Evidence-Based Alternatives to Ferber in Sleep Training

Utter the words “sleep training” and a feeling of dread shoots through most parents. In popular culture, “sleep training” is often synonymous with leaving a baby to cry for longer and longer periods until they sleep—what research calls graduated extinction. Popular parenting advice calls it Ferberizing, pop-ins, the Sleep Wave, etc.

This method is based on behaviorism—the theory from the 1920s that babies are blank slates and learn only through experiences that are “reinforced” by the environment. So, waking and crying are “reinforced” by parental attention. Behaviorists suggest that simply removing the attention will “extinguish” (stop) the crying.

In the behaviorist framework, only behavior and reinforcement matter. The baby’s age, temperament, feeding style, the amount of crying, parent preferences, or values are not relevant or considered.

Whether behaviorism should even be used as a guiding theory for infants is up for debate. It is definitely not the only way to frame sleep. It’s just what’s historically been used. Early researchers (Williams, 1959) saw waking and crying as an undesirable, but solvable problem, generally for toddlers and up. Behavioral theory was a logical fix. Why haven’t we moved beyond what is considered an outdated theory when it comes to infant development?

It's well-known in research and medical circles that parents really dislike extinction. Many studies reported difficulty recruiting parents for extinction research (e.g., Rickert & Johnson, 1988, p. 209). Some reported a 40-50% dropout rate due to even the possibility of being in an extinction group (Blunden et al., 2022; Hiscock et al., 2008). Researchers frequently needed to provide a lot of education and support in order for parents to be able to carry out the intervention (Chadez & Nurius, 1987; Hiscock & Wake, 2002; Rapoff et al., 1982; Reid et al., 1999).

Here's the curious part: Rather than devise less-stressful alternatives, research has focused on talking parents into using extinction. Entire papers are devoted to “cognitive restructuring” so that parents can become better at ignoring crying (Whittall et al., 2023). Instead of attributing parents' resistance to their desire to respond to a crying baby, they say that parents are just “ill-informed” or have worries that they consider “unwarranted” (Byars & Simon, 2016).

Why do parents dislike extinction so much?

1. The most obvious reason is that ignoring crying goes against a parent’s hard-wired response system. Parents build their capacity for attuned responses during the day. Simply turning these off at night is not easy, and often, it doesn’t make sense to parents.
2. It’s inconsistent with the way we teach babies literally every other skill. Imagine handing a six-month-old a spoon and saying, “If I feed you, you’ll become dependent on it, and we’ll start bad habits, and you’ll never learn to do it yourself.” No. But that’s what experts and others essentially say about sleep right from the start. "Don't rock that newborn or they'll become dependent on it." Nonsense. We don’t usually teach children skills by withholding help.
3. In the real world, extinction is not always “quick, easy, and effective.” Extinction works great for mellow babies who might briefly cry half-heartedly and then fall asleep. But intense, sensitive, or reactive babies may cry hard for long stretches over many nights, with no clear endpoint. The books don’t say what to do when this happens. Research on real-world experiences with extinction found that it didn’t work at all for 40-50% of parents (Gordon, 2020; Loutzenhiser et al., 2014). Even in research studies, the “failure rate” is between 16 and 50% of the samples (Gordon, 2022).

Extinction is nevertheless championed as “the evidence-based approach.” It’s true, it does have a massive research base, but not because it’s “the best.” Other methods just haven’t received the same level of research attention. In research, it’s easier (and more attractive) to contribute to an established body of literature than start something new. Extinction has the most evidence because it’s what researchers are interested in researching.

Leaving the room isn’t the only evidence-based option

If the goal is to help a baby shift from a “parent-does-all-the-work” to a “baby-does-more-of-the-work” scenario, we can do that in a way that allows for co-regulation—meaning, a parent helps the baby gradually take on more of this work with presence and help with calming down. This mindset is more congruent with how we teach babies and children every other skill—walking, feeding themselves, riding a bike. The parent helps a lot at first and then reduces how much they need to do.

The Chair Method (Sleep Lady Shuffle, parental fading, responsive approach). Popularized by Kim West, MSW, this approach allows parents to stay in the room and help the child fall asleep with intermittent hands-on support. It also allows for picking up and calming down as soon as they get really distressed. The hands-on help and presence is gradually faded out over the course of a week or two.

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Research on this approach found that, in comparison to Ferber, both worked; however, the responsive group ultimately had fewer nightwakings and the moms were less stressed (Blunden et al., 2022).

As a sleep coach, here’s what I notice about using this approach:

1. Parents can stick with it because they get to stay and support their child and help them calm down as necessary.
2. It works for intense, sensitive, perceptive ones who get very distressed very quickly. Ferber rarely works for these spicy little ones because they often can outlast their parents. Here, there’s no waiting or delay, so parents can act as soon as their child needs help.
3. It also works for toddlers and preschoolers who can be really sensitive to the “leaving the room” aspect of Ferber. Here, you don’t leave, but you also don’t get stuck sitting in the room long-term.
4. It’s flexible. With Ferber, you are either leaving the room, or you’re giving up. There’s really no in-between. Here, you can go slower or offer more support if they’re sick or they’re in a new place, and then just back that support off again.

The “cry-it-out versus cosleeping” standoff isn’t serving families well. A middle ground is exactly what’s needed. It’s time to unseat Ferber as the “only way” to work on sleep. Parents should have a range of effective options to choose from so they can pick something that works for them.