One of the biggest parenting challenges anyone with an infant faces is the extreme lack of sleep due to the fact that babies, well, don’t. Rather, babies do sleep, but they don’t knock out for long stretches like we do. It’s no wonder online parenting groups are full of folks looking for quick and easy sleep training methods. Chief among them is the Ferber method. This form of sleep training is fairly well-known, but it’s also frequently misunderstood. Ferber method sleep training is not solely a cry-it-out (or “extinction” method) where a baby is literally left alone to cry without check-ins, but rather a modified version.
Much like co-sleeping and breastfeeding vs. bottlefeeding, sleep training, in general, is fairly controversial. Because it involves taking a parent’s needs and limitations into account (perhaps more than solely the baby’s needs), the Ferber method can incite just as much praise as it does anger. Here, several experts share what it is, how to do it and whether or not we even should.
What is Ferber method sleep training?
“The Ferber Method is a sleep training regimen in which parents teach their children to sleep on their own,” says Dr. Whitney Casares, pediatrician and author of the forthcoming book “Doing It All.” “Parents wait for progressively increased periods of time before checking on their children as they attempt to self-soothe.”
When using the Ferber method, parents settle their baby into their crib and leave the room. They then check in after a certain amount of time, but are discouraged from actually picking up their child to console them. The goal is for the child to learn how to self-soothe and ultimately get better rest.
Dr. Richard Ferber, well-known physician and director of The Center for Pediatric Sleep Disorders at Children’s Hospital Boston, first detailed his Ferber method of sleep training in 1985 in his book “Solve Your Child’s Sleep Problems,” explaining how a graduated extinction method could help babies learn to self-soothe and sleep better. An expert in the field of sleep and sleep disorders, his book was targeted to exhausted parents whose babies were having a difficult time with sleep.
How does the Ferber method work?
The idea is that babies need consistency in order to change their behavior. According to Dr. Ferber, if a parent no longer rocks, sings or otherwise soothes their child to sleep, they will eventually forget about the old way in which they were put to bed, and instead recall this new way of getting to sleep.
The Ferber method involves graduated extinction, or progressively longer periods, between check-ins, says Dr. Elizabeth Cilenti, internal medicine physician and pediatrician. She explains that on day one, a parent would check in on their child at the three-minute mark. Then, they would check-in again in five minutes. Then, 10 minutes.
“All of those intervals get longer on each successive day, and sometimes that additional structure and guidance for parents really helps them to feel like they have a framework for sleep training and have a plan that they can implement,” says Dr. Cilenti.
For quick reference, you’ll eventually have a “check-in” schedule that might look similar to this:
- Day 1 – 3 min (1st interval); 5 min (2nd interval); 10 min (3rd interval); 10 min (remaining intervals)
- Day 2 – 5 min; 10 min; 12 min; 12 min
- Day 3 – 10 min; 12 min; 15 min; 15 min
- Day 4 – 12 min; 15 min; 17 min; 17 min
- Day 5 – 15 min; 17 min; 20 min; 20 min
What age is appropriate for this method?
Dr. Casares and Dr. Cilenti both say it’s recommended to wait until your baby is at least 4 months, if not older, to attempt the Ferber method of sleep training.
“Factors like prematurity can also influence when initiating any type of sleep training is appropriate,” says Dr. Casares. “Your child’s pediatrician can also ensure starting sleep training is safe for your child based on their feeding and developmental progress.”
While there’s no age that’s too old to begin sleep training, it is generally harder the older they get, says Dr. Clienti.
However, some experts disagree on Ferber method sleep training this early — or at all.
“When we talk about the research on sleep training, it was mostly conducted on older babies and toddlers,” says Macall Gordon, researcher, certified pediatric sleep consultant and co-author of the upcoming book “Why Won’t You SLEEP?! A Game Changing Approach for Exhausted Parents of Nonstop, Super Alert, Big Feeling Kids.” “We know virtually nothing about using Ferber with very young infants.”
And yet, Gordon points out that Ferber has been increasingly recommended for very young infants (under 6 months and, in some cases, as early as 8 weeks). She believes this is because many “experts” and authors are telling parents they “have” to sleep train or else their child may experience issues later that range from ADHD and obesity to learning and behavior problems.
“Authors suggest that if parents don’t act quickly, it will be virtually impossible to shift. Right out of the gate, these parents are already worried that they’re screwing up,” she says.
But Gordon asserts there’s actually no evidence that there’s any benefit to starting sleep training early or any problem with waiting until 6 months or older. And while she acknowledges Ferber works for some, she prefers the Sleep Lady method, which offers a much more gentle approach to sleep training. This entails putting your baby down to sleep while they’re drowsy and sitting next to them, holding their hand or otherwise gently touching them until they fall asleep (and comforting as needed whenever they’re distressed). After a while, you move your seat further away as they fall asleep until eventually you can put them down, say goodnight and walk off sans tears.
Darcia Narvaez, a professor of Psychology Emerita at the University of Notre Dame, counters that babies need to have their needs met immediately until at least 18 months of age, including picking up and holding a child whenever they are distressed and always having someone staying by the child’s side. “If you don’t do that, you’re just stressing the child,” she says. “When you distress the child, you’re changing brain development.” Specifically, Narvaez points out that not meeting a baby’s needs immediately will increase the stress hormone cortisol, which in turn, compromises brain connections instead of fostering them.
How long does it take for the Ferber method to work?
The experts we spoke to have mixed views on how long Ferber takes to work, with some stating that it can take a few days to a week or so, or longer. What most agree on is that the length of time it takes for Ferber method sleep training to work depends upon a few factors:
It depends on when you begin sleep training
Elizabeth Hawkworth, an Indianapolis-based nanny of 25 years, with over a decade of experience in sleep training, has found that for the majority of babies she’s tried the Ferber method with, aged 5 months to a year old, began to cry less and self-soothe quickly enough to get to sleep about two to three days in.
This was also the case for Cayla Wiggs, a mother of two in Colorado who used a modified version of Ferber with her first baby at 4 months, with shorter intervals for check-ins, and then standard Ferber with her second at just 3-and-a-half months.
“It was extremely effective, and we saw results very quickly,” says Wiggs. “Even from the first couple nights, sleep quality noticeably improved for both kids. It took about a week for our first to fully adjust, and only a few days for our second.”
Ferber gets harder to implement with older babies due to separation anxiety, notes Hawkworth.
“With these babies, a combination of Ferber and other sleep training methods (like the chair method, pick-up-put-down and rocking to sleep and then transferring) was the kinder choice,” says Hawksworth.
It depends on the baby’s temperament
“Sleep has so much to do with the way children are wired,” says Gordon. “In research, [Ferber method] often took weeks to work, and it still didn’t work for between 25 and 50% of the families in the study.
This is where she says a child’s individual temperament comes in, with mellower babies crying only a little (say, 15 minutes), while babies with a thinner sensory barrier or a super active brain waking up more and crying for hours.
It depends on consistency
Implementing the Ferber method improperly, which usually stems from a lack of consistency due to parents struggling with hearing their baby cry, can lead to split nights, broken sleep, a chronically overtired child and anxiety for the child and the parents, says Hawksworth. “If you’re going to sleep train, you need to stick it out or quit and try again at least a month later,” she says. “Going back and forth within a short time period is confusing for the child and nerve-wracking for everyone involved.”
“If you’re going to sleep train, you need to stick it out or quit and try again at least a month later. Going back and forth within a short time period is confusing for the child and nerve-wracking for everyone involved.”
—Elizabeth Hawkworth, an Indianapolis-based nanny with over a decade of experience in sleep training
What are the advantages of sleep training?
Some of the advantages of sleep training include improved sleep as well as better mental health outcomes for parents, especially those who have less external support.
Improved sleep for parents
According to Dr. Cilenti, one of the advantages of sleep training (Ferber or otherwise) is better sleep for the parents. In fact, many parents turn to sleep training out of exhaustion and necessity, due to a lack of outside support. Many parents lack sufficient (or any) parental leave, and many cannot afford to take unpaid time off. It tracks, then, that many of the advantages of sleep training revolve around the needs of the parents, and around the need to sustain the household on the whole. If a baby is finally sleeping for longer stretches of time, parents will also enjoy the benefits of sleeping for longer periods as well.
Better mental health outcomes for parents
Dr. Cilenti also says another advantage of sleep training is less general stress and improved parental mental health. Postpartum depression occurs in about 6.5% to 20% of birthing parents while postpartum anxiety affects 6-10%, and some studies show that a lack of quality sleep can exacerbate such conditions.
“While in the short-term, it can be very stressful to listen to a baby crying, helping a baby to learn how to self-soothe and how to fall back asleep on their own is a really valuable skill for babies in the long- term,” she says.
Parents in the US often have little to no outside help, and those with a greater risk of developing postpartum mood disorders may then benefit most from using Ferber method (or other sleep training methods). This could ensure the parents are better able to care for themselves and their child.
This was the case for Rebekah Parr, mother of three in Central Florida and founder of Two Mama Bears, who says she used a slightly modified version of the Ferber method. “I’ve had mental health struggles postpartum, and the cry it out method was just not something I could handle mentally,” explains Parr. “The stress and anxiety it gave me, plus the fears that come with being a new mother and screwing things up, was not worth it. The Ferber method was the perfect way to help my daughter learn to self-soothe without me losing it mentally.”
“We don’t technically know how much crying is OK. We don’t really know if there is an upper end that parents should be mindful of and whether that varies by the age of the infant.”
—Macall Gordon, certified pediatric sleep consultant
What are the disadvantages of Ferber sleep training?
Some of the disadvantages of Ferber sleep training include inconclusive data on the long-term effects on the child and that it may take longer than other cry-it-out methods.
It may take longer than expected or hoped
“The Ferber Method may take longer than other cry-it-out methods, making it more challenging for parents to persist with the method,” says Dr. Casares. Indeed, while there is no conclusive data that Ferber will take longer or shorter, parents hoping for a quick fix may end up disappointed in how long it takes (or even find it doesn’t work for their particular child’s sleep issues).
“Other sleep training methods (like slowly moving yourself further and further away from your baby over a series of nights) can take three to four days or so to work, but all babies are different,” adds Dr. Casares.
The data about long-term effects is still inconclusive
Additionally, experts agree that the data is inconclusive when it comes to the long-term effects of sleep training on children. Some see this as a reason to continue to use the Ferber method, while others view it as sufficient reason to avoid it or at the least, try other methods that don’t involve crying.
“We don’t technically know how much crying is OK,” says Gordon. She points out that studies that have looked at the existence of side effects were conducted on older babies/toddlers and never reported how much crying occurred. “We don’t really know if there is an upper end that parents should be mindful of and whether that varies by the age of the infant,” she notes.
Some point to a study published in the Journal of the American Academy of Pediatrics to prove that there no harm is done when using sleep training methods like Ferber, points out Narvaez. The study looked at a sample of over 200 children with parent-reported sleep problems (a portion of which received behavioral infant sleep interventions aka sleep training at around 8-10 months of age via individual nurse consultations) and then followed up with them 5 years later to see if there were any marked differences between the two groups. The study found that there were no marked long-lasting positive or negative effects.
But Narvaez explains that others view the study as flawed, with critics in the study’s comments pointing out that less than half of the parents who received the consultations actually committed to the interventions. “The child might look like they’re going to sleep, but there is stress,” she says.
She says the parasympathetic system (part of the autonomic nervous system, which is in charge of processes like blood pressure, heart rate, and digestion, and which also helps the body relax after moments of stress or danger) shuts down because it eventually realizes that crying out for help and comfort no longer works. “You’re putting children into a survival system mode,” she says.
Additional considerations about using Ferber method
When making a decision like sleep training, Dr. Casares says parents should pay close attention to the needs of their individual child
“Children who have known or suspected severe medical issues (for example, cardiac or breathing concerns) should consult with their child’s pediatrician before initiating any sleep training regimen to make sure that it is safe and appropriate to do so,” she says.
Furthermore, parents should keep in mind the possibility of things like developmental delays and disabilities prior to starting any form of sleep training. “If parents are worried that there’s a suspicion of a delay or disability, that’s something to discuss with your pediatrician who may be able to give you guidance on how to best handle sleep challenges that come up,” notes Dr. Casares.
Developmental delays and disabilities aren’t always apparent in the first few months of age, however, which means parents may opt to wait longer than the recommended four to six months to sleep train their baby.
The bottomline
Like all parenting decisions, opting to use the Ferber method or another form of sleep training is something that needs to be considered carefully. The Ferber method (and sleep training in general) is not the norm in other parts of the world, so your cultural background may also be a factor in the decision making process. But there’s more to it, including how much support you have overall and how you view the current data (or lack thereof) on the Ferber method’s efficacy, benefits and drawbacks.
If you do decide to sleep train, Dr. Casares recommends factoring in:
- Your child’s circumstances (including medical history, growth trajectory, and sleeping patterns)
- Your family needs
- Your preferences (such as a parent’s views on sleep training overall and the various methods, as their level of anxiety around sleep training and level of sleep deprivation can affect the overall process of sleep training)
Most importantly, parents should consider the information they have, and their resources, as well as what other options (like other forms of sleep training, or finding other ways to help the baby sleep, such as co-sleeping, or even hiring additional help such as a nanny) may be available to them.
“Ferber does work for some children and some families, but it’s not the only option,” says Gordon. “We need to let parents know the real data on this method so they can make an informed choice and that there are alternatives if it hasn’t worked for them.”
