Shush-pat settling: how to do it safely, step by step

Shush-pat settling means helping your baby to sleep in their crib with two simple, repetitive signals: a gentle "shh" sound and slow, rhythmic patting. Your baby stays on their back the whole time, and you stay with them until they're calm or nearly asleep. Australian child health services such as Tresillian, Karitane and Pregnancy, Birth and Baby all describe it as hands-on settling. It can help from the newborn weeks onwards, and it's one of the gentlest ways to practice settling in the crib.

What is shush-pat settling?

Pregnancy, Birth and Baby describes hands-on settling as placing your baby in their crib on their back, watching and responding to their cues, and if they start to cry, placing your hands on them to reassure them until they go to sleep. To help them settle you can:

• make gentle "shh" sounds
• talk quietly in a comforting tone, or say "it's OK" or "time for sleep"
• do gentle rhythmic patting of their thigh, shoulder, tummy or the mattress
• gently stroke their head, arm or leg
• rock the crib in a gentle rhythm

The repetition is the point. Australia's Tresillian's responsive settling tip sheet says rhythmic patting, rocking, stroking and soft singing signal relaxation and sleep.

Where does shush-pat settling come from?

It isn't a branded program. Hands-on settling with shushing and patting is part of the everyday settling advice given by Australian child and family health services, including Tresillian's tip sheets and Karitane's stepped approach to settling. Shushing also features in the 5 S's, a set of calming techniques for young babies.

What age is shush-pat settling used from?

It can be used from birth, but how you use it shifts as your baby grows:

Australia's Tresillian suggests lots of hands-on support for newborns, such as patting, body rocking and a soothing voice, and hands-on settling with shushing and rhythmic patting at 4–5 months. Pregnancy, Birth and Baby says hands-on settling can suit all ages, but younger babies up to 6 months may respond best. Australia's Karitane advises reducing physical touch as your baby calms, as part of its responsive settling for babies aged 3–12 months.

How do you shush-pat, step by step?

In the crib

1. Check the basics. Pregnancy, Birth and Baby suggests making sure your baby isn't hungry, has a dry diaper, is calm and isn't too hot or cold.
2. Wrap or use a sleep sack. For a younger baby, Australia's Tresillian suggests a soft cotton wrap with arms flexed against the chest, room for legs to bend at the hips and head uncovered. See swaddling.
3. Talk quietly and cuddle to help your baby calm before you put them down.
4. Place your baby in the crib on their back, drowsy or awake.
5. Rest a hand on them and start patting slowly and rhythmically on the thigh, shoulder or tummy, or pat the mattress beside them. Keep it gentle and steady.
6. Add a soft "shh" in time with the patting, or quiet words like "time for sleep". Many parents start the shush a little stronger while their baby is crying and soften it as they calm.
7. Ease off as your baby calms. Slow the patting, then leave your hand resting, then step back. Australia's Karitane's settling ladder suggests stepping back down to less support whenever your baby is calming.
8. If your baby fusses loudly, pick them up for a cuddle until calm or asleep, then put them back in the crib on their back, as Australia's Tresillian's hands-on settling steps describe.
9. Stay until your baby is nearly asleep. Pregnancy, Birth and Baby suggests sitting on a chair beside the crib and patting through the crib rails, which is easier on your back.

If you've had enough or your baby isn't getting calmer, it's OK to stop and try something else, says Pregnancy, Birth and Baby.

In your arms

Australia's Tresillian also describes soothing in arms: hold your baby until they fall asleep, using gentle rhythmic patting, rocking, stroking, talking or soft singing, then put them into the crib asleep. The NHS suggests gently stroking your baby's back while holding them against you. Once your baby is calm or asleep, lay them in the crib on their back.

Held settling suits very young or very upset babies; in-crib settling gives your baby more practice falling asleep where they'll wake up. Many families use both, depending on the day.

What does a typical first week look like?

There's no fixed pattern. The first few sessions can take a while as you and your baby find a rhythm, and some sleeps will need a pick up or settling in arms. Australia's Karitane notes it takes anywhere from about 30 seconds to 30 minutes for children and adults to fall asleep, so a stretch of patting isn't a sign it's failing.

Australia's Tresillian says to use the same settling technique each time if sleep is difficult, and that change takes time. Watch for a trend over a week or two, such as calming sooner or needing fewer pick ups, rather than judging a single nap.

Does shush-pat work? What the evidence says

There's very little research. We found no trial that tested shush-pat settling as a method. It isn't among the treatments assessed in the American Academy of Sleep Medicine's 2006 practice parameters for bedtime problems and night waking.

What we do have is consistent practical guidance from Australian child health services, and the NHS's observation that gentle background noise may help distract a crying baby. The NHS also notes that too much rocking and singing can keep a baby awake, which is why slow, steady and boring tends to be the goal. So shush-pat is a reasonable, low-risk technique to try, but there's no research to say how often it works or how quickly.

Who does shush-pat suit, and who doesn't it suit?

It may suit:

• newborns and young babies who like touch and rhythm
• families who want a gentle, hands-on way to practice settling in the crib
• babies who calm when you're close but don't need to be held

It may not suit:

• babies who find touch stimulating. Some babies get more wound up by patting. Try a hand resting still, quiet "shh" alone, or settling in arms.
• very distressed babies. Australia's Tresillian suggests picking up a baby who is fussing loudly and cuddling them until calm, then trying the crib again.
• babies who are unwell. Comfort them however they need, and seek help if you're worried (see below).
• parents with sore backs or wrists. Sitting beside the crib and patting through the rails can help.

What safety rules apply?

• Back to sleep, every time. Australia's Karitane, and the NSW Health safe sleeping guidelines printed in Australia's Tresillian's tip sheet, advise sleeping your baby on their back from birth, not on the tummy or side. Never roll or pat your baby onto their side or tummy to settle them.
• Safe crib. NICHD Safe to Sleep advises a firm, flat, level surface with only a fitted sheet, and nothing soft or loose in the sleep area. Australia's Red Nose recommends keeping your baby's head and face uncovered and sleeping them in their own safe space in your room for at least the first 6 months.
• Wrapping. Australia's Tresillian says to stop wrapping when your baby starts to show signs of beginning to roll over. Australia's Red Nose says to stop when your baby shows signs of rolling or reaches 3 months of age, whichever comes first.
• Gentle hands. Patting should be soft and slow. The NHS and Australia's Karitane warn never to shake a baby, as it can cause brain damage.
• No sofas. If you're settling in arms, don't sit or lie on a sofa or armchair where you might doze off with your baby. NICHD says couches and armchairs are never safe places for babies to sleep.
• Car seats and strollers. The NHS says if your baby falls asleep in the car, move them to a firm, flat surface to sleep as soon as possible.

If you feel frustrated, the NHS suggests putting your baby safely in their crib, closing the door and going to another room for about 10 minutes to calm down. Call your pediatrician's office for support. If you have thoughts of harming yourself or your baby, call 988 (call or text) or 911.

When to stop settling and get help

The NHS says a baby who cries constantly and can't be comforted, or whose cry doesn't sound like their normal cry, may be ill.

The NHS urgent help guide also lists a temperature of 38°C (100.4°F) or higher under 3 months, or 39°C (102.2°F) or higher at 3 to 6 months, among reasons to call an ambulance or go to A&E, so call 911 or go to the nearest emergency room. See a doctor today if your baby seems unwell, has a high temperature, or isn't interested in feeding.

How does shush-pat compare with other methods?

For the full picture, see the sleep training overview, and for practicing settling in the crib without patting, see drowsy but awake.