Andrew Katz, MD, a pediatrician with Mercy Medical Group, shares his expertise and own experience with building sleep habits in this Q&A.

Infant sleep issues can be challenging for any parent. Some children are just naturally-born "easy sleepers," and parents can’t really throw off those kids' sleep patterns, no matter what! I would say that is the case with about 5 percent of kids, or less. I like to remind parents that sometimes kids will still struggle with sleep, even if you do everything perfectly. It’s a small amount — I would say that is about 1 percent of the children I see — but it does happen.

The other 94 percent of children I see in my practice can be trained to sleep without medication. The earlier a parent starts on sleep training the better! The most important concept in sleep training is making sure the child learns to fall asleep without help, on their own.

I recommend in early infancy, before the third month of life, that parents start to put their baby in the crib while the child is still slightly awake. Then allow your child to fall asleep on his or her own. If a child just drifts off to sleep easily, then you are done (and you should do a little happy dance). If the child starts crying, there are three ways to handle it:

1. You can pick the child up and rock them to sleep. This is the choice most parents who end up with a child with sleep problems tend to choose. While it is well-intentioned, this method actually teaches the child over time that they cannot fall asleep without help.
   
   
2. You can pick the child up and soothe them until they are sleepy again (but not asleep) and lay them back down. If they start crying again, repeat this method, but always put the baby back in the crib, so that he is not falling asleep in your arms. This method works as long as the parent is more stubborn than the infant. It helps if the parent reminds his or herself that it is physically impossible to stay awake forever! It can be both mentally and physically demanding, but hang in there.
   
   
3. You can try the “cry it out” method. In other words, the parent lays the infant down to sleep and then leaves the room. The child may cry for quite a while at first, but after a few nights most children stop this and go to sleep much more easily. This method can be hard on parents because they often feel guilty for letting the baby cry. However, it has been validated in reliable scientific studies that infants who have gone through the “cry it out” method do not have long term attachment problems or psychological issues, when compared to children whose parents choose one of the first two sleep methods.

Regardless of which option a parent chooses, having the infant swaddled and using white noise in the room will generally decrease the time it takes to fall sleep, and increase sleep length. Some of the parents I see have infants with truly difficult sleep behavior. And for those kids, I sometimes suggest using a horizontal swing device where the baby can still sleep on their back. This is a good option since the motion often improves the speed of sleep onset and the length of sleep time.

Children won’t fall asleep easily if they are hungry, and they will wake up more frequently if they do not get enough calories in the daytime. To help infants sleep better, I recommend you try to increase the baby's daytime calorie intake. So when infants are 2-4 months old, I suggest parents try to wean nighttime feeds a little bit at a time and move those feeds/calories to the daytime. In other words, if a parent is feeding four ounces of formula or breastmilk at a nighttime feed, they should try decreasing that amount by half an ounce every three to four nights, and simultaneously increase daytime feeds by that amount. Then the parent can gradually eliminate that nighttime feed. If a mom is breastfeeding directly then she can just decrease the time on the breast by one to two minutes nightly, until she weans that feed and she can just increase either the length or frequency of feeds in the daytime by shortening naps slightly during the day.

Are there any sleep methods you use with your own child?

My daughter has struggled with sleep from infancy, and is very attached to her parents.  When she was younger, she would usually fall asleep in her own room, but only if a parent was there in the room with her as she fell asleep.

Recently, my daughter has been struggling with getting enough restful sleep. If she wakes up alone, she calls out for me or comes into my room. To help her get a good night’s rest, I give her melatonin.

Melatonin is helpful because children spend a lot of time in front of screens these days. Many electronic devices and electric lights emit blue light, which can throw off circadian rhythms. Melatonin is a natural hormone the brain secretes to help aid in falling to sleep, but due to the aforementioned artificial light sources it is not secreted like it should in children (and adults for that matter). Without melatonin my daughter would still fall asleep, but instead of getting 10 hours of restful sleep, she would only get maybe 8 hours. Melatonin doesn’t work for everyone – it’s one of those things that either works well right off the bat, or doesn’t work at all. 

Also, we use meditation to help my daughter get sleepy when she's having trouble winding her brain down. Short body scan meditation works well for us. You can have your child practice this meditation by asking them lay still, close their eyes, and focus on relaxing each part of their body, starting at the feet and going up. To help your child get through the meditation you can play audio that guides meditation and do the exercise with them!

Getting enough sleep each night is critical for a child's attention span, mood, and quality of life. Talk with your pediatrician about sleep tips that may work for your child. 

Andrew Katz, MD, is a pediatrician with Mercy Medical Group in Elk Grove. Dr. Katz is currently accepting new patients.

Please visit MyMercyMedicalGroup.org or call 916.667.0600 to learn more and make an appointment.