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![Important caveat before I start: I am not a doctor. I was trained in this topic by a pediatric sleep doctor/pulmonologist and have read the research, but this is not medical advice and is not meant to diagnose a condition. Please consult with your medical provider or a local pediatric sleep clinic for any concerns about low ferritin and sleep. As a sleep coach who specializes in hard problems, I often see clients only after they have tried everything under the sun and are still struggling. However, in the past five years or so, I have seen a surprising number with sleep problems so much worse than behavior (or even temperament) could explain. One client had a toddler who required mom to stand up and hold him with his legs dangling down from 12-5 a.m. every night. Every time she even tried to sit down, he screamed. Another client had a three-year-old who was bouncing off the walls at bedtime (would not lie down), taking over an hour to go to sleep, and was also awake from 2-5 a.m. every night. When they finally would cosleep, the parents reported being pummeled by repeated kicks while he was still asleep. Another client said that the only way they could get their preschooler back to sleep after each of his many wakeups was to put them in the car and drive around. All of them had tried sleep training, but the problem did not budge and worsened over time. Nearly all the hardest problems I have seen across the thousands of families I have encountered had one thing in common: low ferritin. ferritin and sleep in children The link between low ferritin and sleep The culprit in each of these cases was low ferritin, which can result in pediatric Restless Legs Syndrome. The “restless” in RLS doesn’t mean that the legs twitch. It refers to the fact that movement helps dispel the twitchy discomfort that RLS causes. Currently, diagnostic criteria prevent assessment of RLS in children younger than six or eight years. Criteria require a child to be able to verbalize that their legs hurt. Young children may not know that the sensations are coming from their body. It also does not always manifest as pain. Little ones may feel “on edge” or “scared,” but these are interpretations of the sensations in their bodies. They’re just too young to identify that. RLS is happening in younger children; practitioners just aren’t looking for it. The other issue is that practitioners are looking for “iron deficiency” which is a ferritin level of 7 or below. RLS and other sleep disruptions can occur at levels above this. Even that level of 7 is considered absurdly low by some (Abdullah et al., 2017; Mukhtarova et al., 2022). A recent paper in The Lancet: Hematology recommends a ferritin cutoff of 20 (Mei et al., 2021). Some researchers are alarmed that potentially iron-deficient younger children are being missed for sometimes years at a time (Al-Shawwa et al., 2022; Leung et al., 2020; Mukhtarova et al., 2022; Tilma et al., 2013). What is ferritin? Ferritin is a protein that stores iron in cells so that there’s not too much of it floating in the bloodstream. Ferritin releases iron as it’s needed. Ferritin is different from the amount of iron contained in the red blood cells (hemoglobin). Individuals can have enough iron in their blood, but if it’s not absorbed or stored in ferritin, the body cannot use it. Babies receive both iron and ferritin in utero, as well as at birth while the umbilical cord is pulsing (Andersson et al., 2011). These stores of iron gradually decrease over the first four to six months. Exclusively breastfed babies are supposed to receive iron supplementation. Ferritin is critical for brain functioning, memory, and nervous system development, especially in the first few years (Georgieff, 2017). Symptoms of low ferritin Low ferritin can occur in even infants and very young children. We are more familiar with the symptoms of older children because they can tell us what’s bothering them. In infants and toddlers, we only have behaviors to go on. While RLS is primarily diagnosed in older children, research has shown that in most of those cases, symptoms began in infancy and toddlerhood (Muhle et al., 2008; Picchietti & Stevens, 2008). Low ferritin is tricky to detect in younger children because it can masquerade as garden-variety bedtime protest or shenanigans. Low ferritin can masquerade as garden-variety bedtime protest or shenanigans. A child who can’t settle or is bouncing off walls may appear to be stalling, but in fact, they are really and truly uncomfortable. In my experience, about 90% of the worst, hardest sleep problems I have encountered have been due to low ferritin (confirmed by blood test). Symptoms: Sudden onset. The child was sleeping pretty well and then it went sideways, getting worse over time. Child takes a long time (1 hour+) to fall asleep at bedtime. They want to be rocked, then not rocked. They want covers, then no covers. They refuse to lie down. They just can’t get comfortable. Younger children (infants) scream to be picked up off the mattress. When holding or sitting, they need to have their legs dangling (i.e., no pressure on them.) At bedtime, lots of kicking, standing, wanting legs up on something (the wall, the side of the crib, you) to sleep. Lots of movement even when they’re asleep. (Parents who resort to cosleeping will report so much movement that they can’t sleep.) When cosleeping, they need to sleep on top of you or they need to be incredibly (too) close, often needing to touch you all night. There is a long wakeup (1+ hours) in the middle of the night. It will also seem like nothing works reliably to get them back down. Older children will say their legs feel “jumpy,” “tickly,” “prickly,” or that their legs, knees, feet hurt (growing pains are now thought to be RLS). They may say they feel “nervous,” “scared,” or that they just “can’t sleep.” Solid attempts at behavioral (sleep training) strategies haven’t worked...at all. The child wakes at night moaning, screaming, or crying, or they do this in their sleep. For infants, extreme difficulty with anything but full body contact, constant latch/nursing, etc. (i.e., baby screams if nursing stops or parent tries to move away), kicking/thumping legs (Bruni et al., 2015) Breath-holding spells (Hamed et al., 2018) Risk factors Mom had low iron, low ferritin, or Restless Legs Syndrome in pregnancy (about 20% of moms have RLS in pregnancy) No delay of umbilical cord clamping at birth (Ceriani Cernadas et al., 2010). Early cord clamping doubles the risk of low ferritin (Andersson et al., 2011; Ceriani Cernadas et al., 2010; McDonald et al., 2013) Prematurity or intrauterine growth restriction Family history of low iron/ferritin, growing pains, or Restless Legs Syndrome (Tilma et al., 2013). (In one study, 87% of the children with RLS had a parent with RLS; Muhle et al., 2008) Child has (or had) silent reflux, eczema, or food intolerance (cow’s milk, soy, etc.). These can cause gut inflammation that hinders iron absorption (Lee, 2024; Pfeiffer & Looker, 2017). Older children with a diagnosis of ADHD or ASD or suspected symptoms. It’s estimated that 50-75% of children with ADHD/ASD have low ferritin levels (Dosman et al., 2007; Kanofal et al., 2007; Kanofal et al., 2004; Wang et al., 2017). Lead exposure in the home Testing Pediatricians will often suggest testing iron levels (which is just a standard fingerstick). If iron is low, chances are that ferritin is too, but iron can be normal even when ferritin is low. The body technically depletes ferritin first, then it starts working through iron. Some researchers contend that low iron (anemia) is a late-stage indicator of iron deficiency and that we should test for ferritin more routinely and earlier (Georgieff, 2017). Ferritin testing unfortunately requires a blood draw (I know, I know. Yikes.) Results should come back quickly. Here’s another wrinkle: You can’t settle for the office telling you that ferritin is “normal.” Pediatricians’ usual threshold for “normal” ferritin (<7µg). Remember, they are only worried about “iron deficiency.” In the presence of sleep problems, sleep doctors generally want ferritin levels to be 50 µg or higher (Allen et al., 2018). If your child is experiencing significant sleep issues and the pediatrician says it's “normal,” get the actual number and then consult a pediatric sleep specialist for assessment and treatment. If your child has significant sleep issues and the pediatrician says it's “normal,” get the actual number. Also, be sure that they test ferritin. I’ve seen parents get a whole blood panel done and ferritin wasn’t tested.. Treatment Treatment for low ferritin typically involves prescription-level iron supplementation. Multivitamins with iron, over-the-counter iron supplements, or iron-rich foods will not raise levels. Doctors typically need to prescribe and oversee the dosage because incorrect iron dosing can be dangerous. (Important note: DO NOT supplement with more than the label amount of iron on your own.) The other hard fact is that ferritin levels may take several months to reach the target. However, you should see improvement in sleep behaviors before then. Most sleep doctors also want to monitor progress over time to be sure that supplementation is working. What can you do in the meantime? While you wait for iron supplementation to kick in, stretching or leg massages can help at bedtime. Magnesium lotion on the child’s feet or Epsom salts in their bath can also really help. You can also give a young one a bolster or pillow to prop their legs up on. The good news is that once levels start to rise, you should see massive differences. The toddler in my client examples went from needing to be put in the car to go back to sleep to walking to his bed, getting in, and sleeping through the night. The toddler who needed to be put in the car to go back to sleep? Once his levels normalized, he started walking to his bed, getting in, and sleeping through the night. If you feel like your child’s sleep behavior is more extreme than just a behavioral issue, get their ferritin checked. Join the Low Ferritin Parents Network Facebook group to ask questions and get support from other parents going through it. Do you have more questions or need to discuss your situation? I offer a 30-minute Zoom call to discuss low ferritin and see if it might be your culprit. Book a low-ferritin call. Have you been through the low ferritin journey? Willing to share some of this information? I’m collecting some anecdotal data to share with researchers to raise awareness. Fill out my short survey here. Frequently Asked Questions about Low Ferritin Do I need a sleep study to test this? Not necessarily, although children who have sleep apnea (snoring, mouth breathing) often have comorbid low ferritin. A sleep study will only measure movement during sleep. They diagnose Restless Sleep Disorder, which can be different. If your child does not snore or mouth-breathes during sleep, a blood test is the quickest way to check for low ferritin. You do not need a sleep study for that. Can a baby have low ferritin? The iron and ferritin that babies get before and during birth should sustain them for at least the first four to six months. Plus, trying to get the okay for a blood draw on an infant isn’t easy. However, it does happen that some infants are low on ferritin. I had one client with an 8-month-old who tested with a ferritin of 1. I usually only recommend testing infants when we have totally ruled out every other possibility, and sleep is just truly awful. In this case, I honestly recommend booking a call with me to help you figure this out. Can I just offer a multivitamin or iron drops myself? If ferritin is truly low, an over-the-counter dose won’t hurt, but it also won’t bring levels up. You could waste precious time. Ferritin plays a crucial role in nervous system development. Plus, the fractured and disrupted sleep that’s happening isn’t great for your child (or your family). I usually tell parents to start an over-the-counter supplement while they’re waiting to get a test or prescription. DO NOT give your child more than the recommended dose of iron without a doctor's prescription. I’ve heard that oral iron doesn’t always work. What then? This is true. If a child has significant gut inflammation or other metabolic issues, they may not absorb oral iron well and may actually require iron transfusions. I believe this is rare, but it does happen. This is why parents need to get a test to see how low ferritin is, and then they need to get seen by a pediatric sleep doctor or other specialist so that levels are monitored over time. References Abdullah, K., Birken, C. S., Maguire, J. L., Fehlings, D., Hanley, A. J., Thorpe, K. E., & Parkin, P. C. (2017). Re-evaluation of serum ferritin cut-off values for the diagnosis of iron deficiency in children aged 12-36 months. The Journal of Pediatrics, 188, 287–290. https://doi.org/10.1016/j.jpeds.2017.03.028 Allen, R. P., Picchietti, D. L., Auerbach, M., Cho, Y. W., Connor, J. R., Earley, C. J., Garcia-Borreguero, D., Kotagal, S., Manconi, M., Ondo, W., Ulfberg, J., Winkelman, J. W., & International Restless Legs Syndrome Study Group (IRLSSG). (2018). Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: An IRLSSG task force report. Sleep Medicine, 41, 27–44. https://doi.org/10.1016/j.sleep.2017.11.1126 Al-Shawwa, B., Sharma, M., & Ingram, D. G. (2022). Terrible twos: Intravenous iron ameliorates a toddler’s iron deficiency and sleep disturbance. Journal of Clinical Sleep Medicine, 18(2), 677–680. Andersson, O., Hellström-Westas, L., Andersson, D., & Domellöf, M. (2011). Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: A randomised controlled trial. BMJ (Clinical Research Ed.), 343, d7157. https://doi.org/10.1136/bmj.d7157 Bruni, O., Angriman, M., Luchetti, A., & Ferri, R. (2015). Leg kicking and rubbing as a highly suggestive sign of pediatric restless legs syndrome. Sleep Medicine, 16(12), 1576–1577. https://doi.org/10.1016/j.sleep.2015.07.016 Ceriani Cernadas, J. M., Carroli, G., Pellegrini, L., Ferreira, M., Ricci, C., Casas, O., Lardizabal, J., & Morasso, M. D. C. (2010). [The effect of early and delayed umbilical cord clamping on ferritin levels in term infants at six months of life: A randomized, controlled trial]. Archivos Argentinos de Pediatria, 108(3), 201–208. Dosman, C., Witmans, M., & Zwaigenbaum, L. (2012). Iron’s role in paediatric restless legs syndrome: A review. Paediatrics & Child Health, 17(4), 193–197. https://doi.org/10.1093/pch/17.4.193 Georgieff, M. K. (2017). Iron assessment to protect the developing brain. The American Journal of Clinical Nutrition, 106(Suppl 6), 1588S-1593S. https://doi.org/10.3945/ajcn.117.155846 Hamed, S. A., Gad, E. F., & Sherif, T. K. (2018). Iron deficiency and cyanotic breath-holding spells: The effectiveness of iron therapy. Pediatric Hematology and Oncology, 35(3), 186–195. https://doi.org/10.1080/08880018.2018.1491659 Konofal, E., Cortese, S., Marchand, M., Mouren, M.-C., Arnulf, I., & Lecendreux, M. (2007). Impact of restless legs syndrome and iron deficiency on attention-deficit/hyperactivity disorder in children. Sleep Medicine, 8(7–8), 711–715. Konofal, E., Lecendreux, M., Arnulf, I., & Mouren, M. C. (2004). Iron deficiency in children with attention-deficit/hyperactivity disorder. Archives of Pediatrics & Adolescent Medicine, 158(12), 1113-1115. Lee, N. H. (2024). Iron deficiency in children with a focus on inflammatory conditions. Clinical and Experimental Pediatrics, 67(6), 283–293. Leung, W., Singh, I., McWilliams, S., Stockler, S., & Ipsiroglu, O. S. (2020). Iron deficiency and sleep - A scoping review. Sleep Medicine Reviews, 51, 101274. McDonald, S. J., Middleton, P., Dowswell, T., & Morris, P. S. (2013). Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews, 2013(7), CD004074. https://doi.org/10.1002/14651858.CD004074.pub3 Mei, Z., Addo, O. Y., Jefferds, M. E., Sharma, A. J., Flores-Ayala, R. C., & Brittenham, G. M. (2021). Physiologically based serum ferritin thresholds for iron deficiency in children and non-pregnant women: a US National Health and Nutrition Examination Surveys (NHANES) serial cross-sectional study. The Lancet. Haematology, 8(8), e572–e582. https://doi.org/10.1016/S2352-3026(21)00168-X Muhle, H., Neumann, A., Lohmann-Hedrich, K., Lohnau, T., Lu, Y., Winkler, S., Waltz, S., Fischenbeck, A., Kramer, P. L., Klein, C., & Stephani, U. (2008). Childhood-onset restless legs syndrome: Clinical and genetic features of 22 families. Movement Disorders, 23(8), 1113–1121 Mukhtarova, N., Ha, B., Diamond, C. A., Plumb, A. J., & Kling, P. J. (2022). Serum ferritin threshold for iron deficiency screening in one-year-old children. The Journal of Pediatrics, 245, 217–221. https://doi.org/10.1016/j.jpeds.2022.01.050 Peirano, P. D., Algarín, C. R., Chamorro, R. A., Reyes, S. C., Durán, S. A., Garrido, M. I., & Lozoff, B. (2010). Sleep alterations and iron deficiency anemia in infancy. Sleep Medicine, 11(7), 637–642. https://doi.org/10.1016/j.sleep.2010.03.014 Pfeiffer, C. M., Sternberg, M. R., Schleicher, R. L., Haynes, B. M. H., Rybak, M. E., & Pirkle, J. L. (2013). The CDC’s Second National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population is a valuable tool for researchers and policy makers. The Journal of Nutrition, 143(6), 938S-47S. https://doi.org/10.3945/jn.112.172858 Picchietti, D. L., & Stevens, H. E. (2008). Early manifestations of restless legs syndrome in childhood and adolescence. Sleep Medicine, 9(7), 770–781. https://doi.org/10.1016/j.sleep.2007.08.012 Tilma, J., Tilma, K., Norregaard, O., & Ostergaard, J. R. (2013). Early childhood-onset restless legs syndrome: Symptoms and effect of oral iron treatment. Acta Paediatrica, 102(5), e221-6. Wang, Y., Huang, L., Zhang, L., Qu, Y., & Mu, D. (2017). Iron Status in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. Plos One, 12(1), e0169145. https://doi.org/10.1371/journal.pone.0169145 About Macall Gordon Macall Gordon, M.A. has a B.S. from Stanford in Human Biology and an M.A. from Antioch University, Seattle in applied psychology. She is clearly a research nerd. She researches and writes about temperament, sleep, and the gap between research and advice. She is also a certified pediatric sleep consultant working with parents of alert, non-sleeping children. She comes to this work because she had two sensitive, intense children, and she didn’t sleep for 18 years. If you enjoyed this article, Low ferritin: The little-known reason for chronic sleep issues in young children, you might also enjoy: Is Sleep Training Advice Just Gaslighting Parents? What’s a Livewire? Big Brains, Thin Skins, and an Ocean of Feelings Why parental burnout in parents of big-feeling kiddos is worse than I thought. Pin-it for later: Low ferritin: The little-known reason for chronic sleep issues in young children](https://static.wixstatic.com/media/0a105e_fb512bb5d64b4e34bdf347e1029dcad0~mv2.jpg/v1/fill/w_201,h_181,al_c,q_80,usm_0.66_1.00_0.01,enc_avif,quality_auto/Image-empty-state.jpg)
![Books may not always tell you what you need to know For a more detailed deep-dive into this topic, check out my other article, "Pulling back the curtain on cry-it-out research." In our information-centered world, where answers are a click away, the term “evidence-based” carries a lot of weight. This is especially true in the sleep training world, where the stakes feel high, and there are a lot of very strong opinions. Today, everyone is or can be an expert. But when someone lays down the big “research-based” card, people tend to take notice. Research is cited a lot in expert sleep training advice in books and on social media. Experts warn parents that research has found that sleep problems are common and serious and will not resolve on their own. Failure to start early could make change impossible. (No wonder parents are freaked out.) The most evidence-based approach, they say, is extinction (some form of crying it out), which has been shown to be quick (3-7 days), extremely effective, and without any negative side effects, even for very young babies. A lot of parents have issues with some of this: they’re not seeing “quick” results, there’s a lot of crying that doesn’t reduce in a day or two, they don’t want to do extinction at all, they’re not sure about doing something like this with their newborn. So, what does the research say in practical terms about extinction? You might be really surprised. Before we dive into this thorny topic, let me first emphatically say that I am not making a case against crying it out in all its forms. No. I’m not at all saying it’s not a perfectly reasonable drama-less intervention for many families. For anyone who used it and it was successful and not a nightmare, I say "huzzah." That's awesome. There are others who strongly dislike extinction, won’t ever use it, or tried it without success and won’t use it again. In my research with parents, more than 30% said extinction “didn’t work at all” and nearly that many said that there was “significantly more crying than they were told to expect” (Gordon, 2020). While some parents do have quick, easy traction, it’s clear that not everyone does. To read research and advice, it sounds like a settled question ["The only standard recommendation for effectiveness is extinction. . . Extinction has the strongest empirical support” (Weissbluth, 2015, p. 189)]. It’s not settled….at all. There are lots of questions about extinction that have simply not been asked or answered. “Research-based” doesn’t always mean it’s objectively true. It’s important for me to give you a little peek inside how research gets done. Most reasonable adults know that there are ways to cheat with statistics. We know that there are ways to fudge numbers or maybe bias a sample or just plain lie. But research is way more easily biased than that, in ways that may not be so obvious or easy to label as dishonest. Research is rooted in questions. How you ask those questions and the words you choose to use can affect the whole direction of a study. How you choose to measure things can dramatically affect the outcome. A particularly sticky issue is when researchers need to measure something that is abstract…like whether sleep training is “effective.” It may sound like a concrete thing, but what would "effective" actually look like in measurable terms? This is called operationalizing. Say you want to measure the effect of social media consumption on empathy. You probably could easily measure social media consumption by putting some kind of tracker on the phone or laptop…no problem. How do you measure empathy? There are no manuals for this. Researchers need to decide how to measure it. A researcher could use a valid scale or measure that’s been tested to make sure it’s measuring empathy. But researchers could also say, “We measured empathy by asking the subjects’ partners how empathetic they were.” Ummm. You might say, “Is that accurately measuring empathy?” And you’d be right. But as long as researchers devise a plausible way to measure a variable and are upfront about it, they technically can measure it however they want. What does “effective” really mean? When parents read that “extinction is effective,”
they think that means, “sleeping through the night.”
This is not what research has found. In some studies, “effective” meant a longer longest stretch (Hall et al., 2015) or shorter (not fewer) awakenings, or a shorter time to fall asleep (Mindell & Durand, 1993). It never meant “slept through the night without waking” … not once. Across all studies, children were still waking at the end of the study. Remember, research isn’t interested in the resolution of sleep challenges, just improvement. In some sleep training research, they didn’t always even measure sleep. What? You say. How can they do that? I know. They may have just asked the parents, “Did your child sleep better? (yes/no)" (Adachi et al., 2009) or “In the last week, how many times did your child wake up?” (Eckerberg, 2002). You and I know that those aren’t really objective measures. Those are subjective impressions and you’re asking parents to try to remember what happened (Matthey & Speyer, 2008). It’s not a very reliable way to measure anything. But research has used this as hard data to document that the sleep intervention “significantly improved nighttime sleep.” Meta-analyses (these are compilations of a body of studies) found that even though parents reported better sleep, the infants’ sleep didn’t actually change. In many studies, extinction had no impact on nightwakings (Kempler et al., 2016), which is perhaps parents’ biggest concern. In several studies, the impact on sleep in practical terms were really small. One meta-analysis found that across studies extinction only resulted in about 11.3 minutes more nighttime sleep (Fangupo et al, 2021). That’s it. ELEVEN MINUTES. It’s unclear how many parents would put themselves through extinction for only eleven minutes more sleep. Here’s a major kicker: Books seem to suggest that, if you do it right, extinction works 100% of the time. Across studies, extinction did not work for between 16- and 50% of the subjects. That’s a lot of families for whom it didn’t work. Parents rarely get the memo that this intervention might not work for them. Extinction is not as fast as they say. Extinction is also not as fast as they say. For a subset of kiddos, yes, it can be relatively quick and drama-free. But, in research, extinction took THREE WEEKS or more before sleeping through the night happened (Chadez & Nurius, 1987; France & Hudson, 1990, Rickert & Johnson, 1988). Parents are not hearing that part of it. I’m going to bum you out a little more. The investigation of side effects is over-reliant on averages. The idea that extinction (crying it out) is completely without negative side effects for every amount of crying—at every age—is a question that’s never been researched. Let me reiterate that I'm not here to prove or suggest that extinction is always problematic. It’s not. However, it’s not accurate to say it never is. Bear with me… Here’s what you have to know: research deals in averages. So, if, on average, there were no effects, they are able to report “no effects.” Once you start asking about specific subsets of babies, the evidence isn’t quite so definitive. First, there are no studies on side effects for infants under six months. So, even though books say, “There is no evidence that crying it out harms babies ever,” it’s never been tested on younger babies. Plus, most of these studies don’t say how much crying happened. So, we don’t know how much crying is safe and okay. Is 15 minutes without harm? 20? What about 90 straight minutes for a three-month-old? We literally don’t know the answer to this. There is a seminal study that everyone cites (France, 1992), and it’s one of the very few that did report how much crying happened. The study concluded that there were “no negative emotional side effects” ON AVERAGE. On average, there were no negative effects, but it doesn’t mean there weren’t any. Are you following this? because it’s super important. In that study, there were a couple of babies (toddlers really) who only cried a total of about 130 minutes over three weeks. They never cried more than 20 minutes, and they were sleeping through the night in under a week. On the other hand, there was a six-month-old who cried over 900 minutes total and cried for 50 minutes on Day 16. This baby was crying A LOT. Did this baby have “no effects”? We absolutely don’t know. Research doesn’t have to say, “On average they were okay, but the babies who cried more than X had the following effects ….” Researchers are not required to do that. The other problem with this study is that they used a terrible, terrible scale to measure “infant security,” and it’s often been misconstrued as measuring attachment security. This scale does not measure attachment. The Flint Scale was written in 1974 as a very early way to attempt to assess “security” —an early formulation of something like attachment, but is not attachment. Questions on it are filled out by the parent about the infant and include: “Likes rough play,” “Accepts new foods readily,” “Sits patiently for food to be served,” “Allows a stranger to put them to bed.” I’m sorry, WHAT? This is measuring what exactly? To me, this sounds like aspects of temperament or something else entirely. In fact, this scale has never been published in a journal or tested for what’s called internal validity — meaning, does it measure what it says it does? I don’t understand how this is being used to assess the emotional outcomes of anything, but it totally, totally is. Researchers are allowed to use scales that are “reasonable,” but I don’t think anyone at a journal takes a look at them when reviewing the study. This is a truly terrible measure of infant outcomes, and it’s been used multiple times across several pivotal studies on side effects (Eckerberg, 2004; France, 1992; France et al., 1991). Another study cited as evidence that extinction doesn’t impact attachment utilized the Disinhibited Attachment Interview (I had to look this one up too. I had never heard of disinhibited attachment) (Price et al., 2012). This scale was used to assess Romanian orphans who had had such traumatic infancies that they would indiscriminately go off with strangers. So, this study found that extinction doesn’t cause severe attachment disruption? Um…okayyyy. Another study used the Strange Situation (a validated measure of attachment) but did not assess attachment at the beginning of the study…only at the end (Gradisar et al., 2016). So, while it’s good to know that the sleep trained children didn’t disproportionately have insecure attachment, we have no idea where these children started. This just doesn’t give us the whole picture. Many studies just ask parents, “Do you think this affected your relationship with your child?” Well, what are they going to say? “Actually, I do think my baby looks depressed now.” This is called social desirability bias. There’s no parent who’s going to be able to report that something they just did to their child was harmful. PLUS, presumably, they are now sleeping better, and the whole world looks better to them. The business of research Extinction is “the most evidence-based” merely because it’s the most researched, not because it’s better. In fact, head-to-head, nothing works better than anything else. In fact, a study conducted by Sarah Blunden in Australia found that compared to extinction, a more responsive approach was just as effective, and there was less stress for both mother and child. Head-to-head no intervention has ever been found to work “better.” Why, then, does it seem like extinction is the best and only option? Here’s a dirty little secret of research: it’s more attractive to jump on a body of research that’s already established than to buck the system and ask new questions. Once a bunch of researchers are asking the same incomplete questions and measuring outcomes in ways that don’t map to parents’ reality, that methodology just gets replicated, and suddenly, you have a “large body of evidence” that’s all built on the same shaky ground. Research is also a business. Researchers/university faculty need to be published to survive. You need to do work that’s publishable. Here’s how it often goes in Researchland: Researchers conduct a study and get positive “significant” results Other researchers would rather build on that than start something from scratch Now, you have a bunch of studies, and (surprise) they all find the same outcomes. The batch of similar studies gets compiled into systematic literature reviews and meta-analyses. These further carve the intervention into research stone because now, it’s a body of research. Then, it gets crafted into a hierarchy of evidence so that extinction is considered an “empirically-supported treatment for infant insomnia” (Mindell et al., 2006) This gets crafted into practice recommendations for pediatricians and other professionals and becomes part of a policy statement for big sleep medicine associations (American Academy of Sleep Medicine, n. d.; Morgenthaler et al., 2006) And — boom — it’s the only game in town, and it’s unassailable because of the evidence base that got built up. (In fact, it’s been used to dismiss alternatives. One researcher says that “immediate-responding approaches do not meet the required level of empirical backing. . . and would be considered experimental” (Crncec et al., 2010). It’s a racket. No one is policing book authors or other experts to make sure that they’re citing research correctly. One book author I won’t mention says, “Sleep problems cause ADHD.” No, they don’t. Those two things are related, but no researcher on this planet would say one caused the other — — “Correlation does not equal causation.” It could be that sensory sensitivity underlies both sleep problems and ADHD. Sleep doesn’t cause ADHD…or obesity…or behavioral problems. So, what can you do? Be really, really skeptical. If someone is trying to sell you something or persuade you to use a method that doesn’t sound right and research is the crowbar they’re using, use Google Scholar and look some stuff up yourself. Better yet, listen to your gut. If you don’t want to use crying it out, you don’t have to. If you tried it and it really didn’t work, it’s not your fault. You didn’t do it wrong. It’s that the book or expert painted way too rosy a picture of it. You should also know that parents are trying to do all of this on their own. Parents in studies have a ton of evaluation and information and follow-up support. One researcher suggests that parents in the real-world aren’t having the same level of success with extinction simply because they’re forced to do it without all of that backup (Loutzenhiser et al., 2015). Remember that all of this “research-based” rhetoric is made to push you off your center and away from your OWN knowledge — because if you feel like you don’t know what you’re doing…or you’re worried you’ll screw up your child, you will buy products and you will turn to experts for answers. When it comes to research, don't let it bully you into making a choice. That “evidence base” can actually be shakier than it sounds. Macall Gordon has a B.S. from Stanford in Human Biology and an M.A. from Antioch University, Seattle in Applied Psychology, where she is currently a Sr. Lecturer in the mental health counseling department. She is a researcher looking at the relationship between temperament and sleep, and the gap between research and parenting advice on sleep training, and the effect of the oversupply of expert advice on sleep. She is a certified pediatric sleep consultant working with parents of alert, non-sleeping children in private practice, as well as on the women’s telehealth platform, Maven Clinic. She comes to this work because she had two sensitive, intense children, and she didn’t sleep for 18 years. She recently presented this work at the World Infant Mental Health conference in Dublin, Ireland. References
Adachi, Y., Sato, C., Nishino, N., Ohryoji, F., Hayama, J., & Yamagami, T. (2009). A brief parental education for shaping sleep habits in 4-month-old infants. Clinical Medicine & Research, 7(3), 85–92. https://doi.org/10.3121/cmr.2009.814 American Academy of Sleep Medicine. (n.d.). Practice parameters. https://aasm.org/clinical-resources/practice-standards/practice-guidelines/ Blunden, S., Osborne, J., & King, Y. (2022). Do responsive sleep interventions impact mental health in mother/infant dyads compared to extinction interventions? A pilot study. Archives of Women’s Mental Health, 25(3), 621–631. Chadez, L. H., & Nurius, P. S. (1987). Stopping bedtime crying: Treating the child and the parents. Journal of Clinical Child Psychology, 16(3), 212-217. Crnčec, R., Matthey, S., & Nemeth, D. (2010). Infant sleep problems and emotional health: A review of two behavioural approaches. Journal of Reproductive and Infant Psychology, 28(1), 44–54. Eckerberg, B. (2002). Treatment of sleep problems in families with small children: is written information enough? Acta Paediatrica, 91, 952-959. Fangupo, L. J., Haszard, J. J., Reynolds, A. N., Lucas, A. W., McIntosh, D. R., Richards, R., Camp, J., Galland, B. C., Smith, C., & Taylor, R. W. (2021). Do sleep interventions change sleep duration in children aged 0-5 years? A systematic review and meta-analysis of randomised controlled trials. Sleep Medicine Reviews, 59, 101498. Flint, B. M. (1974). The Flint Infant Security Scale for infants aged 3 to 24 months. University of Toronto Press. France, K. G. (1992). Behavior characteristics and security in sleep-disturbed infants treated with extinction. Journal of Pediatric Psychology, 17, 467–475. France, K. G., & Blampied, N. M., & Wilkinson, P. (1991). Treatment of infant sleep disturbance by trimeprazine in combination with extinction. Journal of Developmental & Behavioral Pediatrics, 12(5), 308-314. France, K. G., & Hudson, S. M. (1990). Behavior management of infant sleep disturbance. Journal of Applied Behavior Analysis, 23(1), 91-98. Gordon, M. D. (2020, October). The effect of difficult temperament on experiences with infant sleep and sleep training: A survey of parents. Poster presented at the Occasional Temperament Conference. University of Virginia (Virtual). Gradisar, M., Jackson, K., Spurrier, N. J., Gibson, J., Whitham, J., Williams, A. S., Dolby, R., & Kennaway, D. J. (2016). Behavioral interventions for infant sleep problems: A randomized controlled trial. Pediatrics, 137(6). Kempler, L., Sharpe, L., Miller, C. B., & Bartlett, D. J. (2016). Do psychosocial sleep interventions improve infant sleep or maternal mood in the postnatal period? A systematic review and meta-analysis of randomised controlled trials. Sleep Medicine Reviews, 29, 15–22. Loutzenhiser, L., Hoffman, J., & Beatch, J. (2014). Parental perceptions of the effectiveness of graduated extinction in reducing infant night-wakings. Journal of Reproductive and Infant Psychology, 32(3), 282–291. Matthey, S., & Speyer, J. (2008). Changes in unsettled infant sleep and maternal mood following admission to a parentcraft residential unit. Early Human Development, 84(9), 623-629. Mindell, J. A., & Durand, V. M. (1993). Treatment of childhood sleep disorders: Generalization across disorders and effects on family members. Journal of Pediatric Psychology, 18(6), 731-750. Mindell, J. A., Kuhn, B., Lewin, D. S., Meltzer, L. J., & Sadeh, A. (2006). Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 29(10), 1263–1276. Morgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B., Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., Swick, T. J., & American Academy of Sleep Medicine. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 29(10), 1277–1281. Price, A. M. H., Wake, M., Ukoumunne, O. C., & Hiscock, H. (2012). Five-year follow-up of harms and benefits of behavioral infant sleep intervention: Randomized trial. Pediatrics, 130(4), 643–651. Rickert, V. I., & Johnson, C. M. (1988). Reducing nocturnal awakening and crying episodes in infants and young children: A comparison between scheduled awakenings and systematic ignoring. Pediatrics, 81(2), 203-213. Weissbluth, M. (2015). Healthy sleep habits, Happy child (4th Edition). Ballantine. Additional resources on crying-it-out:](https://static.wixstatic.com/media/0a105e_bcb0b9e0673a402581085e01b6af27af~mv2.jpg/v1/fill/w_123,h_181,al_c,q_80,usm_0.66_1.00_0.01,enc_avif,quality_auto/Image-empty-state.jpg)
The Sleep System: Why your Child Can't "Just Fall Asleep"
Struggling with your child’s sleep? Discover a sleep system designed for alert, sensitive kids who just can’t power down. Learn why some children aren't wired for easy sleep, and how understanding their temperament can make all the difference.
Pulling Back the Curtain on Sleep Training Research
Pulling back the curtain on crying it out explores what research really says about this century-old sleep training approach. Discover why many parents struggle, how behaviorism has shaped modern sleep advice, and why it’s time to question whether assumptions about infant sleep need reconsidering.
![If you're considering moving your energetic 2-year-old from a crib to a toddler bed because you think they'll sleep better, I need to share something important with you: this transition might actually make things harder, not easier. (Safety caveat: If your toddler is actively climbing out of the crib, then this is a safety issue, and you have to move to a toddler bed, of course.) The reality of moving to a toddler bed too early Shifting children younger than three to a toddler bed is opening up a whole new set of potential difficulties. While you may be solving one problem (like hating the crib), you are opening the door to other, even more difficult ones. The main challenge? Keeping them in the bed and in their room. It's close to impossible, and here's why. Why two-year-olds struggle with toddler beds At two years old, children can cognitively understand the rule "I'm supposed to stay in bed." The problem is they don't have the capacity to USE that information to direct their body. This ability doesn't come online until around three years. Think about it this way: your toddler knows what they should do, but their impulse control and self-regulation skills aren't developed enough to follow through. It's not defiance; it's just how two-year-olds roll. What this means for your sleep (and theirs) For potentially another year, they may know they’re supposed to stay in their bed, but be completely unable to keep themselves there. So, you are on the hook to walk your child back to bed many, many times a night. Plus, you'll face additional challenges: How do you keep them from roaming the house once you go to bed? How do you keep them in their room? Close the door? Lock the door? (Spoiler alert: toddlers hate that) How do you keep them safe in their room? (Stuff that can get pulled over, climbed on, slammed shut) How do you keep them from getting up to just play with toys? See? It's a lot. And this is why a toddler in a bed usually translates to an adult sleeping in their room full-time. Alternatives to a toddler bed transition Before you make the switch to a toddler bed, try these strategies to keep your two-year-old manageably in their crib: 1. Lower the crib mattress to the floor Drop that crib mattress all the way down. If your crib allows it, you can lower the mattress to floor level, making it much harder for your little escape artist to climb out. 2. Try special climbing-prevention pajamas If lowering the mattress isn't possible, there are pajamas (like those from littlegrounders.com) with a band sewn between the legs to block their ability to raise their leg and climb. 3. Try a crib tent These were off the market for a while, but they’re back. Find a safe tent that will keep them from climbing. The bottom line on toddler beds before age three. Hold off on a toddler bed or floor bed as long as you can. While the move to a toddler bed might solve a short-term problem (like climbing out), it can cause a few bigger ones that will stick around for a while, namely, disrupted sleep for everyone, nighttime wandering, safety concerns, bedtime battles, and/or a parent becoming the child’s new roommate. Signs your child is ready for a toddler bed Wait for these signs before making the transition: They're consistently climbing out of the crib (and the prevention methods above haven't worked) They're expressing interest in a "big kid bed" They're at least 2.5-3 years old They can follow simple rules and adhere to boundaries consistently They're sleeping well and able to fall asleep independently (mostly) My advice: Keep them in the crib I know it can be tempting to try a toddler bed when your two-year-old seems ready or when sleep becomes challenging. But trust me on this: the crib is your friend right now. Those four walls are doing important work keeping your little one safe and (hopefully) sleeping. Give it time. Keep them in the crib as long as safely possible. Your future self, and your sleep, will thank you. Feeling stuck? Let's figure out your situation together Every family's sleep situation is unique, and sometimes you need more than general advice. If you're dealing with crib climbing, early wake-ups, bedtime battles, or you're just not sure what your next steps should be, I'd love to help you figure it out. I offer a 60-minute Sleep Triage Consult where we'll dig into what's happening with your little one's sleep, look at all the moving parts, and figure out a plan that actually works for your family. No judgment, no one-size-fits-all solutions, just practical guidance tailored to your child and your goals. (There’s also a 30-minute version if you just need a quick look-see or check-in.) [Learn more about the sleep triage consult here] Explore more from Little Livewires Follow Little Livewires on Instagram, Facebook, LinkedIn, YouTube, Pinterest, and TikTok for research-based insights on raising alert, sensitive kids. Read Why Won’t You Sleep?! by Macall Gordon, M.A. and Kim West, MSW — available in print and now on Audible. About Macall Gordon Macall Gordon, M.A., has a master's degree in applied psychology from Antioch University in Seattle with a research-based specialization in infant mental health, sleep advice, and parenting culture. If you enjoyed this article, should your 2-year-old sleep in a toddler bed? The truth about early transitions, you might also enjoy: Sleep routine changes: Surviving night one (eek!) Why sleepy cues just aren’t a thing for livewires Is your wily 3-year-old winning the bedtime battles? Here are some handy (and effective) workarounds. Pin-it for later: Should your 2-year-old sleep in a toddler bed? The truth about early transitions](https://static.wixstatic.com/media/0a105e_a80b657f9dba4a5f9a7be42a01a51b47~mv2.jpg/v1/fill/w_203,h_135,al_c,q_80,usm_0.66_1.00_0.01,enc_avif,quality_auto/Image-empty-state.jpg)
![By Holly Klaassen, M.A. (Edited by Macall Gordon, M.A.) Parents of fussy, colicky or high-need kids are part of an exclusive club—a club that no one ever asked to join. While I’m the first to acknowledge that we need to feel thankful and blessed to have a healthy baby, simply shoving down our frustrations and covering them over with a "Well, at least my baby is healthy" or "Things could be worse," is just not helpful. Glossing over the very real, very frustrating, very life-changing circumstances of having a fussy child doesn’t do anyone any good. Glossing over the very real, very frustrating, very life-changing circumstances of having a fussy child doesn’t do anyone any good. Not acknowledging how very hard it is leads to very angry, very sad, very isolated moms and dads. And I don’t think anyone thinks that’s a good thing. How many times has someone said to you, "It’s just colic“? Or how many times have you felt judged because you were "spoiling" your child or "letting’" your child call the shots? Well, if you find anyone saying these things to you, please send them to me. I’ll set them straight. I’ll explain exactly why it’s not "just" colic or fussiness. The Sleep Deprivation I have heard almost unbelievable stories of sleep deprivation among parents of non-sleeping babies. Many, many parents of fussy, colicky, or spirited babies and toddlers tell me that their child wakes up 12 times per night. TWELVE...times....per....night. In my mind, this is pretty much torture. When Sammy was a newborn, he slept in 45-minute increments. Feed for 45 minutes, sleep for 45 minutes. Do you think I slept peacefully for those 45 minutes? No, I laid there, my stomach in knots, wondering when he was going to wake up screaming. But I could catch up on sleep during the day. I was lucky in that my son napped. Many high need babies do not (or if they do, they sleep only very short stretches). But with a 2.5-year-old toddler? No naps for me. The sleep deprivation (and I don’t use this term lightly) alone is enough to cripple you. But combine that with any or all of the other circumstances that emerge from having a high-need baby? (see # 2-10 below). It’s, simply put, crazy-making. And even for those who don’t have another child, "sleep when the baby sleeps" isn’t always as easy as it sounds. With dishes piled sky-high in the sink begging to be washed, or the chance to squeeze in a quick shower, nap time doesn’t necessarily mean "free time." The Isolation When you have a fussy baby, it feels like everyone else has an easy baby. Although about 20% of babies are colicky, and an estimated 20% of older babies or toddlers are still more intense and sensitive to some degree, it often feels like you’re the only one who has ever had a baby that cried THIS much. It often feels like you’re the only one who has ever had a baby that cried THIS much. You may try to attend playgroups or mom's groups and find yourself having to comfort, soothe, and distract your baby the entire time while the other moms sip their Starbucks and watch their children play. When you try to talk to someone about how hard things are, you may get blank stares or comments like, “I know how you feel. Little Billy fusses almost every night before bed for at least 30 minutes.” It’s hard enough having a fussy baby, but feeling like you’re in this alone makes it doubly hard. The Crying This is especially difficult during the early months when your little one can’t tell you what’s wrong. Some fussy babies have been known to cry during all of their waking hours (I had one of these. The first time Sammy was awake and not crying was when he was four weeks old. It lasted about 10 minutes. We took a picture to commemorate the occasion). Our primal instinct as mothers is to soothe and comfort our crying baby. If we have a baby who cries occasionally when he’s hungry, tired, or sick, we feel deep empathy for him. Our heart breaks as we listen to him cry and try everything to make him feel better. When you have a baby who cries ALL THE TIME, this empathy can be difficult to drudge up. While we may feel it at times, the crying may trigger feelings of frustration, helplessness, anger, and even rage. Constant crying may trigger feelings of frustration, helplessness, anger, and even rage. Is this how you pictured motherhood? The Being Judged It’s SO easy to look in from the outside and know what someone’s doing wrong. Or what they “should” be doing. It’s SO easy for others to think things like "She [the mom] is so stressed out, the baby’s feeding off her anxiety.” Or, "If she would just let him cry it out, the sleep problems and fussiness would disappear.” Or, "If she would just stop coddling him all the time, he would learn to entertain himself.” Do you think we haven’t thought every single one of these thoughts already? Do you think we don’t beat ourselves up on a daily basis over what we “should” be doing and what we might be doing wrong? We’re doing the best we can with what we’ve been given. We’re tired. We’re frustrated. We’re alone. We may feel like we're not quite cut out to even be a mother. We expect judgment from strangers, maybe even friends, at times. We can deal with that. Judgment from our family? From our own moms? This can feel unbearable. Give us a break. Give us a hug! Tell us we’re doing great and to hang in there. Better yet, offer to babysit, take our baby for a walk, or bring us a coffee. The Unpredictability Some babies sleep at regular intervals and are fed 5-7 times a day, with some playtime thrown into the mix. High-need babies are notorious for resisting any kind of routine or schedule. Here’s what that means for you: You can’t plan anything. ANYTHING. Oh, you can try. And sometimes, it might actually work out. But don’t count on it. You can’t plan anything. ANYTHING. Oh, you can try. And sometimes, it might actually work out. But don’t count on it. Naps happen when naps happen. Bedtime tends to be when bedtime is. Plans change from minute to minute depending on how Miss Grumpypants is feeling about life. Finally found a formula or a food that your baby will tolerate? Enjoy it while it lasts. Tomorrow he could be spitting it out if he even swallows it in the first place. Figured out a sleep routine that actually works? Well, I hate to tell you, it may not work tomorrow. The Feelings of Failure As moms, we have this belief that we should know our child inside and out. We should know their likes and dislikes, what calms them, and what upsets them. With high-need babies or spirited toddlers, things just aren’t this cut and dry. I truly believe that they themselves often don’t know what they want or need. So how are we to know? But yet if we don’t know how to help our own child, we feel like a failure. We look at other parents, so competent and confident, soothing their child. What’s wrong with us that we can’t do that? What are we doing wrong? Were we really meant to be parents at all? The No Down Time This one is often tied to unpredictability (above). With “easy” babies, there is usually a period of time during the day that you can count on to get things done, take a nap, check email, etc. And if your baby doesn’t nap much, at least you have some time off at night, right? With no predictable sleep routine, it can be nearly impossible to have any true "down time." You put your little one down for a nap and finally have the chance to sit down with a cold drink and catch up on your favorite TV show. Yet one ear is always open, listening for that cry or scream coming from the crib (of course, if you’re lucky enough to have a baby who will actually sleep in the crib). Many high-need babies and toddlers have great difficulty staying asleep. If your child does nap, 20- to 45 minutes is pretty typical. And this is usually after a long and elaborate soothing routine that can last as long as the nap itself. Short naps and unpredictable nighttime sleep mean no downtime for mom. Short naps and unpredictable nighttime sleep mean no downtime for mom. Think about it: Not even one hour in a 24-hour period where you’re off duty. No time to recharge your batteries or have a chance to think about and miss your child. No time to be proactive in terms of how you’re parenting and how you’re coping. You’re constantly reacting, operating in survival mode. The Second-Guessing Your baby cries. A lot. You may have other children but have no idea why this one cries so much. Your doctor has said it’s “just colic,” or perhaps diagnosed her with reflux. But a part of you isn’t sure. What if it’s something more serious? What if this isn’t simply colic or a temperament issue at all? What if there’s something medically wrong with my child? Even if you’re satisfied there’s nothing seriously wrong with your baby, it’s easy to fall into the trap of second-guessing pretty much everything you do: Did I feed him enough? Did I feed him too much? Am I eating something that’s causing him pain? Is he overtired? Have I been letting him sleep too much? Should I let him cry it out? Should I respond to his cries more quickly? These fussy babies don't give many clear signs that you've made the right choices. The Impact on Marriage and Family Imagine having no time for your partner (and when you do have a few minutes alone, you’re too exhausted to carry on a coherent conversation). Some parents say having a fussy baby brought them even closer to their spouse or significant other, but many others talk about quick tempers, lack of communication, and resentment for the spouse who gets to work outside the home. Perhaps even more challenging is the impact on the other children in the family. Many parents tell me they feel profoundly guilty over the lack of time and energy they’re able to give their other kids. Many parents tell me they feel profoundly guilty over the lack of time and energy they’re able to give their other kids. Parenting a colicky or high-need baby is all-consuming, and it often feels like there’s nothing left for anyone else. When your baby is crying, it’s pretty hard to say, "Now baby, you’re going to have to wait. I need to spend time with your sister." It just doesn’t work like that. When your baby is crying, you drop everything else in an effort to soothe him, regardless of the impact on others. The Lack of Bonding When your baby cries all the time, it’s really, really hard to form any positive memories with him. You know how some people tell parents of newborns, "Enjoy every moment. It goes by so fast!“ ? Well, parents of colicky or high-need babies cannot wait for their little ones to grow up. When my Sammy was a newborn, he spent every waking moment crying or screaming. We didn’t have those calm, peaceful moments cuddling on the couch. I never watched him sleep thinking about how blessed I was. What I did think about was, "What kind of a mother am I that I don’t know if I love my own son?” Although it pains me to say it now, I didn’t even think he was cute. He had a permanent crease between his eyes and frown lines on his forehead from all the crying. What kind of mother thinks these things? Many mothers of fussy, colicky, and high-need babies.... If you take anything away from this, please let it be this: We don't need more judgment. We judge ourselves far more harshly than you ever can. Offer to help us. Love us. Give us a hug. Tell us, "I can only imagine how hard this is for you.” Remind us we're not alone. That we're in this together." Holly Klaassen, M.A. was the Founder of The Fussy Baby Site and Facebook groups of nearly 90,000 parents of spirited kids. She is a mom to two “big kids” and now works in private practice as a parent coach focusing on parents of spirited kids. https://hollyklaassen.com/](https://static.wixstatic.com/media/1c5961_0cc09f10e0184e049b69a37394bf57d7~mv2.png/v1/fill/w_203,h_114,al_c,q_85,usm_0.66_1.00_0.01,enc_avif,quality_auto/Image-empty-state.png)
![I hate the term “helicopter parent” —the notion that some parents swoop in too quickly to solve their child’s problems. It’s just too easy to slap this kind of negative label on a parent. I don’t believe for one second that this impulse to swoop in is parents’ fault. In truth, the parenting advice industry has made parents so incredibly worried about so many things that parents feel like they have to swoop in quickly. I mean, to read parenting advice, you’d think that every decision you make as a parent has massive and enduring negative impacts. “You’d better get this right or else baaaad things will happen.” No wonder parents are a little quick to act. Since the dawn of “the childrearing expert” in the late 19th century, parents have been made to feel like they really don’t know what they’re doing and can’t be trusted to make decisions about their child. Is there good, solid information that parents should know? Yes. Can we, as parents, always do better if we have this information? Yes. However, there is a dark side to all of this. Consumer culture. Dr. Philip Cushman suggests in his book “Constructing the Self, Constructing America” that there are economic incentives to keep individuals doubting themselves. At the simultaneous dawn of both psychology and advertising in the late 1800s, the masses were “educated” about how to be “healthy.” Soap companies and tonic companies used advertising to convince consumers that their usual habits were wrong and what they needed to be “healthy” was their product. Even today, instincts can’t be trusted and there are millions of products and experts (and books) to fill that gap. Monitors, gadgets, trackers, online courses – we get the clear message that the real knowledge is outside of ourselves and can (and should) be gathered and bought. Let’s just look at the tone of some typical sleep advice: Parents “cave” to their inability to withstand a baby’s crying (something that we’re wired to respond to) Parents create sleep problems and “bad habits” by holding, rocking, or soothing If parents don’t start with sleep training early, the baby will develop ADHD, obesity, or any number of behavioral problems The message is: “If you just buy this book/program/special crib, you’ll be parenting correctly.” Look at just how many sleep training “methods” there are out there. LOTS of them. Almost all of them are just a repackaging of the usual Ferber-type graduated checking approach. These are sold under different names as if they are completely separate and brand-new methods. They’re not. Here’s a big secret that the sleep training industry doesn’t want you to know: There’s really only one method: do less. You could even make your own method. Yup! It’s seriously not magic (I’m a sleep coach, I know.) The Guardian columnist, Oliver Burkeman, calls it the “diabolical genius of the baby advice industry.” It whips up your anxiety and worry, makes it impossible to determine which strategies are best, confuses you with conflicting opinions, and then sells you something that cuts through all of the chaos that it created. Genius, right? A world of risk. Consumer and information culture also identifies and highlights the massive number of risks that parents should avoid—from SIDS to non-optimal brain development to behavioral problems. To be a parent today, it’s all you can do to avoid the minefield of risks (plus, the information makes it seem so easy to blow it.) “Don’t do THAT or you’ll ruin your child’s development long-term.” I talk to brand new parents every day who think that the choices they’re making about their baby’s sleep now could ruin their chances of ever sleeping well and may doom them to a life of— (I’m not sure)—badness. They are told that if they do X, Y, or Z with their four-week-old, the baby will never learn to…whatever. As a result, parents turn to Google in hopes that they’ll find the information they think will help them avoid these terrible risks and help them do it “right.” Some refer to this as “intensive parenting” (or “intensive mothering”), making sure you are doing every conceivable thing you can at all times. It’s not necessarily lessons or flashcards or baby Mozart…it’s understanding development, being structured (but not too structured), making sure everything is as good as it can possibly be (meaning YOU are as good as you can possibly be). In our world of access to information, because we can know it means we must know it (and evaluate it and apply it properly—all by ourselves). Here's my big point: Intensive parenting wasn’t parents’ idea. Intensive parenting is a response to a culture that says: “You don’t know what you’re doing. Bad things will happen if you go with your gut. Here’s a product/expert who can tell you the ‘right’ way.” It’s bananas. Our culture sets parents up to be super anxious about every possible threat and then criticizes them when they work hard to avoid those threats. For you parents of livewires, you are maybe really up a creek. I know you are even more down on yourselves because none of this information works well, even if you really wanted it to. So, I say to you: Step away from the Google (Instagram, TikTok, Facebook). The answers are probably not there. Take a moment to tell yourself that even if you don’t feel like you’ve got this, you totally do. Know that parenting is a journey, not a minefield. It’s a long road. Pace yourself. Resources Åström, B. (2015). A narrative of fear: Advice to mothers. Literature and Medicine, 33(1), 113–131. https://doi.org/10.1353/lm.2015.0001 Burkeman, O. (2018, Jan 16). The diabolical genius of the baby advice industry. The Guardian. Cushman, P. (1996). Constructing the self, Constructing America: A cultural history of psychotherapy. De Capo Press. Eaves, K. L. (2006). Moms in the middle: Parenting magazines, motherhood texts, and the “Mommy Wars” [Master thesis]. Wichita State University. Meeussen, L., & Van Laar, C. (2018). Feeling pressure to be a perfect mother relates to parental burnout and career ambitions. Frontiers in Psychology, 9, 2113. https://doi.org/10.3389/fpsyg.2018.02113 Shortsleeve, C. (2022, Dec 19). Does Baby Sleep-Training Culture Fuel Postpartum Anxiety? Parents.com. The VOICE Group. (2010). Motherhood, marketization, and consumer vulnerability. Journal of Macromarketing, 30(4), 384–397. https://doi.org/10.1177/0276146710378170 Macall Gordon has a B.S. from Stanford in Human Biology and an M.A. from Antioch University, Seattle in Applied Psychology, where she is currently a Sr. Lecturer in the mental health counseling and art therapy departments. She researches and writes about the relationship between temperament and sleep, and the gap between research and parenting advice. She is a certified pediatric sleep consultant working with parents of alert, non-sleeping children in private practice, as well as on the women’s telehealth platform, Maven Clinic. She comes to this work because she had two sensitive, intense children and she didn’t sleep for 18 years.](https://static.wixstatic.com/media/0a105e_a6c93030dfcb489d94e201dce637ab35~mv2.jpg/v1/fill/w_203,h_135,al_c,q_80,usm_0.66_1.00_0.01,enc_avif,quality_auto/Image-empty-state.jpg)
![If you’re a parent running on fumes, you’ve probably typed “when to start sleep training” into Google at 2 a.m. and found conflicting advice. Most books insist you can start sleep training at 3–4 months or even earlier. The surprising truth? There’s no research showing any benefit to sleep training before six months, and plenty of reasons to wait. Let’s break down the science, the myths, and what this means for your family. What the research says about early sleep training Parents often assume there must be studies backing up the advice to begin at 3 or 4 months. But when you dig into the research, here’s what you find: Almost all studies on sleep training methods (like the Ferber method or extinction) were conducted with babies six months and older. The few studies done on younger infants weren’t actually “sleep training.” They often were a package of strategies that may have included some instructions about slight delays in responding or using “drowsy but awake.” Only one study exists that used the Ferber method on a group of infants under six months. Studies that tried to prevent sleep problems in younger babies found only tiny improvements that didn’t actually last. The notion that it will be “harder if you wait” has never been studied. So, we actually know very little about using sleep training strategies on infants under six months. If you can wait, babies are developmentally more ready and we actually have more research to back that up. Why four months is particularly hard The four-month regression is due in part to one of the biggest bursts of brain development we have in the lifespan (there's another one at adolescence). As the brain is going through this transformation, other skills can go offline. Trying to put form on something undergoing rapid change could be much more difficult than waiting until the storm has passed. Why six months matters There are big developmental reasons that make six months a turning point in child sleep. Sleep becomes more organized. At this stage, babies have more predictable sleep cycles with chunkier naps and a reliable early bedtime. They can go longer at night without feeds. The four-month sleep regression has passed. Those endless night wakings usually calm down, giving you a better baseline. Babies gain new skills. Six-month motor and cognitive milestones help with self-soothing and make retaining patterns and routines more possible. They may move to the crib and their own room. It’s often when babies move out of their parents’ room. This can be a great moment to learn new sleep skills: new room, new sleep pattern. In other words, at six months, your baby has more “infrastructure” for learning to sleep independently. Rather than sleep training being harder if you wait, it can actually be easier and faster. Why do most books say 3–4 months? “If the American Academy of Pediatrics and research say six months, why do most books say 3 or 4 months? I’ve seen some places say you can start as early as 8 weeks!” The claim that “the earlier you start, the easier it will be” sounds convincing to desperate, sleep-deprived parents, but it’s simply made up. No studies have ever investigated this question, not one. Experts say, “If you don’t start early, habits will become engrained,” but there’s honestly no evidence that this is the case. If you think about it, what does this even mean? That you literally can’t change your child’s behavior? Ever? It’s possible that the unspoken assumption is that older babies will cry more. Younger babies, they will say don’t know the difference. But what they don’t tell you is that younger babies have fewer skills to manage distress. Crying isn’t a neutral behavior. At younger ages, crying is more costly and it takes less to throw a younger baby’s system off. Older babies may cry, but they can do things to help themselves calm down. “Self-soothing” is more within reach of older babies. They have cognitive skills and motor skills and attention skills. They also may understand how to lobby for what they want. So, there can be intentionality behind some of their crying. In that way, it’s harder for the parent, but it’s not harder for the child. Other reasons not to start too early? Sleep is still developing. Before six months, brain structures are still developing and sleep is a moving target. Many books say to start sleep training at three months right before the four-month regression, a time of massive brain development. Lots of babies sleep great at three months only to start waking again at four months. Why spend all that time sleep training if it’s just going to get erased during the regression? The younger the baby, the less crying they can handle. Crying and distress are not benign. The younger the baby, the less they can handle without help. The notion that a newborn can be crying hard by themselves and that they’ve “self-soothed” because they fell asleep isn’t exactly true. The younger the baby, the fewer resources they have at their disposal. A 3- or 4-month-old, can barely get their hand to their mouth to suck on it. If they’re crying hard, they can’t even do that. Self-soothing happens when distress is manageable. The younger the baby, the less distress they can handle on their own. Sleep training tends to overlook feeding issues or needs. Early sleep training tends to underestimate or overlook legitimate feeding needs or issues because of its hyperfocus on behavior. Again, with younger babies, the picture is not so clearcut. Feeding issues are still very prominent in the first part of the first year and not every baby can go long periods without a feed. Books also tend to talk in averages and there’s huge variation between infants in the newborn period. You can’t say what “a generic baby” “should” be able to do at this age. So, when to start sleep training? The best answer is: when you decide you’re ready to change your status quo. There is no “too late.” Before six months, focus on building healthy sleep habits and a predictable sleep schedule, but don’t stress about formal methods. After six months, if things are sustainable and everyone is sleeping fairly well, you don’t have to do anything (I’m serious). If there’s ever a point where you feel like you’re ready to stop [doing that middle of the night feed/laying with your toddler at bedtime/cosleeping at 4am], you can make a change. There literally is no such thing as “too late.” If you need a roadmap that’s not going to scare you into doing something and will give you some commonsense, supportive strategies, check out, Why Won’t You SLEEP?! A Gamechanging Approach for Exhausted Parents of Nonstop, Super Alert, Big Feeling Kids (also on Audible). If you enjoyed this article, When to Start Sleep Training: Why Six Months Is the Sweet Spot, you might also enjoy: Temperament may be the reason your child can't sleep The Sleep System: Why your child can't "just fall asleep" Sneaky sleep disruptors: 4 questions to ask when sleep training hasn't worked . . .at all Pin-it for later: When to start sleep training: At least six months, research says](https://static.wixstatic.com/media/1c5961_813ee89d7445432cb396593c6f730122~mv2.png/v1/fill/w_203,h_115,al_c,q_85,usm_0.66_1.00_0.01,enc_avif,quality_auto/Image-empty-state.png)
Emotional Regulation and Sleep: A Nervous System Guide
Why your intense child's temperament and sensory wiring matter more than any bedtime method. Learn why popular sleep methods fail spirited and sensitive kids, and how to read your child's nervous system signals at bedtime. This guide helps you move from method-hopping to building a sleep approach shaped around your actual child's emotional and sensory wiring.