The Ferber method--also known as "graduated extinction"--is perhaps the most well-known sleep training program for children.
It is also one of the most controversial, primarily because the
method involves a degree of “crying it out." In a series of training
sessions, parents leave their children alone for strictly-timed
intervals, ignoring their children’s protests and cries. When the method
works, kids gradually accept that no one will come to their aid, and,
as a result, their behavior becomes less disruptive (Reid at al 1999).
If you’re considering sleep training for your child, this article
will help you decide if graduated extinction is right for
you. Here I discuss the following:
When is the method inappropriate, and what key questions remain unanswered?
How does graduated extinction work?
What are the arguments for and against graduated extinction?
As I explain below, other methods of sleep training - methods that do
not involve leaving babies alone to cry -- have been tested and judged effective. Desperate, tired parents have more than one option.
Precautions and limitations: What can the experts agree about?
Although Ferber sleep training is controversial, researchers agree on many points.
1. The Ferber method is NOT appropriate for young babies
Young babies need to feed at night, and their sleep-wake patterns are
still immature. For these reasons, even researchers who advocate Ferber
sleep training warn that sleep training is inappropriate for babies under 6 months old (France and Blampied 1999; Owens et al 1999).
2. The Ferber method is NOT appropriate
for kids who have a conditioned fear of being left alone in their beds
or who have a conditioned vomiting response
Common sense suggests that traumatized kids should not be subjected
to graduated extinction, and advocates of Ferber sleep training agree.
If past experiences have taught your child to fear being left alone in
his crib or bed—and/or to respond to separation by vomiting—you should
consult with a behavioral psychologist about the most appropriate
approach to sleep training (France and Blampied 1999).
3. The Ferber method is NOT appropriate as a treatment for most child sleep problems
When parents consider sleep training, it’s usually because their kids
are experiencing bedtime problems and/or disruptive night wakings. The
Ferber method seems like a possible solution. But is it?
Graduated extinction is designed for one, narrow purpose: To get
kids to fall asleep without parental soothing. Judged on this basis, the
method is effective (see “Arguments in favor of the Ferber
But the Ferber method is NOT designed to treat most of the sleep
problems that CAUSE bedtime battles and night wakings. For instance, the
Ferber method doesn’t address
sleep schedule problems caused by bedtimes that are too early
If one of these conditions is responsible for your child’s
bedtime problems or night wakings, it’s important to find appropriate
treatment. Otherwise, you risk worsening your child’s psychological
problems or ignoring potentially dangerous medical conditions.
On the positive side, you might find that treating these
conditions renders sleep training unnecessary. For instance, if your
child resists bedtime because he isn’t sleepy, treating a circadian
rhythm disorder or adjusting his bedtime may solve the problem
4. The Ferber method does NOT teach kids how to fall asleep
As Richard Ferber himself acknowledges, graduated extinction doesn’t
teach kids how to fall asleep on their own (Ferber 2006). Kids are
simply denied access to their parents, and left to work it out for
If you really want to help your child fall asleep, try this alternative to the Ferber method—a sleep training program known as
“positive routines with faded bedtime."
Unlike Ferber sleep training, the “positive routines" program will teach
your child how to relax and prepare for bed (Adams and Rickert 1989).
You can also help your child fall sleep by following these practices:
Dim the lights in the evening
Avoid exercise and stimulating activities before bedtime
Avoid stimulants (like caffeine) and hard-to-digest foods before bedtime
Don't intervene the moment you hear a sound. As noted in my articles about newborns and older infants, babies often sigh, jerk, or vocalize during sleep. You don't want to wake a sleeping baby by mistake, and even if your baby is awakening, she may go back to sleep spontaneously if you give her the chance.
5. Studies leave key questions unanswered
Researchers agree that babies under the age of 6 months should not undergo graduated extinction training. But what about older babies? Are there any risks or side-effects?
Unfortunately, there's still a lot we don't know. Some frequently-cited studies included
toddlers and preschoolers as subjects (France, Blampied and
France 1992; Eckerberg 2004), leaving doubt as to the effects on babies between 6-12 months of age. Other studies are designed in ways that prevent us from drawing key conclusions.
For instance, in a recent study of 6- to
8-month-old infants, parents were randomly assigned to receive instruction in either (1) infant safety issues (like shaken baby syndrome and choking), and (2) baby sleep. Parents in the sleep instruction group got a variety of helpful tips, including information about
reading an infant's tiredness cues,
establishing daytime, bedtime, and naptime routines,
minimizing stimulation before bed, and
feeding 20 min prior to settling
These parents were also briefed in the graduated extinction method. Six weeks later, parents in the sleep instruction group reported fewer nighttime disruptions. But researchers didn't track any
other infant outcomes, nor any effects after 6 weeks (Hall et al 2015). And because parents were given a wide range of information relevant to improving infant sleep, we can't be sure how much graduated extinction contributed to the results.
study (Price et al 2012) tracked outcomes over the long-term -- from
7 months to 5 years -- and reported "no marked, lasting effects
(positive or negative)." However, when it comes to graduated extinction, this study is similarly difficult to interpret. Once again, parents assigned to the sleep training group were presented with a mix of strategies to choose from, including
graduated extinction, and
an alternative technique called "extinction with parental presence" (one of the "gentler" methods I mentioned above).
As I note in this blog post, the study also appears to have lacked important controls. For these
reasons, it's difficult to draw conclusions. This study, like the previous one, tested the effects of educating parents about a combination of tactics. It wasn't designed to reveal information about the specific effects of graduated extinction.
So despite decades of research, we know surprisingly little about long-term outcomes -- how graduated extinction might influence a child’s mood, behavior, and
How the Ferber method works
The Ferber method is actually a variant of a sleep training program called “extinction."
Extinction sleep training is based on the assumption that
children have sleep problems because they have learned to depend on
parental soothing to put them to sleep. Whenever kids are denied this
parental soothing, they may stall, plead, cry, or throw tantrums to
delay bedtime. Because they can’t fall asleep by themselves, kids will
also be disruptive if they awaken during the night.
Parents who “give in" to their children’s demands for attention
are reinforcing the problem behaviors. So the solution is for parents to
put their children to bed (while they are still awake) and then leave
them alone. If kids cry, parents are instructed to ignore it. Parents
aren’t supposed to check on the child again unless it seems absolutely
necessary (Owens et al 1999).
The Ferber method departs from extinction training in one key
respect: It permits parents to check on their children—but only briefly
and according to a strict schedule. On the first night of training,
parents put their child to bed and then stay away for 3 minutes. After a
brief check (during which the parents take care not to pick up or hold
the child) the parents leave again—this time for 5 minutes.
Subsequently, parents wait 10 minutes between visits until the child
finally falls asleep.
For each night that follows, parents gradually increase the time
between checks. For instance, on the second night, parents might wait 5
minutes before the first visit, 10 minutes before the second, and 12
minutes before all subsequent visits. On subsequent nights, these
intervals might stretch to 20 minutes or more.
Some parents who try Ferber sleep training see improvements
within a few days. In studies testing graduated extinction, parents may
complete training within 4 weeks (e.g., Reid et al 1999).
But some parents—disturbed by the notion of ignoring their
children, and concerned about the potentially harmful effects of
training—drop out before they see any improvements in their children's
behavior. Kids subjected to the Ferber method may become much more
distressed during training than they were before. These so-called
“extinction bursts"--which include more frequent and intense crying,
protests, and tantrums—persuade some parents to give up.
In addition, training may fail if parents are inconsistent and
periodically “give in" to their children’s pleas. Ferber advises parents
to stick to the routine, even if the child becomes so upset that he
vomits. In this event, parents should clean up the mess quickly and then
leave the room and continue training (Ferber 2006).
Arguments in favor of the Ferber method
According to scientific studies, extinction sleep training--including
Ferber sleep training--is associated with the following positive
outcomes (Mindell et al 2006):
Kids who complete training are less likely to throw bedtime tantrums
Kids who complete training are more likely to settle down at night within ten minutes
Kids who complete training are less likely to awaken their parents during the night
Parents who complete training report improvements in their own stress levels, mood, and interactions with their children
In addition to these positive results, parents have reported
improvements in their childrens’ daytime behavior, perhaps because sleep
training “graduates" were getting more sleep at night (Mindell et al
For parents enduring nights of sleeplessness and emotional
turmoil, these outcomes are extremely important. Advocates of graduated extinction out that parents who are sleep-deprived are at higher risk
for depression and marital conflict (Mindell et al 2006). Such parents
may develop negative feeling toward their children and the parent-child
relationship suffers as a result. If parents can stop or reduce their
children’s disruptive nighttime behavior, the whole family will benefit.
But the Ferber method isn’t the only sleep training program that delivers these benefits.
As noted below,
alternatives to the Ferber method -- training programs that don’t involve leaving children alone to “cry it out"-- have equally successful track records (e.g., Skulladotir et al 2003; ). For this reason, it’s important to consider the potential costs of graduated extinction.
Arguments against the Ferber method
Although studies show that extinction sleep training can be very
effective in eliminating bedtime protests and stalling tactics, many
people—parents, pediatricians, and researchers included—worry about
potential side effects.
Leaving children alone to cry seems to violate our deepest
instincts, and no wonder. For most of human history, our ancestors
biggest sleep problem was almost certainly the avoidance of predators.
Like modern-day hunter-gatherers, our ancestors slept communally
and shared “watch" duties (Worthman and Melby 2002). Children snuggled
up to their parents and siblings. And if children cried out, it was
important to soothe them quickly to reduce the chances of attracting
predators to the camp.
In this setting--the setting that characterized millions of years
of human and pre-human evolution--leaving a child alone at night would
have constituted child abandonment, if not attempted infanticide.
Our evolutionary past has left its stamp in our brains. When
babies and children are left alone at night, they are likely to
experience one of the most primal and powerful stressors known to young
animals--separation anxiety (Panksepp 2000). Separation anxiety is a
panic response arising from a primitive part of brain that also
processes information about physical pain (Panksepp 2000).
Concerns about separation anxiety and stress have led some
pediatricians, researchers, and therapists to worry about the adverse
effects of the Ferber method on a child’s health and well-being (e.g.,
Sears and Sears 1996; Commons and Miller 1998; Sunderland 2006).
How does the Ferber method affect a child’s stress response
system? His relationship to his parents? His developing personality?
Advocates of extinction training note that no studies yet have
demonstrated that the Ferber method harms children over 6 months old. But the truth is there hasn’t been much research to resolve the question.
Studies of human infants confirm that crying is physiologically
stressful—increasing a baby’s blood pressure, heart rate, and cortisol
levels (Levesque et al 2000; Luddington-Hoe et al 2002). Do the
intensified crying bouts—the so-called “extinction bursts"—associated
with the Ferber method put babies at risk? No one yet has tested this
Nor has anyone has examined the long-term impact of the Ferber
method. As of January 2016, I can find no controlled, scientific studies
that measure the long-term effects of graduated extinction
on a child’s
physiological stress response
attachment relationship with parents
personality development, or
expression of physical affection
As noted above, one study addressed some of these outcomes (Price et al 2012). But because families using the Ferber method were lumped together with families using an alternative method that didn't involve leaving babies alone, the results pertain to the effects of sleep training in general, not graduated extinction in particular. Moreover, it's not clear if parents in the control group actually refrained from sleep training, which makes the results particularly difficult to interpret.
So things haven't changed much since the American Academy of
Sleep Medicine called for more research (Mindell
et al 2006). We still need more information about the impact of treatment on "mood, behavior and development," and we still need to learn how individual differences among children might affect sleep training outcomes (Mindell
et al 2006).
Different children have different temperaments and
different needs. Some children have special problems with anxiety, or
more difficultly coping with negative emotions. These kids may find the
Ferber method especially distressing.
The Ferber method compared: How does it measure up against the alternatives?
The Ferber method is not the only option for parents interested in sleep training. Two alternatives include
"Positive Routines with Faded Bedtime," and
"Extinction with Parental Presence" (in which parents remain in the same room with children until they fall asleep)
The "positive routines" method teaches children how to fall asleep
by pacing them through a series of relaxing bedtime rituals--but only
when the child is already showing signs of drowsiness. "Extinction with
parental presence" is a variant of graduated extinction that doesn’t
involve leaving children alone.
How does the Ferber method stack up against these two alternatives?
In the only controlled, randomized scientific study to compare graduated extinction and "positive routines" head-to-head, there were no significant differences in
treatment outcomes for kids (Adams and Rickert 1989). Similarly, an experiment pitting graduated extinction against "extinction with parental presence" found no difference in treatment outcomes (Matthey and Črnčec 2012).
According to the American Academy of Sleep Medicine, these three
methods "appear to be on a level playing ground" (Mindell et al 2006:
The bottom line
The Ferber method can be an effective way to reduce nocturnal crying,
protests, and requests for parental soothing. But it’s not the only
effective method available.
Before you choose a sleep training program, review these points:
Make sure that the sleep training program is
Screen and address your child’s specific sleep problems
Consider your child’s individual temperament and personality
If your child has a conditioned fear of being alone or shows signs of conditioned vomiting, consult a behavioral therapist
Before training begins, make sure that all participating adults
understand the procedure. Regardless of the method you choose, success
depends on being consistent.
References: The Ferber methods and its alternatives
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between positive bedtime routines and graduated extinction. Pediatrics
Commons ML and Miller PM 1998. Emotional learning in infants: A
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