In this Follow-Up episode, Dr. Mona and sleep consultant Dr. Sarah Mitchell break down common sleep training misconceptions. They clarify that tears during sleep training stem from changing routines rather than emotional damage. Most sleep struggles boil down to two main issues: an over-reliance on external soothing props and being stuck in an overtired cycle.

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00;00;00;03 – 00;00;26;17

Dr. Mona

Welcome back to the follow up. It’s Doctor Mona, and this is a series on the PedsDocTalk podcast, where we revisit a past episode in less time than it takes you to do the 2 a.m. math on how long it’s been since the last feed. I’m rerunning this episode because the questions in my DMs haven’t changed. Parents are still stuck on what Cry It Out actually means and why their friends baby is quote, sleeping through the night at seven weeks while theirs is up every two hours.

00;00;26;21 – 00;00;45;10

Dr. Mona

That confusion causes so much guilt. And this conversation will help clear a lot of that terminology up and remind you that you’re not behind a lot of the fighting about baby sleep online comes down to people using the same words to mean very different things. One parent can say sleeping through the night and mean 11:30 p.m. to 6 a.m. with feeds.

00;00;45;17 – 00;01;01;27

Dr. Mona

Another can mean a 12 hour time period with no feed. One person can hear sleep training and picture a baby crying alone for hours, which is not ever going to happen, while someone else means a few nights of pats and chickens. When we don’t define our terms, we end up judging each other and ourselves for things nobody actually said.

00;01;01;27 – 00;01;21;00

Dr. Mona

So my guest on this follow up is Doctor Sarah Mitchell, creator of the Helping Babies Sleep Method and author of the book of the same name. In this quick follow up, we defined what Cry It Out actually is, what sleeping through the night truly means, and why it looks so different for breastfed and formula fed babies and the two main reasons Sarah sees babies and toddlers struggle with sleep.

00;01;21;02 – 00;01;43;09

Dr. Mona

Consider this a chance to put a few sleep myths to bed. And remember, this is just the follow up. It’s a snippet of a full episode, so download the full episode wherever you get your podcasts, which is in our caption, and make sure to share this on social Tag, PedsDocTalk, the PedsDocTalk podcast, and helping Babies sleep when you do.

00;01;43;12 – 00;01;50;08

Dr. Mona

I think there’s a misconception that there’s a training that has absolutely zero tiers. I mean, there’s going to be some oh yeah.

00;01;50;10 – 00;01;51;22

Dr. Sarah Mitchell

Let’s talk about that. Yeah.

00;01;51;22 – 00;02;02;22

Dr. Mona

Because of course, because anytime you’re teaching your child to do something new, they’re not going to love it, but would love for you to elaborate more on the misconception that all crying is bad and that it’s something that is not something good for the child.

00;02;02;28 – 00;02;17;24

Dr. Sarah Mitchell

Three things are going to influence how much your kiddo cries. Okay, one is going to be your timing. So putting kids down to earlier too late, they’ll cry a little bit more because it’s frustrating for them too early. They’re frustrated. They’re not quite ready. Their sleep pressure has not risen enough yet. They’re not ready too late. They’re overtired.

00;02;17;24 – 00;02;37;19

Dr. Sarah Mitchell

They’re more needy. They want you that much more. Okay. Second thing is your ability to be consistent as you get through this. So, you know, in our first night of sleep teaching, yes, your child might cry 45 minutes the next night. Maybe it’s less, but are we? Be consistent. Where I see a lot of people go wrong is when they are handling night wake ups, and sometimes they feed them and sometimes they don’t.

00;02;37;23 – 00;02;55;25

Dr. Sarah Mitchell

Sometimes they rock them, sometimes they give them a pacifier. Those are very inconsistent responses so that they’re it’s hard for them to figure out what’s happening. They can’t learn. They can’t make progress, usually gets stuck when you’re responding in that manner. And then the third thing is what you mentioned to temperament. Some kids are much more strong well than others.

00;02;55;28 – 00;03;14;23

Dr. Sarah Mitchell

And again in this conversation I am biased. Right. Because the kids that I work with in my 1 to 1 or in my school are more strong willed than other people have. I had kids not cry. Yes I have and it’s not because of anything that I did. It’s because of their temperament and the timing. The parents finally figured out the timing.

00;03;14;23 – 00;03;36;01

Dr. Sarah Mitchell

They were making it early or later, and they offered some physical and verbal reassurance and some padding, and that child accepted that and dozed off to sleep. Right. But not every child would do that. So most kids will cry. Yes, most kids will cry. And I think the common worry is that those tears are saying, you’re abandoning me, I can’t do this.

00;03;36;07 – 00;03;54;20

Dr. Sarah Mitchell

And again, this goes into your mindset, right? Because your mindset influences your actions, which influences your outcome. So in our book, we actually talk about how you have to change your mindset. If you’re going to do sleep teaching because you change your mindset, you do new actions and you get a different outcome. Right.

00;03;54;23 – 00;04;13;04

Dr. Mona

All great points. Yeah. And I think that’s exactly right. And one thing that I think parents are afraid of, regardless of what sleep method they choose, is that, you know, the tears that come with it, whether it’s doing a cry method that is like the Ferber or even just more gradual methods. I don’t like the terminology can make it sound like cry is such this awful thing, but this is like the first time.

00;04;13;04 – 00;04;28;09

Dr. Mona

Like if you say a family chooses to do this in infancy, right? This is the first time that you may see your child cry when you’re not there. If you’re doing check ins, for example, okay? Or you’re patting their back and, you know, laying them down, they may cry a little bit or just may feel like, oh, I’m awful parent.

00;04;28;14 – 00;04;46;20

Dr. Mona

But as you go through parenting, you’re going to realize more and more that you’re going to create these rules and boundaries with your child. And they’re not always going to love everything that you do. A love baby is a baby who sees their parents of love baby as someone who sees their mommy or caregiver daddy, whoever it is in the morning with a smile on their face.

00;04;46;20 – 00;05;05;11

Dr. Mona

Like this is all very important to understanding the big picture of how we approach sleep. And I love talking about that one. The other one that I know you also share with me is the terminology of sleeping through the night, I think is often misconstrued. So explain how you would define sleeping through the night.

00;05;05;13 – 00;05;25;26

Dr. Sarah Mitchell

Yeah. In the Helping Babies sleep method, we talk about sleeping through the night is 11 to 12 hours with no feeds. And that doesn’t happen. You know, when kids sleep through the night really does vary okay. So I’m going to give you generalizations here. So with my exclusively breastfed kiddos it could be 8 or 9 months of age to sleep 11 hours without eating at all.

00;05;25;28 – 00;05;46;13

Dr. Sarah Mitchell

I have for sure had four month olds do it and five month olds do it, but I would say on average it’s around 8 to 9 months. If you have formula that’s completely different, and if you’re bottle feeding, that’s often different because you have so much more knowledge about how much they’re consuming during the daytime, which can help you shift those calories more easily into the daytime.

00;05;46;15 – 00;06;02;29

Dr. Sarah Mitchell

Right. Yes. But what I hear a lot of is sleeping through the night. I remember I had a friend at one point and she was like oh yeah my baby’s seven week old sleeping through the night. I was like get out. What are you doing. Tell me everything. And they put the baby down at 1130 at night, and he wakes up at 6:00.

00;06;03;02 – 00;06;18;12

Dr. Sarah Mitchell

So to them that sleeping through the night, because that’s when they go to sleep. And again, this speaks to what a parent’s threshold is, right? Those parents only need 6.5 hours of sleep. That was not me. I need a lot of sleep. I’m like a nine hour girl. I love sleep, you know, one person’s dream sleeper is someone else’s nightmare.

00;06;18;19 – 00;06;40;02

Dr. Sarah Mitchell

And then there’s also different resources that we’ll talk about, like the newborn stage. And even that’s different. Right? So because technically, medically, I think a newborn is like 0 to 28 days. But in a lot of the research and even in my book, I talk about newborn as 0 to 3. So again, definitions are what are making us all confused and having conflict with each other because we’re talking about different things.

00;06;40;05 – 00;07;05;18

Dr. Mona

Yeah, I love this. And I also, from a medical standpoint, completely agree with all the stuff that you said about the way a person is feeding. Like, yes, I do see breastfed babies who can be trained earlier like four months. I have had some that did three months, like you said before, but yeah, I see it usually later completely reasonable food gets introduced, their calorie intake changes, and I do see that formula fed babies tend to be able to be sleep trained early.

00;07;05;19 – 00;07;18;27

Dr. Mona

Maybe the parents choice. And that also could be because of the calorie. That also could just be because the parents philosophy. But yeah confidence like you understand that your baby’s fine. You understand that there’s attachment without being at your breast. When you formula feed you.

00;07;18;27 – 00;07;36;08

Dr. Sarah Mitchell

Made an interesting point that I’d like to speak to the difference between breastfeeding and formula fed parents, and part of that in the middle of the night is the confidence to look back and say, well, I know you had 25oz today. You’re good. I’m going to wait a little bit longer, right? Yeah. Also, if you’re going to get a bottle, you have to get up and go make it or there’s like a delayed reaction.

00;07;36;08 – 00;07;58;04

Dr. Sarah Mitchell

Where is the breastfeeding? We just whip at the boob and it’s instantaneous like that. Right. And this was my story too. I feel like often when we’re breastfeeding we just want to be there. We want that attachment. And inadvertently, what we do is we use the boob to soothe, not just for sleep, for hunger, sometimes even boredom. Yes, I see, and there’s nothing wrong with that, right?

00;07;58;04 – 00;08;16;20

Dr. Sarah Mitchell

If that works for you, amazing. But one of the most common pitfalls I see people making is with breastfeeding is that they use it to mask fatigue. And they end up in what I call the snacking cycle. They have like frequent feeds or feeding every couple of hours during the daytime. They never get full feeds. So they have to continue to feed in the night time.

00;08;16;25 – 00;08;40;26

Dr. Sarah Mitchell

And then over time with that consistency they end up reinforcing that the boob is a soother that I use when I’m bored, fussy, hungry and they miss those tired signs. So I feel sometimes formula feeding parents or even bottle feeding parents, yes, are able to kind of develop more parenting tools to be detectives and figure out what the root issue is, because they can say, well, I just fed you an hour and a half ago.

00;08;40;26 – 00;08;51;13

Dr. Sarah Mitchell

I know you had five ounces. This isn’t hunger. What else could be bugging you right now? Instead of, oh, they’re fussy them. Maybe it’s hunger and they feed them and they fall asleep or whatever. So food for thought there.

00;08;51;18 – 00;09;10;13

Dr. Mona

Yeah, no pun intended. Food for thought. You know, going back to what you said about your mindfulness approach, you can teach those same philosophies to breastfeeding parents. And I think you’re 100% right, because if you’re breastfeeding, I get it. You whip out the breast quickly. You are right that when you have to get up to get a formula bottle, you are also giving a pause to your child, right?

00;09;10;13 – 00;09;26;11

Dr. Mona

Like, I talk a lot about pausing, and I think every person will talk about how it’s so important to give a moment, especially if your child just ate. But also there’s a night to see. Is this something that’s going to be something that they’ll just go back down, or is this something that they actually need us? But for example, your baby starts to cry.

00;09;26;11 – 00;09;40;25

Dr. Mona

You’re like, oh, it’s been six hours. Let me check. But they’re not rooting. Like, they’re not like putting their hand. And then you go to start to make the bottle and then you come back and they fall asleep. It’s been like three minutes and you’re like, you just gave them the pause that we’re talking about. So I also agree that I love teaching breastfeeding parents.

00;09;41;02 – 00;10;05;04

Dr. Mona

Hey, you can pause, but it’s hard because of the mindset. It’s hard because of the cycle of you feel like, well, no, this is my nutrition and attachment. But I love to say that you can have an attached baby. Okay, you will 100% have an attached baby if you give a pause and just take a moment and really assess their hunger cues, because I have seen parents coming in like seven, eight months, who the baby’s still snacking and I’m like, wait, your baby’s on solids?

00;10;05;04 – 00;10;24;12

Dr. Mona

Like, if this is working like you said, great. But also looking at the developmental perspective, I want the baby to also now start to eat solids and learn about food and learn about that. So love that you like this. Let’s talk about how we can incorporate it with like feeding and, you know, solid foods and also just your sleep habits and getting your sleep back again.

00;10;24;12 – 00;10;31;19

Dr. Mona

We’ll always go back to how much I think sleep benefits the entire family on a mental health perspective and developmental perspective, for sure.

00;10;31;22 – 00;10;50;06

Dr. Sarah Mitchell

Yeah, absolutely. Intentional feeding right, is the third pillar of the helping babies sleep method in the newborn stage and for babies and toddlers as well, because you got to rule out that variable in the middle of the night. If you want to work on independent sleep habits, you have to be able to say, and that’s the thing about breastfeeding parents is they sometimes lack that confidence to be able to say, oh, I’m not sure that this is not hunger.

00;10;50;06 – 00;11;05;21

Dr. Sarah Mitchell

And that’s what we teach in our method, is that as a breastfeeding parent, you have regular feeding windows during the day that allows you to stack the calories, have intervals between the feed so they come to the breast ready to eat, drain one side completely, take half the other side and you’re like, wow, that was a great feed.

00;11;05;21 – 00;11;19;27

Dr. Sarah Mitchell

Okay, now it’s 9 p.m. and they woke up. You’re like, well, no, I can look back in the day and I can see that they ate four times and those are all full feeds. I’m going to wait this one out. La pause. And Pamela Druckerman wrote the book Bringing Up Baby. I don’t know if you can read that.

00;11;19;27 – 00;11;25;22

Dr. Sarah Mitchell

Yeah, that’s where I first learned about the pause, and that’s a great book. Another perspective on parenting that I really enjoyed.

00;11;25;25 – 00;11;37;09

Dr. Mona

The last thing I wanted to ask was, you know, two main reasons. You think that babies and toddlers struggle with sleep. I guess this may not be a misconception, but what are some things that you see if you could kind of say that these are the reasons why there may be struggles.

00;11;37;12 – 00;11;56;20

Dr. Sarah Mitchell

Yeah, okay. This is very generalization again. Right. But in general, one, especially after four months and older, this crowd we’re talking two would be one. They’re relying on something external to help them relax and drift off into sleep even if they’re not asleep from it. So I’ll have a lot of breastfeeding. Parents are like, no, no, we feed this part of our bedroom time routine, but they’re not asleep.

00;11;56;27 – 00;12;12;03

Dr. Sarah Mitchell

But if you made them drowsy, that’s why in my book it says, why drowsy? But awake is setting us all up to fail because we understand sleep. So learn skill. That’s the skill they actually need to learn to be independent sleepers long term. Okay, so the reliance on something external to help them initiate sleep and then return to sleep in the night.

00;12;12;03 – 00;12;34;05

Dr. Sarah Mitchell

And that could be a pacifier, a bottle, nursing, being held, co-sleeping, touch any of those things. That’s number one. The second reason for most of the kids that I work with that I see in the class and in one to ones, is that they’re just stuck in these awful overtired cycles. Sleep really does beget sleep. The more well-rested your kiddo is, the easier it is to get them to fall asleep and then stay asleep.

00;12;34;08 – 00;12;51;09

Dr. Sarah Mitchell

And the opposite is true. When you’re stuck waking up every two three hours a night, you just stay stuck waking up every two three hours a night. It’s like they’re overtired. It’s harder to fall asleep and then stay asleep. And then the third thing I would add, though, for the newborns, like less than three months, kids who are struggling with sleep, they are uncomfortable.

00;12;51;11 – 00;13;11;09

Dr. Sarah Mitchell

They are uncomfortable because they either have a food sensitivity or they have a little bit of reflux, often silent reflux, or they’re not being burped properly, which there is no evidence for whatsoever. But I can tell you from years of experience working with newborns is that kids who will quote only sleep in my arms. There’s something else usually happening.

00;13;11;12 – 00;13;23;10

Dr. Sarah Mitchell

Or something else going on there. They don’t want to be on their backs because of reflux, but generally for the average population it’s overtired and relying on something external.

00;13;23;12 – 00;13;44;22

Dr. Mona

And that’s your follow up. Just a small dose of the real relatable and eye opening conversations we love to have here. If you smiled, nodded or had an moment, go ahead and download, follow and share this episode with a friend. Let’s grow this village together for more everyday parenting wins and real talk. Hang out with us on Instagram at the PedsDocTalk podcast.

00;13;44;29 – 00;14;00;13

Dr. Mona

Want more? Dive into the full episode and more at PedsDocTalk. Com because parenting is better with support. And remember, consistency is key. Humor is medicine and follow ups are everything. I’m Doctor Mona. See you next time for your next dose.