Often, especially at first, your baby then will startle and root for the nipple. Try to very gently hold his mouth closed with your finger under his chin, or apply pressure to his chin, just under his lip, at the same time rocking or swaying with him. If he struggles against this and fusses or roots for you or his bottle or pacifier, go ahead and replace the nipple, but repeat the removal process as often as necessary until he falls asleep.
How long between removals? Every baby is different, but about ten to sixty seconds between removals usually works. You also should watch your baby's sucking action. If a baby is sucking strongly or swallowing regularly when feeding, wait a few minutes until he slows his pace. Usually, after the initial burst of activity, your baby will slow to a more relaxed, "fluttery" pace; this is a good time to begin your removal attempts.
It may take two to five (or even more) attempts, but eventually your baby will fall asleep without the pacifier or nipple in her mouth. When she has done this a number of times over a period of days, you will notice the removals are much easier, and her awakenings are less frequent.
"We got to calling this the Big PPO (Pantley-Pull-Off). At first Joshua would see it coming and grab my nipple tighter in anticipation — ouch! But you said to stick with it, and I did. Now he anticipates the PPO and actually lets go and turns and rolls over on his side to go to sleep! I am truly amazed."
--Shannon, mother of 16-month-old Joshua
If your baby doesn't nap well, don't trouble yourself with trying to use the removal technique during the day for naps. Remember that good naps mean better nighttime sleep — and better nighttime sleep means better naps. Once you get your baby sleeping better at night, you can then work on the naptime sleep.
The most important time to use Pantley's gentle removal plan is the first falling asleep of the night. Often the way your baby falls asleep will affect the rest of his awakenings for the night. I suspect that this because of the sleep-association affect that I explained earlier. It seems that the way in which your baby falls asleep for the night is how he expects to remain all night long.
