What to do when it is not working?

In the videos for each method, I have given rough guides for how long it should take for a baby to get to grips with their new way of falling to sleep or sleeping through the night. I am a firm believer that sleep should come naturally to babies and that these methods always work, UNLESS there is something else bothering that baby. So if, beyond those rough guide timings, things do not seem to be improving, it might be time to start investigating possible reasons why.

Before assuming there might be something else going on though, here are some important questions to ask:

1) Has the family been totally consistent in carrying out the new sleep approach? If the answer is no, then inconsistency is one of the biggest reasons why sleep coaching won’t work. I recommend going back through all the details of the approach and then implementing it again for the number of days suggested, before deciding that it hasn’t worked. 

2) Is baby teething? Teething can be very disruptive to sleep. Ideally, start the sleep coaching at a time where no teething is imminent (signs of which might include bad nappies, bright red cheeks, excessive drooling and lots of daytime clingy behaviour). If a teething bout crops up after only a few days of sleep coaching, baby may need more comfort and the plan to be paused, then restarted once things settle again. This cannot be helped and doesn’t mean it is not working. However, I do find that teething gets blamed for a lot and often, there can be something else behind baby’s grumpiness, such as a food intolerance. If teething seems to be never-ending (weeks on end) and there doesn’t seem to be a gap, then I recommend looking into whether there is something else bothering baby. 

3) Is baby showing any other signs of being unwell? If illness crops up during sleep coaching, this can really derail progress. I always recommend that a baby gets checked out by their GP before starting sleep coaching, as something like an ear infection can show no other signs other than sleep disruption – and too many of my clients have dismissed this on the basis that there has been no temperature. 

If you are confident that baby is neither unwell nor teething, that the coaching has been carried out consistently, and sleep still isn’t improving, here are some of the other things that can affect a baby’s sleep. These factors cannot be ‘coached’ out of babies and instead need to be investigated. 

• Reflux: The number one cause of babies not progressing with sleep, particularly if they have been reliant on some form of sucking like a dummy, or feeding, that has now been taken away. If baby is unable to fall asleep on their own, even with complete consistency with the approach, then it is worth looking for signs of reflux from when they were smaller (see Module 8). It is often the case that the obvious reflux signs will disappear as the months go by, but the sleep side effects will stick around, including not settling for day naps, 30 minute daytime naps (on the dot often!) or one cycle naps (45 minutes). Often (but not always), reflux babies are brilliant night sleepers but struggle with daytime naps. If parents decide this sounds like their baby, I encourage them to speak to a paediatrician to try to help and potentially tackle the cause of the reflux.

• Food intolerances and allergies: In ten years time, I believe there will be lots of research on the link between food intolerances and baby’s sleep, but for now knowledge is patchy. Most of my clients are told their baby would show other signs if they had an allergy/intolerance (eg a rash, blood in poo or not putting on weight), not just sleep disruption. However, I see lots of babies who just sleep less well (night wakes, short naps, early wakes) because they are struggling to digest certain foods – meaning it often isn’t even an allergy. More on this in the Weaning and Sleep section in module 7.

• Sensory Processing Disorder: Many children are not diagnosed until much later in life, but sensory issues can become apparent from the baby months. If parents are worried about their baby’s sleep in conjunction with other parts of their development, be that not reaching milestones, appearing to be very noise sensitive or being very difficult to feed/fussy with food, then it could be worth suggesting they speak to an occupational therapist, who will be able to advise whether they feel there is anything else going on for baby. 

• Other medical conditions: There are many medical conditions that can affect sleep and though most should be diagnosed by this stage of baby’s life, it is the case that some babies do struggle with ears, nose and throat issues that go undiagnosed. If baby has shown signs of multiple ear infections, throat issues, constant colds and illness, then it may be worth the parents asking to be referred to an ENT specialist. Adenoids and sleep apnoea are easily missed and can have a profound impact on a baby’s ability to sleep well. 

Please remember that all babies want to sleep. If you feel you have tried everything and things are still not improving, then be prepared to look at things holistically, as it is not always about ‘coaching’ and sometimes about digging. We can tackle the side of sleep that links to the body clock, behaviour and habit, but not anything else that sits physiologically under the surface. Seek additional support if needed.