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MarionSleep help for families

Controlled crying

Presented neutrally: what it does, what it does not do, and why many parents decline.

The short version

  • Six months and above. That is the firmest point in this area, and this page neither recommends the method nor condemns it.
  • Avoid it if your child has a history of seizures or behaviour that may cause harm. Deal with pain, illness, hunger, itching or fear first.
  • Choosing not to use it costs nothing in the long run: the best long-term follow-up found no lasting benefit. Gentler methods reach the same place.
  • If you use it: agree an interval, go in briefly only to check, no picking up or routine, then leave, wait and repeat.
  • It reliably helps with settling, but works no better in the long run than gentler methods. Stopping is a legitimate decision, not a lapse.

The rest of this page explains where this comes from. You do not have to read it tonight.

About 6 minutes to read

5. Controlled crying, or graduated extinction

The most argued-about method in children's sleep, set out neutrally. We are neither recommending it nor condemning it.

What it is. Parents ignore bedtime crying for set periods, either on a fixed schedule (say every five minutes) or at progressively longer intervals, going in briefly at the end of each to check for about 15 seconds to a minute. It differs from unmodified extinction, or cry it out, where parents do not go in until morning while still monitoring for illness or injury.

Age: six months and above. The firmest point in the area. Douglas and Hill's 2013 review concluded these interventions should be avoided under six months. BASIS notes that of 19 extinction studies reviewed only two included babies under six months, and that those found outcomes small or non-existent, with no significant impact on sleep and effects that wore off within weeks.

Cerebra's protocol:

  1. Agree a starting interval Two minutes is common. Agree it in advance, with your partner if you have one.
  2. At the interval, go in briefly Only to check they are all right and say it is time to go back to bed.
  3. No physical interaction, music, or any part of the routine The check is a check, not a restart.
  4. Leave, wait, repeat Same interval, same brief check.
  5. Start on a Friday The first night can be long.
  6. Increase the interval the next night Two minutes to four, for example.
  7. Continue until bedtime crying reduces A gentler version starts at one minute and adds 30 seconds a night; Gradisar's 2016 trial used 2, 4 and 6 minutes escalating within one night.

Expect it to get worse before it gets better: the literature calls this a post-extinction response burst and treats it as expected.

When Cerebra says not to use it

Avoid this method if your child shows challenging behaviour that may harm them, someone else or the environment, or has a history of seizures. Cerebra recommends bedtime fading instead. In every case deal with physical discomfort or emotional distress first: pain, illness, hunger, itching and fear are not settling problems and will not respond to a settling method.

Evidence that it works. Over six months it does work for settling and night waking in the short term. The 2006 review of 52 studies covering more than 2,500 infants and toddlers found 94 per cent (49 of 52) reported clinically significant reductions in bedtime resistance and night wakings, no study reported detrimental effects, and on average 82 per cent of children improved, with a range of 10 to 100 per cent. Graduated extinction alone accounted for 14 studies and 748 participants, all positive.

What that evidence does not show. Two findings are routinely left out of summaries, and you should have them. In Hiscock and Wake's 2002 BMJ trial of 156 mothers of infants aged 6 to 12 months, sleep problems resolved in 53 of 76 against 36 of 76 controls at two months (P = 0.005), but by four months the difference was no longer significant (P = 0.26). And the 2022 meta-analysis in Scientific Reports, pooling 10 randomised trials across ages 0 to 36 months, found real effects on overall child sleep problems and on maternal sleep quality, but no significant effect on the number of night awakenings (p = 0.10) and none on maternal depression (p = 0.33). So the method reliably helps with settling, and the case that it delivers more sleep or a happier parent is weaker than it is usually made to sound.

The rest of the numbers, including study quality

Quality. Only eight of the 52 studies (15 per cent) were the highest grade of randomised trial, and only three of 34 extinction studies followed children beyond 12 months.

Hiscock and Wake, the rest of the detail: among mothers scoring above 10 for depression, sleep problems resolved in 26 of 33 against 13 of 33 (P = 0.001) at two months.

The 2022 meta-analysis, exact figures: child sleep problems odds ratio 0.51 (0.37 to 0.69, p less than 0.00001); maternal sleep quality mean difference minus 1.30 (p less than 0.00001); child night awakenings minus 0.17 (p = 0.10); maternal depression minus 0.22 (p = 0.33).

What happens in the long run. Price and colleagues followed 326 children five years on, in Pediatrics in 2012. Every measure was non-significant: emotional behaviour, conduct, sleep problems (9 per cent against 7 per cent), salivary cortisol (28.8 per cent against 21.7 per cent), closeness between child and parent, attachment, and maternal depression, anxiety and stress. Their conclusion: behavioural sleep techniques have "no marked long-lasting effects (positive or negative)". They noted that 31 per cent were lost to follow-up and that disadvantaged and non-English-speaking families were underrepresented among those retained. Gradisar and colleagues, also in Pediatrics, followed 43 infants aged 6 to 16 months: sleep improved, salivary cortisol showed small to moderate declines against controls, and at 12 months there were no significant differences in emotional or behavioural problems and none in secure against insecure attachment. That study is often cited as if it settled the attachment question. Forty-three infants is a small sample, and it found no difference in a small sample.

What critics say. Douglas and Hill found that interventions in the first six months have not been shown to reduce crying, prevent later problems or protect against maternal depression, and made three criticisms of the field: feeding difficulties not treated as confounders, the two halves of infancy not distinguished, and overly simplistic analyses. They flagged potential harms including increased crying, premature cessation of breastfeeding, worsened maternal anxiety, and increased risk of sudden infant death where room separation is recommended. BASIS states that "evidence that sleep training actually helps babies to sleep better or longer is scarce", flags publication bias, and reports a 2012 study by Middlemiss in which babies had stopped crying but their cortisol remained high, read as their having stopped signalling distress. The cortisol literature is contested: Gradisar and Price measured it and found declines, or no difference. All three are reported here because that is the honest picture. UNICEF UK Baby Friendly's stated position is that controlled crying is not recommended: they say it can be distressing for parents and baby, detrimental to growth and development, and can undermine breastfeeding. That is their position rather than a UK-wide consensus, and other NHS services do offer the method. Sleep Action in Scotland offers gentle step-by-step strategies without cry-it-out methods at all.

If you try it and cannot do it

You are in large company, and you have not failed. The 2006 review says the major drawback is that it is stressful for parents, and that many are unable to ignore crying long enough for it to be effective. In one recent trial, 26 of the 91 families randomised discontinued or did not complete the post-treatment assessment, mainly because of difficulty sticking with it.

Stopping is a legitimate decision, not a lapse in consistency. And this should take the pressure off entirely: choosing not to use this method costs nothing in the long run, because the best long-term follow-up found no lasting benefit either. Gentler methods reach the same place more slowly.

How long, and who it may not suit. Cerebra's honest summary: it may be quicker, sometimes only a few days, but may be harder in other ways. Not for babies under six months, nor where the contraindications above apply. Flats and shared housing can make sustained crying unworkable. And if you are on your own at night there is nobody to take a turn, which makes this harder than the research protocols assume.

Where this comes from

  • NHS, Helping your baby to sleep, the bedtime routine sequence and the note on excitement before bed.
  • The Sleep Charity, Bedtime routines, the timed routine, "consistency is key" and the two-week rule.
  • NHS Lothian, Graduated withdrawal (PDF), the six stages, the pacing and the "boring parent" instruction.
  • East London NHS Foundation Trust, Sleep Basics (PDF), the camping out protocol including "start where you are", and the warning about abandoning a technique halfway.
  • Cerebra, Sleep: A Guide for Parents (PDF, version 4, October 2025), "choose whatever works for you", the controlled crying and bedtime fading protocols, the contraindications, the autism routine change, the sleep diary columns and "this is normal, keep going".
  • Newcastle Hospitals NHS Foundation Trust, sleep information for parents of babies aged 0 to 12 months: responsive settling, and falling asleep during a feed or while held.
  • Mindell et al. 2009, Sleep 32(5):599-606, the randomised trial of bedtime routines in 405 mothers.
  • Mindell and Williamson 2018, the dose-dependent pattern across 10,085 children.
  • Mindell et al. 2006, the American Academy of Sleep Medicine review: 52 studies, the 82 per cent average improvement, the classification of methods, and the comparisons finding no difference in long-term efficacy.
  • Hiscock and Wake 2002, BMJ, and Hiscock et al. 2007: the controlled comforting and camping out trials, and the loss of significance at four months.
  • Meta-analysis of behavioural sleep interventions, Scientific Reports 2022, 10 randomised trials, including the outcomes that were not significant.
  • Price et al. 2012, Pediatrics 130(4):643-651, the five-year follow-up of 326 children finding no marked long-lasting effects, positive or negative.
  • Gradisar et al. 2016, Pediatrics 137(6), 43 infants, cortisol and attachment at 12 months.
  • Douglas and Hill 2013, systematic review, the case against intervention under six months.
  • BASIS, Sleep training, the critique of the evidence base and the Middlemiss cortisol finding.
  • UNICEF UK Baby Friendly, their stated position that controlled crying is not recommended.
  • Trial report, 26 of 91 families discontinuing or not completing.
  • Pinilla and Birch 1993, Pediatrics, the 26-parent focal feed study.
  • Scope, Keeping a sleep diary, the practical tips and why memory is unreliable when you are sleep deprived.
  • Sleep Action, Scotland, gentle strategies without cry-it-out methods.

Last checked 1 August 2026. This page is general information, not medical advice. If you are worried about your child, speak to your health visitor or GP.