What is meant by baby or toddler sleep training and will it help your little one wake less at night?
Many infant sleep programs don't identify as sleep training, but continue to offer selected elements of extinction or graduated extinction methods, at the same time as the approach is promoted as gentle or responsive. There is no evidence that these hybrid programs decrease frequency of night waking. In contrast, The Possums Sleep Program offers a genuine paradigm shift, because it's built from the foundations up on altogether different principles (with five preliminary evaluations showing efficacy).
What is sleep training?
Sleep training our babies or toddlers isn't bad. But it is, in my view, outdated. Sleep training can make life with your baby or toddler much harder than it needs to be.
A fundamental underlying belief of the sleep training (or first wave behavioural or graduated extinction approach to infant sleep) is that we can change the biology of your baby's or your toddler's sleep. It's based upon the belief that you can teach your little one not to wake and call out for you during the night. The flip side to this is that sleep training approaches also (wrongly) teach that sleep problems are caused by bad habits or negative sleep associations.
You might even feel under pressure to use sleep training techniques because you've been told that sleep problems can cause behavioural or learning problems for your baby or toddler down the track, which is also not the case.
You can identify a sleep training approach because it will include some (or even all) of the following recommendations.
"Sleep breeds sleep"
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Don't let your baby or toddler be awake for longer than the sleep window appropriate for her age. This wake window might be estimated at no longer than 60 minutes as a newborn, or two or three hours in older babies, longer in toddlers.
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Grow long blocks of sleep during daytime naps by settling your little one back to sleep when he wakes after the first sleep cycle
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Put your baby or toddler down to sleep quite early in the evening
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Aim to have your baby or toddler in bed for about 12 hours overnight
"Don't create bad habits"
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Don't breastfeed your baby or toddler, or bottle feed your baby or toddler, to sleep, because this will mean that your little one is dependent upon breastfeeding or feeds to go back to sleep when surfacing from sleep cycles
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Instead, use feed-play-sleep cycles, including by
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Not letting your little one fall asleep with feeds, and
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Teaching him to go to sleep in the cot when drowsy but awake
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Don't cuddle your baby or toddler to sleep, because this will mean that your little one is dependent upon being held to go back to sleep when surfacing from sleep cycles.
"Avoid overtiredness and overstimulation"
"Teach your little one to self-settle"
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Babies and toddlers surface from sleep between sleep cycles, and need to learn to self-settle back to sleep
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Increasingly delay responses to your baby or toddler, stretching out the amount of time you allow your baby or toddler to fuss or cry before responding. This is likely to be accompanied by specific instructions about periods of time and how to increase time before you respond, over a number of nights.
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Respond, but not in the way your baby or toddler actually wants. You might be advised to respond by patting your little one in the cot, or patting the mattress, or sitting by the side of the cot.
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Take the breast out of your baby's mouth when baby is drowsy but not fully asleep, to try to break the association between breastfeeding and sleep.
"Create good habits"
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Teach your little one to go down into the cot drowsy, but awake, to develop the good habit of self-settling in the cot
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Teach your baby or toddler that the cot is always the place she goes to sleep in
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Develop consistent sleep routines for your baby or toddler during the day
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Develop consistent bedtime routines for your baby or toddler in the evening. These are often referred to as positive bedtime routines.
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Watch your little one for tired signs. This advice is often accompanied by a list of signs which are said to signal that your little one is tired.
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Put your little one down to sleep at the first tired sign, to avoid overtiredness
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If your baby or toddler is dialling up, it's a sign of overstimulation
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Sleep your little one in a quiet, dim room during the day.
Sleep training approaches do not improve your little one's behavioural or developmental outcomes
Parents are often given the impression that sleep training is an important part of being in control as a parent, much like good personal hygiene. This is not true. You can find out more about sleep and behavioural or developmental outcomes for babies here and toddlers here.
Sleep training approaches (including hybrid 'responsive' methods) do not decrease the number of times your little one wakes during the night
These days, there are lots of 'gentle sleep' approaches which mix up the latest sleep science and neuroscience with various recommendations which persist from sleep training methods. I find clinically that this mix of methods really doesn't work for many families, and there is also no (reliable) evidence to suggest they result in decreased frequency of night waking.
Systematic reviews are a research tool for finding all the studies that have been conducted on a particular topic, then analysing how well each study was conducted, what was found, and synthesising the findings. You can find out more here.
I have found eight systematic reviews which examine the use of sleep training approaches.
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Six systematic reviews have found that sleep training doesn't decrease frequency of night waking in infants. One of these earliest systematic reviews was conducted by myself and co-author Associate Professor Peter Hill. You can hear us discuss this study, and also the limitations of systematic reviews, here.
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One systematic review investigated sleep interventions which I identify as first wave behavioural in children 0-5 years of age. The authors found that these sleep interventions increased the length of sleep duration at night-times by a mean of nine minutes, and increased sleep duration by 8.6 minutes as a total over a 24-hour period. This finding is clinically irrelevant, and not relevant to families.
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Another systematic review concluded that although first wave behavioural strategies did not change the frequency of night wakings, they might impact on infant sleep durations. Again, I would propose that the small increase in the number of minutes of sleep duration is not relevant to parents.
These systematic and metanarrative reviews show that there is no evidence that sleep training, or first wave behavioural approaches to infant sleep, decrease the frequency of night waking in ways that are likely to benefit families.
But you can find out why sleep training might actually worsen your little one's sleep here.
Recommended resources
Hannah explains how she used sleep training methods with baby Ben
The historical context in which sleep training arose
Sleep training often makes baby or toddler sleep worse
Why watching for tired signs can make sleep worse when you have a baby or toddler
Our babies and toddlers don't resist or fight sleep, though you might hear this said
Do babies become overtired and overstimulated?
Do toddlers become overtired and overstimulated?
What is the Neuroprotective Developmental Care Contextual Model of Infant Sleep (NDC-MIS)?
Selected references
Bryanton et al. Postnatal parental education for optimizing infant general health and parent-infant relationships. Cochrane Database of Systematic Reviews. 2013.
Crichton G, Symon B. Behavioral management of sleep problems in infants under 6 months - what works? Journal of Developmental and Behavioral Pediatrics. 2016;37:164-171.
Douglas P, Hill P. Behavioral sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic reivew. Journal of Developmental and Behavioral Pediatrics. 2013
Douglas PS. Response to 'Behavioural management of infant sleep problems under 6 months: what works?'. Journal of Developmental and Behavioral Pediatrics. 2016;37:520-521.
Douglas PS. High level evidence does not support first wave behavioural approaches to parent-infant sleep. Sleep Medicine Reviews. 2015;29:121-122.
Fangupo L, Haszard JJ, Reynolds AN. 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. 2021;59:101498.
Ioannidis JPA. The mass production of redundant, misleading, and conflicted systematic reviews and meta-analyses. The Milbank Quarterly. 2016;94(3):485-514.
Kempler L, Sharpe L, Miller CB, Bartlett DJ. Do psychosocial sleep interventions improve infant sleep or maternal mood in the postnatal period? A systematic review and meta-analysis of randomised controlled trials. Sleep Medicine Reviews. 2015:doi:10.1016/j.smrv.2015.08.002.
Middlemiss W, Granger DA, Goldberg WA, Nathans L. Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Early Hum Dev. 2012;88:227-232.
NHMRC report on the evidence: promoting social and emotional development and wellbeing of infants in pregnancy and the first year of life. 2017
Park J, Kim YS, Lee K. Effectiveness of behavioral sleep interventions on children's and mothers' sleep quality and maternal depression: a systematic review and meta-analysis. Scientific Reports. 2022;12:4172.
Roser JG, Cassels T. From 'crying expands the lungs' to 'you're going to spoil that baby': how the cry-it-out method became authoritative knowledge. Journal of Family Issues. 2021;42(7):1516-1535.
Sasaki et al. Psycho-educational interventions focused on maternal or infant sleep for pregnant women to prevent the onset of antenatal and postnatal depression: a systematic review. 2020;Dec 19:doi:10.1002/npr1002.12155.