Some parents swear by extinction sleep training while others think it's downright harmful. Is there a middle ground?


Just the very mention of the phrase "cry-it-out" (CIO) can spark heated debate among parents, pediatricians, and psychologists. The cry it out method, also called extinction sleep training, is an umbrella term for any method of sleep training that involves letting a baby cry for a period of time before they go to sleep.

There are numerous variations on the cry it out method, with the more rigid end of the spectrum being total extinction—letting your baby cry alone for as long as it takes until he falls asleep. A gentler, and perhaps the most well-known version, is the Ferber Method, often referred to as graduated extinction, which involves checking in on and briefly comforting your baby at predetermined and increasing time intervals, until he falls asleep on his own.

Many parents have chosen this route, finding that a bit of crying in the short term was well worth the long-term benefits of a good night's sleep for all.

"When I say I was telling everybody [about the Ferber Method], I was telling everybody," says Lanette Stewart, a mother of three in Corsicana, Texas. "I was a huge believer in it because it worked for us, and it changed our lives."

Having twin infants who shared a room was particularly difficult for Stewart. If one baby began to cry, Stewart would rush to pick him up and whisk him away so as not to disturb his sleeping sister. Finally, when she was still struggling to get her then 8-month-old twins to sleep through the night, Stewart says her pediatrician suggested she look into the Ferber Method.

"He said, "it's going to be hard,'" she recalls. "'But it's a very well-known method. It's going to work for you.'"

Like the pediatrician had warned, the Ferber Method was hard for Stewart.

"The first night was horrible," she says. "I remember crying outside [their room] with my little kitchen timer waiting for the time to go down. Waiting, waiting, waiting, and then you rush in. I didn't get a lot of sleep that first night."

But each night the time it took for the twins to fall asleep slowly decreased. By the fourth night, they were sleeping through the night.

"It was amazing," she says.

But Is It Safe?

The controversy surrounding the method stems from some in the field who believe allowing a baby to cry, especially for an extended length of time, is harmful.

"Some argue that it is psychologically damaging for the infant—it disrupts secure attachment, for example," says Douglas Teti, Ph.D., a professor of human development and family studies at Penn State.

"My perspective on this is that parental responding to an infant at night has to satisfy two goals: one is to respond to the infant to promote in the infant, over time, that the parent is there for them when needed," says Teti. "The other is to promote infant self-regulation, and in particular, self-regulated sleep. Responding to the infant is important across the board, but the nature of the response, and at what development period it occurs, need to be considered."

Teti says that the CIO method is not appropriate for infants less than 3 months old, a view that most pediatricians share. Infants at this young age may still need a night feeding, and a parent's comfort during this period "seems to be helpful in establishing physiological and sleep regulation, which may have consequences beyond this early period," says Teti.

Critics of the cry it out method say allowing babies to get distressed can lead to digestive issues or even damaged synapses in the brain.

"I think that's ludicrous," says Craig Canapari, M.D., an associate professor of pediatrics and the director of the sleep medicine program at the Yale School of Medicine. "Honestly, it really wouldn't make much sense if kids got brain damage every time they cry. They cry all the time."

Dr. Canapari says some have used research conducted on neglect in orphanages—in which crying babies were rarely picked up—to make their arguments against these methods.

"[Extinction sleep training] is a very set sort of circumstance in which you're ignoring your child's distress for a set period of time and in a very well-defined arena," says Dr. Canapari. "I think it's perfectly fine."

The Opposition

Not all parents are thrilled with the concept of letting their baby cry it out. And some are downright opposed to it.

"For us, the cry it out method was a huge mistake," says Heather Creekmore, a mother of four who lives just outside of Dallas. She had picked up a book that recommended some crying it out.

"It was our first baby, so going in, I was excited to get a book that told me how to get the baby to sleep," says Creekmore. "Because, [with the] first baby, you're kind of desperate to have anything that will take you back to normal."

What she didn't know was that her oldest was suffering from acid reflux.

"Now, four kids later, I see clearly that I was trying to sleep train a baby who was miserable and uncomfortable," she says. "That's one of my biggest parenting regrets: Not having the resources or the experience to recognize that he was crying not to be fussy or because he didn't want to go to sleep but because he hurt. That I feel is the danger of the cry it out method, especially for first-time moms."

Sujay Kansagra, M.D., the director of the pediatric neurology sleep medicine program at Duke University Medical Center, says that while rigorous studies have shown evidence of short-term benefits to both mother and child using extinction sleep training—and no evidence of long-term risk to a child's health—he advises that they be used in healthy children.

"For children with any health conditions," says Kansagra, "it is always best to speak with your pediatrician prior to sleep training."


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March 1, 2019
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