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The Get-Out-of-Bed-Free CardNew and old strategies for children who won't sleep.

By Sydney SpieselPosted Friday, May 25, 2007, at 7:36 AM ET

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Moore and Friman tracked 19 normally developing children between the ages of 3 and 6 who strongly resisted bedtime by crying, calling out, escaping from their bedrooms—as I like to think of it, the usual stuff. They divided the kids into two groups. About half of them got the "free pass." The parents of the children in the comparison group did nothing special.

Remarkably, to me at least, the free pass was quite successful. After just four days, the kids in the experimental group showed substantial improvement by crying and calling out less often, making fewer flight attempts, and quieting down much faster. Their parents reported that they were very satisfied with the results—only 7 percent said the strategy made them uncomfortable, and none thought that their child experienced discomfort. Follow-up studies after three months showed sustained gains.

How does the free pass differ from other "extinction" methods, in which parents forcefully (and consistently) stop tolerating the bedtime resistance? The literature suggests that those methods also work but at a certain cost. Along the way, there is a difficult period of "extinction burst," when the sleep battles dramatically worsen. Friman and Moore's families didn't report this. A note of caution: This is a small study that needs to be replicated on a larger scale before we leap to follow its lead. And more cautions from the researchers: They say their method is intended for normally developing children ages 3 to 10, because younger children generally won't have the cognitive tools needed to make it work.

So, what to do about those infuriating little ones? My advice to parents in my practice is based on my sense that children wake in the middle of the night seeking the reward of the warmth and affection they have come to expect. In 25 years practicing as a pediatrician, I've found that mothers in particular are often as reluctant as children to give up the nighttime cuddle. It is, after all, a time of pure and intense pleasure with a child, free of worries about hurting someone else's feelings or the need to put breakfast on the table or to answer the phone. The problem, of course, is that eventually the early-hours pleasure makes mothers miserable in the morning. When you get to that point—and if your baby is at least 4 months old—it may be time to decrease the child's reward for waking so as to make it not worth the trouble.

I start by recommending that parents ignore fussing for at least five minutes every time a child wakes. Give the kids a chance to settle down on their own. (Though, contra Ferber, don't wait more than 10 minutes or they're likely to become so anxious that you'll never get them back to sleep.) If this step fails, go to the child but keep it very low-key and unrewarding. Talk as little as possible. Don't turn on the light. Don't look the child in the eye. Pick her up slightly awkwardly, so she's not sure you have a good grip. If it's a cold night, let her tush collect a few icicles. Above all, don't hug or kiss her or tell her how wonderful she is. Also, don't nurse or give formula. A bottle of plain water will reduce the return for waking (and encourage the development of a good pitching arm).

This strategy takes time to work. Initially, you'll have to come back several times, your sleep will be trashed, and you'll hate me. But almost every child will succumb in 10 days, at most.

Additional tips: Kids hate bars. Starting at about 18 months, springing a toddler from the crib to a low bed often leads to better bedtimes. Children inclined to wander (unwanted) into the parental bed can often be satisfied with the explanation that while you sympathize, parents need some privacy, too. Try putting a mattress just outside your own bedroom door (a hook-and-eye on the inside will remind them that you really don't want them to come in). A bed tent, stuffed with every fuzzy the child owns, and a flashlight or two besides, is another source of sleep-time security.

Consistency is pretty important, so don't start down the sleep-or-die road until you're sure you're ready to stick it out. Also, honesty compels me to admit that there are some kids who are too tough for my tricks. Including at least one of my grandchildren.