QUESTION: Do sleep training methods have long term impact on toddlers? How will all this crying impact them in the long run?

Our Quick Take: No Harm, But New Tactics

• It is normal for toddlers to regress and wake up at night, even after successful sleep training as an infant. We explain more below, but rest assured that you are not alone in this endeavor.
  
  
• Toddler sleep training guidance often emphasizes how their cognitive development, compared to an infant, changes the game. The good news is that you can explain the rules to them, and they’ll actually understand. The bad news is that, as you already know, they can manipulate parents to get what they want 😉
  
  
  • Given that ability to communicate and comprehend, many experts emphasize the importance of establishing bedtime rules, explaining them clearly before you begin sleep training, enforcing them consistently, and offering small rewards if needed.
    
    
  • See below for an overview of expert tips on toddler sleep training.
    
    
• There is no scientific evidence of harm from sleep training, though the research doesn’t study the “extinction” method (i.e., not responding at all.) Instead, it is often looking at a spectrum of sleep training that includes “graduated extinction.” More details on that below.
  
  
• Given toddlers’ ability to understand and respond to bedtime rules, you might consider the following:
  
  
  • Announcing a new bedtime rule that you will come visit once in the middle of the night to make sure everything is okay if the child calls out, but you won’t return after that.
    
    
  • For every day that there is no (unnecessary) nighttime wake-up, the child gets a star sticker the next morning as a reward.
    

The Details: How to sleep train a toddler.

You aren’t alone.

There is a lot more info out there on sleep training for infants, but that doesn’t mean toddlers and preschool-aged children don’t have a tough time falling asleep.

In fact, it is quite common, especially waking up in the middle of the night. One study found that 25 to 50% of toddlers wake up during the night, and another large study found up to 20% of preschool and young elementary school children have insomnia.

It works.

The good news is that several different “behavioral interventions” have been shown to work very well for children. Those behavioral interventions include things like…

• Having a regular bedtime routine
• Making sure naps and bedtime are scheduled to encourage nighttime sleep
• Systematically ignoring requests for parents (i.e. extinction and graduated extinction)

A scientific review found that 94% of 52 different studies reported these approaches were effective. They did not find any detrimental effects, and several found positive effects, like less crying or irritability.

Here are the details on two major studies that found there are no detrimental effects related to sleep training:

• A long-term, randomized study of nearly 200 families examined the effects of graduated extinction sleep training compared to a control group. (Note: They did not look at the pure extinction method.) After five years, they found no difference in the emotional health, the children’s relationship with parents, or measured stress levels.  
  
  
• Another study had 43 infants and parents using graduated extinction method, a gradually changing bedtime, or a control group that just got general sleep education. To evaluate stress, they measured the babies’ cortisol levels during the sleep training period and 12 months later, in addition to surveying parents and observing child’s attachment to parents. They found no evidence of increased stress or long-term effects on the child’s attachment to parents or their emotional health from either sleep training practice.

The right sleep schedule.

One of the first steps to helping your toddler sleep through the night is making sure they are sleeping the right amount. If they are getting too much sleep from naps, it could explain why they are waking up at night. Alternatively, some experts say too little sleep makes it harder for them to sleep through the night as well. And some recommend at least four hours between sleep periods.

The American Academy of Pediatrics recommends the following amounts of sleep for each age group:

• Infants 4 to 12 months: Sleep 12-16 hours per 24 hours (including naps)
• Children 1 to 2 years old: Sleep 11-14 hours per 24 hours (including naps)
• Children 3 to 5 years old: Sleep 10-13 hours per 24 hours (including naps)

Making a plan to ignore nighttime wake-ups, explaining it, and enforcing it.

If you have a bedtime routine down and the timing of naps and night sleep in place, then it’s time to turn to “systematic ignoring.” This encompasses everything from the “extinction” method, a.k.a. “cry it out,” to “graduated” extinction, which involves responding to the child’s cries briefly and returning at longer and longer intervals.

Both approaches have been shown to be successful, and it is important to keep in mind that there is no perfect or optimal way to enact these practices. Different tactics will work for different families, though research as shown that graduated extinction is easier to follow and less stressful for parents.

We’ve gathered up tips from experts below. They differ in some important ways, but the biggest consensus is around clearly explaining the new bedtime rule to a toddler and then consistently enforcing it. And while it can be very hard at the start, especially on nights two and three, generally children will improve after a week of consistent enforcement.

• Dr. Harvey Karp, CEO of SNOO: Recommends the “longer and longer” method, in which a parent lets the child cry for 3 minutes, and then briefly visits and assure them everything is fine. If crying continues, the parent returns after 5 minutes, then 10 minutes, then 15 minutes. Repeat until they are asleep. Karp notes that even if the child throws up (as some stubborn toddlers might!) make sure they are okay, clean up the mess, and then tell them everything is fine and leave the room.
  
  
•  Christine Stevens, Sleepy Tots: Stevens emphasizes that while toddlers are more set in their ways than infants, they are also better able to communicate. Which means parents can explain what the new rules are and why you won’t be sleeping with them in the middle of the night.
  
  
• Dr. Susan Zafarlotfi, Institute for Sleep and Wake Disorders at the Hackensack University Medical Center: If night wakings are a sudden development, Zafarlotfi recommends making sure there aren’t any big changes that could be affecting your child (i.e. a new bed or sibling) or ensure they aren’t teething or sick. If it is a habit, Zafarlotfi recommends pushing bedtime by 15 to 20 minutes to see if that helps. And then if they continue waking up, visit to soothe them briefly but then leave.
  
  
• Baby Sleep Site consultants: This group recommends outlining the new rules ahead of time, and then sticking to those rules. They also say to make sure your child isn’t aren’t getting too much sleep when you include naps. If they are over recommended amount of sleep (or toward higher end of the range), try reducing and/or putting them to bed later. And provide incentives, like stickers in the morning, if needed. Lastly, stay calm and consistent.
  
  
• Alanna McGinn, Good Night Sleep Site: Because toddlers are more advanced than babies, they need the expectations and rules outlined for them. She also recommends fewer check-ins with toddlers than with babies, since toddlers are better at manipulating parents. And lastly, she warns against transitioning to a bed until absolutely necessary (i.e. your toddler is able to get out of their crib.)
  
  

Methodology / Sources

We started researching this question in several medical and scientific research sources and journals, including PubMed, the American Academy of Pediatrics, and UpToDate.  We then used a structured Google search to find trustworthy media sources to gather additional information and parse what both experts and parents had to say on this question.

For more reading:

• AAP Supports Childhood Sleep Guidelines – HealthyChildren.org
• Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial | American Academy of Pediatrics (aappublications.org)
• Behavioral sleep problems in children – UpToDate
• Behavioral treatment of bedtime problems and night wakings in infants and young children – PubMed (nih.gov)
• Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep Intervention: Randomized Trial | American Academy of Pediatrics (aappublications.org)
• How to Sleep Train Your Toddler – Tips & Tricks – Happiest Baby
• How to sleep train your toddler (todaysparent.com)
• Medical complaints are more common in young school-aged children with parent reported insomnia symptoms – PubMed (nih.gov)
• Nighttime sleep-wake patterns and self-soothing from birth to one year of age: a longitudinal intervention study – PubMed (nih.gov)
• Sleep Training Science: Myths And Facts About How To Get Baby To Sleep : Shots – Health News : NPR
• Toddler Sleep Problems: Crying, Snoring, and Sleep Schedules (webmd.com)
• Toddler Sleep Training: 7 Tips and Tricks | The Baby Sleep Site
• Toddler Too Old To Cry It Out? Here’s What You Need To Know (romper.com)
  

Maternie Manifesto

Our mission is to get parents the best information out there on the many important questions they encounter when raising children.

Sometimes there are clear-cut solutions. But often there is no perfect answer, and what works for one child may not work for another. Experts can and will have differing opinions, just like families will have different experiences.

That contradictory information can create stress and make an already difficult decision even harder. That’s where we come in. We do the research for you, not only getting you science and evidenced-based information but explaining where there is–and isn’t–consensus among experts and parents.

Our greatest hope is that this information will give you greater confidence in your parenting journey, saving you time and sanity along the way 🙂