So many parents ask me where they should start with sleep training. The landscape is overwhelming - a simple google search or scroll through instagram can result in conflicting information and varying levels of social acceptance or disapproval at every turn. I get it, and I’ve been there.
I think the most helpful way to navigate the various types of sleep coaching is to understand that they all fall into three different “buckets” or methodologies. While there are some variations in how to approach each bucket, every single method largely falls into one of the three areas I will walk you through here.
Is There Any Common Ground?
Yes! Before we explore the differences in each area, it is important for caregivers to know that every sleep coaching methodology has a few foundational tenets in common.
There are three key principles that every sleep coaching method holds paramount. These basic foundations support a child’s healthy sleep habits, no matter which strategy a family chooses to employ once they finally say “goodnight” to their precious little ones.
First, all sleep training methodologies hold that a child’s schedule is of utmost importance. Routine and flexible schedules help children of all ages get the balance of sleep, nutrition, and play they need for a great night’s sleep. In addition to routines and schedules, another common thread across all of the sleep coaching methods is the idea of “Drowsy But Awake” or DBA. Whether following a Cry-It-Out, A Timed Check, or The Shuffle, caregivers are likely seeing a common thread across methods centered around putting a child in their crib or bed drowsy, but not fully asleep. Lastly, all sleep coaching methods focus on the idea of sleep as a learned skill. This means that we can actively teach children to fall asleep - and stay asleep - on their own.
Top Three Sleep Coaching Methods
Here we’ll take a closer look at some benefits and drawbacks of the Cry It Out Method, The Ferber Method, and Parental Fading.
Cry It Out (Unmodified Extinction)
What is the "Cry It Out Method?"
The Cry It Out (CIO) Method was widely popularized by Dr. Marc Weissbluth in his book Healthy Sleep Habits, Happy Child. After going through a developmentally-appropriate schedule throughout the day and a calming bedtime routine, a child will be placed in their crib or bed when they are drowsy (but not asleep). Then, the caregivers will leave the room until the child falls asleep. They will do this same process at every wakeup overnight as well. If a child still needs to eat overnight after consultation with their team, caregivers can feed and then put children down DBA. In addition, if a child needs a diaper change, or if there is any concern about medical issues, parents can check on children, and then move back to the process of putting a child down DBA and leaving the room.
What are some benefits and drawbacks of CIO?
The main benefit is that CIO can be the fastest-moving of the three types of sleep coaching methods. While it can be very difficult for families to commit to hearing kiddos cry, often for extended periods of time, many times children can learn the skill of falling asleep independently within a week. The drawback is that many times, caregivers are distressed when hearing their children cry for extended periods of time. It should also be noted that not everyone finds Extinction to be effective at all across studies, and that for some families, it can take up to three weeks for a child to sleep through the night.
In my work with families over the last decade, I have found this method can be successful for younger children in cribs, but for older children and/or neurodiverse children in beds, this can be extremely difficult for caregivers to implement effectively.
Is it bad to let my baby cry it out?
There continues to be research and debate around babies and crying. The main aspect of crying that concerns most families is how it will affect a child’s attachment to caregivers. I can’t report that there is a definitive answer here, unfortunately. Researchers are studying both cortisol levels in babies and caregivers to try and give more information around the exact short- and long-term effects crying has on babies. As a practitioner working with families, my overall approach is to talk with families about their comfort levels with crying in general, and to discuss how they feel when their children cry and utilize caregivers’ comfort as the guiding light. If a family is particularly sensitive to any crying at all, I usually recommend one of the other methodologies in this article, as the CIO strategy will likely not be a good fit.
Timed Checks / Ferber (Graduated Extinction)
What is "Ferberizing?"
The namesake method of Dr. Richard Ferber falls under the category of Graduated Extinction. There are a number of ways to implement Graduated Extinction, but the basic idea is that the caregiver goes through a calm bedtime routine following a day with a supportive routine, and then leaves the room for specific static or increased intervals, until the child is asleep. This could mean that the caregiver leaves for increasing windows of time (e.g. : 5 minutes the first time then checks on the baby, then leaves for 7 minutes and checks on the baby, then leaves for 10 minutes and checks on the baby, etc…) or the caregiver leaves for static amounts of time (5 minutes out of the room and then check, repeatedly) until the baby falls asleep. Checks for this method are usually suggested to be under 1 minute long.
What are some benefits and drawbacks of the Ferber Method?
Graduated Extinction is a helpful method for parents who are comfortable with some crying, but don’t find that CIO resonates with their parenting styles. Sometimes it can be difficult for caregivers to be consistent with this method however, as it can become increasingly difficult and draining for the caregiver to stick with the process over one or multiple nights.
The Shuffle / Chair Method / Parental Fading (Extinction with Parental Presence)
What is the "Shuffle Method?"
Strategies that fall under Parental Fading are often described as the most gentle options for caregivers to choose when sleep coaching. The Shuffle Method was designed by social worker Kim West, The Sleep Lady. This method centers around supporting children as they fall asleep by staying near their crib or bed until they are fully asleep, and then repeating that process any time the child wakes up overnight. Like the other methods, working on getting kids down in their beds drowsy-but-awake (so only picking up to calm, and not until children are asleep) and following a supportive sleep schedule are foundational. After spending 3 nights right next to the child’s crib or bed (and touching/patting/rubbing children as needed) caregivers move positions away from the crib every 3 nights (usually 2 to 3 positions within the room) and then move out of the room altogether. The idea here is teaching the skill of falling asleep independently while supporting a child through the parent’s presence.
What are some benefits and drawbacks of Parental Fading?
The Shuffle is a great option for parents who are overwhelmed at the thought of their child crying for extended amounts of time. I should be clear though, this is not a no-cry solution. Children will cry, as this is their way of communicating that something is changing and they’re not sure about it. As with any change in a child’s life, it can be confusing for a child, but as long as a parent is committed and consistent, children will understand quickly, and will learn the skill of falling asleep independently. Parents often feel more comfortable being in the room with children in the beginning of this process (usually 9-12 nights) and find the more gradual process much more supportive than the other two types of methods.
Now What? How do I choose?
When talking through various options with families, I think it is important for them to consider their comfort with crying as they read through the different methodologies. In addition, I tell parents that there is no “right” way (regardless of what the socials say!) to support a child in learning this important life skill. The best fit for each family is the one that feels most aligned with their philosophies as well as one that they feel confident they can follow through on consistently for their child. I find consistently following a plan, no matter which one, is key - this consistency by adults ensures that children don’t feel confused and overwhelmed by the changes over time.
I do want to note that research* is limited in all three methodologies of sleep coaching that we discussed here. Some of the studies have used even small amounts of increased nighttime sleep - 11 minutes total - to indicate “success” and I’m not sure parents would agree that going through sleep coaching for that small amount of additional sleep is truly worth it. Researchers are working on bigger study samples as well as more specific definitions of success, and we should have more information on evidence behind each of the methodologies in the coming years.
I hope you found some clarity on the various sleep coaching strategies. If you’d like to chat about your specific child’s and family’s needs and ask questions about the best method for you, set up an informational call with me here.
* A recent meta-analysis found 11.3 additional minutes of sleep using extinction strategies: Fangupo, L. J., Haszard, J. J., Reynolds, A. N., Lucas, A. W., McIntosh, D. R., Richards, R., Camp, J., Galland, B. C., Smith, C., & Taylor, R. W. (2021). Do sleep interventions change sleep duration in children aged 0-5 years? A systematic review and meta-analysis of randomised controlled trials. Sleep Medicine Reviews, 59, 101498.