For me, the first step is always to decide what your parenting philosophies are, especially around sleep. How do you feel about night-time wakings? Do you want to feed your baby at night? Do you want to help train your baby or let them train themselves? These are all questions I have my patients ask themselves as they start to think about getting their baby to sleep through the night. Luckily, there are a variety of methods available to get your child to sleep. And there is something that works with every answer to these questions! The big decision that many parents face is whether or not they want to sleep train their baby. As a pediatrician, I have supported hundreds of patients through sleep training. I always remind them that finding what works best for your family and your baby is a process. There is a lot of trial and error involved. This can be especially true with a cry-it-out method. This is a type of sleep training where, broadly speaking, a parent puts a baby to sleep at night and comes back to get the baby in the morning. This overnight sleep is usually 10 to 12 hours. There are many modifications of this method: some have a parent go in only for feedings, others include a parent check-in on crying after a specific period of time, and the most extreme involves the parent staying out of the room all night. There is a lot of debate about the cry-it-out method, with strong advocates on both sides. On social media, it is common to see posts from anti-cry advocates who claim that these methods are harmful to children. I remind my patients that there is no evidence to confirm these methods are harmful, especially in clinical practice. The term cry-it-out can sound harsh, but at its core, it is neither harsh nor harmful. However, many parents are still unsure how to approach sleep training, or are hesitant to use a cry-it-out method because of what they hear online or from a friend. To help alleviate some of that confusion and concern, let’s discuss the two main methods of cry-it-out methods of sleep training: The Ferber method and the Weissbluth method, and how I approach them as both a doctor and a mom.
The Different Cry-It-Out Methods
The two common cry-methods of sleep training are the Ferber Method and Weissbluth Method. With cry it out methods of sleep training, you are allowing your child moments (or even longer moments) of crying. The idea with these methods is that your child will learn to self-settle themselves and go to sleep. Both of these methods are named after the people who founded these methods.
The Ferber Method
If you use the Ferber method, for example, a parent is checking in with their baby at set intervals if the baby is crying. The Ferber method is also known as “graduated extinction” and is named after Dr. Richard Ferber. In this method, a parent would go in, speak to the baby, and then leave. You can set the intervals at two minutes and build up every time they cry. For example, in night one of sleep training; the parent does a bedtime routine and puts the baby down at 7 p.m. The parent leaves the room. If the baby cries for two minutes, the parent returns and speaks to the baby without picking them up. After one minute, the parent leaves. The next time the baby cries, we let them cry for a longer period (five minutes) before repeating the cycle. This goes on for as long as the child is crying, leaving longer periods of time between each check-in, in an effort to teach the child to self-soothe. The idea here is consistency with the intervals and a brief verbal check-in when you go in. There are variants to this method or a “Modified Ferber,” which allows a parent to feed the baby if they want, but to implement the intervals once the baby is placed back in the crib.
The Weissbluth Method
With the Weissbluth method, a caregiver puts the baby to sleep and returns to check-in in the morning. (This method was named after Dr. Marc Weissbluth.) Usually, the caregiver will watch over the baby on a baby monitor during wake-ups. This method is different than the Ferber method in that there are no or very minimal check-ins. A parent can modify this technique and go in for diaper changes or feedings at set intervals, but traditionally it’s a method where you give a kiss goodnight to the baby and don’t return until the morning. While this method is more controversial, it does tend to work for many babies. In my experience, I have found this method works very well for babies who get upset during the check-ins used in the Ferber method. Sometimes, the visual check-ins make some babies more upset and they cry more than if they used the Weissbluth method.
Question: Is the cry-it-out method of sleep training harmful to my baby?
The Doctor Answer
What the Research Says First and foremost, I am not worried by cry-it-out methods nor do I consider them to be harmful. Much of the anti-cry-it-out sentiment online states that cry-it-out sleep training will make your baby feel abandoned, and lead them to struggle to create a healthy attachment with caregivers. These arguments often rely on the example of the Romanian orphans who were raised in neglect in the 1980s. Following the fall of Romanian dictator Nicolae Ceauşcu, the world uncovered thousands of orphans who had been subjected to emotional and physical deprivation. The children were left with no connected caregiver and subsequently struggled to form bonds with others. Anecdotes from the time note how quiet the babies were. They eventually stopped crying because they knew nobody would come. Those who oppose the cry-it-out method argue that it amounts to the same thing. This is not true. With this form of sleep training, a child still has an attached caregiver who checks in at regular intervals. Many anti-cry method advocates site a study of Romanian Orphans who were deprived of human contact, love, affection, and basic needs for weeks on end. They eventually stopped crying because they knew nobody would come to get them. This study has been twisted to be compared to cry-it-out methods. This is different in that a loving caregiver is involved in sleep training and does a bedtime routine and potentially check-ins (depending on the method). The loving caregiver is attentive when they do see the baby, and the baby continues to express their needs during waking hours. Why It Can Work Well It is important to note that in both of these methods, a loving caregiver is present to implement a bedtime routine. This can include feeding, cuddles, a book, and kisses. The caregiver places their baby in bed and (depending on the method) can return with loving care at different points. When the caregiver does return, the child is often smiling and happy to see them. And the caregiver is present, happy, and attuned to their child’s needs. A caregiver is not neglecting their child by using these methods. Instead, they are training their child to know that bedtime is for sleep; and that their caregiver will be there with open arms, cuddles, and playtime when it is no longer sleep-time. Most importantly, we see that babies who are sleep trained using a cry-it-out method are attuned to their parents—meaning they understand that their caregivers are people they can trust and they can go to when they need help. They cry to get attention during the day, are receptive to the parents’ actions, and show secure attachment. Signs of secure attachment in an infant include the ability to separate from their parent and explore (crawling, walking, etc), seeking comfort from a caregiver when upset, preferring parents to strangers, and showing positive emotions when offered a smile or affection. If a cry-it-out method were harmful to a baby, this would not be the case. As a pediatrician, I can say the cry-it-out method is one that works. The available evidence, as well as my experience as a doctor, demonstrate that babies continue to have a secure attachment to their caregivers when using the cry-it-out method.
When Cry-It-Out Isn’t Right For Your Family
There are other methods for sleep training besides cry-it-out ones. It’s important to know when it may not be the best fit for you or your baby. The first reason is that it’s not in your parenting philosophy. If you don’t like the idea of allowing your baby to cry for any long interval, there are other more gradual methods. The researchers found no difference in terms of emotional stability, parent-child closeness, or attachment in the babies who were sleep trained with cry-it-out methods versus those who were not. The kids who were sleep trained were equally as attached to their parent. There are also methods that allow you to be physically present the entire time. One example is sitting in a chair beside the crib while your child falls asleep. Once they fall asleep, you leave. If they wake up and cry, you sit back in the chair. You gradually move your chair closer to the door until, eventually, they are sleeping without you in the room. Babies who commonly cry more than 40 minutes with a cry method for more than five days, may benefit from either a more gradual method or more time before implementing a cry method. Although there is no research to support how much crying is okay, we can assume that this method may not be working if they continue to increase crying intervals after five days and not decrease the crying intervals. If your child is sensitive to crying, in that they gags or vomits, cry-it-out may not be the right method for them. You can also go into the room, reassure them, and clean up the vomit before leaving. But if they are this agitated, perhaps a more gradual method with you in the room will be more useful for their temperament. Sleep training should be cleared with your child’s clinician to make sure there isn’t a method that’s off-limit and/or if sleep training is overall recommended. If your child has asthma, breathing issues, or other certain health conditions; they may recommend holding on sleep training. If your child does have any medical condition, it’s best to discuss this with your child’s clinician as they know your child the best medically.
The Mom Answer
When we were pregnant, my husband asked me when we would sleep train our son. I wasn’t sure. I knew we would just have to wait and see. I could only really answer the question once I felt our son was ready for it (and we as his parents felt ready for it). Then, I could evaluate what method would be best for all of us. As a pediatrician, I know all the methods for sleep training and their benefits. Sleep training helps babies learn to move through sleep cycles on their own without any help, which leads to better sleep quality. As a mom and a human, I knew sleep was incredibly important for our family. My husband and I both work (he’s an ER physician), and it can be extremely hard to function as a parent and a professional without sleep. Sleep training allowed us to get more shut-eye and be more present for our son. Looking at the combined benefits to our mental health and our son’s sleep habits convinced us to try sleep training. Then, we just had a choose a method. Based on my understanding of infant sleep and development, we originally decided to try the Ferber method at two and a half months, At this point, our son was sleeping up to eight hours at night. We felt his temperament could handle training him to go 11 to 12 hours—a full, overnight sleep. I rarely recommend sleep training before four months, unless a child has stretched their feeds to at least eight hours. To train our son, we focused on a bedtime routine two weeks prior to the training. This meant a consistent routine of a bath, bottle, book, and cuddles. We continued this routine through sleep training, as well, and put him down to sleep at 7:30 p.m. On the first night, he cried for 20 minutes at 2 a.m. We did check-ins during which he seemed to cry more when he saw me stand by his crib. The next night, his longest cry interval was 40 minutes where he seemed more agitated. After about two nights using the Ferber method, we noticed that our son would get more upset when we would come in during his fussy periods, and become harder to settle. I started to wonder if perhaps this was not the best method for my baby. In my practice, I have seen the Weissbluth method work for many families. My husband and I discussed it and decided we would try it ourselves. We kept the same bedtime routine and put him down at 7:30 p.m. Instead of doing the graduated extinction of check-ins, we listened to what he would do. He ended up crying for a maximum of 20 minutes at 2 a.m. before falling asleep. For the training, I stayed in his room in a bed next to his crib. In the morning, I would go crib-side and he would greet me with a huge smile. I knew it was working because the next three nights were met with less crying. In five nights total, he was sleeping 11 hours and greeting me with a smile on his face. It worked much better. Our son cried, but much less than when we were using the Ferber method. Within four nights, he was sleeping 11 hours straight. As a mom, his cries were hard to hear. It was nearly impossible to be in the room and not go to him. What kept me going was the understanding that he was brave, smart, and capable of sleeping on his own. I trusted that he would learn that nighttime was sleep time, and during the day he would get all the feeds, play, kisses, and love. Now, 20 months later, Ryann is a great sleeper in that he falls asleep independently, but also knows when he wants more time with his Momma or Dadda. I can now tell him, “It’s time for night-night,” and he happily grabs his stuffed animal, and I put him in his crib. I give him a kiss goodnight and he gives one back, says “night-night” and goes to sleep. He is a happy, connected child who loves spending time with us. In the morning, he smiles, waves, and asks to be picked up. These are all signs of secure attachment, and further proof to me that we did the right thing by using a cry-it-out method. Our son knows how to sleep independently and still recognizes that we love him. He is safe to explore the world, because we will always be there.
The Takeaway
When it comes to sleep training, you should choose a method that you feel works best for you, your parenting style, and your child’s temperament. This may mean using a cry-it-out method. It could even mean not sleep training at all. Each family and child has individual needs and finding the method that works best for you is what is most important. If you do explore a cry-it-out method, remember that it is not harmful to infants. Plenty of research shows this as does my experience taking care of these babies and seeing their secure attachment to their loved ones and others. Many times, parents feel they must sleep train or if a cry method doesn’t work for their child; that they somehow failed. Remember, that every baby is unique in temperament so sometimes one method that works for another child, may not work for yours. Cry methods—although helpful for many babies—are not an easy method for all families. Hearing your baby cry, even if you know it’s a part of teaching independent sleep, can go against what you feel is best for your baby. Though research shows it’s safe for babies, it’s okay to not agree with it as the choice you make for your family. But, it is important for parents to know various options and feel confident that whatever option they choose will lead to a happy and healthy sleeper. We all make the best choices for our families. As long as you are raising loved children, they will be just fine—sleep trained or not.
