Researchers in Australia worked with 43 sets of parents who had babies between 6 and 16 months of age and who had a common complaint: Their child was having problems sleeping. The researchers taught about a third of the parents about graduated extinction, a technical term for crying it out. Parents were asked to leave the room within a minute of putting their child to bed and, if their children cried, to wait longer and longer periods of time before going back to comfort them.
Another third of the parents were asked to try a newer type of sleep training called bedtime fading. In this approach, parents put their infant to bed closer to the time he or she usually fell asleep and could stay in the room until the child dozed off.
The rest of the parents, the control group, did not attempt sleep training and instead received information about infant sleep.
Three months after starting the intervention, the researchers found that babies in the cry-it-out group were falling asleep almost 15 minutes faster than babies in the control group. The babies in the bedtime fading group dozed off about 12 minutes faster compared with the control group.
These improvements would probably be important for parents in more ways than one, said Michael Gradisar, associate professor of psychology at Flinders University in Adelaide, Australia.
"What our data probably do not capture is the peace of mind surrounding bedtime that we see when we work with families," said Gradisar, lead author of the study, published Tuesday in the journal Pediatrics.
The researchers found that the graduated extinction, or cry it out, group also bested the fading approach in other measures during the three-month intervention, including the number of times babies awoke during the night and their total sleep time.
Marsha Weinraub, professor of psychology at Temple University, agrees that the gains in sleep would help both babies and parents. "When you are waiting for your baby to go to sleep, every minute counts," said Weinraub, who was not involved in the new study.
Although the new fading technique seems to be effective, it is less effective than graduated extinction, and parents may want to try the latter approach if they are comfortable with it, Weinraub said.
Sleep training did not stress out babies
The most important aspect of the study, Weinraub said, is that both sleep training techniques seem safe for babies in the short and long term. The researchers found that the levels of cortisol, a stress hormone, were lower in the babies in during sleep training interventions. Moreover, one year after the interventions, the babies did not show signs of being more attached to their parents, nor did their parents report more behavioral problems compared with the babies in the control group.
"Parents have been told by some experts that children's stress levels will increase over time with these techniques and they will have behavioral problems, and this study shows very clearly, which I think is the first to do so, that there are no [poor] effects on children's stress levels and ... children in the intervention groups show less stress than children in the control condition," Weinraub said.
"This is a concern that has been expressed by many parents, which is interesting to me as a scientist, as there is no compelling evidence to support this claim," Gradisar said.
What's more, the study offers an alternative to letting babies cry it out. "Bedtime fading is the more preferred technique parents choose when provided both options. ... It's a gentle technique that works quickly," Gradisar said, adding that the university's website
has instructions on how to carry out both sleep training methods.
Gradisar and his colleagues found that by a year after the sleep training interventions, all of the babies, including those in the control group, were getting about the same amount of sleep. They suspect this is because babies' sleep health improves naturally as they get older.
Which sleep training style should parents choose?
Dr. Tanya Altmann, a pediatrician based in Southern California and author of "Mommy Calls," advises her parents to start sleep training almost from birth. It starts with newborns having a comfortable, safe sleep environment, typically a crib or bassinet. By the time the babies are 2 to 3 months of age, parents should put them to bed when they are drowsy but not yet asleep.
"It can really benefit them in the long run because self-soothing and sleeping techniques really stay with them throughout their entire lives," said Altmann, who is also the author of "What to Feed Your Baby." However, it can be helpful to try sleep training for babies who are still having trouble sleeping by 6 months, she added.
As for which method to choose, the two methods in the study appear to help in different ways, which could help guide parents.
"If you have an infant that only has nighttime awakenings, it appears from this study that bedtime fading is not as effective," whereas both methods could help if your problem is getting your child to fall asleep in the first place, said Daniel Lewin, a pediatric psychologist and sleep specialist at Children's National Health System in Washington.
"In the real world, you could do a combination" of the two, Lewin said. Parents could put their child to bed later and delay visiting the child if he starts crying, for example.
However, this type of training is not for everyone. Not all parents report that their children have sleep problems, and it is this subset of parents for whom the current findings would most relevant, Lewin said.
For those parents who do think their babies have trouble sleeping, the study brings even more good news: It did not take parents the full three months of the sleep training trial to see effects. Babies in both intervention groups were falling asleep faster one week after their parents started the training, and they continued to improve over the three-month period.
"The thing I often tell parents is that it only takes three days, and [sleep training] is effective," Weinraub said.
Even babies who sleep well can get thrown off when they have a cold or an earache, she said. But if they have a good sleep schedule, it is easy for them to get back on track in just a few days, she added.
Don't feel bad, Mom and Dad
Parents can feel a lot of guilt about not comforting their babies while they are crying. "[But] by setting a clear and loving limit for your child, children can function better," Lewin said.
In his practice, Lewin talks with parents and reassures them that they are not deserting or punishing their child by letting him soothe himself to sleep.
The cry-it-out method can also be difficult for busy parents. Parents may think, "I want to see my infant; I haven't seen them much today," Lewin said. It is OK for parents to feel conflict about this, he said, but it is important for them give children the space to fall asleep on their own.