Sleep training 101: Pick-up-put-down
If you've ever been awake and googling in the middle of the night while trying to get your baby to sleep you may have come across a sleep training method called "pick-up-put-down" or PUPD. Many parenting books and resources have described this method, but the most famous description (and the first we could find) is in Tracy Hogg's book "Secrets of the Baby Whisperer." Just like the Ferber Method and Camping Out, the "Pick Up Put Down" technique is grounded in behavioral psychology principles and has gained popularity among parents seeking solutions for their little one's sleep challenges. As with all sleep training methods, we find that it only works for babies at specific stages and for certain parenting styles.
This post is part of our Sleep Training 101 series. The purpose of this post is not to endorse this method but simply to provide you with information about it so that you can make informed decisions about your child's sleep. Join our mailing list and follow us on Instagram to get an update each time we publish a new blog in the series.
The Science
Pick-up-put-down is a hybrid between graduated extinction (e.g., Ferber Method and Camping Out) and attachment theory methods (i.e., baby-led sleep training). It is a high-soothing sleep training approach that involves providing comfort and reassurance to your baby during the sleep training process. Instead of leaving your baby, the pick-up-put-down method involves alternating between picking your baby up for soothing and putting your baby down awake in the crib.
Research on the effectiveness of the pick-up-put-down method is limited compared to more widely studied techniques like the Ferber Method. One paper suggests that responsive interventions can be quite effective but the techniques tested in that paper are a bit different from the classic PUPD approach described by Tracy Hogg (Blunden and Dawson 2020).
The absence of scientific evidence supporting this method doesn't mean you shouldn't consider it, but it can make it hard to know what to expect without a study to benchmark against. The rest of this post describes our practice-based experiences with this approach from working with thousands of families. While this isn't scientific evidence, we hope it will provide you with a balanced assessment to help you determine whether this approach might be a good fit for you and your baby.
How Does the "Pick-Up-Put-Down" Method Work?
Implementing the pick-up-put-down method involves a fluid approach aimed at gradually teaching your baby to fall asleep without your help.
Here's how it works:
Make sure your baby's schedule is appropriate for his/her age.
Establish a calming bedtime routine to signal to your baby that it's time for sleep.
Put your baby down in the crib while still awake.
If your baby starts to cry, pick your baby up and offer comforting reassurance until your baby calms down.
Once your baby is calm, gently place your baby back in the crib.
Repeat the process as necessary, picking up and comforting your baby each time your baby cries, until your baby falls asleep independently in the crib or bassinet.
It's important to maintain consistency and patience when using the pick-up-put-down method. You should always put your baby down awake because your baby could get very confused falling asleep in your arms after being put in the crib awake over and over again. In addition, your baby may startle when put down after falling asleep in your arms. This can be very upsetting and fuel your baby to be awake for much longer than normal (like hours!). We find that this approach can actually make sleep worse when a baby falls asleep in a parent's arms, even if it's just a microsleep.
What Age is Appropriate for the Pick-up-put-down Method?
While there's no strict age limit for using the pick-up-put-down method, we find that it's a good approach for babies between four and six months who may be in the middle of the four-month sleep regression but who aren't ready for more structured sleep training. We recommend only working on bedtime to start in this age range because the sleep loss that comes with sleep training can be stressful for little ones.
If you decide to implement this approach overnight, do it after your baby has learned to fall asleep independently at bedtime. Also, please remember that it is normal for a four-month-old to wake up 2-3 times overnight to eat. Check our age-by-stage sleep chart to make sure your expectations are reasonable before you start any overnight sleep intervention. Once you've determined how much your baby needs to eat overnight, be sure to organize your baby's night feeding before you work on nights. You should not sleep train through hunger.
We also find that this approach works well for babies over 12 months old. If you opt to use this approach for your older baby or toddler, it's ok to work through the whole night as long as you are sure that your child doesn't need to eat overnight. Most children over 12 months won't need night feeding, but ask your pediatrician if you aren't sure about whether your baby is ready. Know that this approach can be quite hard, if not impossible, to implement for some older toddlers who may hold tight to a parent when being put in the crib.
This approach can also be quite effective for naps but we recommend that you work on naps only after your baby is sleeping well at night.
We find that this approach doesn't work very well for night sleep for babies between 6-12 months. That's not to say that it can't work, but babies in this age range are learning cause and effect. We find that this translates into learning to cry to get picked up for some babies. This can result in constant crying, even when soothed in a parent's arms. As you can imagine, that is a terrible experience!
As always consult with your pediatrician before beginning any sleep training regimen to ensure it's appropriate for your baby's age and development.
How long does pick-up-put-down take?
It typically takes 40-60 minutes for a child to fall asleep at bedtime for the first 4-5 nights. If you implement overnight, expect that your baby will be awake for 40-60 minutes at least once over the first 4-5 nights of implementation. However, toddlers can stay awake for 2-3 hours simply because they have a stronger capacity to stay awake compared with babies.
It typically takes 1-3 weeks to reach complete resolution of sleep problems, although the hardest nights should be limited to the first week.
What else should you know?
If your baby is heavy or if you have back pain, this approach may not be possible for you to implement.
You should also know that you may have to do "reminder" sleep training after travel or illness if your baby re-develops sleep associations.
We find that most parents like the idea of this approach but we don't usually recommend it for babies between 6-12 months. If you know that you want to try this approach, but aren't sure how to handle feedings, schedules, and all of the other little details that are important for success, then you might like our Guide to the Four Month Sleep Regression. It's a short book that takes you through step-by-step guidance on how to build and implement this type of sleep training. We can also work with you to build a plan in a one-on-one consultation.
References:
Blunden, S. and Dawson, D., 2020. Behavioural sleep interventions in infants: Plan B–Combining models of responsiveness to increase parental choice. Journal of Paediatrics and Child Health, 56(5), pp.675-679.
Leslie, A.M. and Keeble, S., 1987. Do six-month-old infants perceive causality?. Cognition, 25(3), pp.265-288.
Träuble, B. and Pauen, S., 2011. Cause or effect: What matters? How 12‐month‐old infants learn to categorize artifacts. British Journal of Developmental Psychology, 29(3), pp.357-374.