Getting your baby to sleep: what the research says about behavioral methods
Learning to settle to sleep often involves some crying, and many parents worry about lasting consequences. Two decades of randomized trials, including a follow-up to age six, draw a calmer picture: modest gains in babies' sleep and in parents' mental health, with no harm detected (Price et al., Pediatrics, 2012).
What these methods actually involve
Behavioral sleep methods cover several approaches. The best known, graduated extinction (often called controlled crying), means responding to a baby's cries at lengthening intervals so they can learn to settle on their own (RACGP, 2014; Korownyk & Lindblad, 2018). Camping out: a parent sits by the crib while the baby falls asleep, then moves gradually further away over one to three weeks (RACGP, 2014).
Trials have also tested bedtime fading, a small, temporary delay of the bedtime at the start (Gradisar et al., Pediatrics, 2016). A review of 59 studies of children from birth to five identified the ingredients of these programs, usually taught to parents by a health professional. Independent settling leads the list (68% of programs), ahead of bedtime routines (53%). Sleep hygiene appears in 47% of programs (Pétrin et al., Sleep Medicine, 2026).
In the benchmark Australian study of 328 families, nurses trained in maternal and child health taught the techniques in structured consultations (Hiscock et al., Archives of Disease in Childhood, 2007), with the choice of approach left to parents (RACGP, 2014). The clinical guidance is explicit: the choice should consider what each option asks of parents (RACGP, 2014).
What the trials found for babies' sleep
The benchmark trial enrolled 328 mothers who reported a sleep problem in their 7-month-old. At 10 months, 56% of intervention families still reported problems, versus 68% of controls; at 12 months, 39% versus 55% (Hiscock et al., Archives of Disease in Childhood, 2007).
A Canadian clinical review that pools these trials puts the benefit at roughly 1 family in 4 to 1 in 10, depending on the outcome measured, a number needed to treat of 4 to 10 (Korownyk & Lindblad, Canadian Family Physician, 2018). In one six-week trial of 235 infants, severe sleep problems were reported for 4% of babies in the intervention group versus 14% of controls, and the share of babies with two or more night wakings was 31% versus 60% (same review).
A later trial randomized 43 babies aged 6 to 16 months: graduated extinction and bedtime fading both shortened the time to fall asleep, and the night wakings fell under graduated extinction (Gradisar et al., Pediatrics, 2016). The most recent meta-analysis, pooling 13 randomized trials, concludes that these programs improve total night-time sleep (Liu et al., Sleep Health, 2023).
What the trials found for parents
In the 328-family trial, mothers in the intervention group reported fewer depressive symptoms at 10 months (an EPDS score on average 1.4 points lower, on the scale used to screen for postnatal depression) and better mental health at 10 and 12 months (Hiscock et al., 2007). The intervention also cost slightly less than usual care, about 97 pounds per family versus 117.
Two years on, fewer mothers in the intervention group still had depressive symptoms: 15.4% versus 26.4% at the population threshold, and 4.2% versus 13.2% at the clinical threshold. Parenting practices and children's mental health were comparable in the two groups (Hiscock et al., Pediatrics, 2008).
The 2023 meta-analysis also found improvements in maternal depression (Liu et al., 2023). A wider review covers 20 studies in infants under 12 months: improvements in sleep and in mothers' mental health are mild to moderate, parenting confidence included. Anxiety and fatigue ease as well. The few studies that measured fathers found improvements in their mental health too (Stanzel et al., Infant and Child Development, 2025).
The long-term worry: what the five-year follow-up shows
Five years after the Australian trial, researchers followed up 225 of the 326 families and compared the children of both groups, then about six years old, on 20 measures. Behavior and emotions on one side, sleep on the other; then attachment and parent-child relationships, and mothers' mental health. No differences between the two groups (Price et al., Pediatrics, 2012; Korownyk & Lindblad, 2018).
The smaller trial found the same at 12 months: mother-child attachment was comparable in the two groups, and so were emotional and behavioral problems. Babies' stress response, measured through salivary cortisol, fell slightly in the intervention groups compared with controls (Gradisar et al., 2016).
The five-year authors conclude: behavioral sleep techniques leave little lasting effect, positive or negative. Parents and health professionals can use them with confidence to reduce the short- and medium-term burden of infant sleep problems and maternal depression (Price et al., 2012). The clinical review adds: no adverse effects reported after five years (Korownyk & Lindblad, 2018).
What the research does not say
These results come from a specific setting. The trials involved families who reported a sleep problem, usually with babies aged six months and older; the Australian clinical guidance places these techniques at six months and up (RACGP, 2014). And at the five-year follow-up, children in the control group showed the same results: the proven benefit concerns the family's comfort in the short and medium term (Price et al., 2012).
Most outcomes rely on parents' reports, and reviews find substantial heterogeneity between studies (Liu et al., 2023; Stanzel et al., 2025). Naps and 24-hour sleep organization are rarely studied: the review of 59 studies measured nights, rarely days (Pétrin et al., 2026). Effect sizes stay modest, these programs improve a difficult situation (Liu et al., 2023; Stanzel et al., 2025).
The tested programs relied on support from a trained professional (RACGP, 2014). Safe sleep in the first months, and a clinician's view when something worries a parent, come before these methods (NHS, 2025).
Choosing, trying, skipping: what matters
In the trials, parents picked between graduated extinction and camping out based on what felt workable, and clinical guidance asked professionals to leave that choice with them (RACGP, 2014). From around four months, parents can put babies to bed drowsy and still awake, so they learn to fall asleep on their own, and can expect a six-month-old to wake briefly at night and drift back off after a few minutes (HealthyChildren.org, 2024).
In the UK, the NHS suggests talking to a health visitor if sleep is a problem, or if parents need advice on routines (NHS, 2025). Skipping these methods remains possible: children in both groups of the five-year follow-up were doing well, and no study shows a child needs sleep training to develop normally (Price et al., 2012).
- Behavioral methods sit among the options: at five years, children in the control group were doing just as well (Price et al., 2012).
- The tested programs offered a real choice of approach and came with professional support (RACGP, 2014).
- Graduated extinction and camping out can improve infant sleep and parental mood in the short and medium term (Hiscock et al., 2007; Stanzel et al., 2025).
- A rebound in night wakings can appear a few weeks in, in about 1 baby in 5; it usually fades within a few nights (RACGP, 2014).
- Safe sleep in the first months and a clinician's view when something worries a parent keep priority (NHS, 2025).
Sources
- Archives of Disease in Childhood · Improving infant sleep and maternal mental health, cluster randomised trial (Hiscock et al.) (2007)
- Pediatrics · Long-term mother and child mental health effects of an infant sleep intervention (Hiscock et al.) (2008)
- Pediatrics · Five-year follow-up of harms and benefits of behavioral infant sleep intervention (Price et al.) (2012)
- Pediatrics · Behavioral interventions for infant sleep problems, randomized controlled trial (Gradisar et al.) (2016)
- Canadian Family Physician · Infant sleep training: rest easy? (Korownyk & Lindblad) (2018)
- Sleep Health · Effects of psychosocial sleep interventions on infant sleep and maternal mood, meta-analysis (Liu et al.) (2023)
- Infant and Child Development · Behavioural interventions for problematic infant sleeping and cry/fuss behaviour, systematic review (Stanzel et al.) (2025)
- Sleep Medicine · Behavioral sleep interventions in children aged 0-5 years, systematic review (Pétrin et al.) (2026)
- RACGP · Behavioural intervention: infant sleep problems and maternal mood (HANDI) (2014)
- NHS · Helping your baby to sleep (2025)
- HealthyChildren.org (AAP) · Getting your baby to sleep (2024)