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Most of us just dont have the patience to read through something on the
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Introductory
Materials
Copyright Notice
2001 Franklin Miami Publishing, LLC
All rights reserved.
Any unauthorized use, sharing, reproduction or distribution of these materials by any means, electronic,
mechanical or otherwise is strictly prohibited. No portion of these materials may be reproduced in any
manner whatsoever without the express, written consent of the publisher.
Published under the Copyright Laws of the Library of Congress of the United States of America, by:
Franklin Miami Publishing, LLC
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Legal Notice
While all attempts have been made to verify information provided in this publication, neither the author
nor the publisher assumes any responsibility for errors, omissions or contradictory interpretation of the
subject matter herein.
This publication is not intended to be used in place of proper medical advice. Often, pediatric sleep
disorders are caused by medical problems, and appropriate medical advice from a licensed doctor should
be sought for any medical problem or perceived medical problem.
The purchaser or reader of this publication assumes responsibility for the use of these materials and
information.
While this publication does provide analysis and opinion regarding the sleep methods of other sleep
experts, this analysis is designed to be informational only. Any perceived negative remarks about any
individuals or organizations are unintentional.
Additional Information
Amazing Baby Sleep Secrets:
The Ultimate Guide to Baby Sleep
Latest Update - March 1st, 2001 - Version ABBS103
Thank you for ordering Amazing Baby Sleep Secrets. If you paid for this
book by credit card, your statement will show a charge from FRANKLIN
MIAMI PUBLISHING, LLC please make a note of this.
I welcome any comments (or questions) you might have. I can be reached
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Contents
INTRODUCTORY MATERIALS
Copyright Notice ...............................................................................................................3
Legal Notice .......................................................................................................................3
Additional Information ....................................................................................................4
Contents ...............................................................................................................................5
Chapter Five: The American Academy of Pediatrics and Dr. George J. Cohen
Background on Dr. Cohen and the AAP.............................................................................35
Introduction to the AAPs Ideas .........................................................................................36
A Little More Sleep Science ...............................................................................................36
Newborns Through Three Months......................................................................................37
Three to Six Months............................................................................................................38
After Six Months.................................................................................................................38
How to Deal With Nighttime Crying in Infants and Toddlers............................................39
Other Sleep Issues and Suggestions....................................................................................40
Section I:
An Introduction to
Infant and Toddler
Sleep Patterns
and Issues
Chapter One:
Infant and Toddler Sleep An Introduction
He/She Issues
Whats Normal?
Although
Night Sleep:
Mid 80% Range and Midpoint
At Six Months
At One Year
At Two Years
1 (1-2 hours)
At Three Years
Section II:
The
Experts Analyzed
Chapter Two:
Dr. Richard Ferber, M.D.
Background on Dr. Ferber
Dr.
http://www.childrenshospital.org/neurology/sleep.html.
If you find any other links to Dr. Ferber, or if you find contact information that he would like to
make publicly available, please drop me an email at babysandman@fmpllc.com.
gradually increase
In
explaining
the
importance of sticking with a consistent
plan, Ferber points out a common mistake
and easy trap for new parents. Many parents
will let a child cry for a period of time, but
then go in to rock her to sleep (following
only steps 1-3 and part of 4, but not the rest
of 4 and 5). In this case, he says you have
just caused her needless trauma, as she has
not learned anything about falling asleep on
her own.
In other words, you and your baby will be
better off sticking to one method than
bouncing around.
Cosleeping
Dr.
Daytime Routines
In
Medical Issues
Dr. Ferber offers a list of general points to keep in mind when determining the causes of your
childs sleep problems. Here are some highlights from his analysis:
If your child cries out at night but quickly quiets when you return and provide the same
associations that were there when she went to sleep, she has learned sleep associations
that require your presence. To resolve this, make sure your baby is falling asleep on her
own, not with you there all the time.
If you are using things like rocking to put your baby to sleep, and she is not waking up in
the middle of the night, then its okay to continue. Probably your child has learned
different associations for returning to sleep than she had for going to sleep.
If your child cries so hard that she throws up, respond immediately. Clean it up, but then
leave so as not to encourage this as purposeful behavior.
Even once your child has learned proper associations, there will be disruptions. These can
span the spectrum including travel, visitors, teething, medical problems or something like
moving from crib to bed. In these cases, you may need to work a bit to reestablish the
patterns
If your child is falling asleep at nap time on her own but needs you at night, the process
will probably go more quickly, as she already knows how to fall asleep on her own.
It is very important that you follow through consistently with your program if you want
consistent results.
If your child is sleeping normally, but at the wrong times, it may be necessary to modify
daytime routines (see section below on this) and to gradually shift her over to the right
time. If the times are close, remember the twenty-five hour natural schedule and adjust
the schedule by shifting your babys sleep time later until it reaches the desired time.
Amazing Baby Sleep Secrets Page 23 Available at
http://www.fmpllc.com/babysandman.html
Early waking can be caused by too early of a nap in the daytime. It may also be caused by
a habit of feeding immediately upon waking. Sometimes, it is just a problem with getting
back to sleep for that one last cycle, in which case you need to pay careful attention to
environmental conditions (light and noise in particular).
If your child is sleepy long before bedtime, she is probably overtired. She may not be
getting enough or long enough naps, or she may need more sleep at night. He
recommends starting by consulting his table of sleep requirements for some guidelines.
As you can see, Ferber has a lot more to offer than just the progressive waiting approach, but
this is a key element of his discussion. He has many followers, and I believe has some valuable
lessons, but read the next chapter for the other side of the story.
Chapter Three:
Dr. William Sears, M.D.
Background on Dr. Sears
William
Dr. Sears has an extensive set of web pages at http://www.askdrsears.com. If you would like to
take a quick jump to his resources related to sleep problems in infants and children, go here:
http://www.askdrsears.com/html/7/T070100.asp.
You
As
Dr.
Chapter Four:
Dr. T. Berry Brazelton, M.D.
Background on Dr. Brazelton
T.
http://www.brazelton-institute.com/. This is
a unit at Childrens Hospital in Boston.
If you didnt notice, yes, this is the same
hospital that employs Dr. Ferber. I cant
help but think that Dr. Ferber has been a
major influence on Dr. Brazelton, especially
in recent years.
Before
The
demonstrates
an
understanding
and
is so vital to the decisions they will make
sympathy for the Sears side as well. Part of
about not just sleep problems, but all
this, he admits, is driven by the fact that we
childcare issues, Dr. Brazelton urges parents
most of us (i.e. most of the people who
to start by analyzing their feelings about
would be reading his book) live in a society
independence. He emphasizes that, in many
that fosters the idea that
cases, it is better for
A
good
relationship
between
self-reliance is necessary to
parents to be unified in
self-esteem.
an imperfect set of
her
parents
is
probably
more
beliefs than for them to
Lastly, he, at least in part,
be divided, even if one of
critical to a childs
addresses one question that
the parents beliefs are
Dr. Sears does not seem to
more helpful in getting
development than her
fully answer. If you are
baby to sleep. As he
sleeping arrangements.
going
to
choose
a
states it, A good
cosleeping arrangement, at
relationship between her
what age should you
parents is probably more
-Dr. T. Berry Brazelton, M.D. transition your child to her
critical to a childs
own room and bed?
development than her
According to Dr. Brazelton, in cultures that
sleeping arrangements. touchpoints, p. 387.
encourage cosleeping, such as India and
Mexico, this typically occurs when the child
In the end, Brazelton comes out on the
is two or three years old.
Ferber side of the argument, but he
Dr.
Miscellaneous Extras
Chapter Five:
Dr. George J. Cohen, M.D., F.A.A.P.,
as Editor-in-Chief
for the American Academy of Pediatrics
Background on Dr. Cohen and the AAP
George
http://www.nlm.nih.gov/databases/freemedl.html.
During
This
Although
In
1998 (Actual)
2010 (Goal)
64%
75%
At Six Months
29%
50%
At One Year
16%
25%
Chapter Six:
Joanne Cuthbertson and Susie Schevill
Background on the Authors
Book Introduction
The
The
Again, the
Chapter Seven:
Gary Ezzo
Background on Mr. Ezzo
Gary
http://www.gfi.org/GFI/about/ezzo.html.
In addition, it is worth noting that,
presumably in response to some criticism of
their works, they have posted a web page
specifically comparing the recommendations
http://www.gfi.org/GFI/articles/babywise.html.
The comparisons shown reveal that most of
Ezzos recommendations are very similar to
the AAPs. Notably absent from this page,
however, is a comparison of the issue about
when to start sleeping through the night. In
my latest version of the AAPs Guide to
Your Childs Sleep, the 1999 version, they
suggest starting to work on getting your
child to sleep through the night only if they
are not sleeping five to six hours by three
months of age. AAP Guide to Your Childs
Sleep, p. 77. Although it is not exactly clear
what Ezzo recommends here, it appears that
he is suggesting that a child three to five
months old should sleep ten to twelve hours
without a feeding. On Becoming Babywise,
p. 132. But on page 182 of On Becoming
Babywise, he states that, at thirteen weeks,
a breast-fed baby can extend his nighttime
sleep to nine to ten hours. On page 43, he
says that [h]ealthy, full-term babies
typically are born with the capacity to
achieve seven to eight hours of continuous
Although
The
7 to 9 Weeks Old
12 Weeks Old
Breast-Fed
Formula-Fed
Mr. Ezzo breaks up the babys first year into four phases, describing typical feeding patterns
during each of these phases.
Phase 1. Stabilization. Birth through week eight. During this time, Ezzo recommends a
two and-a-half to three-hour cycle from the beginning of one feeding to the beginning of
the next. About the first half-hour would be taken by the feeding, followed by about an
hour of wake time and then an hour to an hour and-a-half of sleep. For late evening and
middle of the night feedings, there would, of course, be no wake time.
Although it is easy for sleepy newborns to go to sleep while feeding, Ezzo
suggests using talking, rubbing his feet, or whatever else works to keep her awake. Once
your baby gets past her fourth week, Ezzo says she can sleep as long as she wants after
her late evening feeding. During the first four weeks, he recommends a maximum of five
hours until the next feeding.
Phase 2. Extended Night. Weeks nine through fifteen. During this time, you would
begin to stretch time between feedings, and perhaps drop some. You would also drop the
nighttime feedings by around nine weeks. Ezzo says a breast-fed baby can sleep nine to
ten hours at this age, and a bottle-fed baby can sleep up to eleven. Naps at this point may
come down to two, with a duration of around an hour and-a-half to two hours each.
Phase 3. Extended Day. Weeks sixteen through twenty-four. Somewhere during this
time you will typically begin to introduce solid foods, but you will probably still maintain
four to six liquid feedings. If your child has not dropped her third nap before now, she
will probably do so during this time period.
Phase 4. Extended Routine. Weeks twenty-five through fifty-two. This stage is pretty
much more of the same as Phase 3, but you may drop one more daytime feeding,
typically bringing the total down to four or five.
When you have decided to drop a feeding,
Ezzo suggests three different methods,
depending upon which feeding you are
planning to drop.
If you are dropping one of the daytime
feedings, he suggests you just do it,
adjusting the time between feedings
accordingly so that they are still evenly
spaced.
If you are dropping middle of the night
feedings, which Ezzo says some babies will
Chapter Eight:
Dr. Paul M. Fleiss, M.D., M.P.H., F.A.A.P.
Background on Dr. Fleiss
http://www.amazon.com/exec/obidos/ASIN/0737305479/franklinmiamipub
If you are interested in finding out more
about Sweet Dreams or in purchasing this
book, click on the link below (if you are
I was unable to find a web presence for Dr. Fleiss, but I did find a listing with contact
information at:
http://www.breastfeedingtaskforla.org/DirData2001.htm#Miracle%20Mile%20/%20Downtown
The listing is from the Breastfeeding Task Force of Greater Los Angeles Resource Directory.
Amazing Baby Sleep Secrets Page 55 Available at
http://www.fmpllc.com/babysandman.html
Chapter Nine:
Dr. Jeffrey W. Hull, M.D., F.A.A.P.
Background on Dr. Hull
Jeffrey
Dr. Hulls ego does not allow him to have anyone else (like Amazon or Barnes & Noble) sell his
video, as he is firmly convinced that the personal support he offers represent much of the value
in the video. I can tell you from experience with similar programs that 99% of the purchasers do
not ever contact him, but Im sure he could never admit this to himself. In any case, theres only
one place you can find his video, which is on his website, at www.drhull.com. If you want to
jump right to the page to order, go to http://www.drhull.com/cgi-local/shop.pl/page=Order.html.
First
Chapter Ten:
Jodi A. Mindell, Ph.D.
Background on Dr. Mindell
Jodi A. Mindell, Ph.D., is a Pediatric Clinical Director of the Sleep Disorders Clinic at Allegheny
University of the Health Sciences in Philadelphia. She holds M.S. and Ph.D. degrees in clinical
psychology, is associate professor of psychology at St. Joseph's University, and is the author of
numerous publications on the subject of pediatric sleep disorders (from the back cover of
Sleeping Through the Night).
Dr. Mindell is often quoted and interviewed in various online and offline publications, mostly
those in the parenting genre. She is the author of two books and many articles, but only one of
the books is currently in print. This book, Sleeping Through the Night, is the one she is best
known for authoring.
If you are interested in finding out more about Sleeping Through the Night, or in purchasing this
book, click on the link below (if you are logged in) or cut and paste or type it into your browser
manually when you later log in (if you are not logged in now).
http://psychology.sju.edu/faculty/mindell/web_page.html#F
and for some interesting information about her in a more conversational form, see:
http://www.sju.edu/SLEEPING_THROUGH_THE_NIGHT/about_the_author.htm.
Amazing Baby Sleep Secrets Page 62 Available at
http://www.fmpllc.com/babysandman.html
As
Chapter Eleven:
Dr. Benjamin Spock, M.D.
Background on Dr. Spock
Benjamin
I have been unable to find any web presence for Dr. Spock. If you are aware of any, please email
me at BabySandman@fmpllc.com.
Amazing Baby Sleep Secrets Page 66 Available at
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Chapter Twelve:
Dr. Marc Weissbluth, M.D.
Background on Dr. Weissbluth
Marc
Dr.
Although
Dr.
Section III:
Putting It
All Together
Chapter Thirteen:
The Baby Sandman
The Short Version (I Need Help Now)
Okay, here goes. If youre just plain desperate for help now, heres where you start. This is
organized in a few quick steps, by age. Ages are under three months old, three to eight months
old, and over eight months old. Dont forget to read Chapter One as well, no matter how old your
child is. It has the basics that are necessary for any of this to work well. They are also
summarized in a checklist at the end of this chapter.
Under Three Months Old
Theres
If
Parents
While I strongly encourage you to read this book cover to cover, the following list will give you
some highlights of the most important takeaways from the authors that were reviewed in
Chapters Two through Twelve.
Dr. Richard Ferber, M.D.
By using a methodical, progressive approach to changing behavior, you will end up with
a result that is tolerable where a cold turkey change might prove unbearable.
Your baby needs to fall asleep on her own, not in your arms. If she falls asleep in your
arms, and later wakes up in her crib, she will be confused and disoriented, which will
cause her to cry out.
In changing bad sleep habits, it doesnt have to be all or noneyou can take baby steps
towards reaching your objective.
Dr. William Sears, M.D.
Dont be too strongly influenced by any sleep expert. Make up your own mind based on
your values and what feels comfortable to you.
If you are considering cosleeping, this book offers a long list of the benefits you might
realize and of ways to handle possible criticism from others
If your childs sleep problems may be caused in whole or in part by medical problems,
The Baby Book has a lot of good, self-help medical advice. The advice is useful for some
basic diagnosis as well as for symptom relief.
make the difference between success or failure in sleep training or in many other areas of
life.
5. If your child is experiencing a temporary medical problem or other significant
temporary trauma, try not to change too much until the problem or trauma has
passed. If the medical problem is permanent, you must make some adjustments, but try
to treat your child as normally as you can. Sleep is just as important, if not more
important, to children with medical conditions.
6. Children are not all the same. A good sleep system, therefore, should recognize that
different children will react differently to different methods. The best way to find out
what works is to start with the least traumatic method and slowly work down the list
towards the methods that require more discipline. Methods that require extensive time
crying it out should only be used as a last resort, not as the starting point. Most parents
will not need to use these methods if they start off the right way early enough in their
babys life.
7. Feeding plays an important role in sleep, especially for children under six months of
age. While there may be some ways to use this in sleep training, your childs nutritional
needs should never be jeopardized for a good nights sleep.
8. Trust is much easier to break than to build. Never use methods that can damage your
bond with your child as anything other than a last resort.
9. Helping your child learn to sleep on her own by six to eight months of age is a
desirable goal. While it is never a good idea to force children to grow up too quickly, it
is not unreasonable to expect your child to sleep through the night in her own crib by this
age.
10. Consistency is extremely important to any sleep system. Although some authors
condemn others for training their children like pets, any psychologist will tell you that
all of us try to get more of what we perceive as pleasurable and avoid that which we view
as painful or unpleasant. In order to build associations with pleasure or pain, more
consistency results in a quicker learning curve. Extremely inconsistent responses to our
efforts (such as crying) cause jumbled signals in the brain, and, at the extreme, mental
illness.
11. Children are resilient. While it is important to do the least harm, it is comforting to
know that imperfect parenting still results in good kids. Strive to do your best, and learn
from your mistakes, but dont get too uptight about them. Children from all kinds of
environments have grown up to be perfectly healthy and normal.
As I state above, you may disagree one or more of these beliefs. If you do, you may decide not to
adopt part or all of my system. What I can tell you is that the system works, so consider the
impact different beliefs may have on your decisions. Weigh the pros and cons of any deviations
thoroughly before rejecting any part of the system.
Remember that this system assumes youre already doing the basics as described in Chapter One.
For your convenience, the page following this section includes a checklist for some of the basics
that you can review.
The system for naptime involves four to seven steps, depending upon how your child reacts. If
you are like most parents, your hope is that you will not have to ever go past step 4. The better
you handle the fundamentals, and the younger your child is, the more likely it is that you will not
have to get past step 4. If your child is older than twelve months, and if you have not been
following most of the fundamentals from Chapter One, you should implement them for two to
four weeks before starting this system:
1. Make sure that, if your child is going to feed/eat, this occurs before you begin the
naptime routine in step 2.
2. Use a short, consistent routine to let your child know its naptime. This routine should
occur in her bedroom, and it may involve reading a book or two, playing with a lowactivity toy, or whatever you want that doesnt take too long.
3. Put her into her crib while she is still awake. Ideally, you will learn to catch the sleep
wave that Dr. Weissbluth describes, when she is sleepy but not yet overtired. Look for a
lull in her activity or a distant look in her eyes.
4. For the first two or three days, stay in the room, but be quiet. She should be able to see
you, but try not to touch her or make any sounds. If she is going to sleep easily, you may
find that after the two or three days you can just leave the room when you first put her
down. If you try that, and she screams, return immediately and stay in the room until she
falls asleep. Proceed to step 5. If she doesnt need you there to fall asleep, youre done
with naptime training and can proceed to bedtime. Skip steps 5, 6 and 7.
If your baby cries even with you in the room, you can try caressing her a bit or speaking
to her. If this does not comfort her, and she is consistently unable to go to sleep with you
in the room, skip step 5 and go right to step 6. If this does comfort her, try to slowly
diminish the amount of this comforting that she requires, and when she no longer needs
your touch or voice, proceed to step 5.
5. If you didnt have to return in step 4, she should sleep for a normal amount of naptime
(see table on page 11 for naptime at various ages). If you had to return, you should next
try the disappearing chair trick. Each day, you will continue to stay in the room.
However, you will move your chair a little farther from your child each day. Use your
best judgment to determine how far you should move the chair, but you probably want to
be out the door within one to two weeks. Once you are out the door and out of sight, she
should be able to sleep on her own.
If she will not let you move the chair beyond a certain point, try moving in a bit and then
slowing down the moves. If this doesnt work, go on to step 6. If youve gotten out the
door, youre done with naptime for now, and you can skip steps 6 and 7.
6. In this step, you first have to let her cry a bit. When you put her down, leave the room
rather than sitting with her. If youve gotten to this step, she will probably cry when you
leave the room. Let her cry for three minutes, then return and comfort her briefly (for less
than a minute) without picking her up. Leave again. This time, wait for five minutes, and
if shes still crying, go back in. Comfort her briefly, and leave again. Wait for up to ten
minutes for her to go back to sleep. Keep returning every ten minutes until she sleeps or
until an hour has elapsed. If an hour has elapsed without her going to sleep, get her up
and do not let her sleep until her next nap time. Obviously, if she goes to sleep, let her
sleep.
The next day, start with five minutes, and then ten. The third day, start with seven. The
fourth day, start with ten. Never wait longer than ten minutes before going to your child
at this stage. Ten minutes is a long time when your child is crying.
If you have been trying this routine for two weeks with no improvement, you will have to
move to step 7. Hopefully, she has started to learn to go to sleep on her own. If she seems
to be making improvements, keep trying this step before going on to step 7. If she is
sleeping, skip step 7 and proceed to the bedtime routine.
7. This step is the end. It is almost never necessary for children under twelve to eighteen
months old, and you should not try it if your child is younger than six months. It is simple
to implement. At the end of the naptime routine, put your child down. Leave the room.
Dont go back in unless you think that something is wrong with her (other than being
upset that youre not there). Respond quickly if you think there is an emergency. If she
makes it an hour without going to sleep, get her up and do not let her sleep until her next
naptime.
The system for bedtime is the same basic system, but you should have a more extended bedtime
routine. Do not begin the bedtime routine until your child has been going to sleep on her own at
naptime for two to four weeks, unless she is under six months old. If she is over six months old,
let her attain full mastery of the naptime sleep skill before you get to the bedtime system.
Most children will adopt to sleeping on their own reasonably quickly once they have it down for
naptime. If your child had to go through steps 6 or 7 at naptime, however, you should be
somewhat more willing to get to those steps more quickly at bedtime.
Once your child is asleep, if she wakes in the middle of the night, go to her quickly and meet her
needs. Do what you need to do to get her back to sleep quickly, including holding her if
necessary. Once she locks in the ability to go to sleep on her own at bedtime, she will probably
go to sleep on her own when she wakes in the middle of the night with little effort. If she has
been consistently going to sleep on her own for three or four weeks at naptime and bedtime, but
she is still waking in the middle of the night, you will need to implement the system for the
middle of the night.
The system for the middle of the night assumes that your child is waking for something other
than an appropriately timed feeding in the middle of the night. If she is waking for twice for
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feedings until about three months or once until about six months, it is perfectly normal. You
should be able to drop the feedings as she grows.
If she is waking for attention, and not for a feeding, you will need to work through steps 5 to 7 of
the naptime routine at the waking time. Go in, briefly calm your baby, but do not pick her up.
Progressively work through steps 5 to 7 until she is sleeping on her own.
Thats the complete system. It involves up to seven steps in three different stages. It requires that
you first put the fundamentals in place. It is not complicated, but it works. Nothing is a
permanent fix, however, and dropping feedings, dropping naps, medical issues, developmental
changes or environmental changes (moving to a bed, travel, new siblings, guests) may cause
temporary sleep problems.
At these times, try to keep things as normal as possible. Return to your regular routine as quickly
as possible after the change has passed. You may need to do a mini-repeat of the system to return
her to good sleep habits, but it should be much, much easier for her to return to her good habits
than it was to form them the first time.