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Sleep Training Truths: What Science Can (And Can't) Tell Us About Crying It Out

Michaeleen Doucleff 2016 square

Michaeleen Doucleff

Credit: Scott Bakal for NPR

Welcome to parenthood! For many of us, parenthood is like being air-dropped into a foreign land, where protohumans rule and communication is performed through cryptic screams and colorful fluids. And to top it off, in this new world, sleep is like gold: precious and rare. (Oh, so precious.)

Throughout human history, children were typically raised in large, extended families filled with aunts, uncles, grannies, grandpas and siblings. Adding another baby to the mix didn't really make a big dent.

Nowadays, though, many moms and dads are going about it alone. As a result, taking care of a newborn can be relentless. There are too few arms for rocking, too few chests for sleeping and too few hours in the day to stream The Great British Bake Off . At some point, many parents need the baby to sleep — alone and quietly — for a few hours.

And so, out of self-preservation, many of us turn to the common, albeit controversial, practice of sleep training, in hopes of coaxing the baby to sleep by herself. Some parents swear by it. They say it's the only way they and their babies got any sleep. Others parents say letting a baby cry is harmful.

What does the science say? Here we try to separate fiction from fact and offer a few reassuring tips for wary parents. Let's start with the basics.

Myth: Sleep training is synonymous with the "cry-it-out" method.

Fact: Researchers today are investigating a wide range of gentler sleep training approaches that can help.

The mommy blogs and parenting books often mix up sleep training with "cry it out," says Jodi Mindell , a psychologist at Children's Hospital of Philadelphia who has helped thousands of babies and parents get more sleep over the past 20 years. In fact, most of the time, it's not that.

"I think unfortunately sleep training has gotten a really bad rap because it's been equated with this moniker called 'cry it out,' " Mindell says.

Indeed, the cry-it-out approach does sound cruel to many parents. "You put your baby into their crib or their room, you close the door and you don't come back till the next day," Mindell says. "But that's not the reality of what we recommend or what parents typically do."

And it's not what scientists have been studying over the past 20 years. Cry-it-out is an old way of thinking, says Mindell, author of one of the most frequently cited studies on sleep training (and the popular book Sleeping Through The Night ).

In today's scientific literature, the term "sleep training" is an umbrella term that refers to a spectrum of approaches to help babies learn to fall asleep by themselves. It includes much gentler methods than cry-it-out or the so-called Ferber method . For example, some sleep training starts off by having the parent sleep next to the baby's crib (a method called camping out) or simply involves educating parents about baby sleep.

"All these methods are lumped together in the scientific literature as 'sleep training,' " Mindell says.

In several studies, parents are taught a very gentle approach to sleep training. They are told to place the baby in the crib and then soothe him — by patting or rubbing his back — until he stops crying. The parent then leaves the room. If the baby begins crying, the parent is supposed to check in after waiting some amount of time. In one study , these types of gentle interventions reduced the percentage of parents reporting sleep problems five months later by about 30%.

Myth: There's a "right" amount of time to let your baby cry when you're trying to sleep train.

Fact: There's not a strict formula that works for every parent (or baby).

There isn't a magic number of minutes that works best for checking on a baby after you've put her down, Mindell says. It really depends on what parents feel comfortable with.

"Doesn't matter if you come back and check on the baby every 30 seconds or whether you come back every five minutes," she says. "If it's your first child you're going in every 20 seconds." But by the third, she jokes, 10 minutes of crying may not seem like a lot.

There is no scientific data showing that checking every three minutes or every 10 minutes is going to work faster or better than checking more often. There are about a dozen or so high-quality studies on sleep training. Each study tests a slightly different approach. And none really compares different methods. In many studies, multiple methods are combined. For example, parents are taught both how to sleep train and how to set up a good bedtime routine. So it's impossible to say one approach works better than the other, especially for every baby, Mindell says.

Instead of looking for a strict formula — such as checking every five minutes — parents should focus on finding what Mindell calls "the magic moment" — that is, the moment when the child can fall asleep independently without the parent in the room. For some children, more soothing or more check-ins may help bring forth the magic, and for other babies, less soothing, fewer check-ins may work better.

With my daughter, I finally figured out that one type of crying meant she needed some TLC, but another meant she wanted to be left alone.

Even having a good bedtime routine can make a difference. "I think education is key," Mindell says. "One study I just reviewed found that when new parents learn about how babies sleep, their newborns are more likely to be better sleepers at 3 and 6 months."

"So you just have figure out what works best for you, your family and the baby's temperament," she says.

Myth: It's not real sleep training if you don't hear tons of crying.

Fact: Gentler approaches work, too. And sometimes nothing works.

You don't have to hear tons of crying if you don't want, Mindell says.

The scientific literature suggests all the gentler approaches — such as camping out and parental education — can help most babies and parents get more sleep, at least for a few months. In 2006, Mindell reviewed 52 studies on various sleep training methods. And in 49 of the studies, sleep training decreased resistance to sleep at bedtime and night wakings, as reported by the parents.

There's a popular belief that "cry it out" is the fastest way to teach babies to sleep independently. But there's no evidence that's true, Mindell says.

"Parents are looking for like what's the most effective method," Mindell says. "But what that is depends on the parents and the baby. It's a personalized formula. There's no question about it."

And if nothing seems to work, don't push too hard. For about 20% of babies, sleep training just doesn't work, Mindell says.

"Your child may not be ready for sleep training, for whatever reason," she says. "Maybe they're too young, or they're going through separation anxiety, or there may be an underlying medical issue, such as reflux."

Myth: Once I sleep train my baby, I can expect her to sleep through the night, every night.

Fact: Most sleep training techniques help some parents, for some time, but they don't always stick.

Don't expect a miracle from any sleep training method, especially when it comes to long-term results.

None of the sleep training studies are large enough — or quantitative enough — to tell parents how much better a baby will sleep or how much less often that baby will wake up after trying a method, or how long the changes will last.

"I think that idea is a made-up fantasy," Mindell says. "It would be great if we could say exactly how much improvement you're going to see in your child, but any improvement is good. "

Even the old studies on cry-it-out warned readers that breakthrough crying sometimes occurred at night and that retraining was likely needed after a few months.

The vast majority of sleep training studies don't actually measure how much a baby sleeps or wakes up. But instead, they rely on parent reports to measure sleep improvements, which can be biased. For example, one of the high-quality studies found that a gentle sleep training method reduced the probability of parents reporting sleep problems by about 30% in their 1-year-old. But by the time those kids were 2 years old, the effect disappeared .

Another recent study found two kinds of sleep training helped babies sleep better — for a few months. It tried to compare two sleep training approaches: one where the parent gradually allows the baby to cry for longer periods of time and one where the parent shifts the baby's bedtime to a later time (the time he naturally falls asleep), and then the parent slowly moves the time up to the desired bedtime. The data suggest that both methods reduced the time it takes for a baby to fall asleep at night and the number of times the baby wakes up at night.

But the study was quite small, just 43 infants. And the size of the effects varied greatly among the babies. So it's hard to say how much improvement is expected. After both methods, babies were still waking up, on average, one to two times a night, three months later.

Bottom line, don't expect a miracle, especially when it comes to long-term results. Even if the training has worked for your baby, the effect will likely wear off, you might be back to square one, and some parents choose to redo the training.

Myth: Sleep training (or NOT sleep training) my children could harm them in the long term.

Fact: There's no data to show either choice hurts your child in the long-run.

Some parents worry sleep training could be harmful long-term. Or that not doing it could set up their kids for problems later on.

The science doesn't support either of these fears, says Dr. Harriet Hiscock , a pediatrician at the Royal Children's Hospital in Melbourne, Australia, who has authored some of the best studies on the topic.

In particular, Hiscock led one of the few long-term studies on the topic. It's a randomized controlled trial — the gold standard in medical science — with more than 200 families. Blogs and parenting books often cite the study as "proof" that the cry-it-out method doesn't harm children. But if you look closely, you quickly see that the study doesn't actually test "cry it out." Instead, it tests two other gentler methods, including the camping out method.

"It's not shut the door on the child and leave," Hiscock says.

In the study , families were either taught a gentle sleep training method or given regular pediatric care. Then Hiscock and colleagues checked up on the families five years later to see if the sleep training had any detrimental effects on the children's emotional health or their relationship with their parents. The researchers also measured the children's stress levels and accessed their sleep habits.

In the end, Hiscock and her colleagues couldn't find any long-term difference between the children who had been sleep trained as babies and those who hadn't. "We concluded that there were no harmful effects on children's behavior, sleep, or the parent-child relationship," Hiscock says.

In other words, the gentle sleep training didn't make a lick of difference — bad or good — by the time kids reached about age 6. For this reason, Hiscock says parents shouldn't feel pressure to sleep train, or not to sleep train a baby. "I just think it's really important to not make parents feel guilty about their choice [on sleep training]," Hiscock says. "We need to show them scientific evidence, and then let them make up their own minds."

  • sleep training
  • infant health

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A parent’s guide to sleep training infants and toddlers

May 25, 2023

Written By Angela Holliday-Bell, MD*

  • General Pediatrics
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  • Angela Holliday-Bell MD
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Video Transcript

[MUSIC PLAYING] As your baby starts to grow, questions about sleep training will probably come up. Is sleep training safe? Is it effective? How would I even get started? We spoke to Dr. Angela Holliday-Bell, a UChicago Medicine Medical Group pediatrician and sleep specialist to help debunk some common myths.

Myth number one, sleep training teaches my child to stay asleep all night. Actually, it's natural to wake up multiple times throughout the night even as adults. Sleep training is about building tools to help your child fall back asleep on their own.

Myth number two, sleep training is harmful to my child. This is a common misperception. However, sleep training can have major benefits. A study by the American Academy of Pediatrics found no difference in attachment style or behavioral problems, and babies who completed sleep training showed decreased stress levels.

Myth number three, all sleep training methods are the same. From the cry-it-out method to the graduated-Ferber method, to the moving chair there are a wide variety of techniques. Parents should find the approach that works for them and their baby.

Myth number four, toddlers can't be sleep trained. With toddlers, you just need a different approach because you need their buy in. Try focusing on positive reinforcement like a sticker or other fun reward for staying in bed without getting up at night. And here's a tip. Consistency is key. Your baby is learning and needs to understand what to expect at night. So the best sleep training method is the one that all parents and caregivers will stick with.

To schedule an appointment with Dr. Holiday-Bell and view our team of pediatricians, visit uchicagomedicine.org/pediatricians.

[MUSIC PLAYING]

Sleep training is a commonly misunderstood topic among new parents.

But with proper preparation and consistency, it can be a valuable asset in improving overnight sleep for both you and your child.

Below are answers to frequent questions I get from parents.

What is sleep training?

Sleep training involves giving your infant, toddler or child the tools they need to fall asleep at the beginning of the night and back to sleep in the middle of the night without parental intervention.

A common misperception is that sleep training is teaching your child to sleep straight through the night. That's untrue. Even we adults wake up multiple times at night. This is part of the process as we cycle from one sleep phase to the next.

Sleep training your child is more about helping them develop the independent skills they need to fall back asleep.

What is the best age and weight to start sleep training your baby?

The best age and weight to begin sleep training varies, since every baby develops differently.

Your child’s pediatrician  can help you decide when the time is right. In general, 4 months and 14 pounds is a good time to start.

Babies do not actually develop their own melatonin or regulation of their sleep cycles until around 3+ months. Up to then, their ability to fully distinguish between day and night and connect sleep cycles to night is limited.

Generally, 14 pounds is a good weight because the baby may not need overnight feedings at this time.

What is the best sleep training method?

The best sleep training method is the one you and your partner can maintain until the pattern becomes habit.

For example, many families try the cry-it-out method, where they let the baby cry without intervention or overnight feeds. You often see results quickly with this technique but some parents wind up intervening every now and then.

Inconsistency can stop any progress being made. Your baby is looking to learn and needs to understand what to expect.

So the right method is the one where you and your partner, if a partner is involved, can find a routine and be consistent.

How long does sleep training usually take?

This can depend on the baby and the chosen method, since each baby is a little different.

In general, the cry-it-out method tends to work in as little as three to four days.

The Ferber method, also known as "graduated extinction," usually takes somewhere between seven to 10 days. In this case, the parent comes to check on the baby at longer intervals over time.

More lenient methods can take up to four weeks. These include the chair method, where a parent sits in a chair by the crib/bed at night until the child falls asleep. The parent gradually moves the chair further away nightly so the baby learns to fall asleep with less interaction.

Will sleep training harm my child?

When done with the right preparation and in the right environment, sleep training is safe and effective. In fact, the benefits to children and parents are major.

For instance, The American Academy of Pediatrics conducted a study where infants were divided into two groups. One group went through sleep training, the other did not.

The study measured:

  • Cortisol levels – a key marker of stress - in the baby
  • Parental satisfaction and stress levels
  • Attachment styles once the baby reached 1 year of age

Results found that babies in the sleep training group had decreased cortisol levels by the end of the training. And there was no difference found in attachment style or behavioral problems between the sleep trained group and the non-trained group.

Sleep training can help babies learn how to self-soothe and cope with stress experienced whether parents intervene or not.

Can I sleep train my toddler?

Sleep training a toddler may look different from sleep training an infant, but it’s possible and beneficial.

It can be more difficult for a toddler because they have a voice and they can get up and leave the bed. The cry-it-out method may not work.

However, toddlers understand rewards and motivation. Get their buy-in and use positive reinforcement, like saying, "If you stay in your bed without getting up at night, you get a sticker.”

That kind of praise for accomplishing a task is really motivating to them.

When should you contact your child’s pediatrician about sleep training?

If you’re interested in sleep training, bring it up to your child’s pediatrician first.

They can ensure the baby is ready, healthy, and does not need those overnight feeds.

They can also answer any questions or concerns before or during the training process. Your pediatrician can help make sure your baby is thriving and growing.

*Angela Holliday-Bell, MD, is a UChicago Medicine Medical Group provider. UChicago Medicine Medical Group is comprised of UCM Care Network Medical Group, Inc. and Primary Healthcare Associates, S.C. UChicago Medicine Medical Group providers are not employees or agents of The University of Chicago Medical Center, The University of Chicago, or UChicago Medicine Medical Group - Homewood.

Angela Holliday-Bell

Angela Holliday-Bell, MD*

Angela Holliday-Bell, MD is a UChicago Medicine Medical Group provider and a board-certified pediatrician. Her expertise includes providing infant and toddler sleep training and managing behavioral insomnia in kids.

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Sleep Training

  • PMID: 32155274
  • DOI: 10.3928/19382359-20200218-01

Adequate sleep in infancy and beyond is important for development; however, many children are not sleeping the recommended amount. During the first few years of childhood, infants are frequently seen in the pediatric office for well-visits and a myriad of other concerns, including sleep difficulties. As such, pediatricians should be adequately prepared to address these concerns. This article aims to provide clinicians with a basic knowledge of sleep physiology, sleep patterns and development, and current guidelines and options available for parents to address these issues. [Pediatr Ann. 2020;49(3):e101-e105.].

Copyright 2020, SLACK Incorporated.

Publication types

  • Child, Preschool
  • Infant, Newborn
  • Sleep Hygiene*
  • Sleep Wake Disorders* / therapy
  • Sleep* / physiology

Cara Goodwin, Ph.D.

Does Sleep Training Actually Improve Infants' Sleep?

A summary of the research on the effectiveness of sleep training..

Posted September 21, 2023 | Reviewed by Michelle Quirk

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  • Sleep training may result in modest improvements in at least parent-reported sleep for children over 6 months.
  • Sleep training is unlikely to result in long-term improvements in sleep.
  • Most research on sleep training uses parent-report measures, which may be inaccurate or biased.

In the intense debate over sleep training, even parenting books offer conflicting advice, with about two-thirds advising parents to use sleep training and one-third advising against it. But what does the research actually say? Is sleep training effective?

Research broadly finds that sleep training methods improve sleep for infants according to parent report, yet it is unclear whether they actually improve sleep according to objective measures of actual sleep time. A 2006 review study found that 82 percent of children show clinically significant improvement in sleep with sleep training. However, most of these studies (77 percent) used parent-report measures, which may be biased or inaccurate.

Randomized Controlled Trials of Sleep Training

Fortunately, we have a few randomized controlled trials that use objective measures of sleep, called actigraphy (translation: data from monitors that the infants wear that show whether or not they wake up). One randomized controlled trial of sleep training with 6- to 8-month-olds who had a parent-reported “sleep problem” randomly assigned parents to get instruction on infant sleep or safety. The instructions on infant sleep involved a description of the "checking in" method but also other important information such as the importance of having a bedtime routine. Interestingly, the researchers found that, although parents reported that their babies were waking up less frequently, sleep actigraphy found that the babies in the sleep-training group were waking up just as often. However, the actigraphy found that sleep-trained babies slept longer for their first period before waking—yet, on average, only 16 minutes longer.

After the intervention, 4 percent of the sleep-training group reported their child still had a sleep problem, while 14 percent of the control group did. The parents who received instruction on sleep training also reported improved mood, sleep quality, and fatigue.

This study had some important limitations. Although the intervention group received information about sleep training, it is unclear whether they actually followed these instructions, and researchers did not determine whether any parents in the control group used sleep training. It is also unclear whether it was the sleep training or learning other important sleep information such as bedtime routines that resulted in slightly longer sleep times.

Another randomized controlled trial assigned parents to one of three groups: (1) checking in, (2) bedtime fading, or (3) sleep education . The researchers found that both children in the "checking in" and "bedtime fading" groups slept better after treatment according to parent report but found no differences according to objective measures of sleep.

Although parent report may be biased, these data are still important because it may mean that the parents were sleeping better. There did not seem to be a significant difference in the sleep training group at the end of the intervention for wake after sleep onset, number of awakenings, or total sleep time. Sleep training also did not result in infants “sleeping through the night.” However, the lack of differences among groups may have been because some percentage of parents in the intervention groups did not use the sleep-training methods advised by researchers, and some percentage of the "sleep education" group might have used sleep training even when they were not advised to do so.

A question commonly asked with sleep training methods is whether they lead to any long-lasting changes. One randomized controlled trial followed children for 5 years and focused only on 8- to 10-month-olds with reported “sleep problems.” They allowed mothers to choose either the "checking in" or "camping out" method and taught parents how to use the strategy of their choice as well as positive sleep strategies, such as bedtime routines.

The first report of this study found that mothers were less likely to report their child still had a sleep problem by 10 and 12 months. Yet, 56 percent of mothers at 10 months and 39 percent of mothers at 12 months still reported a sleep problem even after sleep training. A follow-up study found that the difference between the intervention and control groups faded by age two. In the final follow-up study at 6 years , the researchers found no difference in sleep between the two groups, including whether parents reported sleep problems or differences in children’s sleep habits. These findings suggest that the benefits of sleep training may be temporary and not necessary for a child to develop independent sleep skills.

It is very important to mention that we do not have sufficient evidence that sleep training is effective before 6 months. One of the only randomized trials of young infants found no impact of educating parents about infant sleep before 12 weeks. Another larger randomized controlled trial of educating parents about infant sleep before 6 months found that the intervention only decreased night awakening by 8 percent and that the babies only slept for 6 minutes longer during the day.

Translation

Sleep training may provide moderate sleep improvements but is unlikely to result in long-term improvements in sleep or guarantee a child will be a “good sleeper” as a toddler or a preschooler. Two randomized controlled trials suggest that sleep training increases the first stretch of sleep by about 15 minutes when compared to a control group. Some parents may conclude that parent-reported improvements in sleep and the possibility of 15 minutes of extra sleep for their baby is very significant to their quality of life and decide to attempt sleep training. However, other parents may conclude that sleep training may not be worth it without consistent evidence for objective and long-lasting improvements in sleep.

Cara Goodwin, Ph.D.

Cara Goodwin, Ph.D., is a licensed clinical psychologist who specializes in translating scientific research into information that is useful, accurate, and relevant for parents.

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No Need for Guilt, Sleep Training Doesn't Ruin Your Baby Bond

Anna Bizon / Getty Images

Key Takeaways

  • A new study shows babies who are sleep trained slept better and longer than babies who were not sleep-trained.
  • Sleep training did not affect the bonding between parents and infants.
  • The decision to sleep train is up to each individual family, but this study can help parents ease parents anxious minds about sleep training.

If you're a parent, chances are you've been there—we all have. You have a baby that won’t sleep when expected, who then cries incessantly because they are overtired. The exhausted parent in turn also gets cranky and the cycle seems to be continuous and torturous. Sleep training may seem like the obvious answer but some parents worry the process will break the parent-child bond , and possibly damage the child’s mental health.

New research should help calm some of those fears. It not only showed that sleep training worked, but it didn't impact the parents' bond with their babies. This study was conducted in collaboration with Nanit Lab, the research arm of Nanit—a company that makes high-tech baby monitors . The monitors use technology to help track the baby's sleep and growth.

In the study published in the Journal of Pediatrics , 2,090 Nanit users were surveyed about their experience with infant behavioral sleep interventions (BSIs). This is also known as sleep training. Participants were all parents of U.S. infants between the ages of 3 and 18 months. Approximately 64% of parents reported using BSIs.

Sleep Training Doesn't Break Your Bond With Baby

Sleep training is a safe, effective way to help your baby get the sleep they need to set them up for a lifetime of sleep health. ”Babies who were sleep trained slept better and longer than babies who were not," says Natalie Barnett, PhD and vice president of clinical research at Nanit .

Not only are sleep-trained babies sleeping better, but researchers found no correlation between sleep training and negative outcomes such as depression, sleepiness, or damage to parent-infant bonding. This is great news for parents concerned about the connection and safety of sleep training methods. 

“There was no evidence of sleep training interfering with the parent-child bond," Dr. Barnett explains. "There was no difference in attachment between the babies who were sleep trained and the babies who were not,”

Jessica Madden, MD , a board-certified pediatrician, neonatologist, and International Board-Certified Lactation Consultant (IBCLC) agrees. She says she doesn't believe sleep training interferes with the bonding of parents with older infants or children.

Dr. Madden however has one caveat.  She doesn’t recommend sleep training before 4-5 months of age . Babies should get comfortable falling asleep on their own at this age before the separation anxiety phase which usually starts around 8 months old. "It's really important to not initiate sleep training for any babies who have current problems with growth, weight gain, and nutrition or other chronic health problems," she adds.

Babies Who Are Sleep Trained Get More Zzz’s

Sleep training teaches children how to fall asleep faster, stay asleep longer, and the ability to get themselves back to sleep when they wake. These are vital healthy habits that help children feel their best.

“We often don’t realize how impactful sleep training can be for parents as well," says Sydney Lucas , a certified sleep training consultant with Wee-Sleep. "Having guidance and support helps ease parents' stress, anxiety, and exhaustion that comes with lack of sleep and frustration around what to do and how.”

Lucas says having a plan helps parents feel in control and can be life-changing for many families. Children who sleep better are emotionally adjusted , have less difficulty learning , less fussiness, and have a reduced risk of health problems as they grow. Restorative sleep is crucial for the development and overall well-being of the whole family.

From a developmental standpoint, infants do not sleep through the night, on average, until they are at least 6 months old. Dr. Madden advises parents to have realistic expectations and goals if they start to sleep train. “Sleeping through the night means having one stretch of sleep that is at least 6 hours long—so sleeping from 10 p.m. until 4 a.m. is considered to be sleeping through the night," advises Dr. Madden.

It's important to remember there's no 'one size fits all' approach to sleep training. The decision whether or not to start to sleep train, and when, needs to be made from a holistic standpoint. Dr. Madden says parents should factor in the baby’s temperament, sleep environment, method of feeding, age and size of baby, and also parents’ goals and desires. 

Types of Sleep Training Studied

  • Unmodified extinction (“cry it out”): Parents leave their baby’s room at bedtime without soothing them when they cry until they can fall asleep on their own. 
  • Modified extinction (“controlled crying”): Similar to “cry it out”, but gradual. Parents soothe their babies when they cry, but gradually increase the amount of time until they soothe.
  • Parental presence: The parent stays in the room with the baby as they fall asleep, but gradually moves farther away until the baby can fall asleep without them.

Different Methods Yield Different Outcomes

In the Journal of Pediatrics study, babies who were left to cry it out (unmodified extinction) or experienced controlled crying (modified extinction) got the equivalent of an extra night of sleep per month compared to babies who were not sleep-trained.

Controlled crying was the most common approach. "Unmodified extinction was the method that was the fastest to see improvements and took the shortest time to complete, while parental presence took significantly longer to see improvements and to complete,” says Dr. Barnett.

Critics of the unmodified extinction method worry that letting their baby cry it out without comfort will elevate the baby's stress levels.

Dr. Barnett says the benefit of the parental presence method was it was the easiest method for parents to implement. It was significantly easier on the parents than modified or unmodified extinction. However, the study found that it took parents more than 50% longer to see improvements in infant sleep using parental presence compared to unmodified or modified extinction.

What if I Don’t Want To Sleep Train My Baby?

Ultimately, the decision to sleep train is up to the parents. The most common concern parents have is causing emotional stress and damage to the baby. Lucas shares a combination method she often recommends.

“Putting your baby to bed while he or she is still awake, and a parent stays nearby to support them when needed until their baby falls asleep. This is a gentle, supportive way to help your baby learn to sleep without leaving them to cry it out or do it all on their own,” she says.

Parents who did not implement sleep training visited their infants’ cribs 37 times per month more than parents who sleep train their babies. Additionally, parents who did not implement sleep training or relied on parental presence were more likely to perceive their infants' sleep as problematic.

“Sleep training, if done in a developmentally appropriate manner, can help older infants and toddlers start to sleep through the night,” adds Dr. Madden. “To my knowledge, there are not any scientific or research studies showing any real benefits of sleep training. The main benefit I can tell is for both parents and children to get longer stretches of sleep at night."

What This Means For You

Sleep training your baby is safe and can be beneficial for both the baby and the parents. Having guidance and support helps ease parents' stress, anxiety, and exhaustion from lack of sleep and frustration around what to do and how to do it. Speak with your child’s pediatrician before attempting sleep training. The use of a certified sleep training expert can also help to answer any questions and guide you.

Kahn M, Barnett N, Gradisar M. Implementation of behavioral interventions for infant sleep problems in real-world settings .  The Journal of Pediatrics . 2022:S0022347622010009. doi:10.1016/j.jpeds.2022.10.038

Mindell JA, Kuhn B, Lewin DS, Meltzer LJ, Sadeh A, American Academy of Sleep Medicine. Behavioral treatment of bedtime problems and night wakings in infants and young children . Sleep. 2006;29(10):1263-1276.

Mindell JA, Leichman ES, DuMond C, Sadeh A. Sleep and social-emotional development in infants and toddlers .  Journal of Clinical Child & Adolescent Psychology . 2017;46(2):236-246. doi:10.1080/15374416.2016.1188701

Magee CA, Gordon R, Caputi P. Distinct developmental trends in sleep duration during early childhood .  Pediatrics . 2014;133(6):e1561-e1567. doi:10.1542/peds.2013-3806

Pennestri MH, Laganière C, Bouvette-Turcot AA, et al. Uninterrupted infant sleep, development, and maternal mood. Pediatrics . 2018;142(6):e20174330. doi:10.1542/peds.2017-4330

Gradisar M, Jackson K, Spurrier NJ, et al. Behavioral interventions for infant sleep problems: a randomized controlled trial . Pediatrics. 2016;137(6):e20151486. doi:10.1542/peds.2015-1486

Mindell JA, Williamson AA. Benefits of a bedtime routine in young children: Sleep, development, and beyond . Sleep Med Rev . 2018;40:93-108. doi:10.1016/j.smrv.2017.10.007

By Taayoo Murray Taayoo is a New York City-based writer and boy mom who writes about family, health & wellness, and lifestyle. Her work has been published in national publications like Parents, Health, Huffpost Well, Verywell Health, Yahoo Life, Business Insider, New York Times Kids, Giddy, and others.

How to Sleep Train Your Baby

Medical review policy, latest update:, what is sleep training, what sleep training isn’t , read this next, when to start sleep training, sleep training methods, cry it out (cio), ferber method, chair method, bedtime fading method, pick up, put down method, can you sleep train for naps, how long does sleep training take, sleep training tips, when to call the doctor, frequently asked questions, what are some common sleep training methods, is sleep training safe for babies, can sleep training have any negative effects on babies.

What to Expect the First Year , 3rd edition, Heidi Murkoff. WhatToExpect.com,  Getting Baby on a Sleep Schedule , June 2020. WhatToExpect.com,  When Will Your Baby Sleep Through the Night? , February 2022. WhatToExpect.com,  Do I Have to Wake My Baby Up to Feed? , September 2020. WhatToExpect.com,  Cry It Out Method of Sleep Training , February 2020. WhatToExpect.com,  What Is Sleep Regression? , January 2022. WhatToExpect.com,  Newborn and Baby Sleep Basics , May 2020. WhatToExpect.com,  11 Reasons Your Baby Won't Sleep and How to Cope , November 2020. WhatToExpect.com,  What You Should Know About Sudden Infant Death Syndrome (SIDS) , June 2020. WhatToExpect.com,  Co-Sleeping, Bed-Sharing and Room-Sharing: What's Safe and What Isn't? , November 2020. American Academy of Pediatrics,  Getting Your Baby to Sleep , July 2018. American Academy of Pediatrics,  Reduce the Risk of SIDS & Suffocation , January 2017. American Academy of Pediatrics , Pediatrics ,  Reducing Nocturnal Awakening and Crying Episodes in Infants and Young Children: A Comparison Between Scheduled Awakenings and Systemic Ignoring , February 1988. American Academy of Pediatrics , Pediatrics , Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep Intervention: Randomized Trial , October 2012. American Academy of Sleep Medicine,  Behavioral Treatment of Bedtime Problems and Night Wakings in Infants and Young Children , 2006. American Family Physician,  Getting an Infant to Sleep: Graduated Extinction and Sleep Fading Are Effective , November 2016. Cleveland Clinic,  How Can I Tell When My Baby Is Tired? , March 2019. Early Human Development , Asynchrony of Mother-Infant Hypothalamic-Pituitary-Adrenal Axis Activity Following Extinction of Infant Crying Responses Induced During the Transition to Sleep , April 2012. Elizabeth Murray, D.O., F.A.A.P., Assistant Professor of Clinical Pediatrics, University of Rochester, Rochester, NY. National Institutes of Health, National Library of Medicine, Discussion of Extinction-Based Behavioral Sleep Interventions for Young Children and Reasons Why Parents May Find Them Difficult, November 2016. National Institutes of Health, National Library of Medicine,  Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial , June 2016. Sleep.org,  How to Sleep Train Babies , March 2021. UpToDate,  Behavioral Sleep Problems in Children , August 2020. Zero to Three, Helping Babies Learn to Fall Asleep On Their Own: What Research Says , 2022.

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Does Sleep Training Your Baby Cause Long Term Harm?

Sleeping Baby Web

Here’s what you need to know about the latest research on sleep training.

Almost every exhausted new parent has wondered about the pros and cons of sleeping training their baby. Will it work? What method should I use? And the big question: Will it cause harm? While it’s still unclear which method will work best for each baby and family, mounting research suggests that the practice of letting a baby cry for short intervals while learning to put herself to sleep is not inherently harmful —and does not seem to cause long term emotional problems for the baby or disrupt the parent-child bond. However, there are some caveats, explains Kimberly Schneider, M.D. pediatrician at Indiana University Health. Here’s what you need to know about the latest research on sleep training.

In a recent study published in the journal Pediatrics , researchers evaluated 43 sets of parents and babies in Australia. In one group, the parents didn’t follow a particular sleep training method, and instead were given basic sleep information. In a second group, parents used a method called bedtime fading in which they delayed bedtime by prescribed increments each night to land on a time for sleep when their babies were tired enough to doze off easily. (Some proponents of the bedtime fading method also say it’s key to keep a consistent wake time.) A third group followed a method called graduated extinction, which involves letting the baby cry for a short interval, then coming back to check on the baby, and then increasing the intervals between check ins. This is done over several nights.

When the researchers measured the stress levels of the babies by analyzing their saliva for the stress hormone cortisol, the babies in the sleep training groups showed slightly lower cortisol levels than the babies who had no sleep training. This suggests that in the bedtime fading group and the graduated extinction group, the babies had less stress and anxiety. What’s more, the babies that did follow a sleep training method feel asleep more quickly and woke up less frequently in the middle of the night.

The results were positive 12 months later as well. The study authors found that after a year, there was no difference among the groups in the children’s emotional and behavioral health or in the parent-child attachment. “It is an encouraging study and should help parents feel less guilt about sleep training,” says Dr. Schneider. “Though the study is too small to say definitely that there are no long term consequences to the crying, it supports what pediatricians have thought for a long time.”

It’s important to point out, though, that graduated extinction, which is often called “crying it out,” does not mean that you simply let your baby cry indefinitely. “It’s a misconception that ‘crying it out’ means you don’t ever go in and check on your baby,” says Dr. Schneider. “You should not leave a baby in the nursery crying for hours, and not check to be sure he is okay.” This can cause severe stress and could be unsafe as well. “With graduated extinction, you’re letting your baby know with each check in: ‘I’m still here, do you really need me?’” adds Dr. Schneider. “If you see your baby is okay, you let her know you’re going to leave again.”

So what should parents take away from the latest research? “Parents have to decide for themselves if and how much they can listen to their baby cry, but this study suggests that as long as you are there, persistently and gently guiding the way, it’s okay to let your baby cry for short periods of time as he learns to self soothe and put himself to sleep,” says Dr. Schneider. Once he masters that skill, he’ll be able to fall asleep more easily at bedtime and put himself back to sleep when he wakes in the middle of the night. This can, of course, minimize sleepless nights and improve overall wellbeing for babies and parents.

Before you start a sleep training plan, Dr. Schneider recommends that you check with your pediatrician to make sure that your baby is healthy, growing well, and able to skip nighttime feedings. “This usually happens when a baby is around 6 months,” she says. It’s also important to develop a consistent bedtime routine (such as a bath, book, and lullaby) that your baby learns to associate with getting drowsy and going to sleep. Also, keep the room dark for sleep and naps, which will cue your baby that it’s sleep time.  

Finally, one of the best things you can do to set the stage for sleep training, says Dr. Schneider, is to lay your baby down for sleep when she is drowsy but awake, from the very beginning of her life. “That way, your baby learns early on that she doesn’t need you to put her to sleep,” says Dr. Schneider.

-- By Rachel Rabkin Peachman

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Follow-up patients and procedures, sample size and analyses, conclusions, acknowledgments, five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial.

FINANCIAL DISCLOSURE: All authors had financial support from the Foundation for Children for the submitted work (see Funding, below); no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

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Anna M.H. Price , Melissa Wake , Obioha C. Ukoumunne , Harriet Hiscock; Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep Intervention: Randomized Trial. Pediatrics October 2012; 130 (4): 643–651. 10.1542/peds.2011-3467

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Randomized trials have demonstrated the short- to medium-term effectiveness of behavioral infant sleep interventions. However, concerns persist that they may harm children’s emotional development and subsequent mental health. This study aimed to determine long-term harms and/or benefits of an infant behavioral sleep program at age 6 years on (1) child, (2) child-parent, and (3) maternal outcomes.

Three hundred twenty-six children (173 intervention) with parent-reported sleep problems at age 7 months were selected from a population sample of 692 infants recruited from well-child centers. The study was a 5-year follow-up of a population-based cluster-randomized trial. Allocation was concealed and researchers (but not parents) were blinded to group allocation. Behavioral techniques were delivered over 1 to 3 individual nurse consultations at infant age 8 to 10 months, versus usual care. The main outcomes measured were (1) child mental health, sleep, psychosocial functioning, stress regulation; (2) child-parent relationship; and (3) maternal mental health and parenting styles.

Two hundred twenty-five families (69%) participated. There was no evidence of differences between intervention and control families for any outcome, including (1) children’s emotional ( P = .8) and conduct behavior scores ( P = .6), sleep problems (9% vs 7%, P = .2), sleep habits score ( P = .4), parent- ( P = .7) and child-reported ( P = .8) psychosocial functioning, chronic stress (29% vs 22%, P = .4); (2) child-parent closeness ( P = .1) and conflict ( P = .4), global relationship ( P = .9), disinhibited attachment ( P = .3); and (3) parent depression, anxiety, and stress scores ( P = .9) or authoritative parenting (63% vs 59%, P = .5).

Behavioral sleep techniques have no marked long-lasting effects (positive or negative). Parents and health professionals can confidently use these techniques to reduce the short- to medium-term burden of infant sleep problems and maternal depression.

Behavioral techniques effectively reduce infant sleep problems and associated maternal depression in the short- to medium-term (4–16 months’ postintervention). Despite their effectiveness, theoretical concerns persist about long-term harm on children’s emotional development, stress regulation, mental health, and the child-parent relationship.

Behavioral sleep techniques did not cause long-lasting harms or benefits to child, child-parent, or maternal outcomes. Parents and health professionals can feel comfortable about using these techniques to reduce the population burden of infant sleep problems and maternal depression.

Infant sleep problems are prevalent, reported by up to 45% of mothers in the second 6 months of life, and double the risk of maternal depression symptoms. 1 , 2 As a common driver of health care use during infancy, they are also costly for families and health systems. 3 Fortunately, they are often readily treatable. From 6 months of age, extinction-derived behavioral techniques like “controlled comforting” (see D1 in Guide for Fig 1 ) help infants learn to self-settle and sleep independently. 4 , 5  

FIGURE 1. Graphical depiction (“Perera diagram”30) of the components of the trial shared and unique to the intervention and control groups. MCH, maternal and child health.

Graphical depiction (“Perera diagram” 30 ) of the components of the trial shared and unique to the intervention and control groups. MCH, maternal and child health.

Mindell et al’s 2006 systematic review of behavioral interventions for child sleep problems found that 49 of 52 programs led to clinically significant reductions in bedtime resistance and night waking 3 to 6 months later. 4 Secondary benefits included better parent sleep, mental health, and child-parent relationships. No studies, including the longest follow-up to date (3 years’ postintervention), 6 have reported detrimental effects. 3 , 4 , 7 , 8 The American Academy of Sleep Medicine subsequently classified behavioral techniques as “standard” practice for managing infant sleep problems, 9 and a recent expert working party convened by the Australian Research Alliance for Children and Youth concluded that behavioral approaches are safe, at least in the short term. 10  

Despite strong evidence of the short- and medium-term benefit and cost-effectiveness of behavioral sleep techniques, unproved concerns about their long-term harm are limiting their uptake and provoking vigorous debate. For example, a 2011 review by Blunden et al 11 notes that behavioral techniques could prevent parents from responding consistently and sensitively to their child, thereby leading to long-term adverse impacts on child-parent bonding, child stress regulation, mental health, and emotional development. These concerns originated with pure extinction (“crying-it-out”), which is not usually recommended nowadays because of the distress it causes parents and infants. However, the concerns have extended to extinction derivatives like controlled comforting and “camping out,” 11 which are recommended for best practice. 4 , 9 In response to Blunden et al, 11 Sadeh et al 12 countered that there is no evidence that behavioral techniques cause harm. Researchers from these opposing perspectives are calling for a rigorous longitudinal study of the long-term effects of behavioral sleep interventions to resolve this controversy. 11 , 12  

Interestingly, this debate is largely framed around possible harms rather than the potential for lasting benefits. In the absence of long-term follow-up studies, it is entirely possible that benefits to maternal mental health may extend beyond the medium-term already demonstrated. 7 Furthermore, teaching parents to regulate their children’s sleep behavior is a form of limit setting that, combined with parental warmth, constitutes the optimal, authoritative, parenting style for child outcomes. 13 , 14  

In 2003–2005, Hiscock and colleagues 3 conducted the Infant Sleep Study. Designed to improve Australian infants’ sleep problems at 8 to 10 months of age, it was a large, community-based, secondary-prevention randomized trial of a behavioral intervention comprising positive bedtime routines and teaching either controlled comforting or adult fading (also known as camping out), should parents choose to use them. In comparison with controls, intervention parents reported fewer sleep problems at infant age 10 months (56% [intervention] vs 68% [control]; adjusted odds ratio [aOR] 0.6 [95% confidence interval 0.4–0.9]) and 12 months (39% vs 55%; aOR 0.5 [0.3–0.8]), 3 with a sustained reduction in maternal depression at 2 years (15% vs 26%; aOR 0.4 [0.2–0.9]). 7  

To determine long-term harms and/or benefits of this infant behavioral sleep intervention, we now report our 2009 follow-up at age 6 years. We hypothesized that there would be no evidence of intervention versus control group differences in: (1) child emotional and conduct behavior (primary outcomes), sleep, psychosocial health-related quality of life, and diurnal cortisol as a marker of stress; (2) child-parent relationship, disinhibited attachment; or (3) maternal mental health or parenting styles.

The Kids Sleep Study is the 5-year follow-up of the Infant Sleep Study, a randomized controlled trial (International Standard Randomized Controlled Trial Number 48752250) for which we have previously reported methods for outcomes at ages 12 3 and 24 7 months. In brief, the Infant Sleep Study aimed to recruit all mothers with children born in June to July 2003 who attended the free, universal 4-month well-child check with their maternal and child health nurse in 6 sociodemographically diverse local government areas ( n = 982). Of these, 782 (80%) expressed interest in participating; 692 (70%) returned the 7-month questionnaire. Mothers who responded “Yes” to the 7-month screening questionnaire item “Over the last 2 weeks, has your baby’s sleep generally been a problem for you?” were eligible for the trial ( n = 328, 47%). Maternal and child health nurses excluded infants born <32 weeks’ gestation and mothers with insufficient English to complete questionnaires.

After baseline recruitment, we randomized the 49 maternal and child health nurse centers (clusters) which, in turn, determined participant allocation. 3 Because nurses were responsible for delivering the intervention, randomizing clusters rather than participating families minimized the likelihood of contamination between trial arms. Centers were ranked within each stratum according to the number of infants recruited at 4 months, randomizing the largest center and alternately allocating subsequent ones to avoid a marked imbalance in cluster sizes between trial arms. Because all the centers were recruited before randomization and ranked by using a criterion that could not be influenced by the investigators, allocation concealment was achieved. Researchers involved in data collection and entry were blinded; nurses and parents, however, could not be blinded to group allocation.

Intervention nurses were trained to deliver a brief, standardized behavioral sleep intervention at the routine 8-month well-child check to mothers reporting infant sleep problems ( Fig 1 and Guide show details). Based on their needs and preferences, each family chose which (if any) type or mix of strategies they would use to try and manage their infant’s sleep. 3 One hundred of the 174 intervention mothers attended their nurse well-child check visits to discuss infant sleep problem management for an average of 1.52 visits, with mean duration for the first and subsequent visits of 25 and 19 minutes, respectively. Control families received usual care, which meant they were free to attend the scheduled 8-month visit and ask for sleep advice; control nurses, however, were not trained to deliver specific sleep management techniques.

From April to October 2009, we recontacted all families. Of the original 328 Infant Sleep Study children, 3 326 were eligible at age 6, whereas 2 met our prespecified exclusion criteria of intellectual disability or developmental delay ( Fig 2 ). Parents who returned written informed consent were mailed a questionnaire and phoned to arrange a 40- to 60-minute home-based assessment as close as practicable to the child’s sixth birthday, during which the trained researchers (1) administered the Pediatric Quality of Life Inventory 15 to the child and (2) showed families how to collect salivary cortisol (see Table 1 ).

FIGURE 2. Participant flow for the original Infant Sleep Study to 6-year-old outcomes. All clusters were trained (so 0 “did not receive intervention”), but not all individuals received the intervention. †Take-up of the intervention was voluntary. One hundred families reported receiving the intervention. *All lost to follow-up because of failure to return questionnaires. ‡Did not return the 10- or 12-month follow-up questionnaire (were not sent 2-year questionnaire). §Did not return 2-year follow-up questionnaire. MCH, maternal and child health.

Participant flow for the original Infant Sleep Study to 6-year-old outcomes. All clusters were trained (so 0 “did not receive intervention”), but not all individuals received the intervention. †Take-up of the intervention was voluntary. One hundred families reported receiving the intervention. *All lost to follow-up because of failure to return questionnaires. ‡Did not return the 10- or 12-month follow-up questionnaire (were not sent 2-year questionnaire). §Did not return 2-year follow-up questionnaire. MCH, maternal and child health.

Families selected a nonschool day (weekend or holiday) to collect 2 cortisol samples: (1) 30 to 40 minutes after waking to avoid the postawakening rise, because its meaning in relation to the diurnal cortisol profile or psychosocial stress is unclear, 16 and (2) before lunch. We based our collection protocol on the standardized procedures provided by the pathology laboratories responsible for testing samples. Children avoided brushing teeth, eating or drinking for 30 minutes before collection, then thoroughly rinsed their mouth with water 3 times, chewed a piece of Wrigley’s sugarfree gum, EXTRA peppermint, and collected 4 mL of saliva in a plain tube. Families recorded children’s waking and saliva collection times. Families stored samples at room temperature before mailing them back within 1 to 2 weeks of collection, 17 when we froze them at −18°C. Cortisol levels were measured by 2 local laboratories owing to an unexpected company merger (by using the Roche Modular and Avida Centaur systems, respectively). Interassay coefficients of variation fell below 5.3% ( n = 113 samples) and 15% ( n = 54) for the 2 laboratories, respectively. No saliva-based intraassay reliabilities were available. The proportion of intervention samples analyzed by each laboratory was similar (55% vs 46%, respectively).

Table 1 shows details of the outcome measures. For all variables but cortisol, we selected potential confounding variables a priori based on existing research. 18 Throughout childhood, child gender, temperament, maternal depression, and socioeconomic status (maternal education and Socioeconomic Indexes for Areas 19 Index of Relative Disadvantage) are associated with and predict most outcomes examined in the Kids Sleep Study. 1 , 20 Socio-Economic Indexes for Areas is a national index derived from census data for all individuals living in a postal code, with higher scores indicating less disadvantage. We controlled for all 5 potential confounders in the adjusted analyses, except some analyses of binary outcomes in which the sample size was too small to include all 5 without causing instability in the resulting estimates 21 (see “Sample Size and Analyses” below). For Strengths and Difficulties Questionnaire (SDQ) continuous scores, we additionally adjusted for financial stress (6-point quantitative item, “Given your current needs and financial responsibilities, how would you say you and your family are getting on?”; responses range from “prosperous” to “very poor”), because Longitudinal Study of Australian Children data indicate that financial stresses are associated with a doubling of the risk of behavior problems in 2- to 7-year-olds. 22 In the absence of a strong conceptual framework for choosing cortisol confounders, we used exploratory analyses to identify variables associated with “abnormal” cortisol levels at P < .1. 18 This applied to the laboratory at which testing occurred only.

6-Year-Old Outcome Measures; Parent Report Unless Otherwise Specified

The original Infant Sleep Study was powered to detect a difference of 20% between the proportions of mothers reporting infant sleep problems at each of the 10- and 12-month follow-ups with 80% power at the 5% level of significance, with an assumed cluster size of 11 and intracluster correlation coefficient of 0.02. 3 For the Kids Sleep Study follow-up (not considered at the original sample size calculation), we anticipated retaining at least 75% of the 2-year-old participants (99 of 132 control and 110 of 146 intervention families, total n = 209). A sample size of 99 per group would give the study 80% power to detect a difference of 0.4 SD units (ie, effect size) between groups at the 5% level of significance. We did not allow for intracluster correlation, because we expected any cluster effects to fade over the 5 years since the intervention.

We compared trial arms by fitting random effects linear regression models estimated by using maximum likelihood for quantitative outcomes, and marginal logistic regression models by using generalized estimating equations, assuming an exchangeable correlation structure with information sandwich (“robust”) estimates of SE for binary outcomes. 23 Both methods allow for correlation between outcomes of participants from the same cluster. We conducted analyses unadjusted and adjusted for the potential confounders, with the exception of analyses of (1) SDQ binary outcomes, which was not adjusted for maternal education, and (2) child “moderate/severe” sleep problem, which was not adjusted for child gender, maternal depression, or education, because there were potentially too few subjects with clinically high SDQ scores or a sleep problem to obtain stable estimates from models with all potential confounders included as predictors. The omitted variables were not strongly related to the respective binary outcomes.

All retained participants were analyzed in the groups to which they were randomized, applying the intention-to-treat principle. Confidence intervals from analyses of quantitative outcomes were validated by using the bootstrap method. 24 Intracluster (intra–maternal and child health unit) correlation coefficients from adjusted analyses are reported according to the CONSORT recommendations for cluster-randomized trials. 25 , 26 All data files were analyzed by using Intercooled Stata, version 11.1 for Windows (Stata Corp, College Station, TX).

Both the original trial (23067B) and 6-year-old follow-up (28137F) were approved by the Human Research Ethics Committee of The Royal Children’s Hospital, Melbourne.

At age 6 years, 225 of 326 children (69%) participated (see Fig 2 , participant flow). Of these, 193 (86%) participated in the home visit and 177 (79%) agreed to collect cortisol. Of the latter, 167 (94%) provided at least 1 cortisol sample and 149 (84%) provided the 2 cortisol samples and the collection time data required to categorize the diurnal profile as “abnormal” versus “normal.” We were unable to contact 49 of 326 families (15%), and 52 of 326 (16%) families declined for reasons including “too busy” ( n = 26), “not interested” ( n = 6), “personal reasons” ( n = 6), “child illness” ( n = 1), or no reason ( n = 13).

Table 2 shows the sample characteristics. In the control arm, children of mothers who completed a university degree were overrepresented, and children from disadvantaged backgrounds were underrepresented among those retained versus lost to follow-up; children of families who spoke a language other than English at home were underrepresented in both arms. Follow-up occurred at a mean age of 6.0 years (SD 1.9 months). Of the retained families, those who did and did not collect at least 1 cortisol sample had similar baseline characteristics (data available from authors on request), with the exception that those who did were less likely to speak a language other than English at home (13% vs 26%).

Baseline Characteristics According to Follow-up Status (ie, Retained or Lost to Kids Sleep Study) at Age 6 Years

All values are percentages, except where otherwise stated. EPDS, Edinburgh Postnatal Depression Scale, where EPDS >9 is the community cut point for depression; SEIFA, Socioeconomic Indexes for Areas, 2002 Australian census data for socioeconomic status by postal code.

There was little evidence of unadjusted or adjusted differences between trial arms on the child, child-parent, and maternal outcomes ( Table 3 ). Mean scores were almost identical between groups for the parent-reported child emotional, conduct behavior, and total mental health difficulties; Child Sleep Habits Questionnaire; psychosocial health-related quality of life; the child-parent relationship measures; and maternal mental health. The proportions of children with mental health problems, “moderate/severe” sleep problems, and authoritative parenting were also similar between trial arms. Consistent with these findings, the mean scores for children’s self-reported health-related quality of life and the proportions of children classified with chronic stress according to the objective physiologic cortisol measure were similar between intervention and control groups, providing little evidence that the early intervention harmed or benefited the intervention group with respect to child, child-parent, or maternal outcomes at 6 years.

Results of Regression Analyses Comparing the 2 Trial Arms on Child, Child-Parent, and Maternal Outcomes at Age 6 Years

CI, confidence interval; CPRS, Child-Parent Relationship Scale; CSHQ, Child Sleep Habits Questionnaire; DASS, Depression, Anxiety, Stress, Scale; ICC, intracluster correlation coefficient; PedsQL, Pediatric Quality of Life Inventory.

Summary statistics are quantitative (mean [SD]) except where specified as dichotomous (%).

The comparative statistic is the mean difference for quantitative outcomes (intervention minus control) and odds ratio for dichotomous outcomes (the risk of receiving the intervention compared with receiving usual care).

Negative ICCs for SDQ Total and Emotional clinical scores, and permissive parenting were truncated at zero.

Reference group for parenting styles is authoritative parenting. Authoritarian, permissive, and disengaged parenting styles (all negative outcomes) were similar between groups, and were therefore collapsed into a single category for analysis.

There was no evidence that a population-based targeted intervention that effectively reduced parent-reported sleep problems and maternal depression during infancy had long-lasting harmful or beneficial effects on child, child-parent, or maternal outcomes by 6 years of age. Thus, this trial indicates that behavioral techniques are safe to use in the long-term to at least 5 years postintervention.

The study had several strengths. This 5-year follow-up of a rigorously conducted randomized trial (the gold standard for assessing causality) 18 may represent the only opportunity to provide objective evidence investigating any lasting harms or benefits of behavioral infant sleep interventions. This is because, with their known short- and medium-term effectiveness, it is unlikely that new trials with true nonintervention controls and 5-year follow-up could now be ethically conducted. Where possible, we used well-validated, reliable outcome measures 15 , 27 , – 31 collected from multiple sources, including parent report, child report, and objective physiologic biomarkers. Although details of the 30% (290/982) of families originally excluded from the population sample were unknown, the enrolled participants covered a broad socioeconomic range and were similar to Australian and US normative data for maternal well-being and child temperament characteristics, 32 meaning that our findings should generalize to English-speaking families.

The study also had some limitations. Because 31% (101/326) of the original sample was lost to follow-up at age 6 years, the lower and upper bounds of the 95% confidence intervals did not rule out smaller long-term harms or benefits of the intervention that could be meaningful in public health research. 7 Nonetheless, the precision of the confidence intervals make clinically meaningful group differences unlikely. Loss to follow-up can also introduce internal bias and reduce generalizability. Regarding bias, the retained intervention and control participants were fairly balanced ( Table 2 ); however, as more non–English-speaking and disadvantaged families were lost to follow-up, our findings may be less generalizable to these participant groups. Finally, no validation studies of the categorical cortisol variable were available, but our own exploratory analyses within the combined cohort showing that abnormal cortisol was associated with poorer child and maternal well-being suggests that it was indeed functioning as a stress biomarker (A.P., M.W., H.H., unpublished data).

Our findings were entirely consistent with the longest follow-up study before the Kids Sleep Study, 6 , 20 which reported no differences between intervention and control arms on child internalizing and externalizing problems, sleep, or maternal mental health at child age 3 to 4 years (3 years postintervention). Thus, these new data, when interpreted with shorter follow-up data from >50 intervention studies (including 9 randomized controlled trials), suggest that behavioral sleep interventions have short- to medium-term benefits that fade beyond 2 to 3 years’ postintervention.

In the context of potential harm, it is unknown whether there are subgroups of infants (eg, those who have previously been maltreated, experienced early trauma, or are anxious children) for whom the techniques are unsuitable in the short- or long-term. 12 If supported by empirical investigation, there could be a case for using more gradual interventions such as adult fading instead of the more intensive graduated extinction (controlled comforting) to manage infant sleep. Along with trials like ours demonstrating that sleep problems can be effectively treated in older infants, recent efficacy trials for children younger than 6 months suggest that parent education programs that teach parents about normal infant sleep and the use of positive bedtime routines could effectively prevent later sleep problems. 4 , 8  

Our findings highlight the importance of access for parents to effective sleep management strategies and training for the health professionals in such strategies. Currently, the information available to parents about the effects of behavioral sleep strategies is inconsistent and out of date. For example, peak bodies including the Australian Infant Mental Health Association and the Australian Breastfeeding Association, which work to influence policy and practice but argue against the use of behavioral techniques like controlled comforting, have not updated position statements since the mid-2000s. Thus, there is a pressing need to deliver evidence-based information to parents and health care providers, which could be achieved, in part, by updating position statements, policy documents, and training curricula to reflect our current findings that behavioral sleep techniques are both effective in the short- and medium-term and safe to use in the long-term.

The intervention achieved all of its original aims (better infant sleep and lower maternal depression and health care costs in the short- to medium-term). The 6-year-old findings indicate that there were no marked long-term (at least to 5 years’ postintervention) harms or benefits. We therefore conclude that parents can feel confident using, and health professionals can feel confident offering, behavioral techniques such as controlled comforting and camping out for managing infant sleep.

adjusted odds ratio

Strengths and Difficulties Questionnaire

Drs Wake and Hiscock conceived the original study; Dr Price led the 6-year-old data collection phase; Drs Price, Wake, Ukoumunne, and Hiscock wrote the manuscript; all authors had full access to all of the data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and the accuracy of the data analysis; Dr Price is the guarantor.

This trial has been registered with the ISRCTN Register ( http://isrctn.org ) (identifier ISRCTN48752250).

FUNDING: The Infant Sleep Study was funded by the Australian National Health & Medical Research Council (NHMRC) Project grant 237120 and the Pratt Foundation, and the follow-up Kids Sleep Study by the Foundation for Children (Project grant 180 2009) and the Victorian Government’s Operational Infrastructure Support Program. The authors’ work was independent of the funders (the funding source had no involvement). Dr Price was supported by a Melbourne Research Scholarship (The University of Melbourne) and the Murdoch Childrens Research Institute (MCRI), Dr Wake was supported by NHMRC Population Health Career Development Awards 284556 and 546405, and Dr Hiscock’s postdoctoral position was supported by NHMRC Population Health Capacity Building grant 436914 and Career Development Award 607351. The MCRI administered the grants and provided infrastructural support to its staff but played no role in the conduct or analysis of the trial.

We thank all the parents and children who took part in the Infant and Kids Sleep Studies; the Maternal and Child Health nurses from the cities of Bayside, Darebin, Hobson’s Bay, Manningham, Monash, and the Shire of Yarra Ranges who helped recruit and deliver the intervention in the Infant Sleep Study; and Lisa Quinn and Emily Roberts for their help with recruitment and data collection.

Competing Interests

Unethical and unscientific conclusions ignore how infants are harmed.

This article shows a lack of ethical monitoring by reviewers and editors. The authors state: "Behavioral sleep techniques have no marked long-lasting effects (positive or negative)." This is an unconscionable and unscientific conclusion since there is no way that the authors studied all possible effects nor did they examine exactly what the control group was doing (so, what are they comparing against?). They apparently ignored the vast amount of mammalian research showing that distressing young offspring leads to long term negative effects on mental and physical health. By allowing these unconscionable conclusions, you are encouraging irresponsible parenting behavior that will do great harm to children.

Conflict of Interest:

None declared

Sleep Training Not Harmful? Methodological Concerns Question Conclusion

The conclusion drawn by Price and colleagues that behavioral sleep techniques did not cause lasting harms (Five-Year Follow-Up of Harms and Benefits of a Behavioral Infant Sleep Intervention: Randomized Trial) can be challenged on several levels.

Treatment Integrity

Reliability of conclusions drawn in longitudinal research rests on treatment integrity of the initial design. In this Infant Sleep Study, initial treatment integrity was irreparably confounded when 40% of mothers in the treatment group did not engage in treatment (behavioral sleep intervention). This invalidates drawing statistically sound conclusions related to treatment effect initially and longitudinally. How can one draw conclusions about the efficacy or safety of an intervention when almost half of the treatment group declined treatment? Furthermore, the authors did not collect or report information on intensity or duration of treatment use or infant distress for those mothers engaged in the advised interventions.

Neither can the authors say for certain that control group mothers did not engage in a behavioral sleep intervention, since they did not collect that information either. Indeed, given the acceptance in the study location of use of behavioral sleep interventions, there is good reason to suspect that the control group might have been contaminated with subjects who used controlled crying.

Compromised Design

The research design is presented as a randomized controlled study. However, those directly involved in the intervention itself, i.e., nurses and the families, were aware of group membership. This introduces an expectancy effect (see Adair, 1984 for review) in which changes in participants' behavior following an intervention can be associated with the expectation of benefit rather than from the intervention itself.

Cortisol Protocol

The author's method of using diurnal cortisol patterns as an indicator of chronic stress caused by the behavioral intervention is highly questionable. The protocol for salivary collection as outlined -- 30 minutes post waking and noontime -- is not supported in the literature as a means of interpreting diurnal patterns of stress. There is no basis in scientific literature for expecting cortisol levels to be elevated five years after a stressor event, i.e., behavioral intervention, unless the child was subject to ongoing stress in the interim.

Need to Reconsider Conclusions

The authors have no valid basis for their assertion that behavioral sleep interventions cause no long-term harm. Thus, this article cannot and should not be presented as evidence of the long-term safety of behavioral sleep interventions that involve leaving infants to cry for varying periods of time. Given the author's own admission of no evidence of long- term benefit to the children in the intervention group - neither in terms of sleep quality nor measures of family mental health -- they and others who promote the use of behavioral sleep interventions should reconsider their assumptions that such treatments are necessary in order to prevent long-term sleep problems or other negative outcomes purported to be caused by untreated night waking. This is a particularly important reconsideration given the plethora of literature supporting synchrony, responsiveness, and breastfeeding--all of which are compromised in behavioral sleep interventions.

Re:Unethical and unscientific conclusions ignore how infants are harmed

Even as a lay person, I can see that this study proves nothing. The "control" group, if it even qualifies as control, could have actually gotten frustrated and just left their babies to cry to sleep (CIO)at some point. We don't know. If some or many of them did and if we hold the affects against the mammal studies Dr. Narvaez mentions, the test group who used "controlled crying" methods would actually be BETTER off in terms of unregulated stress (which is the concern of leading neuropsychological thought). So there is really no comparison happening here. In other words, you'd have a similar amount of harm in both groups, as Dr. Narvaez indicates. If these researchers are making the claim that everything that happened crying-wise must have been safe, because "all the kids seemed ok" at 6, that's not good science. I wish Allan Schore, one of the leading researchers of our time on the profound effects of early unregulated distress, would respond to this. One point I'm sure he would make, is that you can't necessarily see the effects of a brain wired for stress until later in life when adversity tests our core resilience.

Five Year Follow-up of Harms and Benefits of Behavioral Sleep Intervention: Randomized Trial

The recently reported paper Five Year Follow-up of Harms and Benefits of Behavioral Sleep Intervention: Randomized Trial.1 claims to show that the use of 'controlled comforting' more typically referred to as 'controlled crying' does not cause long-lasting harms or benefits to child, child-parent or maternal outcomes. We are concerned that these claims go beyond what this paper has reliably demonstrated. One of the main concerns about the use of such techniques is their impact on cortisol, and in this study the measure of 'abnormal' cortisol was only available for 46% of the sample, of whom 29% of the intervention group had abnormal cortisol levels compared with 22% in the control group. This difference would probably have been statistically significant had they been able to follow-up more infants. This study also did not utilise a good measure of infant attachment security using only a brief 5-item parent-report of 'disinhibited' attachment, which is typically only identified in children who have experienced abuse or severe neglect.2-3 The study also provides inadequate information about the extent to which these techniques were actually used. One of the main concerns about elevated cortisol levels during the first two years of life is the impact of 'toxic' levels of stress on a number of the developing neural systems, and the 'architecture of regions in the brain that are essential for learning and memory'.4 The current study made no attempt to measure the impact of such techniques on child development or learning. There has been no research to date that has examined the impact of the use of these 'extinction' techniques with infants less than 6 months of age, and the overall research at the current time strongly suggests that young infants should not be left to cry themselves to sleep5 This study does not show that there is no long-term impact of controlled comforting on infants, and more scientific research is needed about the potential benefits and harms before parents can be confidently reassured about the extent to which this technique should be used. In the meantime, there is extensive evidence available concerning the effectiveness of other techniques for promoting sleep and suggesting that parent education/prevention 'may set the standard as the most economical and time -efficient approach to behaviorally-based pediatric sleep problems'.6 1. Price AMH, Wake M, Ukoumunne OC, Hiscock H . Five-year follow-up of harms and benefits of behavioral infant sleep intervention: Randomized Trial. Pediatrics. 2012, 130(4), 643-651. 2. Zeanah CH. "Disturbances of attachment in young children adopted from institutions". Journal of Developmental and Behavioral Pediatrics. 2000, 21 (3): 230-36. 3. Zeanah CH, Scheeringa M, Boris NW, Heller SS, Smyke AT, Trapani J. "Reactive attachment disorder in maltreated toddlers". Child Abuse and Neglect. 2004, 28 (8): 877-88. 4. National Scientific Council on the Developing Child. Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper 2005, No. 3. p.3. 5. Middlemiss W, Granger DA, Goldberg WA, 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 . 2012, 88: 227-232. 6. Mindell JA, Kunh B, Lewin DS, meltzer LJ, Sadeh A (2006). Behavioral Treatment of bedtime problems and night wakings in infants and young children. Sleep. 29(10): 1263-1276.

Long-term effects of sleep training: A flawed methodology

The question of the long-term impacts of sleep training methods is one that is paramount given the preponderance of resources recommending such action. I was quite excited to read Price et al.'s article discussing research looking at this understudied issue. However, after reading the article I admit I'm rather confused as to how the authors can claim that they even addressed the question of interest given the major flaws in the research. Given the space constraints I will only address three of the largest methodological flaws.

Arguably the most serious problem is the lack of control in the control group. Despite randomizing the groups, little to nothing is known about either what the parents in the control group actually did vis-a-vis sleep behaviour or what the nurses discussed with the control group families. Apparently the researchers assumed that these families did not take part in any sleep training with no evidence to support such an assumption (especially when myriad resources suggest sleep training as a remedy for infant sleep problems). As is, the control group is not a true control group with respect to sleep training outcomes.

The second concern pertains to the misuse of the intention-to-treat principle. Although there was an element of self-selecting in the experimental group, that self-selection would not have unfairly biased the outcomes being measured. If indeed there are long-term effects, they have ostensibly been masked by the inclusion of the nearly 43% of the experimental group who refused the experimental protocol (i.e., sleep training). A parallel would be examinations of breastfeeding outcomes. Researchers do not examine these outcomes based on what women intended to do (despite that being important in many ways) but rather what the actual behaviour was. In these instances it is better to collect data on the possible confounds and control for them statistically than to utilize the intention-to-treat principle. Currently, we have outcomes for those who did not sleep train included in the outcomes of those who did which only serves to muddy the waters.

The third concern is that the measures used to assess child outcomes are parent-report. What the authors have presented is an assessment of parental perception of child attachment and behaviour; there is no objective or child-report measure included (with the exception of child health). Parents' perceptions may be colored by their choice (to take part in sleep training or not) and feelings of having intervened rather than the intervention itself and should be supplemented with other measures, especially as the researchers did do a home visit, making this type of assessment possible.

Overall it seems that the authors tried to make their data fit a pressing research question. Unfortunately, what has resulted is a study that has no bearing on the question of interest, and thus more research remains needed. Despite what the authors would like us to believe, we are no closer to knowing the long-term effects of sleep training than we were prior to the publication of this article.

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Fifteen years of research suggests that sleep training for babies can cause them more distress

True responsive care means adjusting to what babies need.

As trends rise and fall, one of the most divisive issues still seems to be whether or not “sleep training” – leaving babies alone to cry themselves to sleep – is as helpful as it’s often presented to be (Photo: Getty)

For parents all around the world, the scope of child-rearing practices, tips and guidance have long been a source of much conflict – especially when it comes to raising babies.

As trends rise and fall, one of the most divisive issues still seems to be whether or not “sleep training” – leaving babies alone to cry themselves to sleep – is as helpful as it’s often presented to be by advocates of the practice.

It used to be an accepted fact that babies tend to be easily distressed and struggle to sleep through the night. But these days many parents take a different approach, with little, if any intervention if their child wakes up crying.

Sleep training is often encouraged by authors, bloggers and some doctors, who claim it helps a baby to learn to calm themselves. But as researchers of the biological and psychological needs of infants for the past 15 years, we can confidently say this is an illusion as sleep training actually violates what early childhood experts call the need for safe, stable, and nurturing relationships.

It also violates the instincts of parents to comfort their young one. Indeed, from an evolutionary perspective , sleep training goes against our mammalian heritage – which emphasises companionship care from multiple responsive caregivers who provide extensive affection and constant comforting presence.

As social mammals, babies need affectionate touch and soothing care as they learn self-regulation and how to live outside the womb. If caregivers are not cuddling and physically present with their young for at least several hours a day, multiple systems can go awry because stress responses can be set to be overreactive, meaning that the brain will always be on the lookout for threats, even when such threats aren’t really there (e.g. when someone accidentally bumps into you but you take it as intentional provocation).

A big part of the problem with trying to sleep train a baby is that it undermines key aspects of the child’s development: brain function, social and emotional intelligence, trust in self, others and the world. Experiments carried out with isolated baby monkeys, depriving them of maternal touch (they could still smell, hear and see other monkeys), for example, found that when untouched, the baby monkeys developed all sorts of brain and social abnormalities . Humans are social mammals too and need responsive and affectionate care , at the very least.

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Human offspring are particularly immature at full-term birth — 40-42 weeks — with only 25 per cent of adult brain volume in place. This is because when humans evolved to walk on two legs, the female pelvis narrowed .

As a result, human infants look like fetuses of other animals until around 18 months, when the upper skull bones finally fuse. The brain of a human baby triples in size by age three and during the early months and years, the child’s brain and body establish the functioning of multiple systems, in response to the care received. And the stress response can become overactive if babies are not kept content most of the time – which can cause long-term physical and mental health problems.

Ongoing biobehavioral synchrony with parents (i.e. the requirement of physical presence, the coupling of heart rhythms and autonomic function, coordination of brain oscillations, and coordination of hormone release like oxytocin) is critical in a baby’s life, and it lays the foundations for the child’s future self-regulation and social-emotional intelligence.

Because of this “cry-it-out” sleep training can be damaging to a rapidly growing brain – and to a growing psyche. Researchers have documented how, with sleep training, infants’ fight and flight instincts activate in the face of extensive distress, such as being left without comforting physical touch. When the distress of separation and lack of response goes on too long, the infant may quiet down but it is to reserve limited energy. This withdrawal into numbness can manifest as an impairment in social trust that can be carried into adulthood . These patterns can continue in adulthood when things become too stressful, shutting down thinking and feeling in situations where the individual is triggered into panic or anger.

Children’s brains and bodies are deeply shaped by caregiving practices and such moulding lasts a lifetime – unless therapy or other intervention occurs. In other words, parents have great influence on their child’s personality and socio-emotional intelligence. And when parents are comforting and calming , this facilitates children’s healthy development.

True responsive care means adjusting to what babies need, helping them stay calm, attending to the gestures and facial expressions that indicate discomfort and moving in to gently restore equilibrium. Crying is a late signal of need, so ignoring it all together may mean you’ve waited too long.

Darcia Narvaez is Professor of Psychology Emerita at the University of Notre Dame and Cathriona Cantio is Assistant Professor in the Faculty of Health Sciences at the University of Southern Denmark

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Once Upon A Bedtime

What Does Science REALLY Say About Sleep Training?

research on sleep training babies

Baby Chick

How Many Hours of Sleep Does Your Baby Need?

G azing on a peacefully sleeping child can melt your heart, and the term “sleeping like a baby” conjures up sweet images in many people’s minds. But for new parents, accomplishing the sight of a serenely sleeping infant amidst showerless days, countless diapers and a lack of sleep can be challenging. It’s well-known that newborns and babies need a lot of sleep for optimal growth and development, but new parents may struggle to establish sleep training and a baby sleep schedule that works for their family. 5 This article discusses newborn and infant sleep recommendations while answering common questions about sleep schedules during your child’s first year.

How Much Do Newborns Sleep?

According to the American Academy of Pediatrics (AAP), newborns do not have regular sleep cycles for up to six months. Although you can expect a newborn to sleep as much as 16 to 17 hours a day, those hours are several frequent one- to two-hour naps. 1

Newborn sleep cycles differ in duration, amount, and timing from older children and adults. A newborn’s sleep patterns can initially seem random, with your baby waking and sleeping around the clock. Conversely, uninterrupted sleeping for more than four to five hours can harm a newborn’s health and is not recommended. 1,5

Newborns up to about 3 to 4 months have different sleep schedules because they are hard-wired that way. Frequent awake times allow babies to maintain adequate oxygen levels and regulate their breathing. 1,2,5 These frequent wakings are essential for optimizing breastfeeding, breastmilk production, nutrition, and growth. Irregular newborn sleep patterns contribute to parental sleep deprivation, and many new parents want to establish routines early. Just realize that as your baby grows and develops over the next few months, so will their ability to sleep in longer stretches. Understanding how your baby sleeps will help you make healthy and informed sleep choices. 1,2,5

How Much Sleep Do Babies Need?

According to the American Academy of Sleep Medicine, babies aged 4 to 12 months should sleep 12 to 16 hours daily, including naps. 4 Parents should work with, rather than against, their child’s developmental stages when prioritizing healthy baby sleep schedules. 1,3,4

Parents interested in sleep training can begin at about four to six months if their baby is growing and feeding well. Make sure to get the okay from your pediatrician before starting. Initiating sleep training may not be reasonable until about six months when a baby’s circadian rhythm is more developed. Circadian rhythm is the body’s natural tendency to sleep at night and be awake during daytime hours. On average, most babies are not neurologically developed enough to be “taught” to sleep before four months, but some of this depends on the child and your situation. 2,3,6,16,17

There are several approaches to sleep training, and while not necessary, studies show it can improve a baby’s sleep schedule and enable parents to get more quality sleep. 5,9,10

The benefits of healthy sleep are well-known in children and include improved: 4,7,8

  • Behavior/mood
  • Emotional regulation
  • Overall physical and mental health

Should I Wake My Baby To Feed?

The answer may depend on your baby’s age, their developmental stage, and whether they had any previous or current medical concerns. Generally, breastfed babies need to nurse eight to 12 times a day in the first month, while formula-fed infants will take about eight bottles daily. Feedings could be anywhere between two to three hours apart. Frequent feedings ensure adequate weight gain in newborns. With this in mind, you should wake your baby for feedings. As infants get older, from three to six months, talk to your healthcare provider about recommendations. Still, according to the AAP, healthy growing babies do not intentionally need to wake to feed. 1

A baby who goes home after a neonatal intensive care unit (NICU) admission may have strict rules on the maximum time between feedings. Babies with special health care needs may have different feeding regimens, and you should consult your physician. 11,12

When Do Babies Start Sleeping Through the Night?

Six hours of uninterrupted sleep is considered “ sleeping through the night” for a baby . 13 According to one study, 28%-57% of infants did not regularly sleep through the night. 13 The conclusions do not necessarily mean infants continued to wake up every one to four hours, as you may expect from a newborn, but still, they did not sleep as long as parents may hope by one year.

However, some babies may sleep six hours at night by 3 to 4 months old. If your baby is growing, otherwise healthy, and still taking naps, this is not typically a cause for concern. Every baby is different, and several factors may affect how parents can reach the goal of sleeping through the night and when. 1,14,15

Helping Your Baby Fall Asleep

First, babies need a safe place to sleep, and not all products are created equally. Ensure that any sleeping equipment you use, including reused cribs, meets safety standards. The AAP has fervently recommended that babies sleep on their backs. You may know of the “Back is Best” campaign established to reduce the risk of sudden infant death syndrome (SIDS). 1,15

  • Helping your baby fall asleep depends on their age and developmental stage. Your approach to sleep time with a 2-week-old versus an 8-month-old will look quite different.
  • However, some strategies to promote a healthy baby sleep schedule include the following: 1,14,16
  • Respond to your baby’s sleep cues . Try putting them to bed when they are drowsy instead of already asleep.
  • Talk in a quiet, soothing voice and keep the lights low.
  • Try swaddling if it’s developmentally appropriate.
  • Read to your baby before bedtime.
  • Give your baby a gentle, relaxing bath and massage before bedtime.
  • You may want your baby to sleep in the same room as you.
  • Encourage awake periods and tummy time during the day.

Sleep Training

Sleep training involves slowly guiding your child into successfully self-soothing behaviors, promoting their ability to fall asleep independently at bedtime. If you plan to try sleep training, you may need to experiment with what works for your family. Some commonly known methods include: 6,9,17

  • The cry-it-out method (CIO)
  • The Ferber method, a graduated variation of the CIO method
  • Bedtime fading, which involves gradually adjusting bedtime

Sleep is a vast and interesting topic, and there are several great resources available online aimed at helping parents establish positive, healthy newborn sleep schedules and routines for their children. Many parts of parenting are trial and error; what worked like a charm for one baby may do nothing for the next. Children are always keeping you on your toes, and getting a good night’s sleep ensures you are both ready for the next busy day.

How Many Hours of Sleep Does Your Baby Need?

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Infant sleep and its relation with cognition and growth: a narrative review

Elaine kh tham.

1 Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore

Nora Schneider

2 Nestec Ltd., Nestlé Research Center, Lausanne, Switzerland

Birit FP Broekman

Infant sleep development is a highly dynamic process occurring in parallel to and in interaction with cognitive and physical growth. This narrative review aims to summarize and discuss recent literature and provide an overview of the relation between infant sleep and cognitive development as well as physical growth.

We conducted online literature search using MEDLINE, Embase, and Cochrane Library databases. We considered original research on humans published in the English language from January 2005 to December 2015. Search terms included “sleep” AND “infant” AND “cognition” OR “memory” OR “executive functioning”, OR “growth” OR “obesity” OR “growth hormone” OR “stunting”, and combinations thereof.

Ten studies on infant sleep and cognition were included in this review. Overall, findings indicated a positive association between sleep, memory, language, executive function, and overall cognitive development in typically developing infants and young children. An additional 20 studies support the positive role of infant sleep in physical growth, with the current literature focusing largely on weight gain and obesity rather than healthy growth. Existing evidence in both the domains is mainly based on cross-sectional designs, on association studies, and on parental reports. In contrast, there were limited studies on longitudinal sleep trajectories and intervention effects, or studies have not used more objective sleep measures such as actigraphy and polysomnography.

The reviewed studies support a critical and positive role of infant sleep in cognition and physical growth. Future studies should consider key environmental and parental confounders, include a combination of more objective (actigraphy) and subjective measures (sleep diaries and questionnaires), and move towards longitudinal trajectory designs of infant sleep and development.

Introduction

Sleep develops rapidly during the first few years of life and is a highly dynamic process. At birth, infants lack an established circadian rhythm and hence sleep across multiple intervals throughout the day and night in short bouts, which may also be due to infants’ feeding needs. 1 At about 10–12 weeks of age, the first signs of a circadian rhythm begin to develop, marked by an increased ease of sleeping through the night. 2 The change in total sleep duration over 24 hours continues and decreases from 16 to 17 hours in newborns, to 14–15 hours at 16 weeks of age, and 13–14 hours by 6 months of age. 3 , 4 While the need for day sleep decreases, 5 night sleep duration increases through the first year of life, 5 – 7 resulting in a shift towards more nocturnal patterns of sleep.

Infant sleep studies show that about 20%–30% of all infants experience night awakenings throughout their first 2 years of life. 8 , 9 Yet, with children’s development, the number of awakenings per night reduces, and the ability to sleep through the night increases witĥ50%–75% of infants sleeping through the night at 12 weeks of age 10 and at least 90% at 6 months of age. 11 Despite the general trend of decrease, night awakenings show the highest levels of variability across all sleep measures, 4 which makes it an interesting research target for sleep quality in young infants.

Concerns that children are not getting enough sleep have been around for over 100 years, with recommendations of ideal sleep duration for children being provided as early as 1897. 12 The National Sleep Foundation (NSF) recommends a daily sleep duration of 14–17 hours/day from birth to 3 months, 12–15 hours/day from 4 to 11 months, 11–14 hours/day for infants aged 1–2 years, and 10–13 hours/day for preschoolers aged 3–5 years. In all cases except for newborns to 3 months, the latest NSF recommendations increased by at least 1 hour from the preceding (NSF) recommendations due to reported changes in sleep durations over the last years (from a systematic literature search) as reviewed by an expert panel. 13 However, many infants and young children sleep less than the above-recommended amount. 12 Short sleep duration is particularly prevalent in predominantly Asian countries. A study conducted on caregivers of 29287 children between the ages of 0 and 36 months from 17 countries reports that total sleep duration in children from predominantly Asian counties is significantly lower than children from predominantly Caucasian countries. 14 Moreover, regardless of age group, children from predominantly Asian countries consistently sleep less or at the lower extreme of the NSF recommendation.

Sleep is a highly dynamic developmental process, particularly in the first 2 years of life, with a high inter- and intraindividual variability. While many studies have focused on children, the link between variations in sleep and developmental outcomes in healthy infants remains less explored. The objective of this narrative review is therefore to summarize and evaluate available literature on the relation between infant sleep during the first 2 years of life and cognitive and physical growth in healthy typically developing infants and young children.

We searched MEDLINE, Embase, and Cochrane Library databases for articles in English and published between 2005 and December 2015. Search terms included “sleep” AND “infant”, in combination with “cognition” OR “memory” OR “executive functioning” OR “growth” OR “obesity” OR “growth hormone” OR “stunting”. Search terms had to be present in either the title or the abstract of the article. In addition, we limited results to original research articles investigating infant sleep during the first 2 years of life in relation to cognitive development and physical growth outcomes both during the first 2 years of life or later, human studies, and studies on term-born, cognitively healthy infants. Studies on sleep disorders, including sleep-disordered breathing symptoms, were excluded from this review, as well as studies in psychiatric populations or preterm infants.

Our literature search resulted in the following hits:

  • Sleep and infant and cognition, and/or memory, and/or executive functioning: 85 MEDLINE hits, 89 Embase hits, and eight Cochrane Library hits. After examining all the extracted titles and abstracts, 31 overlapping articles were removed, four articles were excluded as they were review papers that did not have a focus on sleep and cognition in healthy typically developing infants, and 98 were excluded as sleep was not the main variable of interest or that sleep was not measured during infancy amongst healthy term-born infants. After the exclusion, ten publications were considered relevant for the scope of the review.
  • Sleep and infant and growth and/or obesity and/or growth hormone and/or stunting: 29 MEDLINE hits, four Cochrane Library hits, and 47 Embase hits. Of the 80 screened publications, 29 were considered for inclusion having removed overlapping publications. After screening titles and abstracts and reading the full-length papers, 20 publications were considered relevant for infant sleep and growth, and hence included in this review.

Infant sleep and cognition

Sleep is a period that is characterized by marked change in brain activity, 15 in addition to being a resting period of reduced sensory activity and responsiveness to external stimuli. 16 As such, sleep has been related to subsequent cognitive and developmental benefits. 17 Multiple studies have found relationships between sleep duration and cognitive benefits in school-aged children. 18 – 21 Unlike studies on older children, there have been fewer studies regarding the effects of infant sleep on cognitive outcomes. Out of the ten studies reviewed in this paper, seven were cross-sectional studies, and three were longitudinal studies. Table 1 presents a summary of the reviewed articles.

Summary of reviewed studies for sleep and cognitive development

Abbreviations: WPPSI, Wechsler Preschool and Primary Scale of Intelligence; BMI, body mass index.

Cross-sectional studies

The majority of the reviewed articles for sleep and cognition consist of cross-sectional studies. Within the cross-sectional studies, four studies focused on the effect of post-learning sleep on memory consolidation, one study examined relations between sleep (1 week) prior to learning and subsequent memory, and two studies investigated overall associations between sleep and general cognitive development.

Similar to findings in adults, 22 , 23 researchers have found evidence that infant sleep also plays an important role in memory consolidation, a process whereby a initially weak memory representation becomes stable and more resistant to forgetting. 22 , 24 Seehagen et al found that 6- and 12-month-old infants who napped for at least 30 minutes after learning a set of object–action pairings from a puppet toy recalled significantly more target actions while tested after 4-hour delay and 24-hour delay compared to infants in the baseline condition who were not trained on the object–action pairings and to infants in the no-nap group who spent an equivalent time awake after learning (at the 24-hour delay test). 25 Even though the researchers found an overall benefit of sleep towards object–action memory especially compared to infants in the baseline condition and at the 24-hour delay test, it should be noted that there were no differences in memory performance between the nap group and no-nap group at the 4-hour delay test.

Apart from object–action memory, studies have also shown that infant sleep, in particular daytime naps, is beneficial towards language learning. Gómez et al found that after learning an artificial language, 15-month-old infants who napped for at least 30 minutes were able to abstract grammatical relations amongst the learnt words at a subsequent test session that occurred 4 hours after learning, where they looked longer at trials where stimuli were consistent with the learnt artificial language as compared to inconsistent trials. 26 In contrast, infants who did not nap (but spent an equivalent time awake) did not look significantly longer at consistent compared to inconsistent trials during testing, and hence were not able to learn the abstracted relations between the artificial language. 26 In addition, a further experiment by the above researchers on a similar group of 15-month-old infants showed that the nap-dependent benefits towards language learning (where infants learnt abstract grammatical relations) persisted even after 24 hours. 27 A recent study by a separate group of researchers also highlighted nap-dependent benefits towards language in terms of vocabulary learning. 28 In the study, Horváth et al found that 16-month-old infants who napped after learning sets of new object–word associations spent more time looking at the correct associative pairing at the 2-hour delayed test session, whereas infants who remained awake did not display any differences in looking between the learning and delayed test sessions.

Overall, the above studies on object–action memory and language learning all support the claim that sleep benefits memory consolidation. However, it is interesting that there were no differences between the nap and no-nap group at the 4-hour delay test in Seehagen et al’s object–action memory study, whereas differences between infants who napped and those who spent an equivalent time awake emerged after a similar 4-hour delay in Gómez et al’s study on language learning. In Horváth et al’s vocabulary-learning study, the nap-dependent effects were present just after at a 2-hour delayed test session. One possible reason for the different findings could be that the infants in Seehagen et al’s study were younger (6- and 12-month olds) than the 15- and 16-month olds in Gómez et al’s and Horváth et al’s studies; sleep changes and matures rapidly during infancy, 29 and hence the 3- to 10-month age difference between the infants may have contributed to the different sleep-associated effects between the studies. Another reason for the difference in findings may be due to the nature of the experimental task and test stimuli. Studies in adults demonstrate that sleep shows a preferential benefit towards memories that are deemed to be more relevant for the future. 30 , 31 It is plausible that the object–action associations in Seehagen et al’s study are “less relevant” to 6- and 12-month-old infants, whereas the language stimuli in Gómez et al’s and Horváth et al’s studies may be more relevant and salient to the 15- and 16-month-old infants who are also undergoing a period of rapid vocabulary development (“vocabulary spurt”). 32

In addition to post-learning sleep, a study by Lukowski and Milojevich indicates that normative variation in everyday habitual infant sleep prior to learning may also affect memory of the newly learnt information. 33 First, the researchers collected parental reports of twenty-five 10-month-old infants’ sleep habits for the week prior to the encoding session. Next, during the encoding session, the infants were visually presented with six two-step object–action event sequences with narration during an encoding session. Recall memory and memory generalization (ability to generalize responses to new stimuli that were similar to those presented at encoding) were tested after a 2-hour delay. Infants with a greater number of night awakenings performed poorer (displayed fewer target actions) in the memory generalization task, and infants with longer daytime nap durations performed better in the same task. There was a positive relation between duration of daytime naps and memory recall immediately after encoding, and a negative correlation between higher percentages of night sleep duration (out of total sleep duration) and immediate recall. In contrast, there was no relation between habitual sleep duration and delayed memory recall of the event sequences. The lack of significant associations between sleep duration and memory recall of the object–action event sequences at the delayed testing session is particularly interesting in comparison to the positive nap-dependent effects in the reviewed memory consolidation studies where infants who napped displayed better memory and learning when they were tested after a delay.

Although the cross-sectional studies amongst typically developing infants mainly focused on memory consolidation and learning, two of the reviewed studies examined the relation between infant sleep and general cognitive development. In the first study, researchers found that greater movements or activity during sleep and greater number of awakenings after sleep onset measured via sleep actigraphy recordings were negatively correlated with scores on the Bayley Scales of Infant and Toddler Development second edition (BSID-II) Mental Development Index (MDI) amongst 10-month-old infants. 34 In contrast, greater sleep efficiency (i.e. spending a larger percentage of time asleep between sleep onset and wakefulness) was positively correlated with BSID-II MDI scores in the same group of infants. 34 In the second study, researchers found that 11- to 13-month-old infants who had greater sleep efficiency measured via sleep actigraphy data also displayed better overall cognitive problem-solving skills as measured by the Ages and Stages Questionnaire. 35 Besides sleep efficiency, longer proportions of sleep at night were also associated with better cognitive problem-solving skills. 35 It should be noted that both of these studies also explored parental sleep reports in addition to sleep actigraphy data; however, unlike the sleep actigraphy data, there were no significant associations between parental sleep reports and any of the cognitive measures.

Despite the fact that all the reviewed cross-sectional studies showed sleep-associated benefits, there were no consistent findings amongst the studies regarding the component of sleep (i.e. sleep duration, sleep efficiency, night awakenings, etc.) that benefitted cognition. However, it may also not be feasible to directly compare the studies due to differences in study design as the effects of sleep in the memory consolidation studies were explored in a between-participant design involving sleep within a nap period, whereas Lukowski and Milojevich’s study and the two studies on general cognitive development explored within-infant normative variations in sleep habits.

Longitudinal studies

In addition to the above-mentioned cross-sectional studies, three studies investigated longitudinal relations between sleep and cognition. Two out of the three studies highlighted that infant sleep was related to subsequent executive functioning during toddlerhood and early childhood. 36 – 38 One of the studies showed that higher percentages of parent-reported night sleep (out of total sleep duration) at 12 and 18 months of age were significantly associated with better executive functioning performance at 26 months of age, especially performance related to impulse-control tasks. 38 The benefits of higher percentages of sleep duration at night seemed to extend beyond toddlerhood. Findings from a second study report that 12-month-old infants with higher proportions of night sleep displayed better executive functioning performance at 4 years, measured by the Matrix Reasoning subscale of Wechsler Preschool and Primary Scale of Intelligence (WPPSI) third edition. 37 In contrast, the study found that there was no relation between 12-month-old sleep duration and concurrent general cognitive functioning (Bayley Scales of Infant Development). 37 In all the above studies, the longitudinal relations between infant sleep and executive functioning were independent of confounders such as family socioeconomic status.

One of the reviewed longitudinal studies explored the relation between infant sleep, psychosocial adversity, and IQ scores (assessed using the WPPSI – Revised). 39 Unlike the studies on infant sleep and executive functioning, the longitudinal relation between infant sleep and IQ scores of WPPSI – Revised seems less direct. This current study reports high amounts of maternal-reported infant sleep difficulties and sleep disturbances at 12 and 18 months to be correlated with lower IQ scores at 5 years of age. 39 However, the above finding was no longer statistically significant after adjusting for psychosocial adversity. In addition, the study did not find any significant relations between IQ scores and sleep actigraphy data that were collected at 5 years of age.

In summary, ten studies have been identified that describe the relation between sleep and cognition in typically developing infants. Cross-sectional studies revealed that, similar to adults, sleep benefits memory and (language) learning in infants, both before and after learning. Although all reviewed memory and language-learning studies showed sleep-associated benefits towards cognition, the sleep parameter (i.e. night sleep duration, daytime napping, night awakenings, etc.) that benefitted cognition remained inconsistent. Longitudinal studies on infant sleep and executive functioning consistently showed that higher percentages of parent-reported infant night sleep were related to better subsequent executive functioning performance. 36 – 38 However, it should be noted that the studies were conducted by a single research group using the same participant pool. Although this may not affect the validity of the findings, replication studies in other samples would be useful in interpreting the generalizability of the findings beyond the existing participant pool. 25 – 28 , 33 Although majority of the cross-sectional studies recorded sleep via actigraphy data, the sleep data used in the longitudinal studies were primarily obtained from parental reports. Future longitudinal studies may also consider collecting sleep data via actigraphy; especially, some cross-sectional studies have reported sleep-associated findings with actigraphy data but not parental reports. 34 , 35

Infant sleep and growth

Sleep is controlled by chronobiological mechanisms, and the most rapid development in sleep organization occurs during the first 6 months of life, a period that is also marked by rapid physical growth. Yet, the relation between sleep and growth with a focus on infancy, early childhood, and healthy development has not been systematically addressed in the literature. However, some plausible relationships between sleep and growth have been explored, mainly in epidemiological studies: i) sleep and weight gain/obesity, ii) growth retardation/stunting and sleep, and iii) sleep and growth hormone. Table 2 provides a summary of the reviewed studies.

Summary of reviewed studies for sleep and growth

Abbreviation: BMI, body mass index.

Weight gain and obesity measures

Compared to adolescent and adult studies, only a few studies have examined the impact of sleep on physical growth parameters in infants specifically. However, the relation to obesity appears one of the most investigated concepts with regard to sleep. A study for example found that infant sleep of <12 hours/day in the first 2 years of life was associated with a higher body mass index (BMI), skinfold thickness, and an increased risk of being overweight at 3 years. 40 Secondary analyses of longitudinal changes in sleep duration over the first 3 years of life revealed an increase in mean weight-for-length z -score by 0.02 for each hour/day decrease. Analyses based on the same cohort confirmed the inverse relation of sleep duration of <12 hours/day and the probability of overweight at 3 years of age. 41 The cut-off at 12 hours/day seems supported by the GUSTO study in Singapore which reported sleep of <12 hours/day at 3 months of age to be associated with a higher BMI and shorter body length. 42 However, in both studies, sleep data were based on parental report of infant sleep, while no objective sleep measures were applied. A cross-sectional study points in the same direction: a shorter sleep duration as assessed by parent report was linked to an increase in weight-to-length ratio as early as 6 months of life. In girls only, those findings could be substantiated by actigraphy data with a shorter sleep duration being associated with larger body size measures. 43 In contrast, a study of actigraphic sleep in 1-year-old infants 35 and an observation study using a sleep-monitoring device over the first 6 months of life 44 did not find significant correlations with BMI or weight gain. Similarly, researchers did not find any significant association between sleep duration at 24 months as assessed by sleep questionnaire and BMI or risk of overweight at the age of 3 years in the Born in Bradford birth cohort study. 45 Looking at longer term consequences of infant sleep, a follow-up of the above-mentioned prospective cohort highlights as one of the first studies of the impact of chronic sleep curtailment from infancy to mid-childhood on BMI and adiposity measures. 40 Children with less sleep compared to children with more sleep had a higher BMI z -score, skinfold thickness, total and trunk fat mass index, waist circumference, hip circumference, and higher odds of obesity. Curtailed sleep was defined as <12 hours/day from age 6 months to 2 years, <10 hours/day from age 3–4 years, and <9 hours/day from age 5–7 years. 46

One of the mediating factors in the relation of sleep and weight gain or risk of obesity may be energy intake, as suggested by a study of 16-month-old children of the Gemini twin birth cohort. While the association between sleep and weight was not significant at this age, shorter nighttime sleep as measured by a sleep questionnaire was associated with a higher total energy intake, with children sleeping <10 hours consuming around 50 kcal/day more than children sleeping 11–12 hours a night. 47

In addition, most evidence from our review stems from observation and cohort studies, whereas evidence from intervention studies is still scarce. Only two intervention studies were identified in the context of this review and yielded mixed findings. A pilot randomized controlled trial investigating the effect of modification of parental behaviors with regard to feeding, sleeping, and crying on infant weight gain and early obesity risk found that behavioral modification resulted in lower weight-for-length percentiles at 1 year of age for infants who received a combined soothe/sleep and introduction of solid foods intervention (33rd percentile; P = 0.009) compared to those who received the soothe/sleep intervention only (50th percentile), to those who received the introduction of solid foods intervention only (56th percentile), and to the control group (50th percentile). In addition, the soothe/sleep intervention yielded prolonged nocturnal sleep during the first year of life compared to the control group, especially in predominantly breast-fed infants. 48 As the observed effect on weight gain was strongest in the combined intervention, it cannot be attributed to longer sleep duration as such, but those findings suggest that prolonged nocturnal sleep plays a relevant role as part of a multicomponent intervention early in life. This study served as a pilot to the larger, currently ongoing Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study. 49 In contrast, a short intervention delivering behavioral sleep strategies from 8 to 10 months postpartum did not show beneficial effects on BMI z -score, percentage of overweight/obesity, and waist circumference at 6 years of life. 50 The two intervention studies differ in several aspects, most notably in intervention duration and intensity (1 year vs 2 months), start of intervention (shortly after birth vs at 8 months), follow-up duration (1 year versus 6 years), and most importantly in modulating sleep as a single factor versus modulating multiple factors to impact weight gain and risk of obesity.

Overall, those results indicate the potential risk of shorter sleep duration early in life for overweight and adiposity later in life. Suggested mechanisms that link shorter sleep or sleep restriction to weight gain, obesity, and insulin resistance include counter-regulatory hormones such as cortisol and growth hormone, 51 altered activity of the autonomous nervous system, 52 and the alteration of appetite-regulating hormones like leptin and ghrelin which increases appetite and hunger. 53 Behaviorally, longitudinal data analyses, for example, from the National Longitudinal Study of Adolescent Health, suggest an association between later bedtime and an increase in BMI. 54

Length and height

A recent study suggests sleep and episodic length growth in 4- to 17-month-old infants to be a temporally coupled process with prolonged sleep preceding length growth by 0–4 days. 55 The authors found an increase of up to 4.5 hours and/or three more naps per day to be predictive of length growth suggesting an underlying biological system. In turn, growth restriction or growth-rate reduction as early as in utero (intrauterine growth restriction, IUGR) alters sleep patterns. 56 , 57 IUGR fetuses have decreased amounts of active sleep and increased amounts of quiet sleep and indeterminate sleep compared to appropriately grown fetuses. The time spent in active sleep could have an especially significant effect on brain maturation. 58 Those alterations in sleep organization early in life may persist into childhood: a study showed, for example, lower sleep efficiency and more awakenings during the sleep period in IUGR children aged 4–7 years. 59 In addition, researchers investigated the relation between stunting, iron deficiency anemia, and maternal reports of sleep in 6- to 18-month-old infants in two studies from Zanzibar and one from Nepal. 60 Stunting was associated with a shorter night sleep duration, higher frequency of night waking, and shorter nap duration.

While related mechanisms are not yet well understood, sleep plays an important role in energy balance. Altered sleep-state organization may be an adaptive response to preserve energy in states of IUGR or stunting. 58

Growth hormone

A bidirectional interaction between hormones and sleep can be assumed. Several hormones are both involved in circadian rhythm and sleep and affected by the quantity and quality of sleep. Those hormones include, for example, melatonin, cortisol, leptin, ghrelin, insulin-like growth factor-1, pro-lactin, and growth hormone. 61 The latter hormone plays a major role in stimulating body growth, and its high levels in plasma of infants suggest an important role in the first months of life. 62 The secretion of growth hormone is influenced by factors such as nutrition, physical activity, and sleep patterns. Increased levels of hormones are secreted during sleep, peaking shortly after sleep onset. 63 In the context of this review, no study has been identified to specifically investigate the link or the impact of growth hormone on sleep in healthy infants and young children. While well-characterized data on growth hormone release in association with healthy sleep pattern maturation during the first months of life are lacking, 64 pediatric patients with growth hormone deficiency have been shown to display a reduced total sleep time with increased wakefulness and subsequently a decrease in sleep efficiency compared to control subjects as assessed by polysomnography. 65 The relation between growth hormone and sleep in infants may not be fully understood, but a close interaction of the neuroendocrine and the chronobiological system has been shown in different populations. The (dys-)regulation of one system can affect the other.

In summary, while physical growth and weight gain in the first 2 years of life are largely predicted by birth weight, prenatal factors, and nutrition, 66 a growing body of evidence supports the critical role of infant sleep in growth. Several aspects of growth can be considered in relation to sleep, such as weight gain, stunting, and hormone release. However, the current literature focuses largely on weight gain and obesity rather than healthy growth. In particular, the detrimental impact of sleep deprivation on glucose tolerance, insulin sensitivity, and appetite-regulating hormones has been widely reviewed. In that context, infant and child sleep seems to provide a modifiable and thus promising target for obesity prevention, especially when regarded within multicomponent approaches. It is to be noted that most studies rely on parental report measures, and the quantification of sleep is usually converted to express hours of sleep; objective methods like actigraphy however gain more and more in relevance. Influencers for the sleep–growth relation, especially in infants and young children, include gender, prematurity, health conditions like allergies, nutritional factors like iron deficiencies, energy intake or feeding paradigm, and nighttime versus daytime sleep. 43 , 47 , 67

General discussion

Overall, the review of recent literature highlights that normative variations in infant sleep play an important role in cognitive development and physical growth. Studies on cognition show that individual differences in sleep quantity and quality are particularly important for the development of memory, language, and executive functions. Studies on physical growth indicate the potential risk of sleep problems, in particular shorter sleep duration early in life, for overweight, obesity, or measures of adiposity in infants, toddlers, and preschool-age children.

The findings from this review in infants are in line with epidemiological evidence from studies in older children and adolescents, 29 , 68 – 73 and some associations suggest persisting impact beyond infancy and young childhood. Although normative variations in habitual sleep in infants may be important for development, the review showed little consistency across the studies with regard to the component of sleep investigated (i.e. night sleep duration, daytime napping, night awakenings, etc.). This makes comparisons of studies and the generalization of the findings difficult and may likely be due to different methodologies used across studies. Many tools are available for assessing infant’s and young children’s sleep with different strengths and limitations. Questionnaires and sleep diaries are cost-efficient and can be administered to a large participant pool; however, these measures are also more subjective and less accurate in estimating sleep parameters when used as stand-alone measures. In contrast, sleep polysomnography and actigraphy provide more accurate and objective assessments of sleep, but are often very costly. While polysomnography requires the placement of electrodes by specialist staff and the children to stay overnight at a sleep lab, actigraphy watch may be worn by the children at home for longer periods of time, 74 , 75 and is therefore particularly useful for an objective assessment of sleep in infants and young children or when conducting sleep assessments in large samples as it enables nonintrusive measurement of sleep in one’s natural environment. 76 Hence, it would also be useful for future longitudinal studies to incorporate more objective sleep measures like actigraphy for at least a subsample of participants. Still, particular challenges occur even with more objective measures; for example, individual differences in sleep arrangements 77 such as falling asleep alone versus being rocked to sleep may interfere with the accuracy of the collected data. Therefore, it is also important to consider these methodological differences and individual differences when measuring infant sleep. Overall, a combination of approaches such as using questionnaires and diaries for a large sample and validating data with actigraphy in a smaller subsample may be most promising and yet feasible. Amongst the reviewed studies where both actigraphy and questionnaire data were collected at the same time point, researchers found positive associations between infants’ sleep actigraphy data and general cognitive development, 34 , 35 but no equivalent findings with questionnaire data. With regard to weight gain, most findings are based on parent report and questionnaire measures and largely point towards shorter sleep duration being linked to higher body size measures. Only three studies used actigraphy 35 , 43 and one study a sleep-monitoring device 44 and resulted in conflicting findings.

With regard to study designs, most reviewed studies used cross-sectional and observational designs with infants sampled at different ages. This may be a limitation as both sleep and neurodevelopment are very age-dependent and vary across different developmental stages due to their highly dynamic nature. Alternatively, longitudinal sleep and development assessments with repeated measurements for the same individuals at various time points may allow for a better understanding of developmental trajectories in those domains. Future work would benefit from trajectory studies with objective data (such as actigraphy and polysomnography) from infancy onwards, to detect the role of early infant sleep on later outcomes. Only two of the reviewed studies investigated the effect of sleep-related interventions and only with regard to weight gain. 48 , 50 While the longer (1 year) intervention trial that targeted multiple parental behaviors in the intervention resulted in a positive effect on lower weight-for-length percentiles at 1 year of life, the shorter (2 months) trial targeting behavioral sleep strategies did not show any effects on growth parameters at 6 years of life. In the absence of a bigger body of evidence, no recommendations can be made; however, sleep-related multicomponent interventions may be promising for supporting or improving healthy infant and child development.

Notably, some studies 25 , 33 did not control for known confounding variables such as socioeconomic status, 73 maternal mental health, 78 and parenting effects or effects of bedtime routines, 79 which may explain some of the variations in the cognition-related findings. It would moreover be interesting to explore the role of gender in sleep and cognitive and physical growth outcomes. Gender differences have been reported for sleep and growth; for example, shorter sleep duration was associated with larger body size measures in 6-month-old infant girls but not boys. 43 Although the scope of this review excluded studies on sleep disorders, conditions such as sleep-disordered breathing symptoms have been reported to lead to differences in cognitive outcomes. Recent studies found that infants with sleep-disordered breathing or primary snoring problems performed poorer on BSID scales as compared to age-matched controls. 80 – 83 Therefore, in addition to understanding the role of “normal” infant sleep in cognitive development and physical growth, more research on the impact of infant sleep disorders on cognitive, behavioral, and growth outcomes may be desirable.

Infant sleep is a particularly interesting field of research due to its dynamic trajectories, the developmental changes that occur during this period, and the interaction with other developmental domains. More specifically, we reviewed the association between infant sleep and cognition as well as physical growth. From the reviewed literature, we conclude that sleep plays a key role in those domains with its maturation paralleling, preceding, as well as resulting from interactions with cognitive and physical maturation. Exact mechanisms have not been the focus of this review and still remain to be understood; however, the maturation of central nervous system structures like the hypothalamus or the neurotransmitter system underlies both cognitive development and the regulation of sleep/wake cycles. 84

For future research, a combination of objective and subjective methods of sleep assessment is desirable, especially in the longitudinal exploration of both quantitative and qualitative aspects of sleep and infant development. From the cross-sectional studies, it is not possible to draw strong causal links between the two based on existing literature. For future studies, we propose to adopt a trajectory design which may reflect better the maturation and dynamic development, especially at young ages. It may furthermore improve the predictability of long-term effects on health and development compared to the predictability of cross-sectional time-point estimates as well as enabling us to examine the effects of cumulative sleep as compared to critical periods in the above relation. This is important to understand as sleep is one early life factor that can be targeted for interventions to optimize early development.

Nora Schneider is an employee of Nestec Ltd. The authors report no other conflicts of interest in this work.

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Your 5-Month-Old Baby's Milestones and Development

You're quickly approaching your baby's half-birthday, and it's an exciting time to see them taking big strides! Here's what to expect, plus tips for feeding, sleeping, care, and more.

  • Development
  • Health and Safety
  • Baby Care Basics
  • What Else to Know

Babbles, smiles, and rolls, oh my! Your 5-month-old baby is becoming more active and personable each day. By 5 months, they're a certified pro at crying, eating, pooping, and—hopefully—sleeping. They're likely rolling all over the living room and flashing their ever-adorable smile. Most importantly, you're beginning to see more of a pattern in your child's behavior.

"[Your child] should settle into routines and patterns of behavior that are more recognizable," explains  Samuel Werner, DO , who is board-certified in family medicine. He explains that 5-month-olds love trying out new activities for the first time.

Your growing 5-month-old is making big strides cognitively and verbally, and they're a big fan of eating (possibly even solid foods). They're also learning how to sleep for longer stretches, as well as using those rolling skills to keep you on your toes. Keep reading to learn more about 5-month-old milestones and development.

Illustration by Josh Seong

5-Month-Old Baby Development

At 5 months, your baby is starting to gain more control over their little body. They're also anxious to show off their blossoming personality!

In the earlier months, your baby understood meaning through the tone of your voice, rather than the actual words you were saying. Now their hearing has improved so they can pick up on different sounds, including the way words form sentences. Soon enough, they'll be able to recognize their name and respond to words like "no."

A 5-month-old baby's vision is also developing in the following ways, according to Andrea Bennett, OTD, a board-certified occupational therapist with extensive experience supporting families in early intervention:

  • Babies can now see several feet farther than they could just a few months ago
  • They can usually focus without going cross-eyed
  • They can tell the difference between colors
  • Your baby follows moving items with their eyes
  • They look attentively at faces
  • They recognize familiar people and items from a distance

At 5 months, babies are learning object permanence , which means they understand an object still exists even if it's hidden. You can help them master this skill by playing games, such as hiding a ball under a blanket and having them search for it.

What's more, your 5-month-old is exploring cause and effect. They know if they drop food from their high chair, it will hit the ground. (Fun for them, but not so much for you!)

When to Talk to the Pediatrician

While every baby develops at their own pace, the Centers for Disease Control and Prevention (CDC) recommends alerting the pediatrician if your child isn't doing the following by 6 months:

  • Meeting milestones
  • Reaching for objects
  • Showing affection
  • Bringing objects to their mouth
  • Rolling in either direction
  • Making vowel sounds such as "ah," "eh," and "oh."
  • Responding to nearby sounds
  • Laughing or squealing

In addition to the signs above, contact their provider if your baby doesn't respond to your facial expressions, doesn't smile, or doesn't watch items or people as they move. If your child seems floppy or very stiff, this also warrants talking to the pediatrician.

Your baby will have a well-visit at 6 months old, but if you have any concerns about their development, don't hesitate to make an appointment earlier.

At This Age

  • Development : Your baby is becoming more vocal (babbling and crying), smiling, reaching for objects, holding their head up, and rolling.
  • Sleep : Your 5-month-old should be getting around 10 hours of sleep at night, with around three naps during the day.
  • Food : Your baby is still drinking formula or breast milk, and they might be interested in solid foods.

5-Month-Old Baby Milestones

Between 5 and 6 months old, babies start ramping up their communication skills. They might not say actual words, but it's sure fun to hear them babble ! They're making sounds like "goo," "ma-ma-ma" or "bah-bah-bah." They can now vary their cries to express different needs, such as hunger or tiredness. This is a step toward one of the most exciting milestones: their first word !

Additionally, babies are typically rolling two different ways: tummy-to-back and back-to-tummy. "You may notice they only ever turn over their right shoulder, or over their left shoulder," explains Dr. Werner. "Once these motions are mutually mastered, watch out! The range they can cover by rolling is quite impressive."

Bennett adds that 5-month-olds start gaining the ability to hold their heads up without support, bear weight on their legs when stood up, and push onto their elbows from their tummies. They might even push up into a sitting position when they get closer to the 6-month mark.

If you spend most of the day stopping your 5-month-old from trying to eat random objects, you're not alone, as they're mastering the ability to reach for and grab objects. "This may be purely fun and simple sensory exploration, or it may be fulfilling a need since some infants can start to have their first tooth around this time," explains Dr. Werner. They may also start to pass objects from one hand to the other.

5-Month-Old Baby Food

At 5 months, the focus is still on breast milk and/or formula. "[You] should aim for about 25-35 ounces per day, which often breaks down to approximately 6-8 ounces per feeding," says. Dr. Werner. He explains that it's normal for babies to have days where they drink more or slightly less than the goal. If it seems like their feeds are consistently different, you should reach out to your pediatrician.

Introducing Solid Foods

At 5 months old, you may consider introducing your baby to solid food . Your little one doesn't need any nutrition other than breast milk or formula for the first 6 months of life, and the American Academy of Pediatrics (AAP) doesn't recommend introducing solids before 4 months of age. That said, 5 months could be a good time.

You can look for signs of readiness in your baby, including the following:

  • Able to hold their head up
  • Moves food from a spoon into their mouth
  • Opens their mouth when food is nearby
  • Weighs at least 13 pounds or has doubled their birth weight

While your baby might show readiness at 5 months, Dr. Warner says not to be discouraged if your baby doesn't take to solids right away. "When introducing options beyond breast milk and formula, don’t despair if they turn up their nose at the first or even fifth attempt; just bring it back a couple [of] days later," he says. "Similarly, don’t worry if what was exciting and new loses its initial fascination."

Bennett explains that babies also need to learn how to use their tongue and mouth muscles to help the food go down. "From the color and smell to the texture and taste, babies may need time to adjust to all of these sensory changes," she says.

When trying solid foods, Dr. Werner suggests introducing one new ingredient at a time. "We do this so that if the infant has an allergic reaction to a food , we can know exactly which ingredient they ingested," he says. Wait three to five days before giving your baby another new food.

As for the order in which you introduce various solids, Dr. Werner recommends working through all of the green vegetables before starting orange and red vegetables. "The green colors aren’t as sweet, and they may not be as interested in green veggies after they’ve had the others," he says.

5-Month-Old Baby Growth

By now, your baby should have doubled their birth weight. All babies develop differently, but on average, they will likely gain an additional 1 to 1 1/4 pounds and around 1/2 to 1 inch in height this month.

5-Month-Old Baby Sleep

At this stage, babies are still sleeping more than they're awake. "Infants at this age will need around 10 hours (plus or minus two) at night, with about four hours via naps during the day, split across two to three naps," says Dr. Werner.  "They should still be placed on their backs to sleep, and there should be nothing else in the crib with them, whether it's a blanket, toy, or bottle."

Some babies are more natural “catnappers,” while others will need a longer stretch. By 5 to 6 months old, many babies start sleeping through the night , which means they stay asleep for six to eight hours.

Dr. Werner adds, "Those blessed evenings when they ‘sleep through the night’ are littered with intermittent wakings, which are completely normal." He explains a "good" sleeper will be able to fall back asleep without parental intervention, as long as they're not hungry or need a diaper change,

Sleep Training

When it comes to sleep training at 5 months old, experts have mixed recommendations. "The literature is fairly split on sleep training, and a lot comes back to culture, so it should be a family decision," says Dr. Werner.

That said, by 5 months, babies are typically able to learn how to self-soothe, and they might not require any more night feedings . When choosing whether to sleep train, it ultimately comes down to your baby's specific needs. Of course, your pediatrician can provide the best advice for you and your child.

5-Month-Old Baby Schedule

Depending on when your baby goes to bed (and how well they sleep), you're likely starting your day bright and early. After breakfast and playtime, your little one will be ready for their first nap, followed by lunch, more playtime, and their second nap. At this age, they may still be taking three naps, with the third being the shortest of the day.

During playtime, your baby is still exploring being on their tummy, so find some fun, interactive tummy-time toys! For 5-month-olds, Bennett also recommends these playtime activities:

  • Books and items with various textures
  • Toys that light up and play music
  • Hanging toys and rattles
  • Lying on the floor with them to play

She also recommends helping them sit up and play in a seated position. " The milestone for sitting up is around the corner, and it’s a good time to practice with your support," she says.

5-Month-Old Baby Health and Safety

If you missed your baby's 4-month-old well visit, you can still schedule it! It's imperative to stick with regular check-ups to ensure your child is on track with their development. They'll have another well-visit at 6 months old, where they will receive another round of vaccines .

Here are some other common health and safety concerns for 5-month-old babies.

When evaluating a fever in a 5-month-old baby, consider their symptoms and the possible cause. Most of the time, fevers are simply a sign your baby's immune system is working properly. But according to the AAP, you should call a doctor if your child has the following symptoms along with a fever:

  • Looks very ill
  • Acts unusually fussy or tired
  • Might be overheated (from a hot car or other space)
  • Displays other worrisome symptoms, like a severe headache, stiff neck, breathing difficulty, repeated vomiting, etc.
  • Has problems with their immune system, heart, seizures, etc.

Also call the doctor if the fever is high or persistent. You should always ask your pediatrician before giving your child Tylenol, and they should never be given aspirin due to the risk of Reyes syndrome.

Choking and Injury Hazards

Since 5-month-olds love bringing objects to their mouths, anything they pick up is fair game. To prevent choking, you shouldn't leave small objects within their reach. Never give your 5-month-old large chunks of food, including raw carrots, grapes, apples, popcorn, peanuts, and hot dogs.

Even though they're several months away from crawling, Dr. Werner recommends starting to babyproof your home now. "The mobility offered by flipping from back-to-front and front-to-back should not be underestimated," he says. You may want to start removing any objects that they could potentially knock over or run into, along with covering any electrical outlets.

5-Month-Old Baby Care Basics

Your 5-month-old is growing like crazy and soaking in everything around them. It's an exciting time! Here's what to know about three important baby care topics: diapers, bedtime, and daycare.

To ensure your 5-month-old baby is getting enough food, pay attention to their diapers. Babies should have at least five to six wet diapers and two dirty diapers each day. That said, the frequency of poopy diapers varies widely, and it also depends on whether they're breastfed or formula-fed.

Some breastfed babies may poop after every feeding, while others may only go once a week. The stool should be soft and easy to pass; otherwise, it could be constipation. If you have any concerns, always reach out to your child's pediatrician.

Bedtime Routine

If you haven't yet started a bedtime routine, now is a great time to do so. Don't allow your baby to fall asleep with a bottle or at the breast. They should be placed in the crib drowsy but awake to help them learn to fall asleep on their own.

Before bedtime, you can give your baby a massage , sing a song, read a book, or give them a warm bath (the AAP recommends three baths per week for the first year).  A bedtime routine creates a helpful schedule for your baby, and it can get them ready to snooze.

If your little one attends daycare, you may soon encounter the question that every parent will face at some time or another: Is your baby too sick for daycare? Answering that question is never easy, and it can be especially difficult if you're dealing with a certain workplace environment. In the following scenarios, it's best to keep your baby home.

  • Fever with or without a rash
  • Signs of serious illness (fussiness, irritability, breathing difficulties, constant cough, skin sores, recurrent vomiting or diarrhea, etc.)
  • Any specific illness that is known to be contagious (whooping cough, RSV, strep throat salmonella, influenza, COVID-19, chickenpox, pink eye, impetigo, etc.). Stay home until they're no longer contagious.

Your child doesn't usually have to stay home from daycare if they have a simple cold without a fever. That's good news for most parents since cold symptoms commonly last 10 to 14 days and the average child can get up to 10 colds a year.

What Else to Know About Your 5-Month-Old Baby

As you prepare for your baby’s half-birthday, spend some quality time together in the mornings. It's often the time when your baby is the most active, awake, and happy.

Your baby will learn about the world around them from the ground up, which means you should join them at their level—literally. Plop down on the floor with them, encourage them to roll over or try new skills, or blow raspberries on your baby’s tummy and relish those baby giggles.

At 5 months old, your baby is like a sponge, absorbing all kinds of information about the world from the environment around them. The groundwork for language begins this month, so along with talking and reading to your baby, play music in your home. There’s no need to make it all “baby” music either. Anything with a beat is good to go!

Key Takeaways

Your 5-month-old baby's little brain is hard at work learning about the world. Whether they're rolling across the living room or having a full-on babble conversation with themselves in the mirror, your 5-month-old is a complete joy to be around. Take pictures, savor every smile and giggle, and relish in the amazing ways your baby is growing!

Hearing & Making Sounds: Your Baby's Milestones . American Academy of Pediatrics . Updated 2021.

Infant Vision: Birth to 24 Months of Age . American Optometric Association .

Baby Development at 4-6 Months . Children's Hospital of Orange County .

Milestone Moments . Centers for Disease Control and Prevention . 2020.

Is Your Baby’s Physical Development on Track? American Academy of Pediatrics . Updated 2023.

AAP Schedule of Well-Child Care Visits . American Academy of Pediatrics .

Speech and Language Milestones, Birth to 1 Year . University of Michigan Health . 

Developmental Milestones: Fine Motor Skills and Visual Motor Skills . Children's Hospital of Orange County .

Starting Solid Foods . American Academy of Pediatrics . Updated 2022.

When, What, and How to Introduce Solid Foods . Centers for Disease Control and Prevention . Reviewed 2023.

Infant Sleep . Stanford Medicine Children's Health .

Uninterrupted Infant Sleep, Development, and Maternal Mood . Pediatrics . 2018.

Your Child’s Checkups . American Academy of Pediatrics .

Fever: When to Call the Pediatrician . American Academy of Pediatrics . Updated 2022.

Fever (High Temperature) In Kids . Nemours KidsHealth . Reviewed 2022.

Safety for Your Child: Birth to 6 Months . American Academy of Pediatrics . Updated 2017.

Rear-Facing Car Seats for Infants & Toddlers. American Academy of Pediatrics.

Bathing Your Baby . American Academy of Pediatrics . Updated 2023.

Cold . Boston Children's Hospital .

  • Deals and sales

The Best Presidents’ Day Sales on Mattresses, Furniture, and More

The word "deals" in red with a blue illustrated background.

Tons of Presidents’ Day sales trumpet deals on mattresses, sheets, and pillows. But most of them stink.

We’ve scoured these often-overhyped discounts to highlight only the best deals on our expert-vetted mattress, pillow, and bedding picks, along with additional price drops on recommended electronics, furniture, appliances, and clothing.

Presidents’ Day 2024 sales

Mattress, sheet, and pillow deals, clothing deals from rei, harper wilde, patagonia, and more, home and furniture deals, appliance deals.

The Leesa Hybrid in a bedroom.

Leesa Sapira Hybrid Mattress (queen, king, or California king)

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Leesa Sapira Hybrid Mattress

Our hybrid-mattress pick with loose-cradling foam and nice bounce.

Combining the best components of memory-foam and innerspring mattresses, this longtime pick’s hybrid tech boasts over 1,000 springs and four layers of CertiPUR-US–certified memory foam. We like this mattress for stomach-, back-, and side-sleepers, and we especially appreciate its 100-day trial period and 10-year warranty.

Buying Options

Use promo code WIRECUTTER (queen)

Use promo code WIRECUTTER (king or Cali king)

Other things to know: Mattress is 11 inches tall. Use code WIRECUTTER for the deal price. The king and California king sizes are also on sale (down to $1,300) with the promo code. Deal comes with two free down-alternative pillows and a microfiber sheet (not a Wirecutter recommendation but a nice add-on). Street price has risen by $100 since last year.

Read our review of the best hybrid mattresses .

Saatva Classic (Luxury Firm, queen)

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Saatva Classic

Our plush and bouncy innerspring-mattress pick.

Appealing to those who want to nestle in, as opposed to feeling engulfed, this is the most affordable innerspring mattress we’ve found that still looks and feels luxurious. You can count on it for classic innerspring bounce paired with a cushy but understated 3-inch Euro top.

Other things to know: This mattress doesn’t have the best motion isolation. Comes in thicknesses of 11.5 and 14.5 inches, and you have 365 nights to try it. Discount available on all sizes. We recommend the Luxury Firm comfort level.

Read our review of the best innerspring mattresses .

WinkBed (Luxury Firm, queen)

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The best innerspring mattress

A quilted cover, pocketed coils, and a foamy top give this bed a pleasingly hefty hybrid feel. Its billowy-yet-substantial feel has remained a crowd-pleaser in our tests.

Use promo code WCPD24 (queen)

Other things to know: We like this mattress for back- and stomach-sleepers, side-sleepers who rotate positions frequently, or those who simply prefer a firmer mattress. Deal price reflects the Luxury Firm option in the queen size, but the other sizes are also on sale. Use code WCPD24 to get the discount.

Leesa Original Mattress (queen, king, or California king)

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Leesa Original Mattress

Our memory-foam mattress pick that doesn’t sink.

Consisting of three layers of CertiPUR-US–certified memory foam, it combines the gentle cradle of a classic memory-foam mattress with a firmness that doesn’t hamper movement. It’s a great value for back- and side-sleepers on a budget, especially when it’s on sale (like right now).

Other things to know: Memory-foam mattress provides little edge support. Leesa offers a 100-day trial period and 10-year warranty. Use code WIRECUTTER . Deal price reflects the queen size, but the king and California king sizes are also on sale for $960 with the code. Deal comes with a free sheet set and two pillows—a nice add-on, but we haven’t tested either.

Read our review of the best memory-foam mattresses you can buy online .

Tempur-Pedic Tempur-Adapt Topper (queen)

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Tempur-Pedic Tempur-Adapt Topper

Our top pick for the best memory-foam mattress topper.

Made from a dense memory foam that didn’t overheat our testers, this is the most luxurious topper we’ve found if you need to soften up a too-firm mattress. It’s pricey, but it cradles pressure points better than other memory-foam toppers we tested.

Other things to know: An investment, but comes with a 10-year warranty—the longest of any mattress topper we tried. Weighs about 36 pounds, making it difficult to maneuver. Stated deal price is for the queen size, but all other sizes are also discounted.

Read our review of the best mattress toppers .

King Koil Luxury Air Mattress Queen (20-inch)

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Our runner-up pick for the best air mattress

One of the most comfortable air mattresses we tested, the King Koil lives up the royal pedigree of its name. It lasted an impressive 48-hours during our tests without needing to be re-inflated and deflated easily within 3 minutes—folding up perfectly in the included nylon tote.

You save $40 (27%)

Other things to know: King Koil's customer service record is spotty. The mattress has a designated “top” of the bed with a slightly elevated built-in pillow. Amazon Lightning deal. Recurring deal price but it has yet to drop lower.

Read our review of the best air mattress .

Best Choice Products 4-in Portable Folding Mattress (twin)

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Best Choice Products 4in Portable Folding Mattress (Twin)

A staff-favorite guest-bed alternative.

If you’ve got extra storage space and truly despise air mattresses, this guest-bed alternative is a nice upgrade without having to buy an actual bed. Made of high-density foam, this folding mattress is significantly more comfortable than a blow-up bed.

You save $30 (25%)

Other things to know: We prefer two twins mattresses for the ultimate versatility and storage options. Stack two twin mattresses for a single guest or lay them side by side for a couple. Not a great option if you’re tight on space. Bulky to transport and store.

Read our review of the folding mattress my overnight guests love .

Nest Bedding Easy Breather Pillow (standard)

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Nest Bedding Easy Breather Pillow

The best bed pillow for side- and back-sleepers.

Our longtime favorite pillow’s moldable, customizable shredded-foam filling offers firm, comfortable support for back- and side-sleepers. And unlike some other shredded-foam pillows we’ve tried, it doesn’t have a lingering chemical smell.

Use promo code WCSLEEP24 (standard)

Other things to know: Redesigned in 2021 with a softer, cooler cover; the shredded foam is now encased in its own washable inner pouch. Two-year warranty. Use promo code WCSLEEP24 to get deal price plus free shipping. Deal price is for the standard size.

Read our review of the best bed pillows .

Ecosa Pillow

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Our contoured memory-foam pillow pick for most body types

If you’re a back- or side-sleeper who suffers from neck, shoulder, or arm pain, this may just be the pillow of your dreams. It’s firm, but it still has a bit of squish, and the height-adjustable and curved design provides targeted neck support.

Use promo code WIRECUTTER

Other things to know: Pricier than some of our other pillow picks. Comes with two sheets of extra foam that you can add to the bottom (inside the cover) to adjust its height. 100-night return policy. Matches the previous best price we’ve seen. Use code WIRECUTTER to get the deal.

Read our review of the best memory-foam pillows .

Brooklinen All-Season Down Comforter (full/queen)

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Brooklinen All-Season Down Comforter

Our warm, fluffy, and lightweight down-comforter pick.

With a baffle-box construction and 700-fill-power duck down, this is an all-around great comforter. It’s easy to wash, it doesn’t slide off the bed, and it keeps its loft, even after being in storage.

Use promo code WCDOWNCOMFORTER27 (queen)

Other things to know: One-year return policy and two-year warranty. Use code WCDOWNCOMFORTER27 . Deal reflects the pricing for the full/queen size in all-season weight, but all sizes and weights are discounted with the code.

Read our review of the best comforters .

Cultiver Linen Duvet Cover

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Our luxurious linen duvet cover pick

This is by far the softest linen duvet cover we’ve tested, with a breathable rustic texture that adds a pleasantly rumpled look to any bed. The strong, neat stitching holds up in the wash, and we’ve experienced no pilling, thinning, or construction breakdowns.

Use promo code WIRECUTTER20 (queen)

Other things to know: Swatches are available if you’re unsure of color or texture. Deal pricing reflects the queen size, but all sizes are on sale with code WIRECUTTER20 .

Read our review of duvet covers we love .

Brooklinen Classic Duvet Cover (full/queen)

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Brooklinen Classic Duvet Cover

Our crisp cotton duvet cover pick that comes in modern prints.

Soft, comfortable percale construction makes this duvet cover feel like luxurious hotel bedding—without a luxury-hotel price. In fact, it’s one of the least expensive covers we’ve tried, yet it also comes in the most stylish and interesting variety of prints we’ve seen.

Use promo code WCCLASSICDUVET25 (queen)

Other things to know: Can get a bit wrinkled. After years of long-term testing, we’re still impressed with this cover’s overall construction. Use the code WCCLASSICDUVET25 . Deal price is based on the full/queen size, but the code takes 25% off all sizes.

Riley Textured Cotton Coverlet

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One of our top summer-blanket picks

Featuring a thick cotton top with gauzy backing, this lightweight, breathable blanket can keep you cool whether you tend to sleep hot during warm weather or year-round. The ribbed design and the wide selection of colors and sizes ensure that it looks great on any bed.

Use promo code WCSLEEP

Other things to know: Not the softest blanket we recommend. Stated deal price is for the queen size. Use coupon code WCSLEEP . Not the lowest price we’ve ever seen on this item, but better than most deals we’ve seen within the past year.

Read our review of the best blankets .

Brooklinen Classic Percale Core Sheet Set

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Our pick for the best printed sheets

Perfect for hot sleepers, these percale sheets feel as cool against the skin as they look on a bed. They’re lightweight, breathable, and available in a variety of colors and modern prints to suit a range of styles.

Use promo code WCCLASSICSHEETS25 (queen)

Other things to know: These sheets don’t soften up as much over time as our L.L.Bean pick, but they’re similarly sturdy and hold up beautifully. Set includes a flat sheet, a fitted sheet, and two pillowcases. 365-day return policy. Deal price is for the queen size, but all sizes are discounted with code WCCLASSICSHEETS25 .

Read our review of the best sheets .

Cultiver Linen Sheet Set (queen)

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Cultiver Linen Sheet Set

The best linen sheets.

Great for hot sleepers, this longtime favorite linen sheet set pick is durable, breathable, and one of the softest we’ve tested. The set includes a fitted sheet, a flat sheet, and two pillowcases, but you can also purchase by the piece.

Other things to know: Like any linen sheets, these wrinkle very easily. More limited sizing than other brands. No warranty, and a pretty standard 30-day return policy . Deal price reflects the discount for the queen size, but code WIRECUTTER20 gets you a deal on all sizes.

Read our review of the best linen sheets .

LilySilk 25 Momme Oxford Envelope Luxury Pillowcase (standard size, set of two)

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Lilysilk 25 Momme Oxford Envelope Luxury Pillowcase

A staff-favorite hair-care tool.

Our sleep experts consider these silk pillowcases a holy-grail item for curly or potentially frizzy locks. They feel decadently lustrous and weighty right out of the box, but we like them even more after the first wash.

Add 2 to cart, use promo code WC1 (standard)

Other things to know: The 25-momme count indicates a good weight of silk, while the 6A rating indicates a good strand length. Add two standard-size pillowcases to your cart and use code WC1 for the deal price of $88. You can also get two queen-size pillowcases for $103 with code WC2 or two king-size pillowcases for $116 with code WC3 .

Read our article about a favorite hair-care tool .

Baloo Weighted Blanket (queen, 15 pounds)

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Baloo Weighted Blanket

Our low-maintenance, quilt-like weighted blanket pick.

Combining the best elements of a quilt and a comforter, this weighted blanket is well balanced, crisp, and easy to throw in the washer and dryer. It’s affordable, yet it offers overall better quality than cheaper options.

(queen, 15 pound)

Other things to know: The cotton batting prevents the weight from enveloping your body as closely as that of blankets without such filler. Can feel less breathable and even hot compared with knit-style options. Lifetime guarantee on materials and workmanship. Deal for the full/queen size (60 by 80 inches).

Read our review of the best weighted blankets .

A person wearing the Harper Wilde Bliss Bralette.

Harper Wilde Bliss Bralette

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Our pick for the best bralette for lounging

This bralette offers a pull-on, wire-free design and medium support. The smooth, pleasantly stretchy material gently hugs the skin, and its plunging neckline and low back look good under a variety of tops while providing plenty of coverage.

Price includes shipping

Other things to know: Matches the best price we’ve seen on this item. Available in sizes XS to 3XL in select colors. Band and straps aren’t adjustable. Price includes $6 shipping.

Read our review of the most comfortable bras .

Lunya Washable Silk Set

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A slinky silk-pajama set we recommend as a gift

Unlike most silk pajamas, this luxe set is entirely washable, so it’s a great everyday indulgence. The youthful silhouette features an abbreviated crop top that exposes some midriff and a sporty racerback design that flatters a variety of body types.

Use promo code FOR-WCSLEEP

Other things to know: Made of 100% Mulberry silk. More playful silhouette than on our pajama picks. Available in a variety of colors and sizes. Use code FOR-WCSLEEP .

Read our review of the best gifts for girlfriends (that are great for anyone) .

The Company Store Company Cotton Men’s Robe

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The best terry robe

Comfortable enough for winding down or lounging around, this indulgently soft cotton robe is absorbent enough to dry you off after a shower. It offers a roomy fit that makes it easy to move around in, with a relaxed shawl collar, generous patch pockets, and a tie belt.

(select colors)

Other things to know: The thick terry cloth is a tad too warm for year-round wear. Deal price is for the white color in sizes S to XXL.

Read our review of the best robes .

Eyebuydirect blue-light-lens glasses (35% off plus free shipping)

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Eyebuydirect

The best place to buy glasses online.

Offering both prescription and non-prescription blue-light-blocking glasses, Eyebuydirect has a wide selection of frames and glasses, including the only option we recommend with two size options. Items are consistently high in quality, and the customer service is reliable.

Use promo code WIRECUTTER35 for 35% off lenses + free shipping.

Other things to know: 14-day return policy. Eyebuydirect offers four tiers of blue-light-filtering lens enhancements starting at $19. Pair with the frames of your choice and use code WIRECUTTER35 for 35% off nearly all lenses plus free shipping (some exclusions apply).

Read our review of the best blue-light-blocking glasses .

New Balance Fresh Foam 880v13 Running Shoes (Men's)

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New Balance Fresh Foam 880v13 (men's)

Our pick for a springy and reliable neutral running shoe.

Get a nice boost of energy on daily road runs, long walks, and even trail runs with this pair of cushioned running shoes. Featuring a flexible synthetic/mesh upper, foam midsole, and rubber outsole, they feel supple and soft—but not too soft, so they may take a bit to break in.

Other things to know: May take a bit longer to break in than other shoes. You may want to consider buying the 880v13s in a half-size larger than usual. One runner reported the shoes felt warm but not stifling during warm, humid weather. On sale in select colors and sizes.

Read how to choose the best running shoes for you .

Patagonia Ultralight Black Hole Mini Hip Pack 1L

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Our petite and outdoorsy fanny pack pick

Just strap this compact fanny pack on your person or toss it into your suitcase and you'll be ready for your next adventure. It's lightweight and weather-resistant thanks to its 100% recycled ripstop nylon construction, and it's covered by Patagonia's open-ended guarantee.

With store pickup or REI membership (select colors)

Other things to know: One-liter capacity may not hold enough for some users. Maximum waist strap length is only 36 inches. Maximum waist strap length is only 36 inches. On sale in three color combinations. REI members get free shipping, but non-members can opt for store pickup or add to a combined order of $50 or more to avoid shipping fees.

Read our review of the best fanny packs .

Nisolo Women’s Huarache Sandals

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An elegant handwoven huarache sandal

These high-quality leather sandals are chic and provide great arch support. The closed-toe design keeps un-pedicured toes under wraps and the handwoven leather molds to feet after a few wears. Nisolo is also a certified B Corps brand that meets high social and environmental standards.

Use promo code EXTRA20, price includes shipping

Other things to know: A little pricier than some of the other sandals we recommend, but we think the build quality and sophisticated design are worth it. Deal compares favorably to what we've posted in the past. Use code EXTRA20 , deal price includes shipping.

Read our review of the best sandals .

The Revival Cotton Washable rug, our pick for a lightweight and washable rug, on a wood floor in a living room.

If you’ve been looking for a reason to breathe new life into your home, this is it. Here are the best Presidents’ Day furniture and home sales we’ve found.

Revival rugs (25% off washable-rug purchases over $350)

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Revival Shell Washable Rug

Our easy-to-wash area-rug pick.

These quality flatweave organic-cotton rugs come in neutral and geometric patterns and can be machine washed and hung to dry. We recommend opting for the premium rug pad with your purchase to make it softer underfoot and keep it in place.

Use promo code WCWASH25 for 25% off washable rug purchases over $350.

Other things to know: We like these rugs for dining rooms, living rooms, bedrooms, kitchens, and kids rooms. Save 25% on washable-rug or rug-mat purchases over $350 when you use code WCWASH25 . Deal pricing varies depending on your total.

Read our review of the best area rugs .

Tuft & Needle Wood Frame (queen)

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Tuft & Needle Wood Frame

Our pick for a clean and classic wood bed frame.

Classically handsome with clean lines and a particularly sturdy hardwood construction, this bed is great if you like mid-century design. Our testers especially appreciated how the low headboard offers enough under-bed clearance for easy storage.

Use promo code WIRECUTTER25 (queen)

Other things to know: Impressive 12-year warranty. In a few online reviews, buyers have complained of creaking. The slats are spaced 3 inches apart, but each slat is 10 inches wide. Use code WIRECUTTER25 for 25% off, which you can also apply to the full, king, and California king sizes.

Read our review of modern bed frames to dress up your bedroom .

BenchMade Modern Skinny Fat Bed (queen)

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BenchMade Modern Skinny Fat Bed

Our modern bed-frame pick with the most color and fabric options.

Featuring classic mid-century details, this handsome upholstered bed frame is our only pick with both a headboard and a footboard. It’s easy to assemble and durable, and it comes with a lifetime warranty.

Use promo code WIRECUTTER40, price includes shipping (queen)

Other things to know: Ready-to-ship, preconfigured design comes with Rowan Ivory performance fabric and stained walnut legs. Non-customizable. Slightly faster estimated delivery than custom designs. Price includes $150 shipping to your door. A rare deal, as street price has risen drastically. Use code WIRECUTTER40 .

Read our review of the best modern bed frames to dress up your bedroom .

Frontgate Resort Collection Bath Towel

research on sleep training babies

The best bath towel

The plushest, warmest, and thickest towel we’ve ever tested creates a luxury-hotel experience in your very own bathroom. Available in a wider variety of colors than any other towel we’ve found, it holds up for years and feels fuller and more plush with each wash.

Use promo code WCFEB24

Other things to know: If you prefer thinner towels, this isn’t the pick for you. Bulkier to store and wash than other options. Use code WCFEB24 for the deal price and free shipping.

Read our review of the best bath towel .

Zeroll 1020 Original Ice Cream Scoop

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Our top pick for the best ice cream scoop

Sometimes there’s no beating a classic, which is why we love the Zeroll ice cream scoop. Our top pick since 2013, the Zeroll will have you scooping a perfect two-ounce portion like the pros.

You save $5 (20%)

Other things to know: This scoop is not dishwasher-safe. Lowest price we've seen since 2022. Two ounces per scoop.

Read our review of the best ice cream scoop .

The LG WM4000H washer and the LG DLEX4000 dryer, set side by side in a laundry room.

LG WM4080HWA washing machine and LG DLEX4080W electric dryer

research on sleep training babies

A bundle of expert-approved variants of our top washing machine and dryer picks

This bundle’s front-loading washer is gentle and great at removing all kinds of stains, while the matching dryer quickly and thoroughly dries clothes. Both machines have a large capacity and are Wi-Fi enabled for remote operation via the LG ThinQ app.

Costco membership required

Other things to know: Solid brand reputation for reliability. LG’s customer service is relatively lousy, but Costco’s is relatively good. Costco membership required. Includes delivery, installation, basic parts, and old-machine haul-away. Two-year warranty and 90-day return period.

Read our review of the best washing machines (and their matching dryers) .

Midea U MAW08V1QWT Air Conditioner

research on sleep training babies

Midea U MAW08V1QWT

Our top pick for the best air conditioner.

When you need to cool off but can’t stand a noisy racket, our top pick for best window AC is your best bet. While the installation is a bit tricky, the unique U-shaped design lets you open and close the window. Plus, it’s twice as efficient as non-inverter AC units.

You save $155 (41%)

Other things to know: Cleaning larger units can be challenging. One of the worst installation processes we've experienced, but we have installation tips in our guide. The new app is still working out some kinks.

Read our review of the best air conditioner .

GE GNE27J French-door refrigerator

research on sleep training babies

Our runner-up French-door refrigerator

Although it takes up a bit more space, this sleek French-door model is a fantastic option if you want a fridge that doesn’t have smart-home enabled features and Wi-Fi connectivity. Provides twice as much ice as our top pick, and has more-versatile shelving.

Price reflects in-cart, includes delivery

Other things to know: Not quite as quiet or as energy-efficient as our top pick. One-year warranty on refrigerator, five-year warranty on compressor and cooling system. Price reflects in-cart and includes a $29 delivery fee

Read our review of the best French door refrigerators .

Our pick for best reading light overall, the Glocusent Bookmark Style Reading Light, shown clipped onto a book that is open to a page in the middle.

Glocusent Bookmark Style Reading Light

research on sleep training babies

The best overall reading light

Chic and compact, this handy reading light boasts the most light customization of all our picks. It’s a breeze to use and adjust for both paperback and hardcover books, with a slim clip and a power indicator to monitor its battery life.

Use promo code WIRECUTTER20

Other things to know: Small size, and the buttons can be a bit too sensitive when you’re adjusting clip placement. Use promo code WIRECUTTER20 to get the deal. New low price.

Read our review of the best reading light .

Apple Pencil (2nd Generation)

research on sleep training babies

Apple Pencil (2nd generation)

Our upgrade pick for the best ipad stylus.

If you have a USB-C based iPad and want all the bells and whistles for your stylus, the Apple Pencil 2nd Gen can’t be beat. With pressure sensitivity, magnetic charging, and a tap system for toggling settings, it’s the best option for professional illustrators and artists.

You save $36 (31%)

Other things to know: Only compatible with iPads that have USB-C ports (and not the most recent 10th generation iPad); doesn’t work with older iPads.

Read our review of the best stylus for your iPad .

LG C3 OLED TV (48-inch)

research on sleep training babies

LG C3 Series

Our runner-up pick for the best oled tv.

If you want Dolby Vision HDR or a screen size smaller than 55 inches, this OLED TV is an excellent choice. It offers great contrast, vivid colors, and near-perfect viewing angles, and it’s better for darker rooms than our top pick.

Use promo code PRESIDENT20

Other things to know: Not as bright or as colorful as our top pick. Aside from improved video processing, it doesn’t make major leaps forward compared with the previous-generation C2 Series. Use code PRESIDENT20 .

Read our review of the best OLED TV .

Editor’s note: The photo at the top of this article may reflect previous deals that are no longer valid and have been removed. Check out our Deals page for more great discounts on Wirecutter’s expert-approved picks.

This article was edited by Nathan Burrow and Ben Frumin.

Meet your guide

research on sleep training babies

Kaitlin Mahar

Kaitlin Mahar is a staff writer for Wirecutter’s Deals team. Her byline has appeared in Delish, Esquire, and Town & Country. When she’s not hunting for deals and fiercely defending the Oxford comma, she’s a proud cat parent, an avid yogi, and a co-producer and co-host of the podcast Crime Culture . Please tell your pets and grandparents she says hi.

IMAGES

  1. PR-P003: 5 Research-based Sleep Training Methods

    research on sleep training babies

  2. Sleep Training Baby

    research on sleep training babies

  3. The Ultimate Guide to Baby Sleep Training Methods: What You Need, When

    research on sleep training babies

  4. Finding the Right Sleep Training Method for your Baby

    research on sleep training babies

  5. Toddler Sleep Training: 7 Tips and Tricks

    research on sleep training babies

  6. Baby Sleep Training Methods

    research on sleep training babies

COMMENTS

  1. Sleep Training Science: Myths And Facts About How To Get Baby To Sleep

    The mommy blogs and parenting books often mix up sleep training with "cry it out," says Jodi Mindell, a psychologist at Children's Hospital of Philadelphia who has helped thousands of babies...

  2. What really happens when babies are left to cry it out?

    By its broadest definition, sleep training can refer to any strategy used by parents to encourage their babies to sleep at night - which can be as simple as implementing a nighttime routine...

  3. Infant sleep training: rest easy?

    Sleep training improves infant sleep problems, with about 1 in 4 to 1 in 10 benefiting compared with no sleep training, with no adverse effects reported after 5 years. Maternal mood scales also statistically significantly improved; patients with the lowest baseline depression scores benefited the most. Go to: Evidence

  4. When and How To Sleep Train Your Baby

    In its simplest form, sleep training is the process of your baby learning to fall asleep by themselves — whether that's in the very beginning of the night when they are put into their crib or when they wake up in the middle of the night.

  5. Safe to sleep: A systematic review of the safe infant sleep training

    1. Introduction Prevalent causes of infant mortality in the United States include sudden infant death syndrome (SIDS), accidental suffocation and strangulation in bed (ASSB), and unknown causes ( Lambert et al., 2018 ).

  6. A parent's guide to sleep training infants and toddlers

    Sleep training involves giving your infant, toddler or child the tools they need to fall asleep at the beginning of the night and back to sleep in the middle of the night without parental intervention. A common misperception is that sleep training is teaching your child to sleep straight through the night. That's untrue.

  7. Sleep Training: Definition & Techniques

    Up-to-Date Babies sleep a lot. For their first year of life, babies need approximately 9 to 12 hours of sleep per day, in addition to regular naps. The only problem is they tend to sleep in spurts , a combination of sleeping at night and napping during the day.

  8. The science of healthy baby sleep

    8 February 2022 By Amanda Ruggeri Features correspondent Scientists are cracking the secrets of safe and healthy baby sleep (Getty Images) Sleep regressions aren't real. Night wakes are...

  9. Infant sleep as a topic in healthcare guidance of parents, prenatally

    Parent facilitation of infant sleep is thought to be influenced by the baby's and parents' and caretakers' personalities, family context, economy, general environment, and cultural traditions . Research emphasizes the importance of a good alliance with healthcare professionals when establishing safe and development-promoting sleep ...

  10. How to Sleep Train Your Baby

    Days 1-3: Instead of rocking, you stand by his crib and rub his back. Days 4-6: You sit by your child's bedside but do not touch him. Days 7-9: You move your chair to midway between your ...

  11. Safe Infant Sleep Interventions: What is the Evidence for Successful

    Data were collected in 2010 and 2011. Parental knowledge about recommended infant sleep position improved from 76% to 94% (p<0.001), intended use of supine positioning increased from 80-84% to 87% (p<0.001), and bedsharing the night before decreased from 38% to 16% (p<0.001) [ 41 ].

  12. 'Cry It Out' Sleep Training Gets Support : AJN The American ...

    Now a new study provides some support for the cry-it-out approach. Researchers assessed the sleep training practices of 178 infants and their caregivers and found that crying it out had no negative impact on infant-mother attachment and noted a possible reduction in crying duration and frequency. The infants and their caregivers were assessed ...

  13. Sleep Training

    Abstract Adequate sleep in infancy and beyond is important for development; however, many children are not sleeping the recommended amount. During the first few years of childhood, infants are frequently seen in the pediatric office for well-visits and a myriad of other concerns, including sleep difficulties.

  14. Does Sleep Training Actually Improve Infants' Sleep?

    A 2006 review study found that 82 percent of children show clinically significant improvement in sleep with sleep training. However, most of these studies (77 percent) used parent-report...

  15. Study Shows Sleep Training Won't Break Bond With Baby

    Key Takeaways A new study shows babies who are sleep trained slept better and longer than babies who were not sleep-trained. Sleep training did not affect the bonding between parents and infants. The decision to sleep train is up to each individual family, but this study can help parents ease parents anxious minds about sleep training.

  16. Sleep Training Your Baby

    Experts recommend beginning sleep training when babies are 4 to 6 months old. This age range is the sweet spot, since babies are old enough to physically make it for six to eight hours overnight without needing to eat but aren't quite at the point where the comforting you provide has become a sleep association.

  17. Does Sleep Training Your Baby Cause Long Term Harm?

    In a recent study published in the journal Pediatrics, researchers evaluated 43 sets of parents and babies in Australia. In one group, the parents didn't follow a particular sleep training method, and instead were given basic sleep information.

  18. Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep

    BACKGROUND AND OBJECTIVES:. Randomized trials have demonstrated the short- to medium-term effectiveness of behavioral infant sleep interventions. However, concerns persist that they may harm children's emotional development and subsequent mental health. This study aimed to determine long-term harms and/or benefits of an infant behavioral sleep program at age 6 years on (1) child, (2) child ...

  19. Sleep Training Research

    Overall, there is good evidence that sleep training methods can improve parental mood disorders, or change (parental reports of their) babies' sleep patterns in the short term. Evidence that sleep training actually helps babies to sleep better or longer is scarce. It is also not clear what other — unintended — consequences of such ...

  20. Fifteen years of research shows that sleep training for babies can

    September 21, 2021 7:00 am For parents all around the world, the scope of child-rearing practices, tips and guidance have long been a source of much conflict - especially when it comes to raising...

  21. Sleep training research: unpacking sleep training culture

    Accept We live in a sleep training culture. Its effects on parenting around sleep are powerful, and parents feel that pressure. When you dig into the research on sleep training, however, you find that it isn't as soundly supported as many parents and professionals believe.

  22. What Does Science REALLY Say About Sleep Training?

    In Stein & Newcomb's research, titled, "Children's Internalizing and Externalizing Behaviors and Maternal Health Problems," participants consisted of mothers who had at least one child between the ages of 2 and 10, and their children in that age bracket.

  23. How Many Hours of Sleep Does Your Baby Need?

    According to the American Academy of Sleep Medicine, babies aged 4 to 12 months should sleep 12 to 16 hours daily, including naps. 4 Parents should work with, rather than against, their child's ...

  24. Infant sleep and its relation with cognition and growth: a narrative

    Infant sleep studies show that about 20%-30% of all infants experience night awakenings throughout their first 2 years of life. 8, 9 Yet, with children's development, the number of awakenings per night reduces, and the ability to sleep through the night increases witĥ50%-75% of infants sleeping through the night at 12 weeks of age 10 and at leas...

  25. 5-Month-Old Baby: Milestones and Development

    5-Month-Old Baby Food . At 5 months, the focus is still on breast milk and/or formula. "[You] should aim for about 25-35 ounces per day, which often breaks down to approximately 6-8 ounces per ...

  26. Your Fitness Tracker Comes With Lots of Sleep Data. Here's How to Make

    You may already own a fitness tracker to monitor your exercise—but here's how you can also use it to improve your sleep.

  27. Are Therabody's $200 Eye Massager SmartGoggles Worth the Splurge?

    Therabody's $200 smart goggles offer relaxing kneading sensations and vibrations to help you wind down. But can they help you sleep?

  28. The Best Presidents' Day Sales on Mattresses, Furniture, and More

    Presidents' Day offers sales on everything from mattresses to large appliances. We've sifted through all the sales to find you the best deals.