Navigating the challenges of new parenthood often includes the significant hurdle of establishing healthy sleep patterns for infants. For many families, this means grappling with how to get a baby to sleep and resettle during nighttime awakenings. Persistent sleep disruptions can take a toll on parents’ mental health and overall well-being, prompting some to explore sleep strategies, formerly known as sleep training. These methods aim to teach babies self-soothing skills to fall asleep independently. However, concerns often arise regarding the potential for these strategies to cause harm. Examining the available evidence is crucial for parents making these decisions.

Understanding Infant Sleep and Self-Settling

Sleep, for infants, is a learned behavior. While some babies naturally develop the ability to fall asleep easily, others require more guidance. Research indicates that when implemented correctly, sleep strategies can lead to improved sleep for both babies and parents, without negatively impacting the child or the parent-child bond. The effectiveness of these strategies, however, is often dependent on proper application and suitability for the individual child and family.

When to Consider Sleep Strategies

Sleep strategies are generally considered most appropriate for babies aged six months and older. By this age, most infants can consume sufficient nutrition during the day, reducing the necessity for frequent night feeds. It is also important to assess whether a baby’s sleep is genuinely problematic for the parents. Some families are content with multiple night wakings, and this personal preference should be respected.

A cornerstone of any successful sleep strategy is a consistent bedtime routine. This predictable sequence of events—such as dinner, bath, pajamas, a story, and a cuddle before bed—helps signal to the baby that it is time to wind down and prepare for sleep. Predictability is key to helping babies feel secure and understand what to expect.

Common Sleep Strategy Techniques

Two widely discussed methods for encouraging self-settling include the ‘checking method’ and ‘camping out’.

The Checking Method (Graduated Extinction)

Often referred to in the past as ‘controlled crying’ or ‘controlled comforting,’ this approach is scientifically known as ‘graduated extinction.’ It involves placing a baby in their crib or bassinet when they are drowsy but still awake, and then leaving the room to allow them to self-settle. If the baby cries, parents return at progressively longer intervals—for instance, starting with two minutes, then four, then six—to offer comfort. This comfort may involve patting or rocking the baby until they are calm, but crucially, they are not picked up and are still awake when the parent leaves again. This process is repeated until the baby falls asleep. Parents can choose to pick up and comfort their baby if they feel it’s necessary, and then try again the following night. It is important to note that this is not ‘cry it out’ as parents are actively returning to offer comfort at set times. Typically, the checking method can take between three to seven nights to yield results.

Camping Out (Graduated Extinction with Parental Presence)

Another strategy, known clinically as ‘graduated extinction with parental presence,’ involves the parent staying in the room with the baby. Initially, a parent might sleep on a camp bed or chair next to the baby’s sleep space. For the first few nights, they may pat the baby to sleep before leaving the room. As the baby becomes more accustomed to settling, the parent can transition to offering comfort through quiet talking or singing. Over a period of about ten to 14 nights, the parent gradually moves their sleeping arrangement further away from the baby’s sleep space, eventually progressing out of the bedroom entirely.

Addressing Concerns About Harm

A significant concern for parents considering sleep strategies is the potential for causing harm to their baby. Misinformation, particularly on social media, has sometimes conflated the outcomes of sleep strategies with the severe deprivation experienced by children in Romanian orphanages during the 1980s. These children faced prolonged neglect, leading to higher rates of psychiatric disorders, a situation entirely distinct from the controlled application of sleep strategies within a loving family environment.

Research Findings on Safety and Efficacy

Extensive research, including a five-year study involving 328 Australian babies, suggests that sleep strategies are both safe and effective. This trial, which began in 2003, compared two groups of eight-month-olds: one group received guidance on sleep strategies from a trained nurse, while the control group received standard care. Follow-up assessments at 10-12 months, two years, and five years provided valuable insights.

• At 10-12 months: Mothers in the group receiving sleep strategy advice reported fewer infant sleep problems and improved mental health compared to the control group.
• At two years: Mothers in the intervention group continued to report better mental health. Parenting styles and child mental health outcomes were comparable between the groups.
• At five years: No significant differences were observed between the groups regarding child sleep patterns, salivary cortisol levels (a stress indicator), emotional or behavioral scores, mother-child closeness, use of harsh parenting, or parent mental health.

In essence, the study found no evidence that the use of sleep strategies in infancy led to harm for the child or the parent-child relationship. Further supporting these findings, a 2016 study of 43 infants in Adelaide observed a decrease in salivary cortisol levels in babies who underwent sleep strategies one month after implementation, compared to a control group. A year later, there were no discernible differences in behavioral problems or mother-child attachment between the groups.

Implementing Sleep Strategies Effectively

For parents considering sleep strategies for their baby aged six months or older, open communication with a partner is essential. This includes agreeing on the specific strategy to be used and how it will be implemented within the household. Some couples opt to alternate nights to ensure both parents experience periods of better sleep.

These strategies are most effective when combined with a consistent bedtime routine and implemented during a relatively stable period, ideally one to two weeks with minimal disruptions like illness or travel. If a baby becomes unwell, it is advisable to pause the strategy and resume once they have recovered.

The evidence strongly suggests that sleep strategies can be effective and that there is no substantiated risk of long-term harm to children. If parents require further assistance with infant sleep issues or if these strategies do not yield the desired results, consulting a General Practitioner (GP) or a child health nurse is recommended. These professionals can provide guidance and, if necessary, refer families to more intensive support services, such as inpatient early parenting centers.