Premature Baby Sleep Training: When and How

Premature baby sleep training is a special kind of sleep training.

The basic principles of sleep training apply, with a twist. We have to pay attention to a couple key questions. “What is your baby’s corrected gestational age?” and “Does your baby have any special difficulties related to her prematurity?”

I will review some basics about preemies and sleep training. Then I’ll talk about which sleep training methods are best for premature babies and why.

Premature Baby Sleep Training

The most important thing to know about premature babies is the most obvious. They were born early! But it might be better to say that they were born before they were ready. Harvey Karp would argue that even full-term babies are born before they are ready to be here on earth, but that is another subject!

Sometimes a premature baby will be born before her lungs are ready to breathe air on earth. These babies obviously need to stay in the Neonatal ICU (NICU) until they can breathe on their own. Still other preemies are born before they are able to eat on their own. They too need to stay in at least a special care nursery until they can “remember to eat”.

But the most important difference for our purposes is premature baby sleep. Premature babies sleep differently from full-term babies because, just like their lungs and stomachs are immature, so are their brains.

Turn Down the Noise!

An important difference between us grown-ups and babies is that we have a filter. We can filter out sounds, feelings, smells, tastes, and sights that interfere with our ability to focus. Babies can’t do this. They have to pay attention to everything. And so it’s easier for babies to become overwhelmed by too much sensation. This is what we mean by “overstimulation”. When babies get overstimulated they get fussy, they cry more, they eat poorly, and they don’t sleep! Premature Baby Sleep Training 2

How ever you decide to sleep train your preemie, you have to keep this in mind, particularly if she is still younger than her due date. The risk of overstimulation can be too high with babies with a corrected gestational age less than 40 weeks. For these babies it may be best to put off sleep training.

So You Say You’re Ready for Premature Baby Sleep Training?

Maybe so, but is the baby ready? There are a couple of ways to tell. First, does the baby weigh around what a full-term baby weighs? If she weighs less than 5 lbs 8 oz, it may be difficult. She’ll need to do a lot a feeding for catch-up growth. I recommend discussing with the pediatrician if you want to start at a smaller weight.

Does the baby have any problems related to her prematurity? For example, many preemies have reflux. A premature baby with reflux may be fussy and have trouble settling. Other premature babies go home from the hospital needing oxygen. These are babies I might not recommend sleep training until they are breathing room air. Again, this is something to discuss with the pediatrician.

Premature Baby Sleep Training MethodsPremature Baby Sleep Training 3

All the various sleep training methods fit into two broad groups: baby-led and parent-led. Briefly, baby-led methods lean heavily on paying attention to the premature baby sleep cues. These are eye-rubbing, yawning, and beginnings of fussiness. Parent-led methods lean heavily on providing structure for baby sleep. This includes starting meals at the same time every day, and encouraging naps at the same time every day.

The reality of premature baby sleep training is much simpler: it’s a combination of baby-led and parent-led methods. This is sometimes referred to as “combination” sleep training. That is to say that the most successful baby sleep training that I know of involves a combination of following baby’s cues and providing structure. This is the method I recommend in my practice.

I do make a slight exception for premature babies. Because feeding and growing is so important, I lean more toward following her feeding cues. Your pediatrician may have given you target for the number of calories she should have every day. If so, it’s best to do what you can to make sure she gets enough formula or breast milk to do catch-up growth.

The Ideal Age for Premature Baby Sleep Training

So what is the ideal age to sleep train a premature baby? The key is corrected gestational age. If the baby were full term, the ideal age for sleep training would be four months of age. Prior to that age, you have laid most of the groundwork already. You’ve learned baby sleep cues, and you’ve started providing structure to the baby’s day. You might not even need to sleep train at this point! If you’re doing premature baby sleep training, you want to aim for four months corrected. For example, if your preemie were born at 36 weeks (4 weeks early), your goal should be five months of age. At this point the baby can be expected, reasonably, to achieve the sleep patterns of a four month old full term baby.
Premature Baby Sleep Training 4
I say “ideal age” for premature baby sleep training, because this is the age at which I believe you’ll have the most success. Four months corrected is about the age when a girl baby can soothe herself to sleep. You can put these girls down in the crib fully awake. And they can learn to fall asleep without assistance. For boys, the age is somewhat later. Certainly by six months (corrected) a boy can master the self-soothing skills needed to settle himself… and to sleep through the night (if he’s well-fed!)


  • Premature baby sleep training is just like full-term sleep training, with some exceptions. You need to pay attention to any health issues related to prematurity. And you should lean more towards following her cues.
  • Providing structure is still important. Whichever method you choose to sleep train your preemie, she’ll do better if her day is as regular and as predictable as possible.
  • Expect a girl preemie to sleep through the night at around 4 months (corrected), and a boy by 6 months (corrected)
  • If there are any health concerns at all, please contact your pediatrician.
  • If the baby’s health checks out, you still are having sleep difficulties, I can help!

2-3-4 Nap Schedule

2-3-4 Go!

What is the 2-3-4 nap schedule?

It’s not a guideline. It’s more like an observation. And it’s particularly associated with the 6-month old baby.

The name “2-3-4” refers to the number of hours between naps during the day. It works like this:
[Just a note: What follows is complete fantasy. How we wish every day could be as perfect as the one I’m about to describe! But hey, we can dream, can’t we?]


Baby wakes up at around 5 in the morning, refreshed from 8 glorious hours of uninterrupted sleep. She’s smiling and cooing in the crib, talking to her mobile. You know it’s time to go pick her up, change her diaper and feed her. Because if you don’t, she’ll become cranky with hungry. Depending on her temperament, she may get really cranky and start to cry. This is to be avoided.

The majority of American mothers have begun feeding the baby solids by six months. So in addition to breast or bottle, she might have 2-4 ounces of pureed vegetables (you’ve made this yourself, right? No? It’s easy. You should try it!)

The “2”

You might dress the baby, play with her. You’re certainly going to talk to her and watch her fascination at this “communication thing” you’re doing. She might even want to imitate you. Then, approaching 7 AM, she’ll start to rub her eyes (yes, babies really do this). You know it’s time for that first nap. You go through your “nap routine”: change diaper, sing her a song, a kiss, then place her down in the crib awake. Two hours have elapsed.

Cat nap (sorry, couldn’t resist)

The “3”

Two hours later, at noon, your little kitten begins to stir and stretch. You know the first nap of the day is over. So you change her diaper, change her clothes, and get ready for the day. Let’s say it’s a gorgeous July day, sunny and breezy. We dress in cool, long-sleeves, making sure to put on the hat to shield her face, and head out in the stroller.

At the park, for some reason, every stay-at-home dad in town has brought a baby to the park, and every one of these men is the spitting image of Cristiano Ronaldo (I said we can dream, can’t we?) You enjoy two hours holding court as each Cristiano takes turns ooh-ing and ah-ing over your sweet angel, who smiles and laughs at each face she sees. You nurse her as well at the park, because this is the 21st century and we can do this, right? At 2-ish, everybody gets back into their strollers and heads home.

By 3 o’clock, baby girl is rubbing her eyes again and it’s time for nap #2. Three hours have elapsed.

The “4”

Exactly 2 hours later, 5 PM, baby girl is up and ready for the home-stretch of her day. You change her diaper and take her into your living room (which has been transformed into the baby’s living room) and watch her play with her toys for a while. She may be sitting up by herself at this point, so you might put her in a bouncy seat and watch a short video with her. At about six, your partner, Cristiano Ronaldo, comes home, delighting baby girl.

At 7 PM, it’s time for dinner. She takes her seat (high-chair) at the table to eat with her parents, family-style. Nursing or bottle, 2-4 ounces of pureed vegetables and fruits.

Do not disturb

At about 8PM, the bed-time routine begins. This is the most regular and predictable part of the day. The baby knows exactly what will happen, and in what sequence. There will be a fun bath, changing into pajamas, then quiet hanging out with parents, a song-and-kiss, and time for bed. She goes down in her crib awake and drifts off blissfully at 9PM. Four hours have elapsed.


I actually wrote that without laughing. It was tough. Of course no day is as perfect as this one (although, I hope you get at least one, or a few, like this). But roughly speaking, this is the way the 2-3-4 schedule works, with or without the dream-like elements. It isn’t planned. It just turns out that way.

Where did 2-3-4 come from?

Good question. The earliest mention of it I could find in a Google search occurs on December 12, 2005 at

Once babies hit 6 months or so, many of them will settle into a 2-3-4 pattern. That means that they’ll take their first nap 2 hours after waking up in the morning. They’ll take their second nap 3 hours after waking up from the first nap. They’ll go down for the night 4 hours after waking from the second nap. Not all kids do this, but a surprising number of them seem to.

Moxie had said at the opening of her post that this idea is not “unique”, by which she may mean “not original”. I believe her, but since I can’t find an earlier reference, I’ll credit Moxie with coining the term.

Problems with 2-3-4

Moxie is careful to note that babies “settle into” a 2-3-4 pattern. It’s not set for them by their parents, but neither is it entirely baby-led. Any kind of pattern like this is a result of what I call the “follow her cues but provide structure” approach to sleep scheduling. The pattern that emerges is a neat observation, not a prescription.

The two hour interval seems a bit long to me. Dr. Weissbluth might agree. He says that the first nap should be though of as a continuation of the night’s sleep, complete with REM phases and all the rest. At six months of age, one and a half hours after waking in the morning sounds about right. Some will stay awake longer, some less.

The period of a baby’s life where she’ll nap with this pattern is really very brief. It may start around 4 months and last until 9 months at the longest. Most 9-month olds nap only twice per day.

When 2-3-4 might be useful

This is not to say that the expression is completely useless. If you have a six-month old whose nap schedule is all screwed up for whatever reason, and you need a guideline to get back on track, 2-3-4 may be the way to go. It may require nudging nap times around a little. I would only do this in small quantities: 15 minutes at a time. I do not recommend waking up a sleeping baby to try to achieve any nap pattern. That’s a sin!

But say your 6-month is fighting sleep at 8PM and she’s only been up for three hours. Think 2-3-4.

How Much Should My Baby Nap?

Parents often ask me how often the baby should nap, and for how long. Often what they’re really asking is “Am I doing this right?”

Sometimes they ask because their friend’s baby is the same age as yours and she’s napping three times per day and yours is only napping twice. Or maybe it’s the other way around.

Behind all these questions is the very real and important question: “Is my baby getting enough sleep?”

How Much Sleep Does My Baby Need?

I’m indebted to my colleagues at “Get Your Baby to Sleep” for creating the tables and charts below (so that I didn’t have to make them!!!)

Baby Age Nighttime Sleep Daytime Naps Total Sleep
Newborn to 2 months 2-4 hours between feedings 4-5 naps 16 to 18 hours
2 to 4 months 4 hours between feedings 3 naps 14 to 16 hours
4 to 6 months 5-8 hours 2-3 naps 14 to 15 hours
6 to 9 months 8-10 hours 2 naps About 14 hours
9 to 12 months 10-12 hours 2 naps About 14 hours
12 to 18 months 11-12 hours 1-2 naps 13 to 14 hours
18 to 24 months 11-12 hours 1 nap 12 to 14 hours


I should emphasize here that not every baby has “read the book”, or even “Googled it”, as I guess I should say these days: these are averages. Some babies sleep more than others. That’s why I like to provide ranges and use terms like “about”.


Total Hours of Sleep

For readers who prefer graphs (as I do) this one gives a better idea of how total sleep decreases through the first year of life. Out of a 24 hour period, the average newborn (0-30 days) will sleep 18 hours! This will gradually decrease to 12 hours, or half the day, by a year of life. Take home message: babies sleep a LOT!

Total Hours of Sleep per day, by age

How Many Times Per Day Should the Baby Nap?

In some ways the question begs another question: what do you mean by “nap“? The indispensable Dr. Weissbluth (see below) explains that, starting around 4 months of age, the first of the day’s three naps is basically a continuation of the previous night’s sleep! This nap is rich in REM sleep, when we believe the baby does much of her learning and processing of all the information she’s been receiving during the brief times she’s awake. The three naps per day generally decreases to two naps by 6 months of age.

Number of naps by age


When Am I Going To Sleep Through the Night Again???

The answer to this question, as with so many other parenting questions is “it depends”. In this case, it depends on what you mean by “through the night”.  Some parents define it to mean the usual 8 hours they enjoyed before baby came in to their lives.  They should be so lucky! To other parents, “through the night” means  “the baby wakes up once to feed but the whole thing lasts five minutes so I don’t even count it”. For me, “through the night” means six hours straight, followed by the delightful early morning awakening which lasts 1-2 hours, followed by a few more hours of blissful sleep. This schedule can be achieved at about 6 months for most babies (see the table above).

Uninterrupted sleep, by age


Well, How Did I Get Here?

One of the joys and fascinations with baby sleep is that the tables and graphs I’ve shown you do not depend at all on the type of sleep method you employed to get your baby to sleep! Whether you are an on-demand feeder, a baby-led scheduler, a parent-directed feeder, a contented baby enthusiast, a Baby Whisperer, or an attachment parent, all methods seem to lead to the same result: by one year, baby sleeps 10-11 hours and takes two naps!

I believe that all methods end up like this for a very important reason: Sleeping, and napping, are natural parts of a baby’s life. Given the right combination of reading the baby’s cues and providing structure, every parent can have a happy, healthy baby who sleeps well!

More from Dr. Weissbluth:

Cry It Out: Is There Such a Method?

Cry It Out: You read so much about it on the internet, you’d think it’s a thing.

Is it?

Cry it Out IS a Thing. Sort of.

Every day, on internet forums, there will be dozens of discussions of “CIO”, as it’s referred to. Almost without exception, CIO is help up as a sinister element that lurks out there in the world. I’m almost tempted to read CIA.

Sometimes I wish I could send a group message to the tens of thousands of mothers (and fathers): STOP IT!


But then I have to stop myself and think: Thousands of mothers on the internet refer to CIO, so whether I like it or not, Cry It Out exists. Sort of.

cry it out
We have ways of making you sleep

Cry It Out did exist. Once upon a time. 1894, to be exact, with the publication of “The Care and Feeding of Children” by Luther Emmett Holt. Here is what Holt had to say on the subject, in its entirety:

How is an infant to be managed that cries from temper, habit, or to be indulged?

It should simply be allowed to “cry it out.” This often requires an hour, and in extreme cases, two or three hours. A second struggle will seldom last more than ten or fifteen minutes, and a third will rarely be necessary. Such discipline is not to be carried out unless one is sure as to the cause of the habitual crying.

Note that Holt places the expression in quotation marks. This suggests to me that the phrase had some currency in the late 19th century. Perhaps CIO was the preferred method? But now read closely: Holt recommended CIO only in the case of an infant who already has a sleep problem that was the result of what we’d call today a bad “sleep association“. I’m speculating as to the meaning of  “temper”.

Okay, so this is now the 21st century. Does any modern sleep expert recommend Cry It Out as a sleep training method? Again the answer is ‘No. Sort of.”

Meet Gina Ford

Gina Ford, the author of over 30 parenting books, is a Scottish-born former maternity nurse. In 1999, she published “The Contented Little Baby Book“. The major distinguishing feature of “CLB”, as it became known, was Ford’s recommendation of strict scheduling, down to chunks of five minutes. Despite scathing criticism, CLB has become a best seller. The closest Ford comes to recommending Cry It Out is her reference to something called “crying down”.

It’s a Scottish Thang

Prior to reading Ford, I was unaware of the expression crying down  as a troubleshooting method. Perhaps it’s a Scottish phenomenon. I can’t be sure. Here’s what Ford has to say about “crying down”:

Crying down can be particularly helpful when feeding problems have been resolved and a baby or toddler has only mild sleep association problems or has difficulty falling asleep because he is over-tired or over-stimulated… Reassurance must be kept to a maximum of one to two minutes. Parents should then wait a further 10– 15 minutes before returning. For this technique to work it is essential that the baby is not picked up and that he is allowed to settle by himself in his cot… Provided a baby has been well fed and is ready to sleep, I believe he should be allowed to settle himself. [Crying down] works not only for over-tired babies but also for babies who fight sleep…

It is my belief that, in the long-term, allowing your baby to develop the wrong sleep associations and therefore denying him the sound night’s sleep he needs in order to develop both mentally and physically is a worse option than hearing him cry for a short while. Allowing your baby to learn to go to sleep unassisted is your aim, and it is important to remember that this will prevent much greater upset and more crying if waking in the night is due to your baby not knowing how to go back to sleep after having woken in light sleep (emphasis added).

I’ve quoted Ford at some length because I wanted to highlight three things. First,  Ford’s similarities to Holt’s advice (already cited) emphasizing that crying to sleep might be necessary only for a baby with a bad sleep association or who was overstimulated (I regard “over-tiredness” and overstimulation as the same thing). Second, Ford emphasizes that neither a hungry baby, nor a baby who is not tired, should be put down to sleep. Finally, Ford places herself firmly in favor of good sleep associations, over most other considerations.cry it out

So is there really such a thing as “Cry It Out”?

Gina Ford tells us, correctly in my view, that crying down should not be necessary in the first place. Ford identifies the “need” crying down as bad sleep associations and allowing a baby to become overstimulated. She believes both could be avoided if the baby were put on a schedule from the get-go. Ford truly does not want your baby to cry to sleep. I don’t believe anyone want this, including Luther Emmett Holt.

In fact, if you read closely, Gina Ford is more of a “combination scheduler” than you might think at first blush. It’s true that she advocates a fairly strict schedule. But notice also that Ford insists that you make sure the baby is well fed. Notice also that she doesn’t recommend putting down a baby that isn’t tired!

Slightly Different

Just as virtually all 21st century sleep experts, Gina Ford joins the consensus about baby sleep, if perhaps in slightly different form. Like Baby Wise, Ford might say: Provide structure, but follow the baby’s cues. Sears and Spock might say “Follow the baby’s cues, but provide structure”.

Either way we end up with a method that recognizes a broader consensus about all of human behavior. We are not just a bunch of genes (the “Nature” part of “Nature vs. Nurture”). But neither are we blank slates, requiring inscription by good parents (the “Nurture” part). We all are born with certain biological traits that are then molded and shaped by our environments. And for virtually all babies ever born, the first and most important “environmental factor” is mom.


The Baby Whisperer and Combination Schedules

What are “Combination Sleep Schedules“?

They are considered to be compromises between “Parent-led” and “Baby-led” methods. According to, “…combination schedules provide the consistency that babies and parents need without the hassle of a more rigid, timed-to-the-minute routine.”

The best example of the method is Tracy Hogg’s “Secrets of the Baby Whisperer“, co-written by Melinda Blau.

Word to the Whisperer

I argue (here, and here, for example) that pretty much everybody in the baby sleep world offers some kind of compromise between both camps. It’s only a matter of degree. But Hogg (who left us far too early in 2004) provides us with the best explanation of a common-sense baby care, spun in a Yorkshire accent.

Combination or Common Sense?

I will not be the first reviewer to point out that, for all it’s acronyms and British accents, “Baby Whisperer” essentially offers good old-fashioned common sense. As such, Hogg places herself in the tradition of Ben Spock. Hogg concludes her book, in part, like this:

My wish for you is to relish every moment, even the tough ones. My goal is to give you not merely information or skills, but something even more important: confidence in yourself and in your own ability to solve problems.

Sound familiar? It should. It’s a version of Spock’s famous “Trust Yourself” formula that rocked the parenting world fifty years prior. By 2001, it was old-fashioned advice!


But the book is not entirely derivative, and there is even a fair amount of innovation (Hogg’s acronyms, E.A.S.Y., and S.L.O.W. (see below) are unique, as far as I know). Her major contribution to the field is her emphasis on parents paying attention to their babies, engaging them in a kind of conversation. Hogg is on to something here. It is almost certainly the case that human communication begins at a very early age, perhaps the earliest of ages. Hogg is right to suggest to parent that they appreciate the “messages” that their babies send them, and to communicate back in real human language.

Baby Talk

My only quibble with Hogg’s suggestion is her tendency to echo an annoying pattern of speech in which parents refer to themselves in the third person. “Mummy will be right back”. “Mummy doesn’t like it when you do that”.

Pronouns are hard. Pronouns are hard for anybody learning a language, even their first language. Anybody learning a new language knows that you understand more than you speak at every point along the learning curve. Children understand you when you say “I” and “me”. They will muff the pronouns when they try them out, but they understand you. For heaven’s sake, people, if we are to converse respectfully with our children, let us respect their ability to understand pronouns!

S.L.O.W. Down and Take it E.A.S.Y.

Hogg doesn’t say this explicitly, so I just did it for her: Baby Whisperer philosophy is based on slowing down, taking deep breaths, and listening to your baby. Both acronyms, as corny as they sound, help anxious hurried parents get to know their babies.

S = Stop; L = Listen; O = Observe; W = What’s up? (Hey, she needed a “W”, right?)  In other words, absorb what you’ve heard and seen and evaluate what’s going on for your baby. It’s a bracingly simple and effective tool. I wish I had such an acronym to recite while walking the floor with my colicky first-born! Cleverness aside, it’s important to remember that your baby is a human being that is learning to interact with the world via communication. Hogg reminds us we do better to start early.

Yet more possible combinations

Another of Hogg’s contributions to the baby sleep literature is her clever E.A.S.Y. acronym. E = Eat; A = Activity; S = Sleep; Y = You. The innovation is the insertion of activity between eating and sleeping. This way, parents will avoid the temptation to allow their babies to develop bad sleep associations. To do this, it’s important to separate feeding from the moment of sleep. The activity needn’t be anything stimulating: to the contrary, stimulation prior to sleep is never a good thing. Hogg recommends changing the diaper, singing a song, reading a book, etc.

As for the “Y”, I suspect Hogg needed another letter to spell a nice word. Otherwise, I can’t see why she included it. Hogg really doesn’t need to tell mothers to eat, take a shower, sleep, etc. She doesn’t go as far as Baby Wise Gary Ezzo, who recommends “Date Night” for parents. Indeed, for parents without extended family or disposable income to pay a baby sitter, the latter really isn’t possible. Hogg’s Hollywood clientele could afford it perhaps, but not us normal folk. Surely mothers need to care for themselves, otherwise they’d soon be incapable of taking care of their babies. I’m just not sure they need to be told this. I’m going to stick with the suggestion that she needed the letter “Y”.

One More Abbreviation

Hogg ends the book with an excelling “troubleshooting” chapter, featuring the mnemonic ABC. A = Antecedent. What came before the sleep problem? (Kudos to Hogg for using the word “antecedent”: it’s a dying word, I fear). B = Behavior. What is your baby’s part in starting this sleep problem? C = Consequences. What was kind of pattern resulted from A and B? Usually, the problem to be solved is a bad sleep association, and Hogg walks us through the disassociation process. But I suspect that the ABC method could help unpack other sleep problems as well.


As I’ve said before, I’m a lumper and not a splitter. And as such I’ve argued that we’re all basically “combination schedulers” now. I say this because experts from Ezzo at the parent-led end of the spectrum, to Sears at the baby-led end, all recommend following a baby’s cues, but providing her with structure. To Tracy Hogg’s credit, she says this explicitly.

We’re all Baby Whisperers now. Or we should be anyway.

combination2 combination1

Baby Wise: Parent-led Schedules

Ezzo, Gary, and Bucknam, R. “On Becoming Baby Wise”. Mount Pleasant, SC: Parent-Wise Solutions, 2012

Gary Ezzo is a lucky man.

“On Becoming Baby Wise”, as of this writing, ranks #1 for sleep disorders in Amazon Books. This fact speaks volumes for the message, especially in light of the fact that the messenger, Mr. Ezzo, has been the recipient of some withering criticism for his parenting advice, but especially for his religious beliefs. Some of that criticism, sadly, comes from Ezzo’s own church, or I should say former church. Despite all this, the Ezzo collection has grown to nine volumes. That’s impressive.

baby wise X

When I read “Baby Wise” for the first time, I detected no hint of any religious world-view whatsoever. I did not know of the controversy surrounding Mr. Ezzo and I’m glad I didn’t. I appreciate that the first edition of the book expressed this world-view explicitly. Not so with subsequent versions.

My ignorance allowed me to judge the “Baby Wise” message without regard to the messenger. This is as it should be. Here’s what I took away from it:

Baby Wise

The lesson I took away was the commonsense observation that a baby who has just finished a good feeding is probably not hungry. If one hour later, the baby starts fussing and crying, many experienced parents understand that what is bothering the baby cannot be hunger. Because the baby just ate! “Baby Wise” suggests that parents first seek to find what’s bothering the baby before reflexively feeding her.

This is what happens in the real world. What mother has not looked into the bassinet at her crying baby (whom she finished nursing 30 minutes ago) and thought, “You can’t be hungry, I just fed you!” Mom then proceeds to see if the baby had gas, or needed a diaper change.

Another Fact of Life

“Baby Wise” recognizes a fact of life about babies: they are not born knowing how to get along in this world. They are equipped with certain biological set-points, but becoming a person requires nurture as well as nature. Most parents understand this implicitly.


Ezzo suggests that babies need to be nudged, gently, in the direction of sleeping when it’s time to sleep and eating when it’s time to eat. This may involve staying with the baby for a few minutes to stroke her back, to sing to her, or to give her a fingertip to suck on. I believe that even parents dedicated to attachment methods recognize this truth. I believe “attachment parents” do a fair bit of nudging themselves, though they might not care to acknowledge it!

Baby Wise Claims the High Middle Ground

It has become fashionable in the Baby Sleep World to claim that one’s own method is “centrist” or a “combination method“, and that all the others are either “baby-led” or “parent-led” extremists. Everyone clamors for the exalted, er, middle ground. Ezzo is no exception.

[Parent-directed feeding] is the center point between hyper-scheduling and the re-attachment theories. It has enough structure to bring security and order to a baby’s world, yet enough flexibility to give Mom the freedom to respond to any need at any time. It is a proactive style of parenting that helps foster healthy growth and optimal development. For example, a baby cannot maximize learning without experiencing optimal alertness, and he can only experience optimal alertness with optimal sleep. Optimal sleep is tied to good naps and established nighttime sleep. These advanced levels of sleep are the end result of consistent feedings. Consistent feedings come from establishing a healthy routine.

baby wise
Who’s the director?

Ezzo then goes on to mis-characterize the so-called “baby-led schedule” and “attachment theories” and exhumes the body of Luther Emmett Holt’s clock-feeding schedule.

I wish Ezzo and others were lumpers instead of splitters. We are all “combination schedulers” now. This is where the “debate” has led us.

Off the Rails

Where Ezzo over-promises and under-delivers comes with his discussion of sleeping through the night.

In fact, healthy, full-term babies are born with the capacity to achieve 7-8 hours of continuous nighttime sleep between seven and ten weeks of age and 10 to 12 hours of sleep by twelve weeks of age. But these achievements require parental guidance and a basic understanding of how a baby’s routine impacts healthy outcomes.

I’m not sure where Ezzo gets these optimistic numbers from, but they do not square with observed data, as in this study:

Continuous night-time sleep for at least 6 hours was noted in 35% of the infants under 3 months old and the proportion increased to 72% by the age of 9–12 months. The youngest infants were fed on average 6–7 times per day at 2- to 3-hour intervals in the daytime and at 4- to 6-hour intervals at night.

Ezzo also nods with his misunderstanding of circadian rhythm. “Babies do not have the ability to organize their own days and nights into predictable rhythms, but they have the biological need to do so.” In fact, babies do have the ability to organize day and night, if they are permitted allow synchronize their sleep-wake cycle with the cycle of day and night. This requires no effort on the parents’ part at all. Just allow daytime to be light and nighttime to be dark. You don’t need to train the sun.

I’m not sure what Ezzo means by a “biological need” to organize day and night. There’s a need to sleep, and it’s probably the case that we do better when we sleep long periods at night. Is this what Ezzo means? Perhaps.

baby wise
Oops. Ran out of track

Back on Track

The remainder of the book gives solid common-sense advice about the hazards of overstimulation and bad sleep associations (though Ezzo refers to the latter as “props”, confusing cause and effect). The chapters on crying, feeding, baby care and troubleshooting are all pretty standard fare.

In short, the similarities between Baby Wise and other baby sleep books are greater than the differences. The latter are cosmetic, the exceptions having been noted.


  • Ezzo may be a religious man, but “Baby Wise” is not a religious book
  • Apart from some unrealistic expectation management regarding uninterrupted sleep at night, the advice is solid.

Hail Spock! Leader of the Baby-led Schedule Revolution

Spock, Benjamin M., “The Commonsense Book of Baby and Child Care (9th ed)”. New York: Skyhorse Publishing, 2012

Maier, T., “Dr. Spock, An American Life”. New York: Harcourt Brace & Co, 1998

You Say You Want a Revolution?

Vladimir Putin and Czar Nicholas II walk into a bar and order a bottle of vodka.  After the third or fourth shot, Nicholas begins to reminisce:

“My Okhrana (secret police) would do anything I asked. They were totally loyal to me.”

“Your Excellency,” Putin replies  “my KGB is just as loyal as your beloved Okhrana.”

“Ah, but I could send my enemies to katorga (prison camp) with a wave of my hand!” Nicholas protested.

Putin is unfazed. “Your Excellency, I have just as many enemies in my gulags.”

Czar ruminates over his vodka. “Well, at least I had the best 70 proof vodka in the world…”

Putin springs to his feet. “Your Excellency, today Russian vodka is 75 proof!!!”

“For this,” the Czar smirks, “you had a revolution?”

Ben Spock, Revolutionary

Spock. True Revolutionary

The point of the story is that political revolutions don’t change things all that much. Cultural revolutions are more uncommon than political revolutions, and they are rarely led by individuals. Spock’s was such a revolution. Spock’s “Baby and Child Care” upended the entire enterprise of raising children. Spock raised up the infant and child from the status of mute object of parenting to the subject of parenting, actors to be listened to and respected. Put that in your gulag and persecute it, Vlady!

The Cultural Context

Spock came along in at a very particular time, and in a particular cultural context that was essential for making his revolution possible. Fifty years earlier, in 1900, an Austrian neurologist named Sigmund Freud published Die Traumdeutung (On the Interpretation of Dreams), launching a thought revolution that to this day influences the way we think about ourselves.

Spock underwent Freudian psychoanalysis after medical school at Columbia. Through analysis, Spock learned that his own insecurities and anxieties were the result of his rigid upbringing in New Haven, Connecticut. Spock’s mother forced her children to sleep on a porch, even in winter. Spock and his siblings were subjected to strict rules and schedules. Though Baby and Child Care never says so explicitly, Spock’s philosophy is heavily influenced by Freudianism.


At mid-century, the cultural ground was prepared for suggestions that leaders could be challenged and their authority questioned. The reasons for this are complicated and require a book-length discussion. It’s possible that the experience of two world wars and a post-war baby boom spawned a libertarian uprising in which ordinary people cast off traditional authority and began to assert self-rule and self-ownership.

Mere poser

Spock Steps Up

So when Spock entered the stage advising mothers “Trust yourself. You know more than you think you do,” he was delivering a message mothers were ready to hear. Drawing on his experience in psychoanalysis, Spock suggested that mothers trust their own instincts, and not to bow to so-called experts, including himself. However, especially in early editions of the book, Spock never lets go of the authoritarian impulse to tell mothers how to raise their children. He insists throughout that mothers should listen to the pediatrician. I credit my mother for pointing out that Spock begins his book by telling mothers they know more than they think they do; then he describes in exquisite detail all the things mothers don’t know, like how to fold a diaper.

Trust yourself. You know more than you think you do.

In the 1950’s and 60’s Spock began to draw the ire of his colleagues for publishing articles in Ladies Home Journal. It was thought that a physician should not lower himself to publishing in the lay press. If he should write at all, a physician should publish in scholarly journals only. Imagine what Spock’s stodgy colleagues would think of physician bloggers!


Spock got himself into even more trouble with his colleagues by his vocal opposition to the Vietnam War. He was blamed (incorrectly, in my view) with creating a generation of unpatriotic children raised in permissive homes. Of course, even a cursory reading of Spock reveals no advocacy of permissiveness. Nevertheless, in later editions, Spock felt compelled by his critics to emphasize that parents set limits and enforce them. It’s clear to me that Spock never thought otherwise about the importance of parental limit-setting. He would edit subsequent editions as well to placate feminists who criticized the book for suggesting that mothers stay at home with their children. Spock’s compulsion to please his critics is a failure on his part, in my view. He had authored a book that was more popular than the works of Shakespeare, and sold more copies than any volume other than the Bible. He didn’t need to bow to anyone.


Spock Wins

If  there were only one contribution that “Baby and Child Care” made to the modern world of parenting (and their were actually several), it would be the introduction of “on-demand” infant feeding. Spock made what in retrospect is an uncontroversial suggestion: babies eat when they are hungry. Babies grow best when parents obey hunger signals and feed the baby when she appears hungry. On demand feeding was in fact controversial at the time because the “official recommendation” of scientific pediatrics was strict schedule feeding. Eventually, on demand feeding won the endorsement of the American Academy of Pediatrics.

But schedules and routines never went away entirely and are with us until today. In fact, most experts (present company included) recommend routine and consistency as pillars of health and well-being for infants and children. Perhaps it is this uneasy balance between on-demand and strict scheduling that gives rise to our contemporary division between “baby-led” and “parent-led” camps.

Because I’m a lumper and not a splitter, I don’t see much of a distinction between the two groups. I agree, based on my training and experience, that routine and consistency are most conducive to health and well-being of children. I also acknowledge that you cannot force a baby to sleep who is not sleepy. That’s just a fact of life. I consider it cruel and unusual to force a tired baby to stay awake. I would go further and say that so-called “baby-led schedule” advocates agree that routine is important, and so-called “parent-led schedule” advocates acknowledge that babies are not digital timers. “Combination schedule” advocates only offer recommendations that differ in style, but not in substance.

In future posts I hope to delve a bit deeper into the various schools of thought about schedules.