Should You Sleep Train Your Baby at 2 Months?

A Wall Street Journal article from May 2, 2016, “Can You Sleep Train Your Baby at 2 Months?, by Sumathi Reddi, a weekly consumer health column writer, quotes a pediatrician who routinely teaches parents to train babies to sleep through the night beginning at age 2 months. Dr. Michel Cohen bases his advice on the experience of training his own children a decade ago.  He encourages other pediatricians in his practice to follow the same advice. Dr. Cohen states that, “It actually works better at 2 months than at 4 months.”

Can you sleep train your baby at 2 months?  Perhaps.  Should you sleep train your baby at 2 months might be the better question.  Evidence on infant sleep and development does not support the practice.  A systematic review conducted in the UK showed that sleep training in the first 6 months of life did not prevent sleep or behavioral problems later on, nor did it protect against postnatal depression. It may even worsen maternal anxiety and lead to further problem crying after 6 months of age. J Dev Behav Pediatr. 2013 Sep;34(7):497-507  Sleep training at 2 months involves a significant increase in infant crying, which is stressful not only for babies, but for the whole family. Middlemiss and colleagues showed that when babies were allowed to “cry it out” at night, this resulted in babies having very high levels of stress hormones, such as cortisol, increasing heart rate and blood pressure. Early Hum Dev. 2012 Apr;88(4):227-32.  Alternatively, babies who learn early on that a caring adult will respond to their crying by feeding and holding are less likely to experience stress and isolation, especially during those early months of life, when brain development and connections between brain cells are occurring in rapid fashion.  Young babies and mothers are hard wired to be together frequently.

The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of life, and continuation for at least the first year of life (Pediatrics. 2012 Mar;129(3):e827-41), a recommendation also supported by the Academy of Breastfeeding Medicine, the American Congress of Obstetricians and Gynecologists, the American Academy of Family Physicians, as well as multiple other professional organizations.  Exclusive breastfeeding requires frequent feeding, both daytime and night-time, in order to maintain a good milk supply and support optimal growth.  Babies awaken at night for comfort, but also for feeding, since breast milk is easily digested and babies do not have the reserves to go long periods without feeding.  Longer sleep intervals may impact maternal milk supply and hasten weaning.  Breastfeeding has a positive impact on infants’ brain development, immune systems, and social and emotional well-being.  By contrast, early weaning increases health risks for both mothers and babies.

SIDS (Sudden Infant Death Syndrome) is more likely in babies who sleep in a separate room, especially during the peak SIDS incidence from 2 to 4 months of age.  To reduce the risk of SIDS, it’s recommended that babies sleep in the same room with parents for at least the first 6 months. A sleep training routine that promotes placing the infant to sleep, either in the day or night, in a separate room, increases that infant’s risk of SIDS.

Quality of sleep is important for both babies and their families. As they grow, babies will gradually start sleeping longer stretches on their own, when they can go longer periods without being fed.  Each baby’s timetable is different, but there is no evidence that supports sleep training during the early months.  Just because a practice such as sleep training at 2 months CAN work, doesn’t make it a good practice.

Joan Meek, MD, MS, FAAP, FABM, IBCLC is a Associate Dean for Graduate Medical Education and Professor of Clinical Sciences Florida State University College of Medicine. She has served as president of the Academy of Breastfeeding Medicine, Chair of the American Academy of Pediatrics Section on Breastfeeding, and Chair of the United States Breastfeeding Commitee. You can follow her on twitter @joanymeek 

Melissa Bartick, MD, MSc is an internist at Cambridge Health Alliance and Assistant Professor at Harvard Medical School. 

Larry Noble MD, FAAP, FABM, IBCLC is a neonatologist and Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai in New York City, and a Board member of ABM. You can follow him on twitter @galactodoc

Additional contributors: Teresa Pitman; Linda Smith, MPH, IBCLC; Diana West BA, IBCLC; Diane Wiessinger MS, IBCLC

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.