Dennis Rosen M.D.

Sleeping Angels

Getting a toddler to fall asleep on her own

Getting a toddler to fall asleep on her own, not on the breast

Posted Apr 17, 2009

A reader wrote, in response to my last post:

Any suggestions about what to do with an almost 2 year old who still needs to falls asleep while nursing on mommy's breast. Isn't 2 years old too old for the Ferber Method?

My answer is: it depends. What I would ask is, is this arrangement satisfactory for the members of the family unit involved? If everyone is happy, why change it (a variation of the "if it ain't broke don't fix it" rule)? If, on the other hand, it isn't working (the nursing is taking up too much time, is interfering with her being able to sleep properly, or disrupting her interactions with the other members of the family), it is time to make changes.

The "Ferber Method" (or modified behavioral extinction) is sometimes misunderstood, and seen as heartless and cruel. In fact, what it does is allow the ground rules governing the interaction between the child and his parents while falling asleep to be rewritten, teaching the child to self soothe instead of relying on external stimuli (being held, rocked, stroked, nursed) to fall asleep, while at the same time reassuring the child that the other parameters of the relationship have not changed (hence the frequent checking in on the child, to reassure him that he has not been abandoned). It is similar to parenting strategies employed for other aspects of childrearing (not rewarding temper tantrums in a toy shop with the latest video game, for example).

While most people would not recommend modified behavioral extinction in children younger than 3 months, there is no upper age limit, though the strategies and methods do change in accordance with the child's age and developmental stage. A 2 year old who sleeps in her own bed, and who can run out of the bedroom at will, might need a gate installed at the door to reinforce the message that she needs to stay in her bed and go to sleep even though her mother is not lying down beside her. An older child might need a reward system put in place that will enlist his active cooperation in changing the sleep associated behaviors. Combining the behavioral interventions with a consistent sleep schedule (so as to marshal the circadian, or inner clock, drive to sleep), the establishment of fixed bedtime routines (bath, pajamas teeth brushing, stories, kiss goodnight, lights out), and the allowing of an age appropriate amount of total sleep time will usually succeed in bringing about the hoped for changes in a relatively short period of time.

In the example given by the reader, a good strategy might include putting the child on a regular, age appropriate schedule, moving up the last nursing to at least an hour before sleep time, establishing a regular bedtime routine, installing a gate at the doorway, and frequent checking in with the child during the adjustment phase to reassure him that his parents are still present. It is extremely important that both parents be in agreement about the plan support each other during its implementation. Nothing is more certain to lead to failure than mixed messages and inconsistent behavior by the parents.

Best,

Dennis

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Dennis Rosen, M.D.

Learn how to help your child get a great night’s sleep with my new book:

The Harvard Medical School Guide to Successful Sleep Strategies for Kids: Helping Your Child Sleep Well and Wake Up With a Smile!

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