The Research on Sleep Training a 4 month old
Hi beautiful friends! How is your day treating you?
*Trigger warning: this blog post is about sleep training. Please skip this one if you need to take care of yourself.
A mom reached out to me on Instagram this week needing some support because her pediatrician is pressuring her to sleep train and she said she's been up at night worrying about it. I asked how old her little one is and she said 4 months old.
She also said her little one is only cat napping and sleeping ‘really well’ throughout the night. If anyone says their child is sleeping well throughout the night (especially at 4 months!!!), I am VERY hesitant to suggest shifting patterns. We really have to look at sleep in 24 hour increments and understand that sleep is affected by so many things (sensory input, sleep pressure, emotions, connection, screens, milestones, etc.) Anytime you make a change to daytime sleep, nights will be affected, and anytime you make a change to nighttime sleep, naps will be affected. This is because our circadian rhythms function on a 24-hour cycle.
It's true that some children are just more of cat nappers, but at 4 months, this is ABSOLUTELY TO BE EXPECTED. There is soooo much going on at 4 months. Here's a handout about the 4-month sleep progression if you need one.
I wouldn't even expect to see strong sleep/nap patterns emerge until 5-6 months, so it's angering to me that this doctor is even bringing sleep training up and stressing this mom out. But it's not at all uncommon. Mine did too, and I hear about it alllll the time. These are our trusted healthcare professionals, and this is what the recent research says about sleep training.
There are only 7 studies done that include sleep training infants under 6 months.
2 of them were in a highly supported inpatient setting with therapists and nurses to help the moms through the process. Very different from parents at home trying to cope with this practice alone, which can be very distressing for both mom/dad/parent and baby.
4 of them didn’t distinguish the child’s ages but only said between 4 months and 52 months (4.5 years old). HUGE age range so how can we generalize.
1 study (Simon et. al. 2005) used a true graduated extinction protocol on babies - 258 babies, starting baseline at 2-3 weeks old.
In this 1 study, at 6 weeks the infants were sleeping 30 minutes more and by 12 weeks still 30 minutes more. The longest stretch of nighttime sleep increased by .1 hour longer (that’s 6 minutes!). I don't know about you, but would that be worth it?
And so then what are we ‘training’ the baby to do? I think we need to pause and ponder at what cost are we trying to ‘get’ our babies to sleep more and stop calling for us.
The bottom line is, I don't believe that we actually need research to validate what doesn't feel good in our hearts as parents caring for babies. But not only does the practice of sleep training often go against our natural instincts to respond to our babies when they call out for us, it goes against the very little evidence that we do have in the literature.
What we do know is that:
babies attach through the senses the first year of life, meaning they need to see, hear, smell, touch and taste us (if breastfeeding) in order to feel secure
babies coregulate with us - meaning they can't actually ‘self-soothe’ from a state of distress and they need the presence of a calm caregiver to help them and decrease their level of stress reactivity
it is normal and healthy for babies to wake very 2-3 hours to eat, the entire first year
that being responsive to our child's attempts to communicate with us helps establish a secure attachment and more sound emotional health as they age
and that bedsharing decreases the risk of SIDS (if done safely)
to name a few!
So that's all for now friends! My hope is always that there is something helpful for you in these blog posts. Spring is in the air here in Salt Lake City and I feel the sunshine and warmer temperatures bringing my soul back to life.