcolic Sleep Problems: Postcolic infants are more likely to have night waking problems, which may be due to parents failing to establish age-appropriate sleep routines rather than the colic itself. Parental distress and inconsistent responses contribute to these sleep issues.

• Treatment: Effective treatments for extreme fussiness/colic include rhythmic motions, sucking, and swaddling. Parental breaks and expressing affection are also important, but unceasing attention can prevent the development of self-soothing skills.

Temperament at Four Months

Here are the key takeaways from the chapter:

• Temperament Characteristics: The chapter outlines 8 key temperament characteristics that researchers use to evaluate infant temperament:

  • Activity: The general motion and energy level of the infant.
  • Rhythmicity: The regularity and predictability of the infant's bodily functions like hunger, sleep, and bowel movements.
  • Approach/Withdrawal: The infant's initial reaction to new people or situations, ranging from reaching out and being curious to objecting and withdrawing.
  • Adaptability: How easily the infant adjusts to changes in routine or new circumstances.
  • Intensity: The degree or amount of the infant's emotional response, whether positive or negative.
  • Mood: The direction of the infant's emotional response, whether positive (smiling, cooing) or negative (fussing, crying).
  • Persistence: The infant's attention span and how long they engage in an activity.
  • Distractibility: How easily the infant is distracted from their current state or activity.
  • Threshold: How much sensory stimulation (e.g. noise, light) is required to elicit a response from the infant.

• Difficult vs. Easy Temperament: Infants with a "difficult" temperament tend to score high on intensity, negative mood, slow adaptability, and withdrawal. These infants are more challenging for parents to manage. Infants with an "easy" temperament have the opposite characteristics and are described as "dream babies".

• Difficult Temperament and Colic: Infants who experienced extreme fussiness or colic as newborns are more likely to develop a difficult temperament later on, including shorter sleep durations and more frequent night wakings between 4-8 months old.

• Difficult Temperament and Crying: The crying of infants with a difficult temperament is perceived by parents as more irritable, grating, and arousing compared to the crying of easy infants. This is due to the difficult infants having more silent pauses between cries and a higher pitch at the most intense moments.

• Causes of Difficult Temperament: It is unclear what exactly causes some infants to develop a difficult temperament. The chapter suggests it may be genetic, learned, or related to the infant being overtired.

Connecting Sleep, Extreme Fussiness/Colic, and Temperament

Here are the key takeaways from the chapter:

• Temperament Outcomes for Fussy Babies: For babies with common fussiness, 39% develop an easy temperament, 37% develop an intermediate temperament, and 4% develop a difficult temperament. For babies with extreme fussiness/colic, 14% develop an easy temperament, 59% develop an intermediate temperament, and 27% develop a difficult temperament.

• Risk of Sleep Problems After 4 Months: Babies with easy temperaments have the lowest risk of sleep problems after 4 months (3-39%), followed by those with intermediate temperaments (12-37%), and those with difficult temperaments have the highest risk (4-5%).

• Attachment Parenting vs. "Cry It Out": There is no evidence that one parenting style ("no cry" vs. "let cry") produces a specific outcome. Babies' temperaments and family resources play a big role in what works best.

• Common Fussiness (Low Risk): Babies with common fussiness are more likely to be well-rested, able to self-soothe, and develop consolidated night sleep and regular naps early on. "No cry" solutions usually work for these babies.

• Extreme Fussiness/Colic (High Risk): Babies with extreme fussiness/colic are more likely to be overtired, only parent-soothed, and have fragmented night sleep and irregular naps. "Let cry" solutions may be necessary for these babies.

• Biological and Social Factors: Persistent biological factors from extreme fussiness/colic and social/family stressors can contribute to severe, hard-to-solve sleep problems in a small percentage (9%) of babies.

• Flexibility and Sensitivity: There is no one-size-fits-all approach. Flexibility and sensitivity to your baby's and family's unique needs are key to finding the right sleep strategies.

Postcolic: Preventing Sleep Problems After Four Months of Age

Here are the key takeaways from the chapter:

• Two Groups of Difficult Temperament Infants at 4 Months: There are two groups of infants with difficult temperaments at 4 months of age:

  • The first group (4.5% of infants) comes from the 80% of infants with common fussiness/crying. They are less overtired and their sleep routines are easier to change.
  • The second group (27% of infants) comes from the 20% of infants with extreme fussiness/colic. They are more overtired and their sleep routines are harder to change.

• Transition from Family Bed to Crib: When transitioning a baby from the family bed to a crib, it should be done gradually and slowly over several weeks or months. The transition is easier for babies with common fussiness/crying compared to those with extreme fussiness/colic.

• Postcolic Infants' Sensitivity and Activity Levels: Some postcolic infants exhibit heightened sensitivity to environmental stimuli and boundless energy/activity levels, which can contribute to sleep problems. These characteristics are not part of the diagnostic criteria for difficult temperament.

• Importance of Consistent Sleep Schedules: Establishing and maintaining regular sleep schedules is crucial for postcolic infants over 4 months of age to eliminate frequent night wakings and lengthen sleep durations. Failure to do so can lead to overtiredness, irregular sleep patterns, and behavioral issues.

• Reasons for Difficulty Establishing Sleep Schedules: Parents may have difficulty establishing consistent sleep schedules for postcolic infants due to:

  • Perception that their baby's behavior is out of their control from the colic experience
  • Fatigue leading to inconsistent and overindulgent responses
  • Difficulty separating from the child, especially at night

• Consequences of Persistent Sleep Problems: Persistent sleep problems in children have been linked to psychiatric symptoms in adolescents, hyperactivity in children, and depression in their mothers.

• Colic as a Stage, Not a Medical Problem: Colic should be viewed as a stage of life, not a medical problem, as all babies fuss and cry to some degree.

Summary and Action Plan for Exhausted Parents

• Extreme Fussiness/Colic: Babies who require more than 3 hours per day of soothing to prevent crying, for more than 3 days per week, for more than 3 weeks, are considered to have extreme fussiness/colic. This affects 20% of babies.

• Characteristics of Extreme Fussiness/Colic: Extreme fussiness/colic typically starts around a few days of age, occurs in the evening, ends around 3-4 months of age, and involves fussing/crying when awake and stopping when asleep.

• Soothing Extremely Fussy/Colicky Babies: Simple soothing methods may not work for these babies. Constant holding, breastfeeding, and sleeping with the baby may be required. Review "Resources for Soothing" on page 73.

• Risks of Extreme Fussiness/Colic: Maternal depression, anxiety, exhaustion, and marital stress are likely to develop. These babies are more likely to develop a night-waking habit and a difficult temperament after 4 months.

• Risk Factors for Enduring Sleep Problems: Extreme fussiness/crying plus maternal distress or sleep problems at 5 months of age are risk factors. Extreme fussiness/crying alone is not a risk factor.

• Temperament at 4 Months: Babies with a "difficult" temperament (intense, slowly adaptable, negative in mood, withdrawn, irregular) may represent an overtired child. Improving sleep can make them easier to manage.

• Parenting Decisions and Temperament: For common fussy babies (80%), an early commitment to a family bed usually works well. For extremely fussy/colicky babies (20%), a family bed may be soothing but could lead to sleep problems later.

• Breastfeeding and Extreme Fussiness/Colic: Mothers of extremely fussy/colicky babies may be more fatigued and have difficulty with breastfeeding. Consider a single bottle of expressed breast milk once per day.

• Sleep Training Approaches: "No-cry," "maybe-cry," or "let-cry" sleep solutions depend on the baby's tendency to fuss/cry, temperament, and parental soothing resources.

• Postcolic Sleep Development: Babies with an intermediate or easy temperament are likely to develop consolidated night sleep and regular naps early. Babies with a difficult temperament may require more effort and "let cry" solutions to improve sleep.

Months One to Four

• Genetic and Congenital Differences: Newborn babies have both genetic differences (inborn traits) and congenital differences (not inherited, due to factors like gestational age or maternal behaviors during pregnancy).

• Biological Rhythms and Prenatal Programming: Research suggests that the mother's biological rhythms (sleep/wake, activity/rest, eating) may help set or influence the rhythms of the fetus and newborn baby.

• The One- to Two-Hour Window: Babies quickly become overtired after only 1-2 hours of wakefulness, so it's important to soothe them to sleep within this window before they become overtired.

• Newborn Sleep Patterns: Babies under 6 weeks old tend to fall asleep late at night and have shorter daytime and nighttime sleep. Soothe them to sleep during the day before they become overtired.

• Settling at Night: Around 80% of babies over 6 weeks old become more settled at night, sleep longer at night, and show earlier signs of drowsiness for night sleep. Try to soothe them to sleep at an earlier hour.

• Persistent Unsettled Babies: 20% of babies over 6 weeks old do not appear to become more settled at night. For these babies, spend extra time soothing them to sleep (e.g., prolonged swinging, baths, car rides) and have the father provide extra support.

• Avoiding Crying: For all babies, it's important to soothe them to sleep and not let them cry, as this can lead to an overtired state.

Newborn: The First Week

• Newborns have no circadian rhythms or internal biological clocks: Newborns do not follow a regular sleep-wake cycle, so you should feed, change, and let your baby sleep whenever they need to, without trying to impose a schedule.

• Newborns sleep a lot but in short stretches: Newborns typically sleep 15-18 hours a day, but in short bursts of 2-4 hours, without a clear pattern of day and night.

• Letting your newborn fall asleep during feeding is natural: It is normal and acceptable for newborns to fall asleep while feeding, as they often do not need to be woken up and put down while drowsy but awake.

• The "drowsy but awake" strategy works better for well-rested babies: The "put your baby to sleep when drowsy but awake" strategy is more effective for babies who are not overtired, as overtired babies may have difficulty self-soothing to sleep.

• Sleep training is not the same as "cry it out": Sleep training involves principles like respecting your baby's sleep needs, maintaining brief wakefulness periods, and developing a bedtime routine, but does not necessarily involve letting your baby "cry it out."

• The first week is a "honeymoon" period: Newborns tend to "sleep like a baby" during the first week, but it will become more difficult to soothe and put them to sleep as they get older, especially for the 20% of babies who are extremely fussy or colicky.

Weeks Two to Four: More Fussiness

Here are the key takeaways from the chapter:

• Irregular and Unpredictable Feeding, Diapering, and Sleeping Patterns: Newborns have erratic and unpredictable needs for feeding, diaper changes, and sleeping. Parents should respond to their baby's needs as they arise, rather than expecting a predictable schedule.

• Providing a Calm, Quiet Sleep Environment: While some babies can sleep anywhere, it's helpful to provide a calm, quiet place for the baby to sleep if they sleep better in that environment. However, specific parenting strategies like changes in light or noise don't greatly influence the baby's sleep patterns at this stage.

• Normal Newborn Behaviors: Newborns may exhibit various normal behaviors during sleep/wake transitions, such as sudden jerks, eye rolling, and restless movements like shuddering, quivering, and hiccups. They may also experience unexplained fussiness, crying, and gassiness, which is all part of normal newborn behavior.

• Strategies for Coping with a Fussy Baby: Parents can take several steps to make this period easier, such as taking naps when the baby sleeps, unplugging phones, taking breaks without the baby, and using soothing techniques like swings and pacifiers without worrying about "spoiling" the baby.

• Differences between Breastfed and Formula-fed Babies: Breastfed babies may be fed more often at night than formula-fed babies, potentially due to the faster digestion of breast milk, the mother's sensitivity to the baby's cues, or the mother's desire to soothe the baby with the breast.

• Sleeping Arrangements and Night Wakings: Newborns sleeping in the parents' room or bed is acceptable and can make feeding easier. Frequent night wakings are normal in young infants under 4 months, but may become a behavioral issue in older infants who have difficulty returning to sleep unassisted.

• Developmental Milestones for Sleeping Through the Night: Many infants between 6 weeks and 4 months will naturally sleep for several hours at night without needing to be fed. After 4 months, infants may need to be fed once or twice before waking up, and by 9 months, most infants no longer need night feedings (except for breastfed babies in a family bed).

Weeks Five to Six: Fussiness/Crying Peaks

Here are the key takeaways from the chapter:

• Six-Week Fussiness Peak: All babies experience a peak in fussiness, crying, and wakefulness around 6 weeks of age. This is due to the immaturity of the baby's nervous system and its lack of inhibitory control, which will improve as the brain matures.

• Coping with Fussiness: Parents may feel frustrated and exhausted during this period, but it is important to understand that this is a natural phase and does not make them "bad" parents. Suggestions for coping include getting out of the house, exercising, socializing, and keeping a diary of the baby's sleep and feeding habits.

• Sleep Training Strategies: There are four main sleep training strategies that can be employed, depending on the baby's temperament and the parents' resources:

  • "Let Cry" or Extinction: Involves not responding to the baby's cries at night, which can be effective but difficult for parents.
  • Controlled Crying or Graduated Extinction: Involves gradually increasing the time before responding to the baby's cries.
  • Check and Console: Involves responding to the baby's cries but trying to soothe them without picking them up.
  • Scheduled Awakenings: Discussed in a later chapter.

• Timing of Sleep Training: The best time to try sleep training depends on the baby's temperament and level of fussiness/colic:

  • 6-8 weeks: May work well for babies with common fussiness/crying, especially if they have an easy temperament.
  • 8-16 weeks: Can help babies with common fussiness/crying sleep better at night.
  • After 16 weeks: May be more difficult for babies who had extreme fussiness/colic.

• Importance of Consistency: Whichever sleep training method is chosen, consistency is key. Inconsistent application of the method can lead to failure and frustration for both parents and baby.

• Recognizing Hunger vs. Overtiredness: It's important to distinguish whether a baby's crying is due to hunger or overtiredness, as the appropriate response will differ. Fathers can help by providing a bottle of expressed breast milk or formula to determine if the baby is truly hungry.

Weeks Seven to Eight: Earlier Bedtimes and Longer Night Sleep Periods Develop

Here are the key takeaways from the chapter:

• Tendency for Earlier Bedtimes and Longer Night Sleep: Babies start to develop a tendency to go to sleep earlier at night and sleep for longer periods of uninterrupted night sleep during this period.

• Observing Drowsy Signs: Instead of forcing an earlier bedtime, parents should watch for drowsy signs developing earlier in the evening and put the baby to sleep accordingly.

• Variability in Baby Behavior: Babies can be categorized as "common fussy or easy" or "extremely fussy/colicky", and even "easy" babies may start exhibiting new fussiness during this period.

• Importance of Synchronizing with Baby's Rhythms: The best strategy is to try to synchronize caretaking activities with the baby's own rhythms, and reestablish healthy sleep habits by removing disruptive external factors.

• Recommended Wakeful Period: Babies should not be kept awake for more than 2 hours at a time, as they can become overtired. Parents should watch for drowsy signs and put the baby to sleep before they become overtired.

• Responding to Crying: Parents should distinguish between a protest cry and a sad cry. Leaving the baby alone to self-soothe is important, but the duration should be decided based on the baby's behavior, time of day, and wakeful period.

• Sleep Logging: Maintaining a sleep log or diary can help parents identify trends and improvements in the baby's sleep patterns.

• Caring for Colicky Babies: Colicky babies are difficult to manage and parents should focus on self-care, seeking help, and using soothing techniques like rhythmic rocking, sucking, and swaddling.

• Importance of Smiling: Parents should not save their smiles until the colic ends, as smiling can help reduce crying in the home.

Months Three to Four: Extreme Fussiness/ Colic Ends. Morning Nap Develops at 9:00 to 10:00 A.M.

Here are the key takeaways from the chapter:

• Increased Social Engagement: As your child grows from 3-4 months, they become more social, displaying more smiles, coos, giggles, laughs, and squeals.

• Disrupted Sleep: Your child's curiosity about their expanding world and desire for your company can disrupt their sleep, as they may fight off sleep to spend time with you.

• Importance of Nap Environment: Your child is becoming less portable, and they tend to sleep better in their crib compared to other environments.

• Overtiredness as a Cause of Crying: Intense, persistent crying in infants is often due to overtiredness, rather than hunger or illness. Overtiredness can lead to gassiness and poor sleep/wake transitions.

• Establishing a Nap Schedule: Aim to put your 3-4 month old down for a nap after no more than 2 hours of wakefulness. The nap duration may be variable at this age.

• Distinguishing Needs vs. Wants: It's important to differentiate when your child is crying due to a need to sleep versus a desire to play with you. Allow them some time to self-soothe.

• Flexible but Consistent Approach: While rigid scheduling is not appropriate at this age, it's important to be flexible but also sensitive to your child's sleep needs and establish some consistency.

• Sleep Begets Sleep: As your child gets more rested, they are more likely to accept and expect sleep, creating a positive feedback loop.

• Transition in Morning Nap: Around 4 months, your child may transition to needing a shorter morning nap, as they are now going to sleep earlier at night and waking up more rested.

Preventing and Solving Sleep Problems

• Biologically Determined Sleep Periods: As a baby's brain matures, there are specific times during the day and night when their brain becomes drowsy and less alert. These "windows" of drowsiness are the best times for the baby to be soothed to sleep, as it is easier for them to fall asleep and the restorative power of sleep is greatest.

• Developmental Changes at 6 Weeks: Around 6 weeks of age, babies begin to produce social smiles and their evening fussiness decreases. This reflects maturational changes in the brain, where the baby becomes more able to inhibit stimulating sensations and console themselves, leading to the development of a consistent night sleep pattern.

• Importance of Timing Naps: Keeping the intervals of wakefulness short (less than 2 hours) and soothing the baby before they become overtired is crucial for helping them nap well during the day. "Perfect timing produces no crying."

• Motionless Sleep: Babies tend to have higher-quality, more restorative sleep when they are sleeping in a stationary crib, bed, or bassinet, rather than in a moving car, stroller, or swing.

• Consistency in Soothing Styles: There are two main soothing methods (A and B) that can both work well, as long as the parents are consistent in their approach. Consistency helps the baby learn the process of falling asleep as a habit.

• Importance of Early Nap Training: The sooner parents start being consistent in their nap soothing approach (around 6 weeks), the easier it will be for the family. This is especially important for parents with multiple children.

• Avoiding Nap Mistakes: The key nap mistakes to avoid are: keeping wakefulness intervals too long, using motion during sleep, and inconsistency in soothing methods.

• Flexibility in Scheduling: Parents do not have to become "slaves" to their baby's nap schedule, but should respect their need for good-quality naps on routine days. Exceptional days with disrupted naps are acceptable.

Action Plan for Exhausted Parents

Here are the key takeaways from the chapter:

• Causes of Fussiness and Colic: Babies often become fussy a few days after birth, and about 20% develop extreme fussiness/colic. This is not caused by the parents.

• Importance of Sleep: Lack of sleep is the main enemy for exhausted parents. Babies quickly become overtired after 1-2 hours of wakefulness.

• Soothing Techniques: Effective soothing techniques include encouraging sucking, rhythmic rocking, swaddling, and massage. Soothing should be done within the 1-2 hour window before the baby becomes overtired.

• Sleep Patterns by Age:

  • Newborns (0-6 weeks): Fall asleep late at night and don't sleep long during the day or night. Try to soothe them to sleep during the day.
  • 6+ weeks: 80% become more settled at night, sleep longer, and show earlier drowsiness. Try to soothe them to an earlier bedtime.
  • 20% do not show these improvements - spend extra time soothing them.
  • 4+ months: Babies have longer periods of wakefulness, but soothing should still be synchronized with drowsiness.

• Cry-It-Out Approaches: After 4 months, "let cry", controlled crying, or check-and-console methods may be needed for formerly fussy/colicky babies. This is rarely used for younger babies.

• Consistency: Use consistent soothing styles for naps. Always lie down with the baby or put them down only after deep sleep is achieved.

• Timing: Watch for drowsy signs around 9am as the morning nap develops. Move bedtime earlier as drowsy signs appear earlier.

Months Five to Eight: Early Afternoon Nap Develops at 12:00 to 2:00 P.M. Variable Late Afternoon Nap at 3:00 to 5:00 P.M.

Here are the key takeaways from the chapter:

• Increased Sociability and Playfulness: As the infant reaches 4-5 months of age, they become more sociable and engage in more playful interactions with their parents. This makes having a baby more fun.

• Establishing a Healthy Sleep Schedule: The chapter outlines a healthy sleep schedule for infants 4-8 months old, including wake-up time, morning wakeful time, two naps (midmorning and early afternoon), and a potential late afternoon nap. The goal is to synchronize caretaking activities with the infant's need for sleep.

• Importance of Consistency: Establishing a consistent sleep routine and schedule is crucial, as it helps the infant learn to self-soothe and fall asleep unassisted. Inconsistency can lead to sleep deprivation and other issues.

• Cry-It-Out Method (Extinction): For naps, the chapter recommends the "Extinction" method, where the parent leaves the infant alone to cry for up to an hour to allow them to learn to fall asleep unassisted. This is more challenging for difficult or post-colic infants.

• Nighttime Feedings: Infants may need 1-2 nighttime feedings until around 9 months of age. Parents should respond promptly to these feedings but avoid unnecessary nighttime interactions that could disrupt the sleep schedule.

• Flexibility and Adjustments: The chapter emphasizes that the sleep schedule is a guide, not a rigid set of rules. Parents should adjust the schedule to fit their lifestyle and the infant's needs, while maintaining consistency.

• Importance of Daytime Wakefulness: It is as important to protect the infant's periods of wakefulness as it is to ensure they get adequate sleep. Allowing the infant to sleep during their biological wake times can disrupt the overall sleep-wake rhythm.

• Challenges for Difficult or Post-Colic Infants: Establishing a consistent sleep schedule may be more difficult for infants with a difficult temperament or who experienced colic as younger babies. The chapter provides specific strategies for these infants.

• Avoiding "Helpful Hints": The chapter cautions against relying on various "helpful hints" to soothe the baby to sleep, as maintaining a consistent sleep schedule is more effective than these temporary solutions.

• Prioritizing Healthy Sleep Patterns: The chapter emphasizes that allowing unhealthy sleep patterns to persist can be as harmful as providing a nutritionally deficient diet, underscoring the importance of establishing a healthy sleep schedule.

Month Nine: Late Afternoon Nap Disappears. No More Bottle-feeding at Night

• Toddler Behaviors: Toddlers often exhibit behaviors such as being strong-willed, willful, independent-minded, stubborn, headstrong, and uncooperative. These behaviors are a normal part of the child's development and the evolution of their autonomy or sense of independence.

• Noncompliance and Self-Agency: Psychologists may use the term "noncompliance" to describe the lack of cooperation in toddlers, but this is also associated with the child's increased ability to express their own likes, dislikes, and intentional behavior, which is known as "self-agency."

• Challenging Situations: Toddlers are more likely to exhibit "oppositional behaviors" during specific situations, such as dressing, mealtimes, in public places, and at bedtime.

• Stranger Wariness and Separation Anxiety: Toddlers may develop behaviors described as social hesitation, shyness, or fear of strangers. They may also experience separation anxiety when their mother leaves them alone or with a babysitter.

• Sleep Changes: The major sleep change that occurs around nine months is the disappearance of the late-afternoon nap. If this nap persists, it can lead to a later bedtime. Additionally, bottle-feeding after nine months can lead to night-waking or night-feeding habits.

• Breast-feeding and Night-waking: If a child is breast-fed in the family bed, they may not develop a night-waking habit.

• Incorrect Interpretations: The author suggests that the "stage" theory, which attributes increased resistance in going to sleep or night waking to separation anxiety or fear of being apart from the mother, is an incorrect interpretation.

Months Ten to Twelve: Morning Nap Starts to Disappear but Mostly Two Naps

• Nap Transition: Around 10-12 months, some babies start transitioning from two naps to one afternoon nap. This can lead to earlier bedtimes as the child gets more tired towards the end of the day.

• Nap Deprivation: Allowing a child to skip naps can lead to a "vicious circle" of sleep problems, including difficulty falling asleep at night, increased fussiness, and reduced attention span. Reestablishing regular nap routines can help correct night-sleep issues.

• Boredom vs. Tiredness: Boredom in a child may be a sign of underlying tiredness, rather than a desire to play. Observing the child's activity level can help identify when they are actually tired.

• Nap Needs: Most babies in this age range still need two naps per day, even if parents can only get the child to take one. Sitters are often able to enforce the two-nap schedule more effectively.

• Sleep Maturation Milestones: There are three key milestones in sleep maturation: 6 weeks (night sleep becomes organized), 4 months (day and night sleep cycles develop), and 9 months (third nap eliminated, longer naps, no night feedings).

• Comforting Routines: Maintaining comforting routines like rocking, lullabies, and cuddling can help a child associate these behaviors with falling asleep.

• Nursing to Sleep: Nursing a child to sleep is not inherently problematic, but can contribute to sleep issues if the child is unable to fall asleep independently.

• Night Wakings: It's generally best not to intervene when a child wakes briefly at night, unless they are truly stuck or unable to resettle themselves. Allowing them to resettle can help reinforce independent sleep skills.

• Flexible Schedules: While it's important to have a somewhat organized sleep schedule, it's also important to be flexible and adjust bedtimes based on factors like nap duration and activity level.

Preventing and Solving Sleep Problems: Months Five to Twelve

Here are the key takeaways from the chapter:

• Preventing and Solving Sleep Problems: The major sleep problems in babies from five to twelve months old develop and persist because of the inability of parents to stop reinforcing bad sleep habits. Parents need to give their child the opportunity to learn self-soothing skills and not interfere with this important learning process.

• Maternal Depression and Infant Sleep: Sleep problems in children may cause maternal depression. Teaching infants how to sleep better can help decrease or prevent maternal depression.

• Attachment Theory Myths: Contrary to popular belief, there is no scientific evidence that a critical period for "bonding" at birth affects subsequent behavior in either infant or mother. Additionally, the claim that a 24-hour parent will produce a more securely attached child is not supported by research.

• Crying and Emotional Development: Protest crying at bedtime will not cause permanent emotional or psychological problems. In fact, the capacity to be alone is an important sign of emotional maturity.

• Abnormal Sleep Schedules: Abnormal sleep schedules, such as going to bed too late and sleeping too late in the morning, can set the stage for frequent night wakings and an overtired, hyperaroused child.

• Nap Deprivation: Nap deprivation can lead to increased levels of arousal and alertness, causing difficulties in falling asleep, staying asleep, or both.

• Brief Sleep Durations: If a child starts waking at night around ten, eleven, or twelve months, it may be because the customary bedtime hour was too late, and shifting the bedtime earlier can resolve the issue.

• Early Awakenings: Most children five to twelve months of age should go to bed between 6:00 and 8:00 PM and wake up between 6:00 and 7:00 AM. Trying to keep them up later or waking them for a feeding at night is usually not effective in preventing early awakenings.

• Night Wakings: Night wakings are typically caused by disturbed sleep patterns, such as sleep fragmentation, nap deprivation, or parent reinforcement of the waking behavior. Letting the child learn to self-soothe is an effective strategy.

• Sleep Training Techniques: The "fading" technique involves gradually reducing parental involvement in the child's sleep, while the "extinction" (or "cry it out") technique involves abruptly stopping the reinforcement of night wakings. Both can be effective, but the extinction method works faster.

Action Plan for Exhausted Parents

• Nap Schedule for Months 5-8: During this period, 16% of children have 3 naps, while 84% have 2 naps. For children with a difficult temperament, put them down for the morning nap within 1 hour of wakefulness, and expose them to bright natural light during this time.

• Handling Crying: If the child cries, leave them alone for 10-20 minutes. For easy-tempered children, be prepared to leave them alone for up to 1 hour.

• Ideal Nap Times: Try to establish naps around 9 AM and 1 PM, and potentially a late-afternoon nap if needed. Avoid naps at other times.

• Nap Transition (Months 9-12): By Month 9, 5% of children have 3 naps, 91% have 2 naps, and 4% have 1 nap. Eliminate the late-afternoon nap to protect an early bedtime. By Months 10-12, the morning nap starts to disappear, so move bedtime 20-30 minutes earlier.

• Preserving the Afternoon Nap: If the afternoon nap starts to disappear due to a longer morning nap, move bedtime much earlier to shorten the morning nap and protect the afternoon nap. If there is resistance to the afternoon nap, start it earlier.

• Soothing Strategies: Consider your resources for soothing (as discussed on page 73). If resources are limited, tackle one problem at a time (e.g., bedtime battles). If resources are unlimited, address the entire 24-hour schedule at once (bedtime battles, night waking, and nap fighting).

• Changing Sleep Strategies: If the baby cries hard and vomits, consider changing sleep strategies to one that involves less crying.

Months Thirteen to Fifteen: One or Two Naps

Here are the key takeaways from the chapter:

• Transition from Two Naps to One Nap: Between 12 and 15 months of age, there is a dramatic transition from 82% of children taking two naps to 56% taking only a single afternoon nap. This transition may not be smooth, and parents may experience a period where one nap is not enough but two naps are impossible.

• Moving Bedtime Earlier: One strategy to ease the transition is to move the child's bedtime earlier. This can cause the morning nap to become shorter or turn into quiet playtime without sleep, making it easier for the child to transition to a single afternoon nap.

• Shortening the Morning Nap: Another strategy is to shorten the morning nap by waking the child after 1-1.5 hours, so they are more tired for the midday nap. This can help the child transition to a single afternoon nap.

• Delaying the Morning Nap: If the child continues to take a morning nap but resists the afternoon nap, parents can slowly delay the onset of the morning nap over several days or weeks until it occurs closer to the middle of the day. This can help the child transition to a single afternoon nap.

• Flexible Nap Schedules: Some parents may find it helpful to declare certain days as "two-nap days" and others as "one-nap days", depending on the child's needs and the family's schedule. The key is to be flexible and responsive to the child's changing sleep requirements.

• Importance of Early Bedtime: An early bedtime (e.g., 5 PM) can be helpful during this transition, as it allows the child to catch up on sleep and prevents them from becoming overtired in the late afternoon or evening.

• Monitoring Child's Cues: Parents should observe their child's cues, such as fussiness, brattiness, or tantrums, to determine if they need longer naps. The goal is to ensure the child is well-rested.

Months Sixteen to Twenty-one: Morning Nap Disappears

• Morning Nap Disappearance: By 18 months, 77% of children take a single afternoon nap, and by 21 months, 88% sleep only in the afternoon. This transition can be challenging, as an early bedtime may lead to an earlier wake-up time, making the child more tired in the morning and increasing the need for a morning nap.

• Adjusting Bedtime: If the child is taking only the morning nap, it may be helpful to temporarily put them to bed a little later at night, with the hope that they will sleep in later. However, this requires patience and trial and error, as putting them to bed too late can make it difficult for them to fall asleep and stay asleep.

• Addressing Night Crying: If a healthy child cries at night but stops as soon as they are picked up, it is important to look at the bigger picture of their sleep pattern. Potential factors to consider include nap timing, bedtime, and any recent disruptions to their schedule that may have caused them to become overtired. Attending to the night crying may lead to fragmented sleep, which is poor-quality sleep.

• Strategies for Avoiding Night Crying: Suggestions for avoiding attending to night crying include tying a ribbon around your ankle and your partner's ankle to prevent going to the child automatically, waiting for your partner to be away for a few days to ignore the crying without them undermining the plan, and using earplugs, earphones, or pillows to create distance from the child's cries. The goal is to do what is best for the child while also taking care of yourself.

Months Twenty-two to Thirty-six: Only a Single Afternoon Nap

Here are the key takeaways from the chapter:

• Nap Transition: Between 24-36 months, the majority of children transition from two naps to a single afternoon nap. By 36 months, 91% of children take a single afternoon nap, and 9% no longer nap at all.

• Reestablishing Naps: If a child stops napping but appears tired during the day, parents can try to reestablish the nap by slowly adjusting the bedtime earlier or later, using a soothing pre-nap routine, and temporarily lying down with the child.

• Nap Duration: The average nap duration at 36 months is 2 hours, with a range of 1-3.5 hours. The majority of children (80%) nap for 1.5-2.5 hours.

• Transitioning to a Bed: Let the child ask for a "big bed" as they approach 3 years old. Moving them too soon can lead to them getting out of bed frequently.

• Fears and Sleep Disturbances: Nightmares, fears of separation/darkness/death are common between 2-4 years old. Reassurance, a consistent bedtime routine, and "stimulus control" techniques can help.

• Routines and Schedules: Aim for a regular but flexible nap and bedtime routine, between 7-9 PM for bedtime and 6:30-8 AM for wakeup. Be cautious about scheduling activities that conflict with nap times.

• Transitioning for a New Sibling: When a new baby arrives, consider moving the older child to a "big bed" around 4 months after the baby is born, when the infant's sleep pattern is more stable.

Preventing and Solving Sleep Problems

Here are the key takeaways from the chapter:

• Disturbed Sleep in Young Children: Around 20% of 1-2 year olds wake up 5 or more times per week, and 26% of 3 year olds wake up at least 3 times per week. Disturbed sleep in young children is common and often persists unless the child learns to soothe themselves back to sleep.

• Relationship Between Sleep and Injuries: Children who wake frequently are much more likely to have injuries requiring medical attention compared to good sleepers (40% vs 17%).

• Normal Sleep Patterns in 1-5 Year Olds: The majority of 1-5 year olds have a bedtime routine less than 30 minutes, go to sleep with the lights off, and fall asleep in about 30 minutes. They typically wake up once per week, with only a few waking more than once per night.

• Sleep Problems and Personality Development: Sleep problems in 12-36 month olds are often related to the child's evolving stubbornness, willfulness, and desire for independence during this period.

• Addressing "Getting Out of Bed": A 5-step plan is provided to address the "Jack-in-the-Box" syndrome where the child keeps getting out of their crib or bed at night. Key elements include being silent/unemotional when returning the child to bed, using a signal like a bell to know when the child is out of bed, and rewarding cooperation.

• Crib Tents and Locking Doors: For some children, a crib tent or locking the parents' bedroom door may be necessary as a last resort to prevent the child from getting out of their sleeping area.

• Sleep Rules: Establishing clear "sleep rules" (stay in bed, close eyes, stay quiet, go to sleep) with rewards/privileges can help older toddlers (around 3 years) learn to follow bedtime routines.

• Addressing Nap Refusal: Strategies are provided for dealing with resistance to taking one nap or completely refusing naps, including structuring nap times and using controlled crying.

• Addressing Early Waking: Using a digital clock as a cue, and not responding until the set wake-up time, can help address the problem of a child waking up too early.

• Addressing Bedtime Resistance and Night Waking: Removing parental attention and reinforcement during these behaviors, through techniques like "extinction", can help extinguish these habits over time.

• Importance of Consistent Schedules and Routines: Establishing age-appropriate sleep/wake schedules (temporal control) and promoting sleep-compatible behaviors (stimulus control) are key to addressing sleep problems in young children.

Action Plan for Exhausted Parents

• Nap Transition: During the transition from multiple naps to a single afternoon nap, earlier bedtimes can help the child adjust. The transition typically occurs between 13-21 months, with 23% having two naps and 77% having one nap at 18 months, and 12% having two naps and 88% having one nap at 21 months.

• Delaying Nap Onset: If the child has only a morning nap, the onset of the nap can be slowly shifted towards midday by delaying it by 10-20 minutes every few days.

• Adjusting Bedtimes: If the child refuses to nap but still needs rest, experimenting with earlier or later bedtimes can help the child get more sleep.

• Crib Escapes: If the child climbs out of the crib, a "silent return to sleep" technique or a crib tent can be used to keep the child in the crib.

• Sleep Rules: Around age 3, sleep rules can be introduced to help keep the child in their crib or bed.

• Early Risers: A digital clock can be used to provide a visual cue for the start of the day, helping to address the issue of the child waking up too early.

• Nighttime Fears: If the child has fears, extra time should be spent soothing them to sleep, and a timer can be used to control the duration of middle-of-the-night reassurance.

Years Three to Six: Naps Disappear

Here are the key takeaways from the chapter:

• Nap Frequency Declines with Age: Most children (91%) nap daily at age 3, but this declines to 50% napping 5 days per week at age 4, and 25% napping 4 days per week at age 5. Naps are usually gone by age 6, unless it is a family custom to nap on weekends.

• Nap Duration Decreases with Age: Between ages 3-4, naps are 1-3 hours long, and between ages 5-6, naps are 1-2 hours long. Naps gradually decrease in duration as children get older.

• Overscheduling Can Disrupt Naps: When parents push children into too many preschool/nursery school activities before they are ready, naps get scheduled out, leading to sleep deficits. Parents should enforce "declared holidays" where the child stays home and naps or engages in quiet activities.

• Temperament and Sleep are Interrelated: Children with "easy" temperaments slept longer than those with "difficult" temperaments. Parenting practices that encourage good sleep can help "difficult" children develop an "easy" temperament over time.

• Sleep Loss Impacts Behavior More in Children: Sleep loss affects mood and behavior more in children than in adults, as the developing brain may be more sensitive to sleep deprivation.

• Better Sleep Quality Reduces Behavior Problems: Preschoolers with less sleep exhibit more "externalizing" behavior problems like aggression and hyperactivity. Consolidated, sufficient sleep and regular bedtimes are associated with fewer behavior issues.

• Short Sleep Duration Linked to Obesity: Research shows a connection between shorter sleep duration and increased obesity risk in 5-6 year old children, even after controlling for other factors like physical activity and TV watching.

Preventing and Solving Sleep Problems

Here are the key takeaways from the chapter:

• Consistent Parental Approach: The chapter emphasizes the importance of a consistent parental approach in addressing sleep problems in children. Inconsistent behavior from parents can reinforce undesirable sleep behaviors in children.

• Gradual Reduction of Parental Attention: The chapter discusses a "fade" strategy, where parents gradually reduce the amount of attention and interaction with the child at bedtime, rather than a "cold-turkey" approach. This helps the child learn to self-soothe and fall asleep independently.

• Importance of Parental Involvement: The chapter highlights that the success of sleep interventions is closely tied to the involvement and attendance of both parents in the consultation sessions. Marital discord and parental psychiatric problems can also impact the success of the interventions.

• Day Correction of Bedtime Problems: The chapter introduces the "Day Correction of Bedtime Problems" strategy, which focuses on addressing the child's daytime behaviors and ensuring they are tired, quiet, and relaxed at bedtime, rather than just addressing the nighttime issues.

• Importance of Regular Bedtimes: The chapter emphasizes the importance of regular bedtimes and sleep/wake schedules, as variability in bedtimes and late bedtimes can predict poor behavioral adjustment in preschool children.

• Use of Sleep Rules and Rewards: The chapter discusses the use of sleep rules (e.g., "Do not leave your room until you hear the music") and rewards (e.g., small toys, favorite foods) to encourage cooperation and the development of desirable sleep behaviors in children.

• Addressing Nighttime Fears: The chapter suggests strategies to address children's nighttime fears, such as using a dream catcher or guardian angel, and allowing a limited number of nighttime check-ins with parents.

• Reestablishing Naps: The chapter provides guidance on reestablishing nap routines, even for children who have not napped regularly for several months, by using techniques like napping with the child and gradually transitioning them to napping independently.

• Challenges for Parents with Irregular Work Schedules: The chapter acknowledges the difficulties faced by parents with irregular work schedules or demanding jobs in maintaining consistent bedtime routines for their children, and suggests that finding a solution may not be easy.

Action Plan for Exhausted Parents

• Naps Disappearing After Age 3: After the third birthday, children's naps begin to disappear, and some may need an earlier bedtime to accommodate their busy schedules.

• Ignoring Mild Distress: When a child is mildly frustrated or upset, such as when playing with blocks, it is best to ignore the distress rather than intervene. This technique, known as "day correction of bedtime behavior," should be applied to the easiest situations first, as it becomes more challenging as the child gets older.

• Rewarding Morning Routine: Implementing "sleep rule #5" (from page 353) can help reward the child for staying in their room until a certain time in the morning, which can improve their sleep routine.

• Shaping Behavior: The concept of "shaping" (explained on page 355) can be used to gradually modify the child's behavior and sleep patterns.

• Importance of Sleep: Ensuring adequate sleep is crucial for a child's mood, behavior, and overall performance. If the bedtime is consistently too late, it is important to establish a regular, consistent bedtime routine.

• Locking the Door: If a child becomes unmanageable at bedtime, it is better to lock the door than to become angry or potentially harm the child.

Years Seven to Twelve: Bedtime Becomes Later

• Bedtime and Sleep Duration for 12-Year-Olds: Most 12-year-olds go to bed around 9:00 PM, with a range of 7:30 to 10:00 PM. The typical sleep duration for 12-year-olds is 9 to 12 hours, and researchers have found that pre-pubertal teenagers need 9.5 to 10 hours of sleep to maintain optimal alertness during the day.

• Difficulty Falling Asleep: In a survey of 7-8 year olds, about 30% resisted going to bed at least 3 nights per week, and 10% had difficulty falling asleep, taking up to an hour on more than 3 nights per week. Children with both bedtime resistance and difficulty falling asleep also exhibited other problems like fears, anxiety, and the need for parental reassurance.

• Persistence of Sleep Problems: The study confirmed that sleep problems in early childhood tend to persist, and that it is a mistake for professionals to advise that the child will "outgrow the problem."

• Sleep and Academic Performance: Surveys from Belgium and Taiwan found that school achievement difficulties were more common among poor sleepers compared to good sleepers. Additionally, children on a college track who felt more academic pressure tended to sleep fewer hours.

• Somatic Complaints: Many children in this age range complain of aches and pains (e.g., abdominal pain, limb pain, headaches, chest pain) for which no medical cause can be found. These somatic complaints are often associated with significant sleep disturbances and are thought to be related to stressful emotional situations.

• Approach to Somatic Complaints: The chapter advises against extensive medical testing to rule out obscure diseases for these somatic complaints, as the tests are painful, risky, expensive, and may reinforce the notion in the child's mind that they are "sick." Instead, the focus should be on addressing the underlying emotional and sleep-related issues.

Adolescence: Not Enough Time to Sleep, Especially in the Morning

Here are the key takeaways from the chapter:

• Adolescent Sleep Needs: Teenagers, especially those aged 14-16, require more sleep than in previous years to maintain optimal daytime alertness. Many teenagers would benefit from being allowed to sleep longer in the morning.

• Napping and Sleep Patterns: Afternoon napping in teenagers can lead to later bedtimes and shorter overall sleep duration. It may be better for teenagers to avoid napping, go to bed earlier, and wake up earlier to do homework.

• Chronic Sleep Deficits: Chronic sleep deficits, defined as taking 45+ minutes to fall asleep 3+ nights per week, waking up 1+ times per night for 30+ minutes 3+ nights per week, or having 3+ awakenings per night 3+ nights per week, are common in 13% of teenagers and are associated with mood changes, depression, and other issues.

• Delayed Sleep Phase Syndrome: This condition causes teenagers to have difficulty falling asleep at a socially appropriate time, leading to later bedtimes (e.g. 1-3 AM) and struggles waking up for early school start times.

• Kleine-Levin Syndrome: A rare condition characterized by excessive sleepiness, overeating, and loss of sexual inhibitions, which may be mistaken for other psychiatric or neurological disorders.

• Fibromyalgia Syndrome: An uncommon sleep problem in pre-teen and teenage girls, characterized by disturbed, non-restorative sleep, diffuse pain, fatigue, and other symptoms. Improvement often starts with better sleep quality.

• Chronic Mononucleosis: Can cause disabling daytime sleepiness in teenagers following the acute viral infection, sometimes leading to misdiagnosis of depression.

Preventing and Solving Sleep Problems

Here are the key takeaways from the chapter:

• Relaxation Techniques for Falling Asleep: The chapter discusses several relaxation techniques that can help older children fall asleep more easily, including:

  • Progressive Relaxation: Tensing and releasing individual muscle groups to reduce overall muscle tension.
  • Biofeedback: Using visual or auditory cues to monitor and reduce muscle tension.
  • Self-Suggestion: Repeating calming suggestions, such as feeling the arms and legs becoming heavy and warm.
  • Paradoxical Intention: Focusing on staying awake rather than trying to fall asleep, which can break the cycle of anxiety about not sleeping.
  • Meditative Relaxation: Focusing on the physical sensation of breathing to induce relaxation.

• Stimulus Control and Temporal Control: The chapter discusses two key principles for establishing healthy sleep habits:

  • Stimulus Control: Associating the bed and bedroom with sleep by avoiding non-sleep activities (e.g., watching TV, reading) in the bedroom.
  • Temporal Control: Maintaining a consistent sleep schedule, including going to bed and waking up at the same time each day, and avoiding napping during the day.

• Delayed Sleep Phase Syndrome: Some teenagers suffer from delayed sleep phase syndrome, where they are unable to fall asleep until late at night but have no trouble sleeping once they do. The treatment, called "chronotherapy," involves gradually shifting the sleep schedule to an earlier time.

• Avoiding Sleep Medications: The chapter cautions against relying on sleep medications, as they can have negative side effects and do not address the underlying causes of sleep problems. It recommends exploring non-pharmacological solutions, such as the relaxation techniques and sleep hygiene principles discussed.

• Dietary Factors and Sleep: The chapter examines the potential effects of diet on sleep, noting that while high-carbohydrate meals, foods high in tryptophan, and eliminating refined sugar have been suggested as sleep-promoting, the scientific evidence is inconclusive. It also cautions against using supplements like melatonin without established safety and effectiveness for children.

• Performance Anxiety and Sleep: The chapter acknowledges that school-age children may experience anxiety about their academic or athletic performance, which can interfere with their ability to fall asleep. It recommends seeking professional help, such as from a child psychologist, to address this "performance anxiety" through relaxation training.

Sleepwalking

• Prevalence of Sleepwalking in Children: Sleepwalking occurs in about 5% of children between the ages of 6 and 16, with an additional 5-10% experiencing it once or twice a year. This behavior is more common among identical twins than fraternal twins, indicating a substantial genetic factor.

• Timing and Duration of Sleepwalking Episodes: Sleepwalking episodes typically occur within the first 2-3 hours after falling asleep and can last up to 30 minutes. During these episodes, the sleepwalker appears unconcerned about their environment, with an uncoordinated and purposeless gait.

• Behaviors Associated with Sleepwalking: In addition to walking, sleepwalkers may engage in other behaviors such as eating, dressing, and opening doors. These behaviors are often not purposeful or coordinated.

• Lack of Emotional Stress or Behavioral Problems: When sleepwalking starts under the age of 10 and ends by age 15, it is not associated with any emotional stress, negative personality types, or behavioral problems.

• Treatment Approach: The primary treatment for sleepwalking consists of safety measures to prevent the sleepwalker from falling or harming themselves, such as removing toys or furniture from their path. Attempts to wake the sleepwalker are generally not effective, as they usually wake up spontaneously without any memory of the episode.

Night Terrors

• Night Terrors: Night terrors are a type of sleep disorder that occurs during non-REM sleep, usually within the first two hours of going to sleep. They are characterized by a child waking up in a state of extreme agitation, fear, and confusion, with physical symptoms like dilated pupils, sweating, and a rapid heartbeat.

• Distinction from Nightmares: Night terrors are not the same as nightmares, which occur during REM sleep. Children have no memory of night terrors once they are awake, unlike nightmares.

• Age of Onset: Night terrors typically start between the ages of 4 and 12 years, and are not associated with any emotional or personality problems when they occur before puberty.

• Triggers: Night terrors are more likely to occur when a child has a fever or when their sleep patterns are disrupted, such as during long trips, school vacations, holidays, or when relatives visit. Recurrent night terrors are often associated with chronically abnormal sleep schedules.

• Treatment: The primary treatment for night terrors is to ensure the child gets enough sleep. Moving the bedtime earlier by just 30 minutes has been observed to make night terrors disappear. Drug therapy is generally not warranted, and most children will outgrow these problems without the need for complex tests, drug treatments, or psychotherapy.

• Relationship to Other Sleep Disorders: Night terrors, sleepwalking, and sleep talking all occur mainly during non-REM sleep and are not associated with seizures, convulsions, or epilepsy.

Nightmares

• Nightmares in Old English Mythology: In old English mythology, a nightmare was believed to be a female spirit or monster that would come upon people and animals at night while they were asleep, causing a feeling of suffocation.

• Personal Experiences with Nightmares: The author has experienced nightmares of suffocation, strangulation, breathlessness, choking, being crushed or trapped, drowning, entrapment, and being buried alive, but only when sleeping on their back or having an alcoholic drink before bedtime. The author's wife has observed that their breathing sounds like a "diesel truck with a bad motor" during these nightmares.

• Cause of Nightmares: The author's nightmares occur when their upper airway is partially blocked, which happens when they sleep on their back or drink alcohol before bedtime. Occasionally, they have less dramatic dreams of breathlessness while running, flying, or being chased.

• Nightmares in Children: Some children may have similar nightmares when they have bad colds or throat infections that partially obstruct their upper airway. However, most young children's nightmares do not seem to be associated with any specific emotional or personality problems.

• Frequency and Effects of Nightmares: About 30% of high school students have one nightmare a month. Adults who have more frequent nightmares (more than two per week) often have other sleep problems, appear more anxious and distrustful, and experience fatigue in the morning.

• Psychological Factors in Nightmares: Two recent reports have concluded that anxiety issues or other psychological problems are associated with nightmares in children aged 5-8 and 6-10 years. However, the author cautions against generalizing the analysis of dream content in disturbed children to normal populations of children, as the exact value or limitations of dream interpretation are not well understood.

• Responding to Nightmares: If a child comes into the parents' room multiple times a night complaining of nightmares, and the parents strongly suspect the child is not feigning the nightmares for attention, the parents should consider consulting with a child psychologist or psychiatrist.

Poor-Quality Breathing (Allergies and Snoring)

Here are the key takeaways from the chapter:

• Allergies and Snoring Can Disrupt Sleep: Allergies and snoring can cause difficulty breathing during sleep, leading to poor-quality sleep, daytime sleepiness, and behavioral and academic problems in children.

• Symptoms of Poor-Quality Breathing: Symptoms of poor-quality breathing during sleep include snoring, difficulty breathing, stopping breathing, restless sleep, chronic runny nose, mouth breathing, frequent colds, nausea/vomiting, difficulty swallowing, sweating, hearing problems, excessive daytime sleepiness, poor appetite, and recurrent middle-ear infections.

• Allergies and Behavioral Problems: Allergies can cause behavioral problems in children by producing swollen respiratory membranes, large adenoids, or large tonsils, which partially obstruct breathing during sleep, leading to fatigue, irritability, and tension.

• Snoring and Associated Problems: Snoring in children can lead to daytime drowsiness, bed-wetting, decreased school performance, morning headaches, mood and personality changes, and weight problems.

• History of Recognizing Snoring Issues: Enlarged adenoids and tonsils causing disrupted sleep and behavioral problems in children have been recognized in medical literature since the early 1900s.

• Causes of Snoring: Snoring can be caused by enlarged adenoids or tonsils, or by too much relaxation in the neck muscles during sleep, which allows the airway to narrow.

• Diagnosing Breathing Disorders: Diagnostic tests like X-rays, sleep studies, and imaging can be used to determine the cause and severity of breathing disorders during sleep.

• Treatments for Breathing Disorders: Treatments can include removal of enlarged adenoids or tonsils, use of oral devices to keep the tongue in place, weight reduction, and management of allergies.

• Reversibility of Problems: Behavioral, developmental, and academic problems caused by poor-quality sleep due to breathing disorders are reversible when the sleep deficits are corrected.

• Ongoing Support After Treatment: Even after treatment, long-standing bad habits or chronic stresses may still require ongoing professional support like counseling or tutoring.

Hyperactive Behavior

• Hyperactive Behavior in Children: Hyperactive behavior in children is often diagnosed as Attention Deficit Hyperactivity Disorder (ADHD), which is characterized by similar academic problems and poor sleep patterns as those seen in children with snoring or severe allergies.

• Relationship between Sleep and Hyperactivity: Restless sleep or increased movement during sleep has been documented in hyperactive children, suggesting that their hyperactive behavior may be linked to chronic poor sleep habits starting from infancy.

• Infant Characteristics and Hyperactivity: The study of infant boys aged 4-8 months found that those with more difficult temperaments (irregular, withdrawing, high intensity, slow to adapt, and moody) and active sleep patterns also had briefer attention spans, indicating that their "racing motors" may contribute to both poor sleep and difficulty concentrating during the day.

• Preschool Children and Hyperactivity: A study of preschool children at age 3 showed that children with increased motor activity when awake also had physically active sleep patterns, and were more likely to exhibit characteristics associated with hyperactivity, such as restlessness, impulsivity, short attention span, and mood changes.

• Transformation from Infant to Hyperactive Child: The research suggests a transformation from an extremely fussy/colicky/difficult temperament baby with brief sleep durations to a hyperactive school-age child, where the infant's traits of irregularity and short attention span are replaced by hyperactivity and increased intensity as the child becomes more fatigued.

• Chronic Sleep Loss and Hyperactivity: Children who do not learn to fall asleep unassisted and accumulate chronic sleep loss develop chronic fatigue, which can cause them to become more active both at night and during the day, and interfere with their learning.

• Cycle of Disturbed Sleep and Hyperactivity: Crying and sleeping problems present at birth can trigger parental mismanagement, which can then cause disturbed sleep, elevated neurotransmitter levels, and a more aroused, alert, and irritable child. This "turned-on" state further disrupts the child's sleep, creating a cycle of disturbed sleep and hyperactivity.

• Causes of School and Behavioral Problems: The combination of a fatigued child who is too alert to sleep well, and irregular, inconsistent parents who are also tired and anxious, can lead to a child who finds it difficult to concentrate, appears hyperactive, or has behavioral problems that make them difficult to manage.

Seasonal Affective Disorder

• Seasonal Affective Disorder (SAD): SAD, also known as "winter depression," is a type of depression that occurs during the winter months, typically from October to November.

• Symptoms of SAD: The symptoms of SAD include feeling blue or sad, decreased interest or pleasure in activities, dramatic weight gain or loss, sleeping too little or too much, restlessness or slowed-down behavior, fatigue, feelings of worthlessness, difficulty concentrating, and recurrent thoughts of death or suicide.

• Causes of SAD: The reduced amount of daylight during the winter months, with shorter days and longer nights, is believed to be the primary cause of the depressive symptoms associated with SAD.

• Treatment for SAD: One of the main treatments for SAD is light therapy, which involves using a bank of special fluorescent lamps behind a plastic diffusing screen. The intensity of light needed, the duration of the light treatment, and the potential risks to the eyes are currently being investigated.

• Prevalence of SAD in Children: Survey studies have shown that between 2 and 5 percent of children between the ages of 9 and 19 fulfill the diagnostic criteria for SAD. The symptoms are more prevalent in northern regions, where the days are significantly shorter during the winter months.

• Importance of Recognizing SAD in Children: If an older child seems to be struggling after the first few months of the school year, it is important to consider the possibility that they may be experiencing SAD, rather than attributing the issues to other factors such as the teacher, coach, or increased homework load.

Bed-wetting

• Bed-wetting Prevalence: Bed-wetting is a common occurrence, affecting around 20% of children at age 4, 10% at age 5, and 5% by age 10. It is more common in boys and has a tendency to be inherited.

• Causes of Bed-wetting: The exact cause of bed-wetting is unknown, but it is not caused by emotional problems. It is believed to be related to deep sleep patterns and difficulty in controlling the bladder during sleep.

• Treatments for Bed-wetting: Pediatricians or pediatric urologists may offer bladder-training strategies or other treatments, but there is no single best treatment as most children outgrow the problem. Restricting fluids before bedtime is not an effective treatment.

• Moisture Alarms: Moisture alarms are an effective treatment for bed-wetting. These alarms wake the child as they begin to urinate, which can help the brain learn to better control the bladder and prevent future bed-wetting episodes.

• Deep Sleep in Bed-wetters: Bed-wetters appear to have very deep sleep, which may be a major contributing factor to the problem. Some children may sleep through the moisture alarm, requiring the parent to be able to hear the alarm and wake the child.

• Relationship between Sleep Quality and Bed-wetting: Children with too-late bedtimes or severe allergies causing difficulty breathing during sleep may be overtired during the day and more prone to bed-wetting at night. Improving sleep quality, such as through the removal of enlarged adenoids or tonsils, can lead to dramatic "cures" of bed-wetting.

New Sibling

• Maintain Regularity During Pregnancy: It is best to maintain as much regularity as possible during the pregnancy and not move the young child to a bed until the new baby is about four months old, if then. This helps the older child adapt to the inevitable decrease in parental attention.

• Prepare for Decreased Attention: Toward the end of the pregnancy, the mother is more tired, and the older child becomes aware that her mother has less energy or patience. The older child will have to get used to receiving less attention or not as prompt a response.

• Transition to a "Big Kid's Bed": If you need to move the older child from a crib to a bed, consider leaving the crib up and empty for a while before the younger child is shifted to it. This helps the older child feel like they are "graduating" to a bigger bed.

• Expect Potential Regression: The child might experience fearfulness in the big bed or realize they can easily get out of bed to explore the house, which may require returning them to the crib. A crib tent or a portable crib may be necessary in these cases.

• Establish Stable Routines: When the newborn is about four months old, the developing biological rhythms in the baby permit a new and stable social rhythm in the household. The older child now knows approximate times when the mother is feeding the baby or putting it to sleep, which makes the older child feel more secure.

• Avoid Inhibition: Don't be inhibited because of a fear that you are causing a "regression" or sense of failure in your child. Under these circumstances, the baby might have to go to a portable crib, another crib if the children are close together in age, or maybe some temporary larger substitute for the bassinet.

Twins, Triplets, and More

Here are the key takeaways from the chapter:

• Raising Multiples Requires Extra Effort: Having twins, triplets, or more children at the same time significantly increases the amount of work and responsibility required, as parents cannot simply clone themselves to handle the increased demands.

• Importance of Early Sleep Training: It is crucial to start sleep training twins, triplets, or more children early, around the time of their birth or due date, in order to avoid the overtired state and help synchronize their sleep schedules.

• Strategies for Early Sleep Training: Key strategies include:

  • Avoiding the overtired state by putting babies down for naps after 1-2 hours of wakefulness
  • Controlling the wake-up time in the morning to partially synchronize sleep/wake cycles
  • Allowing only a very brief (1 hour) interval of wakefulness before the first nap
  • Exposing babies to bright light in the morning to help set their sleep/wake clock
  • Practicing consistency in how babies are soothed to sleep, using the "put down awake" method (Method A)

• Challenges of Synchronizing Sleep Schedules: There is a strong genetic component to sleep patterns, so it may be more difficult to fully synchronize the sleep schedules of fraternal twins compared to identical twins. Parents may need to be creative in temporarily separating "good" and "bad" sleepers.

• Importance of Sleep Logs: Keeping detailed sleep logs can help parents understand their children's sleep patterns and strike a good compromise between avoiding overtiredness and synchronizing schedules.

• Seeking Support: Parents of twins, triplets, or more should consider consulting other parents of multiples or their pediatrician to get advice on managing sleep and other challenges specific to their situation.

Moving

• Maintain Consistent Routine: When preparing for and following a move, it is crucial to maintain a regular and consistent pattern for the child's sleep and bedtime rituals. This helps to minimize disruptions to the child's established routine.

• Reestablish Sleep Patterns: If the child is younger than a year old, it is important to quickly reestablish the bedtime rituals and sleep patterns that worked best before the move. This may involve being firm and ignoring any protest crying that may have evolved from the irregularity and inconsistency during the move.

• Gradual Approach for Older Children: For older children, a more gradual approach is recommended. Fears of newness, excitement over novelty, and uncertainty regarding further changes may cause new problems, such as resistance to naps, difficulty falling asleep at night, or night waking. Reassurance, extra time at night, night-lights, and open doors can have a calming or soothing effect.

• Use a Kitchen Timer: For older children, consider using a kitchen timer to control the amount of extra time spent with the child at night. This helps the child to learn to expect that the parent will leave for the night after a predictable time period.

• Social Weaning: After several days, start a deliberate process of "social weaning" to encourage a return to the child's old, healthy sleep habits by gradually reducing the duration on the timer. This should usually take no more than several days in most instances.

• Anxiety and Fear are Normal: Anxiety or fear in the child regarding a move is natural and normal, and should not unduly alarm the parent. It is important to be gentle, firm, and decisive in addressing these concerns.

Vacations and Crossing Time Zones

Here are the key takeaways from the chapter:

• Vacations with Children Require Flexibility: Vacations with children should be approached as a "semiholiday" where parents need to be flexible, forget schedules, and focus on having fun rather than intense concentration on activities.

• Jet Lag Affects Children More: Children are more sensitive to light, especially morning light, when crossing time zones, so parents should use this to help adjust their child's sleep schedule to the new time zone.

• Strategies for Adjusting to New Time Zones:

  • If arriving late at night, let the child sleep in late the next morning, but shorten naps to maintain an early bedtime.
  • If arriving in the afternoon/evening, wake the child at their normal wake-up time the next day to reestablish their regular schedule.
  • When returning home, quickly reestablish the child's normal routine, as a "reentry" period of protest is common if the transition is gradual.

• Importance of Advance Planning: Carefully planning accommodations, activities, and the child's routine can help ensure a smooth vacation, as demonstrated by Claire's parents who booked a family-friendly condo and maintained her nap/bedtime schedule.

• Benefits of Maintaining Routine: Preserving the child's normal nap and bedtime schedule as much as possible during the vacation allowed Claire's parents to have more flexibility and relaxation during the day.

• Adapting Activities to the Child: Claire's parents were able to take her to various attractions by timing her car naps and picking family-friendly restaurants, demonstrating how vacations can be enjoyable for both parents and child with some adjustments.

Frequent Illnesses

• Frequent Illnesses and Night Wakings: Illnesses, especially those with fever, can cause increased and prolonged night wakings in children. This is because the fever and pain can disrupt their normal sleep patterns.

• Parental Intervention and Learned Behavior: When parents soothe or calm their child back to sleep during these night wakings, the child can learn to associate the parental presence with returning to sleep. This can lead to the child developing a dependency on parental intervention to fall back asleep, even after the illness has passed.

• Three Options for Addressing Night Wakings: The chapter presents three options for parents to address the issue of night wakings after an illness:

  • Option 1: Continuously responding to the child's night wakings, which can lead to the child becoming more dependent on parental presence and the parents becoming sleep-deprived.
  • Option 2: Intermittently responding to the child's night wakings, which can reinforce the child's crying behavior and make it more persistent.
  • Option 3: Collaborating with the pediatrician to distinguish between serious illnesses and minor common colds, and gradually reducing parental intervention during night wakings to help the child learn to self-soothe and return to sleep independently.

• Distinguishing Serious Illnesses from Minor Colds: The chapter suggests that parents can learn to distinguish between serious illnesses, which require more intervention, and minor common colds, which do not significantly affect the child's daytime behavior and can be addressed by gradually reducing parental intervention during night wakings.

• Sleep Loss and Immune System Impairment: The chapter notes that sleep loss itself can impair the body's immune system, creating a vicious cycle where illnesses disrupt sleep, and poor sleep makes the child more vulnerable to becoming sick.

Mother's Return to Work

• Quality of Caretaker is Important, Not Biological Relationship: The chapter emphasizes that the quality of the caretaker, whether a biological parent or not, is what matters most for a child's care and development. It suggests that some adults may be more sensitive to children's needs and appreciate the benefits of regularity, consistency, and structure in child care activities, while others may not.

• Establish Sleep Rituals and Track Sleep Schedules: The chapter advises parents to write down specific instructions for sleep rituals so that the baby-sitter, nanny, or day-care provider knows what soothes the child best. It also recommends tracking the child's sleep schedule and nap patterns when cared for by someone else, and asking the nanny to keep a sleep log to monitor the child's sleep habits.

• Establish Consistent Sleep Routines: The chapter cautions against assuming that the child's sleep habits will suffer when the mother returns to work outside the home. It suggests using a consistent sleep routine, such as "Method A" (putting the child down for naps after soothing, whether or not the child is asleep), to help the child learn to self-soothe and fall asleep.

• Create a Familiar Sleep Environment: To help the child sleep better during natural room changes, such as vacations, moves, or bringing the child to the parent's workplace, the chapter recommends creating a familiar sleep environment by using specific cues, like the same bumper pads, music box, stuffed animal, or a spray of perfume, only at sleep times. This can help the child associate these sensations with falling asleep and reduce the disruptive effect of new surroundings.

• Avoid Disrupting the Child's Sleep Routine: The chapter cautions parents against letting guilt about being away from the child during the day cause them to keep the child up too late, reinforce night wakings for private time, or induce nap deprivation on weekends. It emphasizes that the child needs consistent sleep, just as they need consistent food, and that household chores or social events should not rob the child of unstructured, low-intensity playtime.

Home Office

Here are the key takeaways from the chapter:

• Balancing Work and Baby Care: Parents who work from home need to make compromises between their own needs, the baby's needs, and the expectations of any hired caregivers. It can be challenging to focus on work while hearing the baby cry and wanting to attend to them immediately.

• Establishing a Routine: It's important to start early in respecting the baby's sleep needs and avoiding an overtired state. Introducing a single bottle of expressed breastmilk or formula around 2 weeks old can help the baby adapt to taking a bottle, providing more flexibility.

• Benefits of a Home Office: Working from a home office allows parents to be more attuned to the baby's sleep needs, establish good sleeping habits, and provide early bedtimes. It also enables breastfeeding for longer periods and more participation in the child's activities.

• Productivity Advantages: Working from a home office can lead to increased productivity due to fewer interruptions, no meetings, and the ability to work uninterrupted during the baby's nap times.

• Challenges of a Home Office: Unexpected issues can arise when the caregiver is not available, and parents may miss out on office social interactions. Setting up a mini-nursery in the office is generally not recommended, as it is difficult to attend to the baby's needs while also conducting business.

• Exceptions: The only exception to the challenges of working from home with a baby may be when both parents are working together, with one always available to attend to the baby's needs.

Dual-Career Families

• Overtiredness in Dual-Career Families: When both parents work outside the home, children may be put to bed too late, leading to overtiredness. This can happen because the child is picked up from daycare late, the daycare doesn't maintain a good sleep routine, or parents want to play with the child before bedtime.

• Consequences of Overtiredness: Overtiredness leads to increased irritability, fussiness, and short temper in children. It can also cause bedtime battles, night waking, and other sleep-related issues that parents may mistake for other problems like teething or separation anxiety.

• Importance of Early Bedtime: To prevent overtiredness, parents should put their child to bed earlier, even if it means the child has less time with them in the evening. This will help the child get better quality sleep and be more rested during the day.

• Sleep Begets Sleep: Contrary to the fear that an earlier bedtime will lead to an earlier wake-up, it actually helps the child sleep better and longer. An earlier bedtime can also help regulate naps, leading to a more restorative afternoon nap.

• Balancing Work and Family Time: Parents may feel they are missing out on time with their child by putting them to bed earlier, but the child's needs for adequate sleep should take priority. Parents can try to coordinate with the other caregiver to ensure the child's bedtime routine is maintained, even if one parent comes home later.

• Maintaining Routines on Weekends: Dual-career families may struggle to maintain the child's sleep routine on weekends, leading to severe overtiredness. It's important to respect the child's need for naps and quiet time, even when there are errands or other activities to be done.

Adoption

• Biological vs. Social Influences on Infant Sleep Patterns: Infants' sleep patterns are initially influenced by powerful biological or genetic forces, but as they grow older, their sleep patterns begin to reflect more of the social circumstances of their family and culture. The child's biological sleep needs may or may not be met by their experiences.

• The "Weissbluth Method" for Establishing Healthy Sleep Habits: The parents in the story had successfully used the "Weissbluth method" to help their biological son, Charlie, develop excellent sleep habits. This method involves consistent nap times and an early bedtime, which helps the child avoid becoming overtired.

• Challenges in Establishing a Sleep Schedule for an Adopted Child: When the parents adopted their daughter, Carina, they faced difficulties in getting her on a consistent sleep schedule. Carina was initially resistant to sleeping in a crib and being alone, and she would cry and resist nap times.

• Persistence and Consistency in Implementing the Sleep Schedule: Despite the initial challenges, the parents persisted in following the "Weissbluth method" and worked closely with their pediatrician, Dr. Weissbluth, to get Carina on a reasonable sleep schedule. This involved putting her down for naps at specific times and sticking to a consistent bedtime.

• Recognizing and Responding to Carina's Sleep Signals: As Carina settled into her new home, the parents learned to recognize the different sounds she made when she was settling back to sleep versus when she was in distress. They also learned to leave her alone when she woke up in the middle of the night, as this was often just a normal part of the sleep cycle.

• The Positive Impact of Healthy Sleep Habits: Once Carina's sleep schedule was established, the parents observed that she became a much happier and more affectionate child. Her healthy sleep habits also helped her bond with her new family, including her older brother, Charlie.

Injuries

• Preventable vs. Nonpreventable Injuries: Preventable injuries, such as falls from changing tables, poisonings, and electrical shocks, occur due to parental neglect or lack of forethought. Nonpreventable injuries, such as those resulting from natural disasters, are truly accidental.

• Accident-Prone Children: Studies have shown that "difficult" babies, who are irregular, low in adaptability, initially withdrawing, and negative in mood, are more likely to suffer cuts requiring stitches during the first two years of life compared to "easy" babies. This is likely due to the fact that "difficult" babies sleep less, leading to increased activity, excitability, impulsivity, inattention, and distractibility.

• Fatigue and Injury: Chronic fatigue, often caused by insufficient sleep, can lead to more injuries, such as cuts and falls, in children of all temperaments. Children who frequently wake up at night are more likely to require medical attention for injuries compared to those who sleep through the night.

• Parental Supervision and Sleep Patterns: Parents who do not ensure their children's sleep needs are met may also be less likely to supervise their children's play, leading to increased risk of injuries. Addressing a child's sleep issues may be more important than medical interventions, such as CT scans, for minor injuries.

• Preventing Falls from Bunk Beds: Falls from bunk beds can be serious, but most can be prevented by always using side rails in the upper bed and removing the bed ladder when not in use.

Overweight, Exercise, and Diet

• Overfeeding as a response to fussiness can lead to obesity: The chapter suggests that some parents may respond to their children's fussiness by feeding them, which can quiet the child but also set the stage for obesity later in life. This is because the child's fussiness may have an evolutionary basis in ensuring survival during times of food scarcity, but in modern times, it leads to overfeeding and excessive weight gain.

• Misattributing crying to hunger instead of fatigue can lead to overfeeding: The chapter notes that in the author's pediatric practice, "fat babies are almost always overtired babies" whose mothers incorrectly attribute their crying to hunger rather than fatigue, leading them to overfeed their children.

• Transitioning from nutritive to non-nutritive feeding can contribute to obesity: The chapter explains how some children may start "recreational feedings" with bottles or breastfeeding as a pacifier, leading to excessive calorie intake and weight gain, rather than eating solid foods when they are older.

• Overtiredness in children is linked to increased risk of overweight and obesity: The chapter cites evidence that "the more tired the child is, the more likely it is that he will be overweight or obese" in the 5-7 year old age range.

• Bottle-feeding before sleep is not inherently problematic: The chapter states that using a bottle to comfort a child before sleep is not harmful, as long as the rate of weight gain is not too fast, the bottle is not propped, and it is not part of a larger sleep problem.

• The effects of exercise on sleep are complex: While exercise is often assumed to improve sleep, the chapter notes that strenuous exercise, especially in teenagers, may actually mask an underlying problem of insufficient sleep, leading to a "twilight zone" of drowsiness, impairment, and emotional dysregulation.

• The link between diet and sleep is not well-established: The chapter states that while diet should influence sleep by providing the chemical building blocks for neurotransmitters, studies in infants and adults have not shown a strong link between sleep and diet.

Child Abuse

• Crying as a Trigger for Child Abuse: The chapter acknowledges that when parents are extremely tired and their baby's crying at night becomes difficult to manage, they may experience intense feelings of anger, resentment, or a desire to "shut the baby up." This can make the crying baby a potential target for abuse or even infanticide.

• Nighttime Crying and Infanticide: The chapter states that historically, the situation of a crying infant who refuses to sleep at night has been a setup for infanticide. This highlights the dangerous connection between a baby's persistent crying and the risk of harm from a parent.

• Acknowledging Difficult Emotions: The chapter encourages parents to be honest with themselves and acknowledge that they may have experienced the urge to "get even" or "shut the baby up for good" when dealing with a relentlessly crying infant. This admission is important for parents to recognize their own limits and seek help.

• Seeking Help: The chapter provides contact information for two organizations, the National Committee to Prevent Child Abuse and Parents Without Partners, as well as suggesting reaching out to social workers or the pediatrician. This emphasizes the importance of parents seeking support and assistance when they are struggling with the challenges of caring for a crying, sleep-deprived infant.

• Sleep Deprivation and the Need for Help: The chapter acknowledges that it is difficult to solve sleep problems when the parents themselves are extremely sleep-deprived. This underscores the importance of parents recognizing their own need for help and support during these challenging times.

Competent Parents, Competent Child, by Karen Pierce, M.D.

Here are the key takeaways from the chapter:

• Parenting is both rewarding and challenging: The role of a parent is the most rewarding job, but also the most challenging one. Raising children requires hard work, and parents' competence gradually improves through this process.

• Competent parenting teaches competence to the child: As parents become more competent, they teach that same competence to their child. Maturation does not happen effortlessly, and parents play a crucial role in developing their child's competence.

• Setting limits is an important part of loving parenting: Loving our children includes introducing and teaching them to live with frustration. Saying "no" to a child is just as important as loving them unconditionally. This early training helps children later in life when learning other skills.

• Discipline means "to teach": The word "discipline" has harsh connotations for some parents, but it actually means "to teach." Teaching and setting limits is an act of love, as it helps children develop and thrive.

• Balancing love and limits is challenging: Parents may struggle to balance their love for their child with the need to set clear limits and boundaries. There is a concern that setting limits may "break their child's spirit," but this is a misunderstanding. Effective structure and routine are essential for children's development.

• Pediatricians may provide limited advice: The chapter provides an example of a parent seeking a child psychiatrist's advice, as the pediatrician had simply suggested "letting the child cry to train him to sleep." This limited advice highlights the need for more comprehensive support for parents.

Self-esteem

• Self-esteem Development: Self-esteem stems from the experience of competence and appropriate functioning. It is a genuine sense of one's self as worthy of nurturing and protection, which allows for growth and development. As self-esteem is reinforced, a sense of competence leads to further increases in self-esteem, creating a positive spiral.

• Parenting and Competence: As parents gain experience and knowledge, their competence as parents increases. This is evident in the ease with which they can answer questions like "When do I feed him?" or "How do I stop this crying?" as they have more children.

• Infant Capacity and Exploration: Infants are born with the capacity to organize experience and progress to higher levels as they mature. Their brains are programmed to work toward competency and efficiency, and this ability expands as they experience more situations and develop the capacity to tolerate a wide range of stimuli. However, all exploration must be done in the context of a loving caregiver.

• Emotional Attunement: Emotional attunement is a three-step process where the caregiver matches, labels, or identifies the infant's internal feeling state, recognizes that the internal feeling state is different from the overt behavior, and responds to convey emotional resonance. This helps the infant become more organized, learn cause and effect, and feel more competent.

• Infant Variability and the Baby-Caregiver Unit: Babies vary in their endowment and maturation rates, which creates differences in how they experience initial and subsequent events. The baby-caregiver unit is formed with the unique endowments of both the baby and the caregiver, and this powerful unit brings changes to all parties involved.

• Separation Anxiety: The chapter explores the mother's own separation anxiety when it comes to putting her daughter to bed, as she is reluctant to let go and separate from her. This realization helps the mother understand her own role in the bedtime routine and the need to encourage a healthy transition from day to night for both herself and her daughter.

Good-Enough Parenting

• Parental Confidence: Parental confidence can make the parenting job much easier, even despite the inevitable problems and pitfalls of child rearing. This means that parents should not strive for perfection, as there is no one style of parenting that is perfect.

• Mistakes and Learning: Parents will inevitably make mistakes, but it is the pattern of daily response, not the moment-to-moment response, that a baby internalizes and forms memories of. Missing one signal in an infant's life will not cause permanent damage as long as the parent learns and does not repeat the same mistakes.

• Emotional Microenvironment: The emotional microenvironment is growth-promoting or growth-inhibiting, depending on the caregiver's ability to read her child's affective state. Maintaining a child's arousal within a moderate range that is high enough to maintain interactions but not so intense as to cause avoidance or distress is important.

• Secure Attachment: A child must have the conviction that her surroundings are secure, providing pleasure and satisfaction while preventing or balancing anxiety. Babies who are securely attached to their caregivers respond more positively to peers and teachers later in life.

• Frustration Tolerance: Babies need to learn to tolerate frustration and learn self-soothing techniques to calm themselves and prepare them for life's inevitable obstacles. Gentle limits are the way to do this, as parents need to step away at times to promote growth.

• Projecting vs. Attunement: It is important to remember that a baby may not be feeling or experiencing what the adult feels. Adults have a tendency to project their own feelings onto the baby and not really listen to or attune to their baby's needs.

Development of Internal Controls

• Infants learn internal regulation: Infants learn to balance inhibitory and excitatory control through the routines and regularity of their environment. This helps regulate their physiological needs like hunger, thirst, sleep, and tactile stimulation.

• Healthy emotional development requires appropriate regulation: Healthy emotional development occurs when the family appropriately regulates the infant's developmental tasks. As parents regulate the infant, the infant internalizes this as self-regulation.

• Scaffolding and gradual withdrawal of support: When adults provide the necessary skills to help an infant complete a task, they increase the child's knowledge to a higher level. However, this support is gradually withdrawn so the child can function independently.

• Crying as communication, not just distress: Babies cry to communicate their needs, not necessarily to signal distress. Calming a baby leads to positive attachments and feelings of safety, and crying can be a signal for the mother to come and play.

• Balancing frustration and comfort for self-soothing: There are various ways to help babies learn self-soothing, such as waiting before picking them up, providing objects or blankets, and using soothing words. The key is creating a balance between frustration and comfort, as too much frustration is disorganizing, but no frustration prevents the child from learning.

• Rudimentary steps to self-regulation: The methods used to help babies learn self-soothing are the beginning of a journey in teaching the child self-regulation. These steps lead to less fussiness and crying, and maximize the baby's growing competence and self-control.

Saying No Helps Your Child

Here are the key takeaways from the chapter:

• Discipline means teaching, not humiliation: Discipline should be done with reason and firmness, in a positive and loving environment, to teach the child rather than shame or punish them.

• Setting limits is important from an early age: Even infants can learn routines and self-soothing techniques through simple actions like waiting to pick them up or speaking slowly. This lays the foundation for setting limits as the child grows.

• Parents are in charge, not a democracy: Families are not democracies where children have an equal say. Parents must take charge and make decisions in the best interest of the child, even if it causes distress.

• Limits should be clear and consistent: Limits should be presented simply and in advance so children know what to expect. Parents must stand firm on these limits, just as they would with a seatbelt law.

• Behavior can be modified: Understanding the behavior is the first step in changing it. Techniques like showing soothing methods can help modify a child's behavior, rather than just telling them "don't do that."

• Saying "no" is important, even for older children: It's never too late to set limits. The example of the 13-year-old girl who had never been taught to sleep through the night shows how important it is to set limits, even for older children.

• Limits provide a sense of protection: If a positive and protective environment has been established, the child will see limits as an extension of that protection, not as punishment.

• Limits build competence and positive relationships: Enforcing limits, even if difficult in the short-term, can lead to renewed energy, positive relationships, and a sense of accomplishment for both the child and the parents.

My Child Has Sleep Problems. What Do We Do Now?

Here are the key takeaways from the chapter:

• Sleep Disruption is a Habit, Not a Cry for Help: If a child's sleep disruption persists for more than several nights, it has become a habit and is no longer a cry for help. The parent should recognize this and gently introduce limits.

• Avoiding Sleep Training is Counterproductive: The longer a parent delays correcting a child's sleep problem, the more difficult it will be to remedy. All developmental steps involve some frustration and difficulty, and a child's brain needs order and predictability to develop properly.

• Letting a Child Cry is Not Punitive or Withholding: Letting a child cry during sleep training is not damaging or neglectful. It is a necessary part of teaching a physiological need, like sleep. Infants and young children do not appear to remember crying spells, but they do remember repeated behaviors from caregivers.

• Sleep Training Requires Parental Support: Parents need to support each other in training their children to sleep. The process can be difficult, but the parent's goal is to reward good behavior (sleeping) without inadvertently rewarding poor behavior (waking).

• Awakening is Not a Signal of Unmet Needs: It is a common misbelief that a child's awakening is a signal of unmet psychological needs. This leads to parental guilt and blame, which should be stopped immediately.

When Other Issues Get in the Way

• Challenging Children: Some children are born with difficult temperaments, such as excessive crying, sleep problems, and extreme reactions to stimuli. Raising these children can be stressful for parents, leading to feelings of frustration, exhaustion, and short-temper.

• Parenting Strategies for Challenging Children: The key to parenting challenging children is to be more flexible, leave more time for transitions, and repeatedly set and enforce limits. These children may not respond immediately, so parents must be patient and avoid power struggles.

• Children with Learning Deficits: Some children may have deficits in their learning processes, such as auditory processing issues or difficulty reading nonverbal cues. Parents need to find ways to compensate for these deficits and still teach their children frustration tolerance.

• Parental Issues: Unresolved personal issues in parents can interfere with effective parenting. This includes the inability to read a child's signals, a desire to avoid strict parenting, and a tendency to keep a child in a certain developmental stage to meet the parent's own needs.

• Marital Issues: Babies can disrupt the equilibrium of a family, and the lack of emotional support and conflict between parents can negatively impact a child's development. Mothers may become overinvolved, and fathers may withdraw, both of which can be damaging to the child.

• Bedtime Routines: Establishing a consistent bedtime routine with clear limits, such as using a kitchen timer, can help parents and children transition to bedtime more smoothly. This can improve the child's sleep, mood, and appetite, as well as provide more quality time for the parents.

• Separation Anxiety: Some parents, like Esme's mother, may have separation anxiety and struggle to set boundaries, wanting to prolong bedtime interactions. Recognizing and addressing this issue can help parents establish healthier boundaries and routines.

Proper Association with Falling Asleep (Richard Ferber's Theory)

• Proper Association with Falling Asleep: Children associate certain conditions, such as being held, rocking, or lying on a sofa, with falling asleep. When these conditions are missing in the crib or bed, the child has difficulty returning to sleep.

• Ferber's Progressive Approach: This approach involves gradually increasing the time before responding to a child's crying at night. The parents start with a 5-minute delay, then return to the room for 2-3 minutes without picking up the child, and repeat this process with increasing delay times (10 minutes, 15 minutes, etc.) until the child falls asleep.

• Reassuring the Child: The brief interaction between the parents and the child during the delay periods is thought to reassure the child that all is well, even though the parents are not providing the usual sleep-associated conditions.

• Consistency and Repetition: The progressive approach is repeated over several nights, with the delay times increasing each night (e.g., 10-15-20 minutes, 15-20-25 minutes, etc.). This helps the child learn to associate their bed or crib with falling asleep and returning to sleep.

• Challenges in Maintaining the Schedule: The author notes that it can be very difficult to maintain a consistent schedule, especially in the middle of the night, due to frustration and exhaustion. This can make it challenging to follow the progressive approach as intended.

Unrestricted Breast-feeding and the Family Bed (William Sears's Theory)

• Unrestricted Breast-feeding and the Family Bed: The author, William Sears, advocates for these practices as the way to get babies and children to sleep, which he refers to as "attachment parenting" or "natural mothering".

• Criticism of Sears's Approach: The author of the commentary criticizes Sears's approach, stating that it is based on a strong personal opinion rather than scientific evidence, and that it ignores individual differences in temperament, parental experience, and age-specific sleep patterns of children.

• Psychological Terminology: The commentary criticizes Sears's overreliance on vague psychological terms and unsupported psychological mechanisms to advance his cause, such as the idea that "an unfulfilled need is never completely erased".

• Lack of Scientific Evidence: The commentary points out that there is no good scientific study that supports Sears's recommendation to use the strong hypnotic prescription drug chloral hydrate to "knock out" a child if "natural methods of nighttime parenting" fail.

• Bias in the Source: The commentary notes that the original book was published by La Leche League International, a breast-feeding support group, which suggests a potential bias in the presentation of the information.

• Balanced Approach: The commentary acknowledges that the author, as a father and pediatrician, supports breast-feeding, but argues that there is more to being a good parent than just the method of feeding.

Summary

• Importance of Prevention and Treatment: The chapter emphasizes the importance of focusing on the prevention and treatment of sleep problems, rather than just addressing naps and schedules. Healthy sleep habits involve more than just not waking up at night.

• Parental Responsibility: Children often develop poor sleep habits due to parental mismanagement, such as too much attention, irregularity, or inconsistency in bedtime routines. Accepting this responsibility is the first step in developing a treatment plan.

• Gradual vs. Abrupt Approach: The chapter discusses the pros and cons of a gradual, "fading" approach versus an abrupt, "cold turkey" approach to addressing sleep problems. The choice depends on the parent's resolve and the available external support.

• Partial Success and Inconsistency: Many parents start with a gradual approach, see partial success, but then get worn down and become inconsistent. This can lead them to shift to a more abrupt approach.

• Underlying Stresses: Some parents cannot even start to correct their child's sleeping problems because the same personal stresses that created the unhealthy sleep habits in the first place are still present, such as the child's emerging independence, marital discord, and other parental problems.

• Courage and Commitment: To maintain or develop healthy sleep habits for a child, parents need to have the courage to do what is best for the child. With time and commitment, this can lead to a loving home, a happy and well-rested child, and well-rested parents.

Discussion

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