Sleep Training 101: The Ferber Method
Unless you live under a rock, you've certainly heard of the Ferber Method. But, guess what? The Ferber method wasn't invented by Dr. Ferber. It's actually a well-established behavioral approach that is used by psychologists to modify behavior in many different scenarios. Guess what else? The Ferber Method isn't actually what people call "cry it out." It certainly involves crying, but it doesn't involve leaving your child alone in a room until morning (that's extinction and is the subject of another post!). This post walks you through the science behind the method and how to do it. Other posts in this series cover in-room sleep training, non-sleep training approaches, and baby-led sleep training. Be sure to join our mailing list so that you know when they are posted!
The Science
The Ferber Method is actually a technique called "graduated extinction." It's also called "controlled crying" by some researchers. The method is based on "extinction" which is the elimination of an unwanted behavior by removal of reinforcers. Simply put, extinction means that you take away whatever the source of the unwanted behavior is cold turkey.
Graduated extinction is a variation of extinction that involves the slow withdrawal of a reinforcer to change behavior. It was tested as a sleep training approach in several studies when it became clear that many parents felt uncomfortable with extinction (i.e., cry it out). In the case of sleep training, graduated extinction means spending less and less time with your child night after night so that your little one adapts to not having you present for falling asleep or for night wakings.
Graduated extinction has been tested in a few randomized controlled trials. A randomized controlled trial is a gold-standard method for assessing the impact of an intervention. Most studies have found positive impacts using graduated extinction, with reductions in the time that it takes a child to fall asleep, as well as the number and duration of night wakings.
Notably, a survey of families in Canada found that half of those who tried this method were not successful in implementing it. The researchers speculate that this may be because parents are sleep training babies who are too young or because parents are inconsistent in their response when they try to implement a sleep plan without the help of a professional. We find that many parents start sleep training out of desperation, without first having a plan for how to adjust their child's schedule, sleep environment, and feedings. Diving in without a thoughtful plan can lead to disaster!
How does the Ferber Method work?
This method involves putting your child down awake and aware, leaving the room, and returning to offer comfort intermittently. There are many different schemes for how often to return to provide consoling. A common approach is to return after 2, 4, and 6 minutes, repeating every 6 minutes until your child falls asleep. Notably, there is no magic formula for how often to "check in." You could return after 5, 10, or 15 minutes, or every 5 minutes, or at some other frequency that feels good to you. You would repeat the method for night wakings (but PLEASE do not sleep train through hunger! See this blog to organize your baby's feedings first).
Technically, you can do the Ferber Method for naps, but we rarely recommend it when we work with families during consultations. Coming in and out of the room when the sleep drive is weak during the day can sometimes prevent a baby from falling asleep.
How long does the Ferber Method take?
It typically takes 40-60 minutes for a child to fall asleep at bedtime and at least once overnight on the first 3-4 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 1-2 weeks to reach complete resolution of sleep problems, although the hardest nights should be limited to the first week.
What age is it appropriate to use the Ferber Method?
The studies that have been done only evaluated babies over six months. As a result, we don't recommend sleep training under six months, unless your pediatrician has explicitly said that it's ok. If you do sleep train before six months, then please consider a phased approach, only working on one aspect of sleep at a time (e.g., start with bedtime only) to minimize your baby's sleep loss.
When babies go through a phase of separation anxiety, typically between 8-10 months, watching a parent leave the room can be stressful. This method could lead to more crying in babies who are in the midst of strong separation anxiety because the method requires you to do the exact thing that causes a stress response.
What else should you know?
We find that most parents find the Ferber Method to be a reasonable "middle-of-the-road" approach. However, you shouldn't use this approach if you don't feel you can implement it consistently. Our class offers four different approaches to sleep training, including a version of the Ferber Method that we call 'check and console,' but it also includes other options that allow you to stay in the room with your child or stay out of the room if you think that's a better fit. We designed it so that you could understand each option and pick the strategy and implementation approach that best suits your situation.
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 'Check and Console' guide. It's only $10, it's a quick focused read 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.
You should also know that you may have to do "reminder" sleep training after travel or illness if your baby re-develops sleep associations.
References:
Hiscock, H. and Wake, M., 2002. Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. Bmj, 324(7345), p.1062.
Gradisar, M., Jackson, K., Spurrier, N.J., Gibson, J., Whitham, J., Williams, A.S., Dolby, R. and Kennaway, D.J., 2016. Behavioral interventions for infant sleep problems: a randomized controlled trial. Pediatrics, 137(6).
Sadeh, A., Juda‐Hanael, M., Livne‐Karp, E., Kahn, M., Tikotzky, L., Anders, T.F., Calkins, S. and Sivan, Y., 2016. Low parental tolerance for infant crying: an underlying factor in infant sleep problems?. Journal of sleep research, 25(5), pp.501-507.
Honaker, S.M., Mindell, J.A., Slaven, J.E. and Schwichtenberg, A.J., 2021. Implementation of infant behavioral sleep intervention in a diverse sample of mothers. Behavioral Sleep Medicine, 19(4), pp.547-561.
Lawton, C., France, K.G. and Blampied, N.M., 1991. Treatment of infant sleep disturbance by graduated extinction. Child & Family Behavior Therapy, 13(1), pp.39-56.
Loutzenhiser, L., Hoffman, J. and Beatch, J., 2014. Parental perceptions of the effectiveness of graduated extinction in reducing infant night-wakings. Journal of reproductive and infant psychology, 32(3), pp.282-291.
Todd, T.P., Vurbic, D. and Bouton, M.E., 2014. Behavioral and neurobiological mechanisms of extinction in Pavlovian and instrumental learning. Neurobiology of learning and memory, 108, pp.52-64.