Cry it out method (aka extinction method): Is it right for your baby?

Amber LoRe - Sleep Consultant / Pediatric sleep consultant / Updated Jan 12, 2022
cry it out method

It's time to discuss one of the most hotly debated topics out there: the cry it out method. We’ll explain what it is, and take a look at the research so you can decide if it’s right for your family. You’ll get evidence-based facts here, not judgment (we’ll leave that to your social media circles).


IN THIS ARTICLE:


Cry it out (also known as CIO or extinction) is a method of sleep training. In short, a child is put into their sleep space while they’re still awake, and then left to fall asleep on their own. It’s typically used to solve sleep issues caused by sleep onset associations, e.g., if your baby is accustomed to being rocked, fed, or held to sleep. As the name implies, the method often involves tears, since the child’s routine is suddenly — and drastically — changed. 

Depending on who you ask, total extinction can be synonymous with cry it out, or it can be one variation of CIO. Either way, the term refers to putting a child into their sleep space while awake and leaving them until a set time in the morning. Parents are instructed not to intervene, and to ignore crying and tantrums unless there’s a concern that the child is ill or hurt.

Graduated extinction is a progressive waiting approach that is also known by a host of other names:

  • Ferber Method

  • check and console

  • controlled comforting

  • controlled crying

Like total extinction, some sleep experts view gradual extinction as a variation of CIO. Others don’t consider graduated extinction to be a form of cry it out, but rather a different method of sleep training altogether. 

We don’t need to get bogged down in semantics. All can agree that graduated extinction means putting your baby down into their sleep space while still awake, and leaving the room, but returning for visits. Unlike the total extinction method, which doesn’t incorporate visits, graduated extinction involves intervening in gradually increasing intervals. 

The Ferber Method is undoubtedly the most well known graduated extinction method. Developed by Dr. Richard Ferber in the popular book “Solve Your Child’s Sleep Problems,” his technique starts with a visit to reassure the child after 3 minutes of crying. Parents are encouraged to keep their visits 1 - 2 minutes long, while the child remains in their crib. The time increments are then increased with subsequent visits, with the next visit taking place after 5 minutes. Eventually the intervals between visits increase to 30+ minutes. 

baby crying it out

Controlled comforting, like check and console, and controlled crying, are generic terms for graduated extinction. The “rules” regarding how long to wait in between checks to reassure your child can vary depending on who you ask. Similarly, the parameters around how much the parent should intervene can vary as well. 

The idea remains the same: Ultimately, the goal is for the child to fall asleep without direct contact from the parent, but visits to reassure the baby (and the parents) are encouraged. That means the child should fall asleep without being held, patted, or fed to sleep — but the parent should make regular check-ins until that happens. One sleep expert may encourage parents to keep their visits brief, while discouraging picking your child up. Other consultants allow for longer visits with more interaction.  

Yes. The short-term goal of cry it out is to help the child learn to fall asleep without caregiver assistance, i.e., to change sleep onset associations which can disrupt sleep. The long-term goal is to reduce night wakings and decrease bedtime resistance.

A 2006 review by the American Academy of Sleep Medicine took a look at 19 studies involving behavioral treatments for children with sleep issues. The evidence is clear that behavioral interventions, including both total extinction and gradual extinction, lead to significant improvement in a baby’s ability to fall asleep and stay asleep.

Cry it out is effective. Research supports that behavioral interventions (including both total and gradual extinction) result in significant reductions in bedtime resistance and night wakings. 

Sleep training improves parental mental health. Better sleep leads to improvements in child and family well-being. This is particularly significant for mothers, since maternal depression and poor maternal health have been linked with infant sleep problems. 

These methods can achieve faster results for some families. While some would rather spend weeks gradually transitioning away from sleep associations, families who commit to a total or gradual extinction approach can see significant improvement within several days.

Ignoring your baby’s cries can be hard. Really hard. As a result, parents find it difficult to be consistent, which can hinder progress.

Because we’re wired to respond to our baby’s cries, this method can be more stressful in the short term than others. Some parents and children find the dramatic changes in routine very upsetting and prefer a gradual method that aims to limit tears in the short term.

Cry it out methods can lead to a lot of initial sleep loss, especially when applied to the entire night, as opposed to beginning with bedtime only. This can sometimes lead to increased night waking, as well as daytime clinginess and difficulty with naps for the first few days.

The short answer: 5-6 months or older. Since younger babies aren’t always capable of consistently falling asleep independently, we recommend waiting until your baby is at least 5 months old before using a cry it out method at bedtime

If you’d like to use the graduated or total extinction method in the middle of the night, we recommend waiting until 6 months of age. You’ll also want to check with your pediatrician to determine whether your baby is ready to night wean or should continue to eat at night. 

The amount of crying will vary depending on a number of factors, including your baby’s temperament and their current level of sleep pressure (meaning how long they've been awake and whether they’re over or under-tired). Some babies fuss for under 10 minutes and quickly accept a new way of falling asleep. More persistent babies may cry for hours the first few nights. 

Some babies will cry when you initially change their routine, no matter what steps are taken to minimize tears. We get it — adults have a hard time changing habits too, even if it’s for the better! The first few nights are generally the hardest and then the changes become easier to accept. 

Making sure your baby’s needs are met before any form of sleep training will help bring peace of mind. This includes making sure your baby:

  • has a calm bedtime routine, with lots of cuddles

  • is in a safe sleep space

  • isn’t hungry

  • has a dry diaper

  • is in comfortable clothing

Since overtiredness can increase tears, we also recommend following an age-appropriate schedule. 

There’s no data to support that the cry it out method is harmful in the short term or long term. On the contrary, a 2004 study from Sweden found that babies who were sleep trained using a graduated extinction method showed increased security and attachment after the program.

Likewise, the 2006 review looked at thirteen sleep training studies for adverse secondary effects. None were identified. In fact, infants who participated in sleep interventions were found to be “more secure, predictable, less irritable, and to cry and fuss less following treatment.”

In a Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep Intervention, researchers concluded that “[b]ehavioral sleep techniques have no marked long-lasting effects (positive or negative). Parents and health professionals can confidently use these techniques to reduce the short- to medium-term burden of infant sleep problems and maternal depression.”

That said, some children get very upset when left to fall asleep on their own. For families choosing the total or graduated extinction methods, we do recommend using a video monitor to ensure that the child remains safe in their crib, especially if they’re already pulling up/standing in their sleep space.

Yes, the cry it out method can be used to sleep train during the day.  We recommend using it for the first 2 naps of the day only. Work on each nap for an hour. If your baby isn’t asleep at that point, get them up and try again an hour later. 

Absolutely. Research supports that a variety of behavioral interventions can improve sleep. 

Families looking for a more gradual, or gentle, approach may prefer to slowly transition away from helping their child to sleep.

For instance, if your baby falls asleep while being rocked, you’d begin by rocking with less intensity. Then you’d move onto holding your baby to sleep, without movement. Over time, you’d decrease the amount of help you’re offering until it has completely faded away and your baby is falling asleep on their own. This can be an effective way to solve sleep issues caused by parental-led sleep onset associations.

Studies have shown that toddlers and preschoolers who resist bedtime have seen improvement by combining  a consistent pre-bedtime routine along with a delayed bedtime. The idea is that you connect a warm, positive routine between the parent and child along with a later bedtime, so that the child falls asleep fairly quickly. The child then learns to connect the sleep cues of the routine with the experience of falling asleep quickly. Once this happens, bedtime can slowly be moved earlier each night until the bedtime goal is achieved.

The traditional total extinction method has parents leaving the room while their child falls asleep. This variation allows the parent to remain in the room without contact. Some families prefer to stay in the room to provide reassurance, while other families find that this can increase a child’s frustration since the parent isn’t doing what the child wants, and expects them to do at bedtime. 

Maybe. Whether a family decides to sleep train, and what method they choose, is a highly personal decision. Since quality sleep is crucial to physical and mental health, we encourage families to make changes if they, or their child, aren’t getting enough sleep. 

Cry it out can be a good option for families with a healthy child over 6 months of age who:

  • has nap, bedtime, or night-waking issues due to a sleep association 

  • are comfortable allowing their child to cry if their needs have been met

  • prefer to make bigger changes over a shorter period of time

Other families will want to consider alternative solutions for sleep issues.

Cry it out sleep training method FAQ

Q: Does cry it out work for all parents?

A:

No, there aren’t any “one size fits all” solutions when it comes to sleep. Cry it out can be an effective method for some families, but not others. If your baby is 6 months or older, has a sleep association, and you’re comfortable with letting them cry for periods, then it may be an effective solution for your family.

Q: What is the difference between the cry it out method and Ferber?

A:

The cry it out method refers to a sleep training technique where a child is left alone to fall asleep independently. While most experts use it to describe total extinction, where the parent does not intervene, others expand the term to include graduated extinction, where parents visit in gradually increasing intervals of time. The Ferber method refers to a graduated extinction method of sleep training developed by Dr. Richard Ferber.

Q: Why do babies cry themselves to sleep?

A:

Babies cry at bedtime for a variety of reasons, which is why we recommend that parents ensure that all of their child’s needs have been met, before laying them down to sleep. However, if you’re sleep training, it’s important to know that it’s common for babies to cry when their routine is changed — even if all of their needs have been attended to. If your baby has become accustomed to falling asleep in a certain way, it can be upsetting when that routine changes without warning.

Q: Does CIO sleep training cause psychological damage?

A:

Quite a few studies have explored this question, and to our knowledge there is no evidence that any method of sleep training, including cry it out, causes harm. Contrarily, researchers have found that sleep training can improve the mood of both babies and their parents.

Q: Is it really ok to let a baby cry to sleep?

A:

We’re unaware of any research that supports the idea that letting your baby cry to sleep during sleep training causes short- or long-term harm. But before embarking on sleep training, please ensure that your child is physiologically ready to fall asleep independently (which typically happens by 6 months of age), and that their needs have been met, i.e. they aren’t hungry or in discomfort.

Q: How long should I let my baby cry it out at naptime?

A:

Limit sleep training attempts during the day to no more than one hour at a time. Make sure that your baby is at least 6 months of age and use CIO for the first two naps of the day. If your baby is taking three naps, it’s okay to offer some help with the third one so that they’re not overtired by bedtime.

Q: How do I know if my baby is emotionally ready to self soothe?

A:

In our experience, the vast majority of babies 6 months and older are capable of learning how to fall asleep on their own. If your baby has difficulty falling asleep or staying asleep, it’s important to consider whether teaching them to fall asleep independently can improve their overall sleep habits.

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Note: The content on this site is for informational purposes only and should not replace medical advice from your doctor, pediatrician, or medical professional. If you have questions or concerns, you should contact a medical professional.