Infant sleep training: Gentle alternatives to "cry it out"

Gentle infant sleep training

© 2008 - 2016, Gwen Dewar, Ph.D., all rights reserved

When parents hear about infant sleep training, they often think of babies left alone in their cribs to cry themselves to sleep.

But there are alternatives to such an approach. Here I describe two such alternatives, both of which have been scientifically tested on babies and young children.

1. Positive routines with faded bedtime

The theory behind this sleep training method is simple:

Children will fall asleep more easily if they are led through a series of predictable, pleasant, quiet, bedtime rituals. But if you pick a bedtime that is too early, children won’t feel drowsy, and they may resist falling asleep.

With this program, you train your infant to associate the bedtime routine with feeling drowsy, and you do this by waiting until you are sure your baby is ready to fall asleep--even if this means starting bedtime later than you like.

You begin by noting your baby’s current sleep patterns (for help, see this article on signs of sleepiness and sleep deprivation). At what time of night does your baby fall asleep naturally? Establish this as your new bedtime, and introduce a soothing routine that leads up to it each night: Up to 20 minutes of quiet, calm, pleasant activities.

Because your baby is already inclined to fall asleep at this newly-appointed time, you shouldn't experience much trouble, and your baby will learn to associate the new bedtime routine with falling asleep. As this lesson is learned, gradually shift your schedule, making bedtime 10-15 minutes earlier every few days until the desired, final  bedtime is reached (Adams and Rickert 1989).

Will it work? When researchers tested the approach in a randomized, controlled study of children aged 18-48 months, they got good results (Adams and Rickert 1989). Bedtime routines with faded bedtime was as effective for reducing bedtime tantrums as was graduated extinction, or the "Ferber method" (an approach to infant sleep training that involves leaving babies alone to "cry it out" for increasingly lengthy periods of time.)

Other studies have tested routines on children, but these studies parents used "positive routines" in combination with other infant sleep training methods. As a result, it isn’t possible to say which methods were more effective (Mindell et al 2006).

Currently, I can find no controlled, experimental studies that test the specific effects of positive routines on infants under 12 months. However, given that the approach does not impose any distress or separation anxiety on babies, it seems entirely safe. And a recent survey suggests that children who start bedtime routines before 12 months tend to have better sleep outcomes as preschoolers: They fall asleep more quickly, and get more sleep overall (Mindell et al 2015).

2. Extinction with parental presence

With this approach to infant sleep training, you put your baby to bed while he’s still awake, and you lie down with him until he falls asleep. However, you pay progressively less attention to him each night.

For instance, after a few days, you might touch the baby less often. A few days after that, you might look away more often, and sit up in bed rather than remain lying down. The next step is to sit at a chair alongside the bed, and the step after that is to move the chair a bit farther away. You can read or do some other silent activity while you keep up your vigil.

By making these gradual changes, the baby is weaned from extensive parental soothing rituals. After several days, you might try leaving the room for a few seconds, returning before the baby starts to cry. This may help the baby learn that you can be trusted to return after an absence (Skuladottir 2003). But you remain in the baby’s presence until he falls asleep.

When baby awakens in the middle of the night, you take the same approach. But baby becomes more adapted to the new program, you may try letting the baby wait for you for a minute or two before you return (Skuladottir 2003).

When this method of infant sleep training was tried on sleep disturbed infants aged 6-23 months, infants slept longer and experienced fewer night wakings (Skuladottir 2003).

A somewhat similar approach, in which the parent stays in the same room with baby but sleeps in a different bed, has also reported successful results (Sadeh 1994).

More recently, researchers in Australia randomly assigned 8 of 16 families to a program of sleep training called "parental presence with minimal check," in which parents "feign sleep inside the infant's room" before responding to the baby's cries. The other 8 families were assigned a program that required parents to leave their crying babies alone in another room. When researchers analyzed short-term outcomes, they found that both approaches were equally effective (Matthey and Črnčec 2012).

It appears, then, that parents don't have to close the door on babies to encourage the development of self-soothing skills.

More reading

For more information about coping with sleep problems, see these articles about baby sleep.



References: Infant sleep training

Adams LA and Rickert VI. 1989. Reducing bedtime tantrums: Comparison between positive bedtime routines and graduated extinction. Pediatrics 84(5): 756-761.

Matthey and Črnčec. 2012. Comparison of two strategies to improve infant sleep problems, and associated impacts on maternal experience, mood and infant emotional health: a single case replication design study. Early Hum Dev. 88(6):437-42.

Mindell JA, Kuhn B, Lewin DS, Meltzer LJ, Sadeh A and the American Academy of Sleep Medicine. 2006. Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep 29: 1263-1281.

Mindell JA, Li AM, Sadeh A, Kwon R, and Goh DY. 2015. Bedtime routines for young children: a dose-dependent association with sleep outcomes. Sleep 38(5): 717-722.

Sadeh A. 1994. Assessment of intervention for infant night waking: Parental reports and activity-based home monitoring. J Consult Clin Psychol 62(1):63-8

Skuladottir A and Thome M. 2003. Changes in infant sleep problems after a family-centered intervention. Pediatric Nursing 29(5):375-8.

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