At the end of the 1970s, American pediatrician Richard Ferber published a behavioral method for childhood insomnia management ( https://en.wikipedia.org/wiki/Ferber_method), which became popular around the world. The basis of this method is the extinction of crying over a brief period. But this method is not for everyone. For this reason, other variations based more on physical attachment have been developed (Elizabeth Pantley: The No Cry Sleep Solution http://elizabethpantley.com/no-cry/sleep/At the Sleep Institute, we recognize that there is not a universal method for the treatment of all types of childhood insomnia, and that strategies must be adapted to each individual family’s circumstances.
In very general terms, the recommendations can be made: If the cause is thought to be medical, go to the specialist with the child to solve the problem.
If the cause may be learned bad sleep habits or behavioral problems, then the parents may consider consulting a psychologist or doctor specializing in these problems if results are not seen within a week of trying to implement healthy sleep habits that help the child learn to make the transition between wakefulness and sleep without the participation of the parents.
The child must learn to sleep alone, under conditions that are reproducible when he or she wakes up in the middle of the night. In some cases, deterioration will occur during the first two or three days, so it is advisable to start the treatment plan during the weekend so if the parents don’t sleep the first few nights, they can do so the next day.
- Place the child in bed or a cradle with only his or her favorite objects that can remain next to him or her during the night so he or she becomes accustomed to sleeping next to these objects and associates them with sleep. Thus, if the child wakes up in the middle of the night, he or she can fall back asleep without anyone.
- The room must be dark, quiet and a comfortable temperature.
- Parents can reassure and comfort the child until he or she is lying quietly in bed. Once the child is quiet in the bed or cradle, the mother/father must leave the room.
- If the child starts to cry, do not go to them immediately. After a few minutes (at least 2 minutes) the mother or father may return to the room to comfort the child, who should not move from the bed, until he or she is quiet (though awake).
- Then the parent should leave the room. If the child begins to cry again, the parent will wait a slightly longer time (for example, 2 to 5 minutes) before entering and repeating the previous step.
- The process must be repeated (with a waiting time of no more than 2 to 5 minutes on the first night) until the child is asleep.
It must be kept in mind that during this first night, the cry-answer process can last several hours until the child falls asleep. The plan will succeed only if parents are persistent and consistent with the “treatment” and do not give in to the temptation to take the child from his or her bed. It should involve everyone who takes care of the child to ensure consistency in the implementation of the plan.
The following nights will progressively extend the wait times before reassuring the child if he or she cries. Wait times are usually proportional to the age of the children (with older children, the wait time should be longer).
- Interventions of parents should be supportive. The child should know that they are close and understand the child.
- Parents should never externalize anger or frustration. They must not allow these emotions increase as the night progresses.
- Improvement is generally seen after the third night. The nighttime awakenings tend to be shorter, and crying is weak and brief. The child learns to fall asleep alone without the help of their parents.
It is advisable that throughout the treatment parents fill out a sleep diary to document progress. This will serve both the parents and the doctor overseeing the process. Once the child has learned to sleep alone, he or she will continue to do so in the future. However, it is possible that a slight deterioration may occur at times when regular hours are changed, such as during holidays, birthdays, etc. The persistence of these relapses will depend on the way the parents respond. If the response occurs according to the stated plan, relapses will be resolved alone and the child will continue sleeping well.