Sneaky sleep disruptors: Four questions to ask when sleep training hasn't worked . . .at all.

The parenting books make it sound so easy, don’t they? A few nights of 10-15 minutes of crying and your child will be sleeping through the night…. Or not.

And it’s not always for lack of trying. Your child isn’t sleeping well anytime, anywhere. Naps are hard, bedtime is hard. And nighttime? Don’t even ask. You’ve tried crying-it-out, pick-up-put-down, cosleeping, sleepsuits, white noise….Nothing seems to work.

As a sleep coach, I frequently see frustrated, exhausted parents who have been trying so hard. The saddest part is that they think it’s all their fault; that somehow, they are doing something wrong.

Parents, take a breath. There are some good reasons why sleep training sometimes doesn’t work, and many of them have nothing to do with what you are or aren’t doing.

Important questions to ask when you’ve "sleep trained" without success:

Is your baby younger than 6 months?

If your baby is younger than six months and you’re not seeing success with sleep training, it may be that your baby is too young. Infants under 6-months (and especially those in the throes of the 4-month regression) are going through a giant leap in brain growth. As a result, they have a limited capacity for managing distress or night waking.

It’s okay to do what works for now so you can get some sleep, and conserve your worry energy. If you can wait to work more assertively on sleep for 6-months, you may find that the process is easier and quicker. The notion that sleep behaviors in the early months become “habits” that can’t possibly be shifted, is, honestly, made up and not supported by research. There’s no research that says it’s any easier or better to start early. In fact, research on preventing sleep problems through behavioral strategies found that improvements were non-existent or very small and/or they wore off in just a short time. It’s okay to do what works for younger babies until they have a few more skills at their disposal.

How is your child napping?

Make sure you know how much naptime your child needs for their age. An overtired baby/child will have more trouble going to sleep and staying asleep. Sometimes, just getting naps at the right time will help both daytime and nighttime sleep (Click here for guides on naps and timing). Kim West (aka The Sleep Lady) suggests that if your child is really nap-deprived, try to get naps in any way that works for a while and work on bedtime go-to-sleep skills. Once your child is sleeping like a champ at night, you can work on going back to crib sleep during the day.

Also, know how long your child can stay awake for their age. By 6-months, it’s only two hours max. Even at a year, children can only manage about 3-4 hours before they need a nap. If you are waiting for sleepy signals, but not watching the clock, you may be missing those optimal windows for naptime and bedtime.

Have you been inconsistent in your efforts up until now?

If so, it totally makes sense. No judgment here. We’ve all been there...many times. If you have an intense, persistent little one, they just outlast you. You work and work and work, only to finally cave and just rock/nurse/bounce them to sleep because it’s been an hour or more of hysterics. I hate to tell you, but this is a major cause of more protest and outrage on your child’s part when you try something new. Giving up when you started out meaning business ends up biting you badly. You may need to be even MORE consistent the next time you try to work on sleep because your child doesn’t believe it’s going to stick.

Does your child have any of the following physical symptoms?

• Snoring or mouth breathing (not associated with a cold

• A sweaty head when they sleep (not associated with a warm room)

• Restlessness when they sleep?

These symptoms can point to conditions that can indicate obstructed breathing. Tonsils and adenoids can grow at disproportionate rates and cause breathing during sleep to be difficult. A check-in with the pediatrician or a pediatric ear, nose, and throat doctor might be in order.

• Kicking/thrashing at bedtime, during sleep, or in the middle of the night?

• Is your child awake for long periods at night when nothing seems to work to get them back to sleep?

• An older child who complains that their legs hurt (“growing pains”)?

• Does the child seem to want to be up off the mattress (i.e., being held) or do they stand up a lot? Does it seem like they are trying to avoid lying down?

• Do you get a hugely negative response to even the smallest attempt to change behavior?

• Is there a family history of low iron or Restless Legs Syndrome?

• Was mom anemic in pregnancy?

Low ferritin levels are a surprisingly common cause of truly bad, immovable sleep problems. Ferritin is the iron storage capacity in the blood and can “run out” as a child grows, causing significant discomfort at bedtime/nighttime and disrupting sleep architecture. Read this article on this site for more detailed info on diagnosing and treating low ferritin.

Silent Reflux Signs

For children under a year (especially under 6-months):

• Does it ever seem like they’re physically uncomfortable or in pain when lying down flat?

• Do they arch their back while nursing/feeding?

• Do they ever grimace or have gurgling sounds in their throat?

• Do they prefer to sleep on an incline (e.g., in arms, in a seat or carrier)?

• Do they only feed a little at a time?

• Do they wake up screaming?

• Do they feed best when they’re half asleep?

• Do they prefer to sleep on their side?

These are symptoms of silent reflux. Silent reflux does not involve “spitting up” and can cause pain as stomach acids bubble up. This kind of pain directly interferes with the ability to go to sleep or stay asleep. While it’s true that reflux rarely hits a child later in infancy, or those who never had reflux as a newborn, there are cases where reflux has not fully resolved, or teething/growth spurts cause symptoms to return. Food intolerance can also cause stomach distress or even itchiness that can make sleep difficult. If your child seems like they just aren’t comfortable, it’s worth consulting your pediatrician.

If none of these seem like the problem, here’s what you can do:

Pick your battles, but fight the ones you pick: In their desperation, and lack of confidence, parents may try too many things too quickly, resulting in frustration and confusion. Pick something you can really commit to, and don’t look back. It’s the waffling that throws children off.

Stick with the new routine for at least three days. If there’s any improvement at all, you’re on the right track. Know that your child may really protest at first. That’s normal because they don’t know what’s changing or why. If you can stay consistent and supportive, they will get the hang of it.

If you try for three nights and literally NOTHING has shifted, not even a tiny bit, it’s time to step back and consider if something physiological is up with your kiddo.

Really commit at bedtime: The best, easiest time to get the biggest bang for your sleep-training buck is at bedtime. Babies develop patterns for what it means to go to sleep (and therefore back to sleep). Gradually work on encouraging your baby/child to go to sleep without being rocked, nursed, held all the way to sleep. There are several approaches that work, so pick one that you can live with and stick with it.

It’s okay to go slowly. For many people, crying-it-out works and works easily. For others…not so much. The good news is, it’s not the only approach. It’s okay to go more slowly and more gradually. As long as you are consistently moving forward, it’s okay to go at a pace that’s right for you. It’s also okay to help children calm down when they need it. We want to keep them in the zone of “challenge” not “overwhelm.”

The over-emphasis on behavior (both the child’s and parents') sometimes causes important outside factors to be overlooked—and then the blame falls squarely onto parents. If any of these “sleep disruptors” are in the mix, sleep training will be hard, if not impossible. So, parents, take a breath. It’s definitely not all you.