Parents debating sleep training can rest (literally and figuratively) easy. New data out today in Pediatrics found that letting babies cry-it-out (CIO) or self-soothe does not increase signs of stress compared with babies who don’t. The study out of Australia tested two sleep training methods: “graduated extinction” (parents leave and return at increasing intervals of time, AKA one version of CIO) and “bedtime fading” where parents shifted bedtimes based on how long it took babies and young toddlers to fall asleep. The groups of babies and their moms were compared to those in a control group of babies and moms/dads who received only sleep education. The group in total was small, some 43 infants spanning 6 months to 16 months randomized into the three groups. I was fortunate to be able to discuss the study and what it means for parents on The TODAY Show this morning. In addition, I chatted about the study design, findings, and implications with Dr. Maida Chen, the Director of the Seattle Children’s Sleep Center. We were both excited as the study evaluated baby’s sleep, tracked their sleep with actigraphs (movement monitors), evaluated sleep by parental sleep diaries, measured morning and afternoon cortisol levels (a stress hormone) and tracked time to fall asleep, number of nighttime awakenings, total sleep time, mom’s stress, mom’s mood and long-term bonding. Even though the study may have some limitations (very small sample size and parents self-selected to the study with sleep concerns therefore it may be non-representative of parents at large who AREN’T worried about sleep) the randomization to the three groups and the measures studied boost the exciting results.
6 Take-Aways From The Baby Sleep Study
- No matter the sleep training method, moms reported feeling less stressed. Huge win! Moms showed significant reduction in stress in the two groups who used sleep training compared with the control group of moms.
- Babies allowed to CIO showed no more signs of stress (cortisol levels — a stress hormone– measured in the morning and afternoon) than babies who were sleep-trained via other two methods.
- The CIO method (graduated extinction) proved better in reducing the number of times the infants woke during the night, as well as the amount of time they spent awake during the night. Babies in the study who were allowed to CIO slept roughly 20 more minutes at night.
- The method known as “bedtime fading” means putting your infant to bed a little later each night (if infants took longer than 30 minutes to fall asleep) in the hopes that they will fall asleep quicker if more tired. Bedtime fading proved to help babies fall asleep quicker, but did not show as many benefits as CIO in regards to awakenings at night and total sleep time. Tip: can use different techniques to help with different challenges.
- No matter the sleep training method, there were no differences in behavioral issues and/or bonding with mom. In addition, no matter the sleep method or education control group, there were no differences in mom’s overall mood.
- All babies, over time, improved their sleep reflective developmental progress. In addition, babies were found to awaken at times (on actigraphs, the baby movement trackers) and not cry out for help. Researchers interpreted this as successful self-soothing.
The Bottom Line: Babies who are sleep trained tend to sleep better — those given a chance to self-soothe . There are a variety of methods in the sleep training toolkit, allow yourself some time to research the options and select one that matches your family’s style and values. You can even try combining different methods.
Mama Doc Tips For Considering Sleep Training And Cry-It-Out
- The study out today finds that babies may be no more stressed if using techniques that rely on crying-it-out versus some more gentle bedtime shifts or in the control group. Letting your baby learn to self-soothe does decrease night awakenings and increases sleep. It also reduces a mom’s stress! WIN-WIN.
- Consistency from night to night is key. Your consistency with the sleep routine is far more important than what method you choose to help get your baby to sleep. The ritual at bedtime (reading, bath, rocking, etc) is one of the most important daily activities you establish for your child from day 1 (or day 30). Choose a method that matches your philosophies.
- Letting your baby learn to fall asleep all on her own at 1 to 2 months of age will serve you and your child again and again. Try this at naptime or bedtime. Put your babies to sleep on their backs in a bare crib while still awake but drowsy. They will learn how to drift off without you! Research shows that infants and children who are allowed to learn to self-soothe and get themselves to sleep will often be far better sleepers, even as adults.
- If you’re concerned about your baby’s sleep challenges, talk directly with their doc. Research found that 1 in 10 children under age 3 has a sleep challenge, and often sleep trouble persists from infancy to toddlerhood.
- Sleep needs to be a priority (for us all). Making sacrifices to have consistent bedtimes from early infancy that support routine bedtimes and sleep routines will always be worth it. For you and your child.
- After your baby is 4 months of age consider letting them self-soothe and get themselves back to sleep after they awaken. Although babies will often wake up 5-10 times nightly, they won’t always need you to fall back asleep. Babies need practice learning how to get themselves to sleep on their own.
- Swaddling can be a great way to soothe babies. It’s okay to swaddle infants and put them on their back to sleep in early infancy but it’s not recommended to START swaddling a baby older than 4 months. And it’s good to be out of swaddles once a baby shows signs they are able to roll around 3-5 months. (more info in this recent blog post on new data that swaddling babies on side or tummy increases SIDS rates)
- 10 reasons babies wake up at night.
Adrien Andre says
I’m sure this will be a relief to many parents! That said, as a parent of a child on the autism spectrum who is highly capable, aka twice exceptional, I wonder how this relates to kids with this variant of neurology. I had one of those babies whose distress increased with time as he was left to CIO and required herculean effort to calm if allowed to get past a certain point. Clearly the ability to learn to self-soothe is different for these kids. So perhaps we need our own study! Any comments you have would be appreciated for the next gen or parents who are dealing with babies who seem to defy all norms and recommendations…
Joseph Piacentine, MD says
You are spot on, this can’t be generalized to children on the spectrum. Any study on sleeping children with ASD would be welcome. As a pediatrician I often feel helpless as there is so little to do for non sleepers with autism.
Katie says
Wonderful news and great segment on the Today show. Any chance you can get them to not use their final sleeping baby clip with the baby bottle hanging out of the sleeping baby’s mouth ever again unless it’s on a segment about not doing that? That disturbed me far more than anything else!
Mel Neal says
I do not believe this study. It is using poor research methods and is not large enough. A few results does not a study make.
Amber McAfee says
As a provider in the Seattle Children’s Sleep Disorders Center for over 13 years I have seen many infants, children and parents with difficulties sleeping. If infants, young children or older children have sleep disruption and they require help getting to sleep initially, allowing them to learn to self soothe is very useful to decrease sleep disruption. We all wake up about 4 times a night, what we see and hear needs to be the same all night long so we won’t be confused and wake up fully. So I believe the results of this study and agree with these recommendations! I have seen children improve sleep quality when they don’t rely on parents to fall asleep initially at bedtime. Our sleep colleagues in behavioral sleep medicine, such as Jodi Mindell and Judy Owens, would agree, and there are other research that supports this.
Our patient population consists of many children diagnosed with Autism. I describe children with autism as ‘sensitive sleepers’ and we do have resources that may be helpful for families to improve sleep. The Autism Speaks Autism Treatment Network has a good parent’s guide for Strategies to Improve Sleep in Children with Autism Spectrum Disorders. I also believe that standard cry it out method can be more alerting to this population and usually we provide families with a slow process of allowing children on the spectrum to learn self soothing. Especially avoiding electronics at bedtime and in middle of the night. Occupational Therapy to help with being over aware of their environment. Rested parents are better parents, and so any research in this area is great! Thanks for getting this information out Wendy!
Sandy King says
Thanks for a thought-provoking article and discussion.
One thing that surprises me is the research on sleep problems. I would have estimated the figure to be higher than 10%, but the study you have linked seems pretty comprehensive.
It’s good to have a benchmark number to keep in mind with some actual science behind it. Thanks again!
Cortney Keller says
Hello Dr. Swanson,
We are former patients of yours, now living in CA. We did the CIO method with our first two kiddos at around 4 months of age and it worked wonderfully. Both slept through the night just after a few days. However, child #3 is not responding well to the same method (currently at the age of 8 months) and we are 3 WEEKS into this method! We have the nightly routine in place and he initially goes down to sleep without a fuss. The issue is that he constantly wakes up anywhere from 5-6 hours into the night and cannot seem to self soothe back to sleep. I don’t pick him up, just go in 1-2 times to rub his back then leave. He is excellent at meal time so I believe he is getting plenty of calories during the day. I am regretting not doing CIO with him earlier.
I would love ANY advise on this scenario – How do I get him to SLEEP through once and for all?!?
I am one exhausted mommy. Thank you in advance! ~CK
Wendy Sue Swanson, MD, MBE says
Hi Cortney,
I hope all is well and this 8 month old gets the hang of self-soothing promptly! Sometimes overnight awakenings in later infancy are due to other developmental changes (i.e. separation anxiety from parents). And there is no question that some babies simply do this better than others. If feeding is going great, and CIO isn’t working when implemented consistently, perhaps consider talking with your pediatrician about other strategies, too.
Here’s a post on why infants wake up at night that may be of help:
https://www.wendysueswanson.com/why-do-babies-wake-up-at-night/
Carrie Ann says
While it may not hurt to let a baby cry themselves to sleep it is very difficult to do. I could never do it.