Cry it out and controlled crying are commonly recommended for addressing sleep problems. There are alternative sleep training methods. Mindell and colleagues (2006) reviewed research on 5 approaches (including cry it out and controlled crying). They concluded that each approach was much more effective than no intervention at reducing bedtime problems and night wakings. Sleep Training Methods Image

In summary, any approach that improves sleep for babies and mothers has benefits for the family. I would recommend prevention education for babies under 6 months old. For babies and toddlers 6 months and up I would try positive routines before scheduled awakenings, controlled crying, or cry it out. The review found all methods to be beneficial.

Here are quick links to the 5 methods reviewed:

If none of these sound quite right for you, or you just want more options check out:

Sleep training approach 1: Prevention education

Prevention education involves teaching parents sleep strategies. The following advice was provided in five large evaluation studies. Advice common to all studies is stated first. Advice unique to a single study is stated last.

  • Settling methods
    • Lie baby in the cot sleepy but awake.
      • If baby won’t settle, try again after one of these (Give each action 10 minutes to work before trying another; James‐Roberts &Gillham, 2001):
        • Check nappy.
        • Check and adjust temperature.
        • Try burping.
        • Stroke and talk softly. Cuddle if necessary.
  • Importance of routine.
    • “Dream feed” between 10pm and midnight*.
    • Bath at the same time each day.
  • Maximise day and night differences (noise, light, activity levels).
    • Respond to physical needs at night, but keep lights dim and avoid playing and socialising.
  • If weight gain is sufficient at 3 weeks of age, stretch intervals between night feeds by using alternative settling methods*.
  • Respond to crying, not fretting. Babies often fret before falling back to sleep.
  • Don’t allow lengthy daytime sleep.
  • Change the nappy every night feed if 3 or 4 hours apart, or as required for night feeds less than 3 or 4 hours apart.

*Steps marked with an * were recommended, but were not followed by parents. They may still be effective, but cannot explain the observed results.

Does this advice work?

Yes. The studies reviewed found that babies of parents given advice like this:

  • Were more likely to sleep for 5+ continuous hours at night at 6-9 weeks (Pinilla & Birch, 1993; Wolfson, Lacks, & Futterman, 1992) and 12 weeks of age (2.5 times more likely than a control group; James‐Roberts & Gillham, 2001).
  • Woke and fed less frequently at night at 6-9 weeks of age (but still consumed the same amount of milk per 24 hour period as babies in a control group; Pinilla & Birch, 1993; Wolfson et al., 1992).
  • Slept for longer at night (total sleep compared to a control group; Pinilla & Birch, 1993).
  • Had fewer night wakings, and woke on fewer nights at 9 months of age (than babies in a control group; Adair, Zuckerman, Bauchner, Philipp, & Levenson, 1992; Kerr, Jowett, & Smith, 1996).
  • Had fewer difficulties settling to sleep at 9 months of age (than babies in a control group; Adair et al., 1992; Kerr et al., 1996).The No Cry Sleep Solution: gentle sleep training method (Image)


This advice attempts to set up ‘good’ habits early. ‘Good’ is based on largely Western ideals of independence and pragmatic preferences for feeding more during the day than the night. Whether this is ‘good’ advice depends on the parents ideals and family situation. The No Cry Sleep Solution by Elizabeth Pantley provides a lot of this advice in detail and helps parents to assess what ‘good’ habits are given the family situation (click here for a review).

Appropriate age

The studies reviewed gave advice during pregnancy or around the 3 month mark. Babies begin to develop a body clock at around 10-12 weeks of age (as mentioned in this post). Therefore, some advice, such as differentiating day and night and implementing a routine, may be more effective after 3 months.

For further ideas on how to achieve a calm and sleepy baby in his/her cot (which can be a challenge). These posts might help:

2: Positive routines/Faded bedtime with response cost

These involve variations on the following steps:

Step 1: Determine when your child would naturally fall asleep if allowed to stay up.

Step 2: Decide on a short bedtime routine (less than 20 minutes) with 4-7 quiet activities involving positive parent-child interaction.

Step 3: Initiate bedtime routine when natural sleep time is approaching and your child shows signs of sleepiness. Praise co-operative behaviour.

Step 4: Once routine is established, and your child is falling asleep quickly, move the routine start time earlier by 15-30 minutes night-by-night or week-by-week until the desired bedtime is achieved.

Do Positive Routines work?

Positive routines were found to reduce the frequency and duration of bedtime tantrums compared to a control group with no intervention (Adams & Rickert, 1989; Mindell, Sadeh, Kohyama, & How, 2010). Improvements were comparable to a controlled crying technique. Only 3 studies assessed positive routines, far more have examined controlled crying techniques.

Dream Baby Guide. Quick reference guide to the book, and night-waking triggers, if you buy the book via my links.

Dream Baby Guide. Quick reference guide to the book, and night-waking triggers, if you buy the book via my links.


Positive routine are designed to aid sleep by:

1. Producing a calm, happy mood conducive to sleep.

2. Using a chain of events that become associated with sleep.

3. Praising and hopefully increasing appropriate behaviours.

A routine-based approach that I found really helpful with my first child is detailed in the dream baby guide. I found the guide repetitive and patronising but effective – see the full review and outline here.

Appropriate age

Positive routines are likely to be most effective once the baby has an established body clock, after 10-12 weeks of age. Positive routines were effective for toddlers and preschoolers (1-4 years of age) but not tested with babies under 1 year old.

For further ideas on setting up positive routines with faded bedtimes see the following posts:

3: Scheduled awakenings

Step 1: Determine when your baby naturally wakes at night.

Step 2: Slightly arouse and comfort baby 15-60 minutes prior to the natural awakening time.

Step 3: Gradually fade out scheduled awakenings.

Do scheduled awakenings work?

Scheduled awakenings don’t address bedtime struggles but have been found to reduce night-wakings. However, it can take weeks to result in more consolidated sleep.


The theory behind scheduled awakenings seems to be that parents can get the baby into the habit of sleeping longer. However, this approach fails to address the baby’s ability to self-settle and therefore is not helpful for bedtime struggles. Also, brief awakenings at night are common. Therefore, I would not predict lasting reductions in night-wakings. Tests of this method only included follow up examinations of less than 6 months or no follow up.

Appropriate age

Scheduled awakenings was tested predominantly with children from 6 months to 2.5 years old and can apparently help with night terrors.

For an anecdote of a variation of scheduled awakenings see:

4 and 5: Cry it out and controlled crying

Cry it out refers to putting your child to bed at bedtime and not responding to cries until a designated time the next morning, while monitoring for illness or injury. This is a painful option for parents and children. Controlled crying is a modification that incorporates limited responses (patting, not hugging) at set intervals of time.

Do cry it out and controlled crying methods work?

Cry it out and controlled crying methods do reduce bedtime troubles and night wakings, as attested to by many studies (Mindell, Kuhn, Lewin, Meltzer, & Sadeh, 2006).

Both methods are based on the behavioural psychology concept called extinction. When an action, such as crying, stops producing the desired result, such as parental presence, that action is performed less and less often. I have a number of issues with using this technique to reduce sleep-time crying.

  1. Firstly, crying is babies’ primary means of communication. I’m not sure we want to teach babies that attempts to communicate do not bring the desired result. One study found that babies have the same cortisol levels after self-settling to sleep as they did after crying themselves to sleep during the cry it out treatment (Middlemiss, Granger, Goldberg, & Nathans, 2012). This needs further research, but suggests that babies learn not to cry, rather than learning to feel calm by themselves.
  2. Secondly, these methods have to be repeated multiple times. “Extinct” behaviours often spontaneously return (Mazur, 2006), and this has been observed after cry it out and controlled crying methods (France, Blampied, & Henderson, 2003). Add teeth, and illness, and you have to re-train self-settling multiple times.
  3. Finally, during this kind of “sleep training” babies often cry hysterically, kick and scream, try to escape the cot, and eventually cry themselves to sleep. After days of this, the duration of crying reduces until they fall asleep without crying. This behaviour reminds me of learned helplessness. This is where animals will try everything to escape an electric shock. If they can’t, they stop trying. Eventually, the animal will sit and endure the electric shock even when the cage door is open. The animal appears calm, but is most probably in pain. The behaviour observed in these techniques is not too different. Sure, it’s not an electric shock babies are trying to escape, but we can’t know what the baby is feeling to make them scream, nor what they are feeling when they appear calm.

Despite my concerns, a recent review of controlled crying trials reported no negative effects on mental health or behaviour, and some evidence of improvements in infant security, likeability, emotionality, and tension (Črnčec, Matthey, & Nemeth, 2010). The impact on parent-child attachment was not examined.

Appropriate age

Controlled crying and cry it out techniques are generally not recommended until 6 months plus. One rationale for this is that it is around this age when babies understand that when you leave them, you still exist somewhere (object permanence; Price, Hiscock, & Gradisar, 2013).

For more information on implementing controlled crying and cry it out techniques, see the following posts:

Zero to Three talking about babies, toddlers, and sleep

Raising Children on “Controlled comforting”

Net Mums on “Controlled Crying”

Other options

Those other options again are:

Please subscribe, rate and share!

Subscribe: iTunes, RSS, or Stitcher

Please leave a review: in iTunes, and Stitcher

Share: Tweet, Facebook page


If you would like access to the transcript, please sign up.

Your experiences

Have you tried any of these techniques? What were your experiences. What other methods have you tried? Please discuss in the comments section. Techniques are deemed effective if they work for most babies, that doesn’t mean they work for every baby or every parent. What do you think worked for you and your baby? What didn’t?

If you have enjoyed this post, and think you could benefit from learning more, please consider signing up using the form below.


Adair, R., Zuckerman, B., Bauchner, H., Philipp, B., & Levenson, S. (1992). Reducing night waking in infancy: A primary care intervention. Pediatrics, 89(4), 585-588.

Adams, L. A., & Rickert, V. I. (1989). Reducing bedtime tantrums: Comparison between positive routines and graduated extinction. Pediatrics, 84(5), 756-761.

Črnčec, R., Matthey, S., & Nemeth, D. (2010). Infant sleep problems and emotional health: A review of two behavioural approaches. Journal of Reproductive and Infant Psychology, 28(1), 44-54.

France, K. G., Blampied, N. M., & Henderson, J. M. T. (2003). Infant sleep disturbance. Current Paediatrics, 13(3), 241-246.

James‐Roberts, S., & Gillham, P. (2001). Use of a behavioural programme in the first 3 months to prevent infant crying and sleeping problems. Journal of paediatrics and child health, 37(3), 289-297.

Kerr, S. M., Jowett, S. A., & Smith, L. N. (1996). Preventing sleep problems in infants: A randomized controlled trial. Journal of Advanced Nursing, 24(5), 938-942.

Mazur, J. E. (2006). Learning and behavior. New Jersey: Pearson.

Middlemiss, W., Granger, D. A., Goldberg, W. A., & Nathans, L. (2012). Asynchrony of mother–infant hypothalamic–pituitary–adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Early human development, 88(4), 227-232.

Mindell, J. A., Kuhn, B., Lewin, D. S., Meltzer, L. J., & Sadeh, A. (2006). Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 29(10), 1263-1279.

Mindell, J. A., Sadeh, A., Kohyama, J., & How, T. H. (2010). Parental behaviors and sleep outcomes in infants and toddlers: A cross-cultural comparison. Sleep Medicine, 11(4), 393-399.

Pinilla, T., & Birch, L. L. (1993). Help me make it through the night: Behavirol entrainment breast-fed infants’ sleep patterns. Pediatrics, 91(2), 436-444.

Price, A., Hiscock, H., & Gradisar, M. (2013). Let’s help parents help themselves: A letter to the editor supporting the safety of behavioural sleep techniques. Early human development, 89(1), 39-40.

Wolfson, A., Lacks, P., & Futterman, A. (1992). Effects of parent training on infant sleeping patterns, parents’ stress, and perceived parental competence. Journal of consulting and clinical psychology, 60(1), 41.