What is meant by baby or toddler sleep training and will it help your little one wake less at night?
This article is part of a collection inside The Possums Sleep Program called Deeper Dive, which explores the more complex scientific, historical and social contexts in which families and their babies or toddlers live and sleep. You don't need to read Deeper Dive articles to be helped by The Possums Sleep Program.
What is sleep training?
Sleep training our babies or toddlers isn't bad. But it is, in my view, outdated. Sleep training can make life with your baby or toddler much harder than it needs to be.
Many sleep programs now don't identify as sleep training, but continue to offer selected elements of it, at the same time as the sleep approach is promoted as gentle or responsive.
Sleep training aims to change the biology of your baby's or your toddler's sleep. It's based upon the (disproven) belief that you can teach your little one not to wake at night. The flip side to this is that sleep training approaches also (wrongly) teach that sleep problems are caused by bad habits. You might even feel under pressure to use sleep training techniques because you've been told that sleep problems can cause behavioural or learning problems for your baby or toddler down the track, which is also not the case.
You can identify a sleep training approach because it will include some (or even all) of the following recommendations.
"Sleep breeds sleep"
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Don't let your baby or toddler be awake for longer than the sleep window appropriate for her age. This might be estimated at no longer than 60 minutes as a newborn, or two or three hours in older babies, longer in toddlers.
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Grow long blocks of sleep during daytime naps by settling your little one back to sleep when he wakes after the first sleep cycle
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Put your baby or toddler down to sleep quite early in the evening
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Aim to have your baby or toddler in bed for about 12 hours overnight
"Don't create bad habits"
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Don't breastfeed your baby or toddler, or bottle feed your baby or toddler, to sleep, because this will mean that your little one is dependent upon breastfeeding or feeds to go back to sleep when surfacing from sleep cycles
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Instead, use feed-play-sleep cycles, including by
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Not letting your little one fall asleep with feeds, and
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Teaching him to go to sleep in the cot when drowsy but awake
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Don't cuddle your baby or toddler to sleep, because this will mean that your little one is dependent upon being held to go back to sleep when surfacing from sleep cycles
"Teach your little one to self-settle"
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Babies and toddlers surface from sleep between sleep cycles, and need to learn to self-settle back to sleep
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Increasingly delay responses to your baby or toddler, stretching out the amount of time you allow your baby or toddler to fuss or cry before responding. This is likely to be accompanied by specific instructions about periods of time and how to increase time before you respond, over a number of nights.
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Respond, but not in the way your baby or toddler actually wants. You might be advised to respond by patting your little one in the cot, or patting the mattress, or sitting by the side of the cot.
"Create good habits"
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Teach your little one to go down into the cot drowsy, but awake, to develop the good habit of self-settling in the cot
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Teach your baby or toddler that the cot is always the place she goes to sleep in
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Develop consistent sleep routines for your baby or toddler during the day
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Develop consistent bedtime routines for your baby or toddler in the evening
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Watch your little one for tired signs. This advice is often accompanied by a list of signs which are said to signal that your little one is tired.
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Put your little one down to sleep at the first tired sign, to avoid overtiredness
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If your baby or toddler is dialling up, it's a sign of overstimulation
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Sleep your little one in a quiet, dim room during the day.
These days, there are lots of 'gentle sleep' approaches which mix up the latest sleep science and neuroscience with various recommendations which persist from sleep training methods. I find this mix of methods really doesn't work for many families.
In contrast, The Possums Sleep Program offers a genuine paradigm shift, because it's built from the foundations up on altogether different principles.
The historical context in which sleep training arose
You could say that sleep training is very 'last century'!
Sleep training is an outdated health system response to the very chaotic feeding and sleep experiences endured by many women after the birth of their babies, dating from the 1950s. This miserable chaos, of screaming babies who failed to sleep or gain weight, and breastfeeding that didn't seem to work, was often (though of course not always) accidentally created by medical and nursing practices within hospital settings. Back in the 1950s and 1960s, these practices made it very difficult for many mothers and their babies to get in sync, and were accompanied by high rates of formula use.
Routinised feeds and sleep became popular in maternity hospital wards after the Second World War as the first wave of a school of psychology called behaviourism swept the world. This first wave of behaviourism fitted in nicely enough with the Scientific Motherhood approaches of the early 20th century, promoted for example by New Zealand paediatrician Dr Frederick Truby King.
In 1974, when it was still compulsory for 14-year-old schoolgirls in my home state of Queensland, Australia, to complete a subject called Mothercraft, I was taught that
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“Good sleeping habits should begin in the earliest months of life, for habits learnt in babyhood are likely to last into childhood.
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“So much sleep is needed because his body is growing quickly and his brain is developing very fast and his nervous system develops best when he is asleep. If he does not have sufficient sleep and rest, he will not grow so well, he will be nervous and fretful, and when overtired will not eat his meals well.
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“Some form of routine is good for the baby because …. good habits are formed which will last him all his life. His nervous system develops best in calm, unchanging surroundings …
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“Do not play or talk to the baby … when he is supposed to be going to sleep. Do not awaken the baby to show him to visitors.”
These are extracts from the handouts I was given as a schoolgirl by the Queensland Maternal and Child Welfare Service. You can see that health authorities in the 1970s had high levels of concern about the brain effects of overstimulation of the nervous system and overtiredness, beliefs which persist in our health systems today. Authorities believed these negative effects on the nervous system could be prevented by strict sleep and feeding routines, good habits, and by not overstimulating or overfeeding babies. This is how sleep training was promoted as 'scientific' well before the rise of evidence-based medicine.
In fact, sleep training is a socioculturally-created infant care practice or belief system, which started well before we began to use research studies to guide practice. You can find out more about this here.
Sleep training approaches do not improve your little one's behavioural or developmental outcomes
Parents are often given the impression that sleep training is an important part of being in control as a parent, much like good personal hygiene. This is not true. You can find out more about sleep and behavioural or developmental outcomes for babies here and toddlers here.
Sleep training approaches do not decrease the number of times your little one wakes during the night
Systematic reviews are a research tool for finding all the studies that have been conducted on a particular topic, then analysing how well each study was conducted, what was found, and synthesising the findings. You can find out more here.
I have found eight systematic reviews which examine the use of sleep training approaches.
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Six systematic reviews have found that sleep training doesn't decrease frequency of night waking in infants. One of these earliest systematic reviews was conducted by myself and co-author Associate Professor Peter Hill. You can hear us discuss this study, and also the limitations of systematic reviews, here.
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One systematic review investigated sleep interventions which I identify as first wave behavioural in children 0-5 years of age. The authors found that these sleep interventions increased the length of sleep duration at night-times by a mean of nine minutes, and increased sleep duration by 8.6 minutes as a total over a 24-hour period. This finding is clinically irrelevant, and not relevant to families.
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Another systematic review concluded that although first wave behavioural strategies did not change the frequency of night wakings, they might impact on infant sleep durations. Again, I would propose that the small increase in the number of minutes of sleep duration is not relevant to parents.
These systematic and metanarrative reviews show that there is no evidence that sleep training, or first wave behavioural approaches to infant sleep, decrease the frequency of night waking in ways that are likely to benefit families.
But you can find out why sleep training might actually worsen your little one's sleep here.
Selected references
Bryanton et al. Postnatal parental education for optimizing infant general health and parent-infant relationships. Cochrane Database of Systematic Reviews. 2013.
Crichton G, Symon B. Behavioral management of sleep problems in infants under 6 months - what works? Journal of Developmental and Behavioral Pediatrics. 2016;37:164-171.
Douglas P, Hill P. Behavioral sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic reivew. Journal of Developmental and Behavioral Pediatrics. 2013
Douglas PS. Response to 'Behavioural management of infant sleep problems under 6 months: what works?'. Journal of Developmental and Behavioral Pediatrics. 2016;37:520-521.
Douglas PS. High level evidence does not support first wave behavioural approaches to parent-infant sleep. Sleep Medicine Reviews. 2015;29:121-122.
Fangupo L, Haszard JJ, Reynolds AN. Do sleep interventions change sleep duration in children aged 0-5 years? A systematic review and meta-analysis of randomised controlled trials. Sleep Medicine Reviews. 2021;59:101498.
Ioannidis JPA. The mass production of redundant, misleading, and conflicted systematic reviews and meta-analyses. The Milbank Quarterly. 2016;94(3):485-514.
Kempler L, Sharpe L, Miller CB, Bartlett DJ. Do psychosocial sleep interventions improve infant sleep or maternal mood in the postnatal period? A systematic review and meta-analysis of randomised controlled trials. Sleep Medicine Reviews. 2015:doi:10.1016/j.smrv.2015.08.002.
Middlemiss W, Granger DA, Goldberg WA, Nathans L. Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Early Hum Dev. 2012;88:227-232.
NHMRC report on the evidence: promoting social and emotional development and wellbeing of infants in pregnancy and the first year of life. 2017
Park J, Kim YS, Lee K. Effectiveness of behavioral sleep interventions on children's and mothers' sleep quality and maternal depression: a systematic review and meta-analysis. Scientific Reports. 2022;12:4172.
Roser JG, Cassels T. From 'crying expands the lungs' to 'you're going to spoil that baby': how the cry-it-out method became authoritative knowledge. Journal of Family Issues. 2021;42(7):1516-1535.
Sasaki et al. Psycho-educational interventions focused on maternal or infant sleep for pregnant women to prevent the onset of antenatal and postnatal depression: a systematic review. 2020;Dec 19:doi:10.1002/npr1002.12155.
