Ferber method

The Ferber Method is a set of steps intended to help infants and toddlers learn to fall asleep by themselves. It is also known as “graduated extinction,” the “cry it out method” or “Ferberization.” Intended for use with children between the ages of about six months and two years of age, the Ferber Method encourages parents to let their children settle down to sleep by themselves even if they cry. The parents do not immediately respond to the crying, provide limited consolation when they do return, and progressively extend the intervals of time before responding. The method was first proposed in 1985 and has since been met with some controversy.

Background

The method was proposed by pediatrician and author Richard Ferber, founder of the Center for Pediatric Sleep Disorders at Boston’s Children’s Hospital. In 1985, Ferber published Solve Your Child’s Sleep Problems, which proposed a seven-day method intended to train children to fall asleep on their own even if they cry when they are left alone. Ferber revised the book in 2006 to clarify the process.

According to Ferber, for children to learn to fall asleep by themselves—as opposed to while being actively held or otherwise engaged with the parent or caregiver—the child first needs to learn ways to self-soothe. Actions such as sucking on a pacifier or thumb would be examples of self-soothing. He proposed putting children to bed while they were still awake and allowing them to find a way to self-soothe, even if they cried. Limited parental soothing is allowed on a specific schedule. Ferber also suggested that parents not sleep in the same room or bed as their child because this hampers the child’s ability to learn to self-soothe.

Overview

In the Ferber Method, parents establish a soothing bedtime routine, including such things as giving the child a bath, reading a story or singing a lullaby. The child is then put to bed while sleepy but still awake, and the parent leaves the room. If the child begins to cry, the parent waits a specified amount of time before returning. For example, on the first night, this might be three minutes. The parent enters the room and soothes but does not pick up the child. This soothing can include gentle back patting or standing by the crib and speaking softly.

After a minute of this, the parent leaves again, even if the child is still crying. The parent then waits about five minutes before returning to again soothe the child. After another minute of soothing, the parent again leaves. If the child continues to cry or stops and restarts crying, the parent waits ten minutes before reentering the room. Ferber called this “progressive waiting.” According to the method, it teaches children that their crying does not result in any change in the situation. When they realize crying does not help, they find other ways to soothe themselves and learn to fall asleep on their own. The process is repeated for about seven nights, with longer intervals before the first soothing and later soothings until the crying ends altogether. For this reason, the Ferber method is also known as a graduated extinction method.

This process is similar to another method known as the camp-out method. In this version, the child is still allowed to cry with limited soothing, but the parent remains physically present in the room, possibly on a cot or air mattress. The parent gradually moves their bed farther away from the child until the child is falling asleep and sleeping alone.

Advantages

The Ferber method is intended for use with older infants and young toddlers who are otherwise healthy and simply have difficulty falling asleep on their own. Proponents say that it helps children learn to fall asleep within a short time, usually about ten minutes, and to go back to sleep on their own if they wake during the night. This allows both the child and the parent to get more sleep, reducing stress for both. Children who are “Ferberized” are said to be less prone to tantrums and better behaved, possibly because they are better rested. Parents also experience daytime benefits, including a lower likelihood of depression and family problems.

Counter-indications

There are some instances where this method is inappropriate, according to Ferber. It should not be used with children younger than four to six months, since they still need night feedings, have not yet developed regular sleeping patterns, and do not yet have the full ability to establish self-soothing behaviors. It should also not be used with children who have learned to be afraid when they are alone in their crib. Children who have been traumatized by being left alone will likely be further traumatized by a graduated extinction process.

It is also inappropriate for children who have developed a conditioned habit of vomiting when stressed. If a child without the conditioned vomiting response does happen to become upset enough to vomit during the sleep training process, the Ferber method advises cleaning it up with little fuss or interaction and then leaving the room, thus resuming the process. However, it is recommended that the process be discontinued if the child is actually ill and restarted when health has returned.

There are other situations in which the Ferber Method is not advised. These include children who experience nightmares or who have significant separation anxiety, children who have a sleeping disorder, children who snore or have other nighttime breathing disorders, and children who have any form of medical condition that might cause pain or nighttime discomfort. It is also not recommended for children who are having a problem going to sleep simply because their bedtime is too early.

Criticism

Critics say that being left to cry is cruel and creates feelings of abandonment and stress that can affect the child for life. Some point to studies that say blood pressure and cortisol levels are higher in children left to cry than in children who are comforted until they are asleep. Some parents also feel significant stress from listening to their child cry.

Some of this criticism is based on the misconception that the child is not comforted at all in the Ferber Method. Some of the studies that indicated higher cortisol level were also done in sleep labs, not in a familiar environment. Others note this is counter to the way humans have cared for their children for ages, and that humans are “wired” to care for a crying child, making this method unnatural.

Bibliography

Coukell, Allan. “Dr. Ferber Revisits His ‘Crying Baby’ Theory.” National Public Radio, 30 May 2006, www.npr.org/templates/story/story.php?storyId=5439359.Accessed 8 April 2019.

DeWar, Gwen. “The Ferber Method: What Is It, and How Does It Affect Babies?” Parenting Science, July 2017, www.parentingscience.com/Ferber-method.html. Accessed 8 April 2019.

“The Ferber Method Demystified.” Baby Center, 2019, www.babycenter.com/0‗the-ferber-method-demystified‗7755.bc. Accessed 8 April 2019.

“The Ferber Method Explained.” Parents, 2019, www.parents.com/baby/sleep/basics/the-ferber-method-explained/. Accessed 8 April 2019.

Gold, Tammy. “The Ferber Sleep Training Method - How to Implement It.” Huffington Post, 19 February 2017, www.huffpost.com/entry/the-ferber-sleep-training-method-how-to-implement‗b‗58a98cfce4b0fa149f9ac74b. Accessed 8 April 2019.

Iannelli, Vincent. “Ferber Method - Getting Kids to Sleep through the Night.” VeryWell Family, 12 Feb. 2018, www.verywellfamily.com/the-ferber-method-dr-ferbers-sleep-book-2634262. Accessed 8 April 2019.

Miller, Korin. “The Ferber Method Explained.” The Bump, 2018, www.thebump.com/a/ferber-method. Accessed 8 April 2019.

“Stress, Cortisol, and Getting Your Baby to Sleep.” Children’s MD, 13 May 2013, childrensmd.org/browse-by-age-group/newborn-infants/stress-cortisol-and-getting-your-baby-to-sleep/. Accessed 8 April 2019.