The Three Temptations

This is a story about The Three Temptations.  And it’s a true story: one hundreds of parents have told me.
Mom and Dad will buy a phone consult about their nine-month old daughter.  It turns out that nobody in the house has had a good night’s sleep since baby was born. They are physically and emotionally exhausted – you can hear it in their voices. They are fairly begging for relief. All they want is a few hours in a row of sleep!

I listen to the story and remember my own sleep deprivation when our boys were this age. I remember how that physical and emotional exhaustion can take a toll on relationships.

At one point in the story, the parents tell me a key piece of information: Baby girl falls asleep at the breast.  Boom.  I believe we’ve found our answer. It all has to do with a temptation that can be irresistible in the middle of the night when mom and dad are exhausted, but it’s critical to solving baby’s sleep problem.

When parents tell me that their baby (four months or older) wakes up every two hours during the night, one of the first things I ask about are sleep associations. I want to know what surrounds the baby at the moment of sleep, since these are the things we want surrounding the baby when she moves into shallow sleep every two to three hours.

  • Is the baby in the place where you plan to have her sleep throughout the night (hopefully!)?
  • Is she nursing or taking a bottle while she falls asleep?
  • Does she have a binky (pacifier) in her mouth?
  • Is she making contact with mom’s or dad’s body while she falls asleep?
  • Was some kind of moving mobile or sleep-toy on that turns itself off?

If the answer to any of these question is yes, we probably have found why the child wakes so frequently at night. The solution is to remove the bad association sooner rather than later. In my experience, cold-turkey is the only effective approach. Weaning a baby away from most bad sleep associations turns out to be more difficult than it sounds.


For example, it’s notoriously difficult to wean a baby off a pacifier. As long as the binky remains in the house, the temptation to give it back to the baby for any reason is simply too strong.

Think about this: is there any way to wean a baby off of becoming used to falling asleep in your bed, when you want her to spend the night in her crib?

Nursing to sleep, on the other hand, lends itself much better to weaning because the object of the exercise is to increase the amount of time between the last feeding and the moment the child falls asleep. In practice, however, the toughest and most important step is the first one: taking the baby off the breast or the bottle before she is asleep!

To troubleshoot sleep associations, take inventory.

See what things she’s surrounded by at the moment of sleep and make sure those are the things that will be there in two to three hours. If any of those things are difficult or impossible to reproduce in two to three hours, it’s best to work at changing or removing them.

The Three Temptations, and How to Avoid Them

For a baby who has developed her own internal soothing mechanisms but who wakes in the middle of the night and demands attention, I recommend a strategy I call “Avoiding the Three Temptations.” The temptations are:

  1. Going in to the baby
  2. Picking her up, and
  3. Giving her something to eat.

I counsel parents that if they cannot resist the temptation to go in to see their fussy baby, they should resist the temptation to pick her up. Instead, I recommend stroking the baby’s back and talking to her calmly and reassuringly.

But if mom cannot resist the temptation to pick the baby up, she should resist the temptation to feed her. Instead, she should make calm sounds and gently rock the baby.

But if mom/dad cannot resist the temptation to give the baby something to eat, they should not breast-feed or formula-feed the baby!

Instead: give the baby a bottle of water. (Note: Never give pure water to a baby younger than four months of age; there’s a small but measurable risk that the baby’s blood may become diluted.) The baby does not want water. Since most babies are smart enough to reject less-than-enticing incentives for waking up, eventually, usually after a night or two, the baby realizes that waking up for water is not worth her while. Then the parents can work on resisting the first two temptations! The three temptations are too many.


Sleep Associations: What I Learned from “The Juggler”

The story I’m about to tell you, about The Juggler, is really a story about sleep associations:


The Problem

The Juggler was 2 years old when I met him. His mother called me for a consult because the boy just would not sleep through the night. Mom had been back to work for over a year, but the sleep deprivation she was suffering from was seriously affecting her productivity. She and her husband wanted to have another child, but they were so exhausted they didn’t have the strength or the will to “work at it.” And frankly, mom admitted to me, if number two was going to sleep as badly as number 1, they weren’t sure they’d survive a second child!

I went to meet this mom at a cafe. She brought the boy with her. What I saw simply astounded me: This boy had a binky (pacifier) in his mouth, and one in each hand.


As his mother began to tell her story, out of the corner of my eye I caught a glimpse of the boy doing something I had never seen before: he would pop the binky in his mouth out into one hand and replace it with the binky in the other, then repeat the action with the other hand. He did this fast, like he was practiced at it.  And he was. It was impressive to watch, in an odd sort of way.

“Holy Moly, he’s juggling!” I had to interrupted the mom.

“Yup. He does that all day.”

“May I assume he sleeps with three binkies as well?” I asked mom.

“Well, he doesn’t sleep very long,” mom replied, “That’s why we’re here”

Then came the “ah-hah” moment.

The Solution: Sleep Associations

Mom told me that she thinks the boy wakes up at night when the binky would fall out of his mouth.  She would respond to his cries by dragging herself into his room, popping the binky back in his mouth, and dragging herself back to bed.

What this boy had done was develop a bad sleep association. His parents tolerated it because they had grown used to it for one thing, and for another they were kind of amused by the juggling act.

But the juggling act was a sign of the most common sleep problem I encounter in my practice. I’d say that > 90% of the consults I perform involve bad sleep associations and how to manage them.

In future posts, I’ll tell more stories about bad sleep associations and how I taught parents to get rid of them!

Troubleshooting Sleep Problems

If parents have followed my sleep method and it’s still not working, there are a number of ways of troubleshooting sleep problems that we pursue until we solve the problem.


Troubleshooting 101:
I start by asking parents to describe their bedtime routine. I think of the bedtime routine as a series of highly predictable events that begins at your baby’s dinner time and ends when she falls asleep. The time frame we are talking about may be anywhere from 30 to 60 minutes in length. I listen particularly for indications that the baby may be overstimulated during this period. For example, is the lighting bright and harsh? Is the television on, even softly? Is there music playing? Are there a lot of people talking loudly? Is everybody passing the baby back and forth among themselves? If it turns out that there are too many stimuli, I discuss ways to reduce them, which sometimes is more easily said than done. In some homes there are simply too many people and too much surrounding chaos to reduce stimulation. Dr. Spock would argue that this is not necessarily a bad thing and that babies will get used to it, but Dr. Weissbluth and I would not agree with him. In general, less stimulation is better than more, and the empiric research seems to corroborate this. The trick is finding a way to reduce stimuli. The solution may be to find a quiet but well-ventilated corner of the house or apartment where light, sound, and tactile stimulation can be kept to a minimum.



Teething pain often interrupts the process of getting a baby to learn to go to sleep. At around four months of age, give or take, a baby may start drooling much more than before and may start grinding her fist into her mouth. This is likely the start of the teething process, though actual teeth may not appear for eight months.


Colic almost always happens when babies and their parents want to be sleeping. Once all the other causes of crying have been ruled out (baby just ate so she can’t be hungry, diaper is clean, she’s not constipated, and so on), you might settle on colic as the cause. Troubleshooting colic is a subject unto itself, and beyond my scope in this post!


This is actually a subcategory of colic. Many babies wake up crying because they have to poop and they can’t. There are many easy ways to help a baby through constipation problems. Your pediatrician can help you with these

Need for more calories?

Many of my mom-clients are so successful that their babies outgrow their supply! A healthy baby that is born to a healthy mother and grows as fast a human being can grow eventually reaches the point where 20-calorie-per-ounce breast milk or formula is no longer sufficient for her needs throughout the entire day. Sometimes the baby will signal this change by waking up in the night at times when she used to sleep. This phenomenon is real but is often short-lived because feeding is so often a self-regulated phenomenon. Breast-fed babies will stimulate their mothers to make more milk during the day, and formula-fed babies will drink larger or more frequent bottles. Sometimes it works, sometimes not.

Naps: What is the Deal?

For reasons that remain mysterious, babies seem to know the difference between naps and nighttime, and they treat each sleep experience differently. I’ve coached many parents whose babies sleep solidly six to eight hours at night but who nap infrequently or inconsistently.

Naps vs. Real Sleep: The Difference is Between Night and Day

As long as the baby is getting enough total sleep during a 24-hour period, inconsistent napping doesn’t seem to be a problem. Most experts will tell you, and experienced parents will confirm, however, that a baby who naps well during the day will sleep better at night. This is because the baby who naps will avoid overstimulation during the day. So what do you do if your baby is a bad napper? Since sleeping is one of those things you can’t force a baby to do, I usually recommend the next best thing: downtime. Since stimulation is the problem that disrupts nighttime sleep, I recommend that during nap time parents place the baby in a low-stimulation environment— one with low light and low sound— for at least an hour. A caregiver can stay near the baby so long as she turns the lights down and doesn’t actively engage the baby in any kind of stimulating play.


The Consistency of the Substance

If inconsistent napping is the problem, then I suggest you focus less on the “napping” and more on the “inconsistent”.

Call me boring, but I like consistency. I find that consistency works. Consistency and predictability makes for better sleep.  If your baby is an inconsistent napper, then the reason may be that the baby’s day is inconsistent. I recommend trying to be boring for a few days.  Do the same things with the baby every day at the same time.  Feed at the same times. Play at the same times. To the extent possible, change clothes at the same times.

White Noise

Many parents also use a “white noise” machine.  For babies who are “light nappers”, those that wake if someone flushes a toilet somewhere in the neighborhood, white noise machines are great.  The soothing sound of rain or gentle wind actually buffers any noise that might disrupt a baby’s nap.  White noise machines are great for the non-napping downtime baby.

About Me – Testimonials

I’m just like you. I once brought home beautiful, healthy (hungry!) baby boy and started the strange and wonderful world of parenthood. Here’s a short story about me.


About Me

Very soon after, sleep-deprivation set in. This boy Would. Not. Sleep. All he did was eat, poop, calm very briefly and then wake up in half an hour, sometimes hungry, sometimes not. I was lucky, I got to go to work every day so I could relax (not nap, but relax). My wife was not so lucky. She didn’t even have time to eat, dress, or sometimes even go to the bathroom without baby boy attached to her. And forget a proper shower!

At night we took turns getting up to change him and get him ready for breast-feeding. None of the three of us slept. This went on for about three months.

The situation became extremely stressful. We loved this baby, but we were NOT enjoying parenthood. Something didn’t seem right. We were supposed to be enjoying the best time of our lives – our new lives with our baby! But instead we were irritable, grouchy, and we snapped at each other a lot.

The solution was clear – solve this baby’s sleep problem or something dire and terrible would surely happen – at least that’s what we feared.

We tried everything.


We bought books. We looked on the internet. We joined Facebook groups. We would try anything that seemed like a good idea to us.

We tried what we thought was the “Ferber Method” (without actually reading Ferber, see further on in this book!) We tried the “No Cry Method”. This too didn’t seem to fit. We tried with the pacifier, without the pacifier. We tried white noise machines. Everything seemed to work for exactly 48 hours and then we were back to square one: screaming bloody murder from 11PM to 3 AM. Every. Single. Day.

We dragged ourselves to the pediatrician at four months, both having lost a ton of weight and ragged from stress. The pediatrician pronounced baby boy strappingly healthy (he was almost 17 lbs at four months!) and sent us on our way.

The Solution

Finally, we figured it out. As I’m going to explain in this blog and in my instructional materials, there is a scientifically-based, logical formula (no pun intended) for getting a baby to sleep, but we didn’t figure it out from books or groups. We figured it out from brute-force trial and error, mostly error. Were we just lucky, or had we hit on some magic formula?

I wouldn’t say it was entirely magic. It turns out that there is a sound basis for what I’m going to teach you. I went on to advise hundreds of parents over 15 years, who had sleep problems with their own babies. Every parent-baby pair was different, but the basic issues were the same: I have now distilled everything I’ve learned from my personal experience and the experience of the families I advised and I’m ready to pass this knowledge on to you.

I’ve helped hundreds of parents solve their baby’s sleep problems over 15 years.  I’m confident I can help you as well!

I hope it works. If not, please first see your pediatrician and investigate if there may be a medical reason why your baby won’t sleep.

If it turns out your baby is like our first, and just won’t sleep, you may benefit from this method. If not, you may have a more complicated sleep problem. I can help you with more complex problems as well, but that is a subject for a future course or counseling session.



What People are Saying about “Sleep, Baby!”

Parenting is such a change of life and such hard work that being a good mom on its own was challenging – without the sleep deprivation thrown in on top of it. When my son “T” wouldn’t sleep for more than an hour or two in a row at night, we became exhausted. My husband and I took turns trying to console him. We tried changing his diet (to anything anyone suggested), rocking, pacifiers, baby sleep holders, music … nothing worked. It was distressing to go without sleep night after night.
Rob’s knowledge and kindness was a god-send. His interest in and focus on us, where we were, and what we needed, was truly a gift. Working with Rob made our lives better, and we recommend him, his common sense, his method, and his skill, without reservation — Kirsten J.

Rob, thank you SO much for all your help with M… we were literally at wits end. I was sure there was something seriously wrong with him when he kept waking up every 1 1/2 two hours for weeks on end!!! Both my husband and myself were relieved that what was going on was normal and was so easy to fix — Tammy R

My friend told me her baby slept through the night from the day she brought her home from the hospital. I felt like a failure as a mother but I couldn’t tell anybody because I was ashamed.  Rob was so patient and kind to me and made me feel like a good mother. Baby L is sleeping like a champ now.  I can’t tell you how grateful I am — Amy C

You know how you think you’ve got this ‘parenting thing’ figured out and you’re feeling pretty good about life and then WHAM, your 9-month old throws you this wicked curve ball and then you’re back thinking you’re going crazy and the rest of the world thinks you may be right? Well, that’s where I was with my little peanut when he stopped napping then was a screaming mess by 6:30. I was pretty sure something was messed up and it was all my fault. We couldn’t find any information on line that was any good so my girlfriend told me about Rob who had helped her with her son when he was going through a growth spurt or something. Anyway… to make a long story short, Rob was SOOOO kind to us and he explained what was going on and it took about two weeks but L is more or less back to normal and I feel like I can breathe again — Shane M.


When I was growing up, the expression “emergency room”, was always appended to the expression “rushed to”, as in “he was rushed to the emergency room”. It was always rush.

Of course you got rushed to the emergency room: There was some kind of emergency going on! Either you were having a seizure, or you fell off a ladder and broke several bones, or you were having crushing chest pain radiating down your leftrush arm… And virtually always you were rushed to that emergency room in an ambulance.

Emergency rooms back in the day didn’t look like they do today. There was very little regular staff, certainly no dedicated emergency room doctors.  An excellent picture of the 1960’s emergency room is drawn by the film Parkland , which tells the story of the doctors of Dallas’ Parkland Hospital on November 22, 1963, the day JFK was assassinated.  Every physician called to the emergency room that day (and by the looks of it, by the end, every physician in the house was in that room) had been elsewhere in the hospital prior to the President’s arrival.   None were dressed in scrubs or operating room gear. Each was wearing white shirt, tie, and black pants. And each was fairly drenched in the President’s blood by the end of the code (which is wrenching to watch).


Where’s the rush?

A lot has changed in 52 years. The expressions “emergency room” and “rushed to” have been separated. Ambulances often bring people there, but more often than not people are driven there by family, or drive themselves (presumably not in mid-seizure).

The expression “emergency room” itself has evolved to “Emergency Department”, to reflect the fact that these formerly empty, intermittently used spaces are now fully functional, fully staffed parts of a hospital.

Sometimes the word “emergency” is dropped entirely when one talks about a medical misadventure. The word “hospital” is substituted. “I went to the hospital”. “We took her to the hospital”.  Well of course, the individual went to the hospital, but not exactly.  They went to the emergency room of the hospital. This may be because of tacit acknowledgment that there was no true emergency, but I cannot be sure.

Why does all this matter?

As I hope to describe in future posts, the transformation of the emergency room into the Emergency Department is central to the story I am trying to tell in this blog. It is a multi-layered and nuanced story and by no means do I intend to distill the many issues down to One Big Thing.

For now, I will observe only that the disappearance of the expression “rushed to” is a symptom of our culture of over-treatment, about which I will have much to say later. There are two foci in the universe of over-treatment: one is the private doctor’s office, and the other is the Emergency Department.  How the universe of over-treatment came into being is a long story with many parts.

Stay tuned.


Our culture of over-treatment is the subject of one of the main arguments I make on this blog. To discuss it properly we need to define our terms.


according to the Free Dictionary is “the treatment of clinically insignificant disease, that is, minor or indolent illnesses that do not require aggressive or invasive therapy.” Reilly and Evans, writing in the Annals of Internal Medicine, refer to the phenomenon as “unnecessary care”, and define it as “diagnostic or treatment service that provides no demonstrable benefit to a patient.” They argued that 30% of all medical care in the United States (in 2009) might have met their definition.

My Definition

I tend to employ a broader definition that encompasses what I have already referred to as The Culture of Over-Treatment: Over-testing, over-medication, over-referral (to specialists), and over-hospitalization. The common feature of these four “overs” is that they satisfy Reilly and Evans’ condition of failing to provide demonstrable benefit to a patient. The “culture” of over-treatment refers to the institutions, practices, and mind-sets that propagate unnecessary care.



And I take the argument further. I claim not only does over-treatment fail to provide benefit, but that over-treatment does harm. Always. Sometimes the harms are small – the recipient of over-treatment isn’t physically harmed but treatment cost money that didn’t need to be spent. Or the treatment did nothing but cause anxiety. This is difficult to measure but cannot be discounted – in future posts I hope to deal more fully with the “anxiety factor.” And finally there is physical harm.  It’s bad enough when people are harmed in the course of treatment that threaten life or limb: when injuries happen in the course of over-treatment, it is doubly catastrophic.

Measurement of harm in medicine is a relatively new phenomenon. Harms studies are different from mere complication rates after surgery or rates of readmission after hospitalization. Today, more attention is paid to adverse outcomes from tests and treatments previously thought to be innocuous, such as routine blood tests, or antivirals for the treatment of Influenza.

But the harms that interest me the most are more difficult to define and quantify, but are no less devastating, and these are harms related to the ways we think about ourselves: our lives, our health and wellness, and particularly the way we experience our children.

There are several excellent books on the subject, especially “Overtreated” by Shannon Brownlee, about which I have a personal story that will have to wait for a future post.

I hope the tide is turning away from the culture of over-treatment but I see no solid evidence of this happening.  Talking about it is the best way I know how to buck the trend.  Read on.

The Myth of the Unhealthy Child

My mother once told me that when she and my father were starting our family in the mid 1950’s, she never imagined that she would give birth to unhealthy children. As it turns out, she was right: between 1956 and 1964 she gave birth to four healthy babies. My mother’s expectations were not all that unusual: Sixty years ago, most parents expected that their children were probably going to be born healthy and grow up to lead healthy lives.

Infant Mortality

Most parents believed this despite the fact that the infant mortality rate was 26 per 1000 live births, over four times what it is today. Polio was still a threat, and public swimming pools were regularly closed during the summers of the 1950’s for fear of polio. As if polio weren’t scary enough, twice as many children were dying of Measles as from Polio in 1956. We were years away from an effective Measles vaccine.


And in an age where car seats were never heard of, and seatbelt laws did not exist, four times as many children died in accidents in 1956 compared today.

And yet, our parents believed we would probably be born healthy and grow up safe and sound. They believed that children were essentially healthy human beings. That is to say, it is an element of their essence that children are healthy.  Sure, things would happen: they’d catch the flu, they’d fall down and break a bone, but the children were essentially healthy and they’d recover.

Fast forward to 2016

The mindset that was common among my mother’s peers has been turned on its head. Instead of believing that their children are essentially healthy, it is common today for parents to believe that their children are essentially un-healthy. A version of this mindset is that their children are potentially unhealthy, one sniffle away from certain doom.

The facts suggest the complete opposite.  Babies born in 2016 in the United States belong to a cohort of human beings who are the healthiest that have ever lived on planet Earth. That is not just pie-in-the-sky optimism: that is demonstrable fact. And yet parents are more worried than ever that their children are sick or will become sick.

It is the aim of this blog to explore this phenomenon of the “Essentially Unhealthy Child”: to test the truth of the hypothesis; to examine the possible reasons we’ve come to the pass; and to explode the myths that have come to surround the institution of parenthood.

We really that unhealthy?

There are several consequences of The Myth of the Unhealthy Child that I believe are at best counter-productive to the enterprise of raising healthy, happy children. At worst, the consequences threaten our very self-concept of our health and well-being as adults.

I hope you’ll join me on this journey – I look forward to hearing your contributions.