Management of Sleep Onset Association Type BIC

Management of sleep-onset association type BIC includes establishing a good sleep routine, and the use of positive sleep associations: e.g. a comforting object (stuffed toy or used mother’s shirt) that the child can bring to bed with him/ her each night.

There is no ‘best’ method to help a child fall asleep independently, but the key is to be ‘consistent and persistent’ every night, especially if more than one caregiver is involved.

Often, once the child is able to fall asleep independently at bedtime, he/she is more likely to be able to self-soothe to sleep during spontaneous night awakenings.

Some methods that have been used include:

1. Extinction
   Putting the child to bed at a fixed time and ignoring his/her cries until a specific ‘wake’ time. This method is not recommended for infants below the age of 6 months, and may be emotionally draining. Parents should be prepared for a ‘post-extinction burst’ (a period of worsening before improvement) in some children.
   
2. Graduated extinction
   This is a ‘gentler’ method, where you can respond to your child briefly each time he/she calls (after being put to bed), but only after progressively longer periods of time e.g. 5 minutes, then 10 minutes, and then 15 minutes until he/she falls asleep. This method is likely to take longer to work, but is less emotionally taxing.
   
3. Fading of adult intervention
   Establish a bedtime routine before sleep, and gradually increase the physical distance between you and your child while he/she is falling asleep (sit by the crib or bed, and move the chair slightly further away each night, until out of sight of the child). This method is also likely to take longer but is less emotionally taxing.