“Cry it out” (CIO) sleep training is one of the most commonly used and recommended sleep training methods. It’s the best studied in the medical literature.It’s also the sleep training method that most pediatricians have used for their own children— precisely because it is so effective and quick.
CIO sleep training has many names and variants:
- Extinction sleep training
- Graduated extinction (also known as the Ferber method, after Dr. Richard Ferber)– this is sometimes known as “controlled crying”
- Bedtime fading sleep training
- Extinction with parental presence (also known as “camping out” sleep training
For simplicity’s sake, I’m going to call it by “popular” name, CIO sleep training, although “extinction sleep training” is the most correct term in terms of the behavioral science.
Here’s the thing about CIO: it’s also the most controversial. When I started writing about sleep issues in children, I received hate mail about how I was going to cause “brain damage” in babies because I was talking about sleep training. To be frank, sleep training is perfectly safe when done correctly. So, in this article, I’m going to explain to you about WHEN to consider CIO sleep training and HOW to perform it.
What are the benefits of CIO sleep training?
As with all sleep training techniques, the goal is for your child to fall asleep independently at bedtime, so when she has natural awakenings during the night, she can put herself back to sleep.
If she needs you to put her to sleep, she will need you to put her BACK to sleep when she wakes up at night. To understand why, here is an article on sleep onset associations.
What is the downside to CIO sleep training?
Honestly, it’s hard to listen to your child cry. Not every parent can tolerate this. You can read about it all you want, but it’s pretty hard to do.
When to perform Cry it Out Sleep Training
What is the best age for CIO sleep training?
From my standpoint there is a relatively narrow window where CIO sleep training is effective. The earliest I would recommend it is in a four month old, as that is when babies start to evolve the capacity to self soothe. Other’s have recommended CIO sleep training in early infancy; I don’t think it is a good idea.
Before four months of age, I think it’s fine to try to put your child down drowsy but awake, but I would not let him fuss for two long and he is unlikely to be able to self soothe. Fortunately, there are steps you can take when your baby is younger to potentially avoid sleep training. I’m especially a fan of the “Le pause” method.
Most babies will respond well to CIO sleep training starting between four to six months of age.
The OLDEST I usually recommend CIO sleep training is 18 months of age, and I think it is better prior to a year of age. The reason is that toddlers can cry A LOT longer than infants, and some older kids can climb out of their cribs.
For older kids, camping out sleep training may work better.
Other techniques include taking a break or the excuse me drill.
What to do before sleep training
I would recommend that you move your child’s crib to the lowest setting so there is no chance they can climb out of their crib in a fit of rage.
I would take steps to stop bedsharing if you are doing so before starting this process. Here’s how to stop cosleeping.
Make sure that you have a good bedtime routine and have selected a time for bed where your child typically falls asleep within 15-20 minutes of lights out.
I would also try to move feeding earlier in your child’s bedtime sequence for a few days prior to starting. I think nursing or feeding to sleep is a potentially potent sleep crutch, so I would like to take it out of the equation.
So if your bedtime sequence is
- Read story
- Rock
- Nurse/give bottle to sleep
I would change it to
- Read story
- Nurse/Give bottle
- Rock to sleep
Finally, make sure you and your partner are on the same page. This can be difficulty and it helps that you are in agreement beforehand. I love this clip from Modern Family, which Mitch and Cam are definitely NOT on the same page:
How to perform CIO sleep training
The first steps for ALL extinction/CIO sleep training methods is the same:
- Put your child to bed drowsy but awake.
- Leave the room.
What you do next will depend on whether you want to perform unmodified or graduated extinction, or use bedtime fading with a response cost.
If you are doing unmodified extinction, that’s it. If you want to use the Ferber method/graduated extinction, you will be checking on your child intermittently until she falls asleep.
If you are not sure which is right for you, read on.
What is difference between unmodified extinction, graduated extinction (the Ferber method), and bedtime fading with response cost?
The differences is HOW YOU RESPOND when your child is fussing. In unmodified extinction, you just ignore them until they go to sleep. I find this works the most quickly.
In graduated extinction, you go in at set intervals to check on your child. The goal of these checks is to reassure your child and yourself that everything is OK. Some children are soothed by checks. With my older son, checks made things worse. When we went in the room, he would calm down for a bit but then start crying more and more when we left. You probably won’t know if this is the case for your child until you try checking I think it is reasonable to try using checks if you think they might be helpful.
If you are using bedtime fading, you only let your child cry for 15 minutes then get them up and keep them up for a set period of time.
How to perform the Ferber Method / graduated extinction
First, you need to understand what a check is. A check is a short and simple visit to the room without physical contact. You shouldn’t pick your daughter up or soothe her to sleep. You go in and repeat your final bedtime cue, such as, “I love you. It’s time to go to sleep. Good night,” and leave the room. It’s generally not a good idea to pick up your child, as she may immediately fall asleep—and then you have set the precedent that prolonged crying means you will “rescue” her.
Dr. Ferber has a fairly complex checking schedule:
- Night one 3 min, then 5 min, then every 10 min
- Night two 5 min, 10 min, then every 12 minutes
And the list goes on.
Here’s the table from my well worn copy of Solve Your Child’s Sleep Problems.
Honestly, I find it unnecessarily complicated.
Let me be clear: I’m not saying don’t use checks. If using checks helps you stick with sleep training, I’m all for it. However, I am saying that they aren’t necessary, and you need to decide if they help your child sleep more quickly or not.
If you do decide to check on your child, here’s how to do it. On the first night of CIO, try checking on your child at five minutes in. Gauge her response when you leave the room. Does checking on her seem to have calmed her down, or does it seem to have revved her up? Do you need the checks for your peace of mind? If it seems helpful, continue checking at set intervals. I like to keep the schedule simple because—let’s be real—you’re pretty tired.
- Night 1: every 5 minutes
- Night 2: every 10 minutes
- Night 3: every 15 minutes
Go in if your child is screaming. On the other hand, if she seems to be calming down, stay out of the room. If in doubt, wait a little longer.
Bedtime Fading With Response Cost Sleep Training
This is another extinction/ CIO based training method that can work and potentially reduce the amount of crying. I think this is especially helpful when you are actually unsure about what is your child’s “ideal” bedtime.
The name is pretty clunky: bedtime fading with response cost. Bedtime fading just means moving bedtime later. Response cost means the delay in in bedtime if your child does not fall asleep.
Note that bedtime fading can work well in older children as well but is performed differently.
This involves progressively delaying bedtime to harness your child’s natural sleep drive. This works well for parents who can’t imagine allowing their child to cry for more than fifteen minutes but are interested in using the magic of CIO to rapidly improve sleep.
This can work in a few days but does require a fair amount of parental energy and investment. Note that your child may be up pretty late for the first few nights.
Here’s how to do it:
- Place your child in his crib drowsy but awake and leave the room at their USUAL bedtime.. For the sake of this example, let’s assume this is at 8:00 p.m.
- After fifteen minutes of his crying, pick him up and calm him down. Keep him awake until 9:00 p.m. This can be pretty tricky. Quiet, calm activities are key. That can mean stories, puzzles BUT NOT SCREENS– they are too exciting. Note that the “response cost” here is 45 minutes.
- Put him down again and tell him goodnight at 9:00 p.m. If he continues to cry and does not fall asleep within fifteen minutes, get him out of bed and soothe him. Keep him awake until 10:00 p.m. and try again.
- Eventually, he will fall asleep within fifteen minutes of putting him down.
- Maintain his current wake time in the morning, and don’t let him get extra sleep during his naps. This is key– if your child sleeps in or extends their nap, this will not work. Note that your child will likely be cranky during the few days you are doing this.
- Repeat the process on night two and subsequent nights until he is falling asleep within fifteen minutes at his bedtime.
There are a few reasons I am not fond of this method. The first reason is that it is difficult to keep your child awake while soothing him, especially as the night progresses.
The other is that this is a bit complicated. Complexity is the enemy of success for tired parents. However, if the prospect of hearing your child cry for more than fifteen minutes is unbearable and if you can manage to keep your child awake, this is a helpful option.
I remember one mom who was adamantly against allowing her child crying for prolonged periods, but also thought that “camping out” (described later) would not work. After some discussion, we settled on this method. She called me a few days later and told me that it had been hard for a few days—her child was tired and cranky—but eventually it had worked like a charm.
What to do if your baby wakes up during the night during sleep training?
After you check and make sure that your child is OK, you have two options.
The first is to do exactly what you did at bedtime, either unmodified extinction (let your child fuss until they fall back to sleep) or modified extinction (doing brief checks on your child). The benefit of this method is that it will make the training go more quickly, as each time you allow your child to fall back to sleep independently, they have the opportunity to learn the skill of independent sleep. The downside is that you are likely in for a few rough nights.
The second is to soothe your child quickly back to sleep. This will help you (and perhaps others in your household) get more sleep. The night time awakenings will get better over time— just not as quickly. If your child needs you to fall asleep at bedtime and wakes up multiple times during the night, I estimate that the night time awakenings will go away in 4-6 weeks after they start falling asleep independently.
FAQ about CIO sleep training
Is letting my baby cry it out harmful?
No. In a nutshell, extinction sleep training has been shown to have no longer ill effects on children. One study in 2004 showed that attachment between parent and child actually improved after sleep training. A long term study showed no ill effects on children five years after sleep training. Finally, a randomized controlled trial of sleep training methods showed a marked improvement in time to fall asleep, reduction in night wakings, and decreased maternal stress without any evidence of long term effects on parent-child attachment or child emotions and behavior
The sleep training isn’t working. It’s been four nights and my baby is still crying a lot.
If you feel like you are not making progress, it’s ok to take a break, If your child is on the young side (four or five months of age) they may not be ready. I wait a few weeks, check in with your pediatrician, and try when they are a bit more mature.
What mistakes can cause sleep training to fail?
I have an article on the most common sleep training mistakes here. I suggest you read it before you start.
When should I go into the room?
I would definitely go in if you are worried if your child is hurt or sick.
The crying is so loud on the monitor! I can’t take it
Pro tip: Unless you live in a giant mansion, you will be able to hear him crying. I give you permission to turn off or mute your monitor until he quiets down.
One of us can’t stand it when our child cries, but we still want to try CIO. What do we do?
This is a common situation. In my household, I had the higher crying tolerance (having been through a pediatric residency and fellowship, I was pretty used to having kids scream in my presence). Since CIO sleep training is relatively quick, I think it is fine for one parent to be in charge of it for a few nights while the less tolerant parent sips a glass of wine while wearing noise cancelling headphones, or goes out to a movie with friends.
Can you perform CIO sleep training if you are sharing a room with your infant?
Yes, absolutely. It helps to have a visual barrier. You can use a curtain, screen or perhaps even something fancier like a Slumberpod (affiliate link). A white noise machine can also help to mask any sounds that you make. (We’ve been using this model since my 16 yo was born (affiliate link)). Remember, however, that you should make sure that the sound machine is not too close to your babies head as many commericially available sound machines are too loud. Alternatively, you may end up doing something like camping out sleep training.
How much will my baby cry during sleep training?
It depends on your child, but it is usually less than you think I wrote a whole article on the topic of how long most kids cry during sleep training. Note that your baby may cry more on night two or three, a phenomenon called the extinction burst. This is when the behavior you are trying to get rid of (needing you to fall asleep in this case) worsens a bit before it improves.
My child throws their pacifier out of the crib and calls for me to put it back in. What do I do?
I think it’s ok to replace it once. But if your child just keeps doing it, then I would stop replacing it.
My child is now falling asleep independently at bedtime but it has two months and she is still waking up at night. What do I do?
If your child is truly falling asleep at bedtime without any involvement from you, but still either crying or coming to your room, I would first recommend you have your child evaluated by her pediatrician to make sure there is no medical cause.
Once any medical issues have been ruled out, you can then try the same method you tried at bedtime. If you are following this guide, that probably means ignoring them at night. Soon I’m going to publish an article on what to do if your sleep trained child is still waking up at night.
If you prefer listening to reading, I did a whole podcast episode on CIO sleep training which you can find here.
So, this is my comprehensive guide on CIO sleep training. What did I miss? What questions do you have?