Chapter 11 / Part Two / The First Year
Sleep Training
What works, what the studies find, and how to make a consistent plan.
On this page
Core idea: Behavioral sleep-training methods generally improve sleep and parental mental health, and the studies reviewed do not show lasting harm to children. Method choice matters less than selecting a plan the caregivers can apply consistently.
One-Minute Recap#
- Extinction or "cry it out" approaches are effective at reducing sleep problems for many families.
- Graduated checks, full extinction, and parental-presence approaches can all work.
- Sleep training can improve parental depression, stress, and family functioning.
- Studies reviewed in the book find no short- or long-term harm to attachment, behavior, or emotional development.
- The absence of detected harm is not proof that every method suits every child, but it is reassuring.
- Learning to fall asleep at bedtime is separate from being developmentally ready to go all night without feeding.
- Nap training has less evidence and is often less predictable than nighttime training.
- Consistency and caregiver agreement are the central practical ingredients.
Guidance at a Glance#
| Label | Takeaway |
|---|---|
| OPTION - High | Use behavioral sleep training if better sleep would benefit the child or family. It is not required for good parenting. |
| RECOMMENDED - Moderate | Confirm health, growth, feeding, and age-related readiness with the pediatrician before changing night feeds. |
| RECOMMENDED - High | Choose a method all caregivers can follow consistently and write down the plan. |
| RECOMMENDED - Moderate | Keep a predictable, calming bedtime routine and safe sleep environment. |
| SKIP - High | Skip claims that sleep training has been shown to damage attachment or cause lasting emotional harm; the reviewed evidence does not support them. |
| SKIP - High | Do not assume sleep training requires eliminating necessary night feeds. |
Method Cheat Sheet#
| Method | What caregivers do | Main tradeoff |
|---|---|---|
| Full extinction | Put the child down awake and do not return until a defined feeding/time unless safety requires it | Often simpler and potentially faster; emotionally difficult |
| Graduated checks | Return at planned, increasing intervals with brief reassurance | More caregiver contact; checks may calm or stimulate the child |
| Parental presence | Stay nearby while reducing help over time | Less separation initially; can take longer and requires restraint |
| Bedtime fading/routine work | Temporarily align bedtime with natural sleep onset, then shift it | Less crying for some families; requires schedule management |
Written Plan Template#
- Goal: falling asleep independently, fewer wake-ups, night weaning, or a combination.
- Start date:
- Bedtime routine and target bedtime:
- Chosen method:
- What counts as a check and how long it lasts:
- Feeding policy approved by clinician:
- Exceptions: illness, breathing concern, vomiting, unusual cry, unsafe situation.
- Morning start time:
- How long we will try before reassessing:
- Which adult is responsible at each point:
Practical Playbook#
- Separate bedtime learning from night-feeding decisions.
- Choose a relatively stable week and align every caregiver beforehand.
- Use the same brief routine and response rules each night.
- Expect protest; decide in advance what would indicate distress or illness rather than ordinary crying.
- Evaluate over several nights, not minute by minute.
- Pause for illness or a material safety/feeding concern, then restart deliberately.
What Is Still Uncertain#
- Which method is best for a particular temperament; trials show success across methods but little basis for ranking them.
- The ideal starting age for every child.
- How well nighttime evidence generalizes to naps.
- Very rare harms and outcomes far beyond the follow-up periods studied.
My Family Notes#
- Why we do or do not want to sleep train:
- Pediatrician's feeding/readiness guidance:
- Method we can consistently follow:
- Exceptions and stopping rules:
- Start and reassessment dates: