Birth to five

Your NHS guide to parenting in the early years

Common sleep problems in children

Lots of young children find it difficult to settle down to sleep, and they wake up during the night. For some people, this might not be a problem. If you're happy for your child to go to bed at the same time as you, that's fine.

But if you or your child are suffering from lack of sleep, you may like to try some of these suggestions. Every child is different, so do only what you feel comfortable with and what you think suits your child.

If your child won’t go to bed

  • Decide what time you want your child to go to bed.
  • Close to the time that your child normally falls asleep, start a 20-minute ‘winding down’ bedtime routine. Bring this forward by 5-10 minutes a week (or 15 minutes, if your child is in the habit of going to bed very late) until you get to the bedtime you want.
  • Set a limit on how much time you spend with your child when you put them to bed. For example, read only one story, then tuck your child in and say goodnight.
  • Give your child their favourite toy, dummy (if they use one) or comforter before settling into bed.
  • If your child cries, leave them for 5-10 minutes before going back in and settling them down again.
  • Don’t pick them up or take them downstairs. If your child gets up, put them back to bed again.
  • Leave a drink of water within reach and a dim light on if necessary.
  • If you keep checking to see if your child is asleep, you might wake them up, so leave it until you're certain that they're asleep.
  • You might have to repeat this routine for several nights.
  • If you try this, you will need to try to be firm and not give in.

If you child keeps waking during the night

By the time your child is six months old, it’s reasonable to expect them to sleep through most nights. However, up to half of all children under five go through periods of night waking. Some will just go back to sleep on their own; others will cry or want company. If this happens, try to work out why your child is waking up.

For example:

  • Is it hunger? If your child is a year or older, some cereal and milk last thing at night might help them to sleep through the night.
  • Are they afraid of the dark? You could use a nightlight or leave a landing light on.
  • Is your child waking up because of night fears or bad dreams? If so, try to find out if something is bothering them.
  • Is your child too hot or too cold? Adjust their bedclothes or the heating in the room and see if that helps.

If there’s no obvious cause, and your child continues to wake up, cry or demand company, you could try some of the following suggestions:

  • Scheduled waking. If your child wakes up at the same time every night, try waking them 15-60 minutes before this time, then settling them back to sleep.
  • Let your child sleep in the same room as a brother or sister. If you think your child may be lonely, and their brother or sister doesn’t object, put them in the same room. This can help them both sleep through the night.
  • Teach your child to get back to sleep by themselves. First check that everything is alright. If it is, settle your child down without talking to them too much. If they want a drink, give them water but don’t give them anything to eat. For this approach to work, you need to leave them in their cot or bed. Don't take them downstairs or into your bed. Let them cry for around 5-10 minutes before you check on them. Over the next few nights, gradually increase the amount of time you leave them before checking. It might take a week or two but if you keep the routine going, your child should start falling asleep on their own.
  • Tackle it together. If you have a partner, agree between you how to tackle your child’s sleeping problems. You don’t want to try to decide what to do in the middle of the night. If you've both agreed what's best for your child, it’ll be easier to stick to your plan.

Nightmares

Nightmares are quite common. They often begin between the ages of 18 months and three years. Nightmares aren’t usually a sign of emotional disturbance. They may happen if your child is anxious about something or has been frightened by a TV programme or story. After a nightmare, your child will need comfort and reassurance. If your child has a lot of nightmares and you don’t know why, talk to your GP or health visitor.

Night terrors

These can start before the age of one, but are most common in three and four-year-olds. Usually, the child will scream or start thrashing around while they’re still asleep. It usually happens after the child has been asleep for a couple of hours. They may sit up and talk or look terrified while they’re still asleep. Night terrors aren’t usually a sign of any serious problems, and your child will eventually grow out of them.

Don't wake your child during a night terror. But if they’re happening at the same time each night, try breaking the pattern by gently waking your child about 15 minutes beforehand. Keep them awake for a few minutes, then let them go back to sleep. They won’t remember anything in the morning. Seeing your child have a night terror can be very upsetting, but they’re not dangerous and won’t have any lasting effects.

Extra help with sleeping problems

It can take patience, consistency and commitment, but most sleep problems can be solved. If you’ve tried the suggestions on these pages and your child’s sleeping is still a problem, talk to your GP or health visitor.

They may have other ideas or may suggest you make an appointment at a sleep clinic, if there is one in your area. Sleep clinics are usually run by health visitors or clinical psychologists who are trained in managing sleep problems. They can give you the help and support you need.

In the meantime, if you’re desperate, try to find someone else to take over for an occasional night, or someone whom your child could stay with. You’ll cope better if you can catch up on some sleep yourself.

Coping with a disabled child

Some children with illnesses or disabilities may find it more difficult to learn to do things like sleep through the night or use a toilet. This might be linked to their medical condition or disability, and it can be challenging for them and for you. Contact a Family can provide information, suggest further sources of support and put you in touch with other parents who have faced similar problems.

Further information

Last reviewed: 18/08/2011

Next review due: 18/08/2013

Comments are personal views. Any information they give has not been checked and may not be accurate.

dunsmure said on 05 January 2012

It all boils down to whether your child is the most important thing in your life - or whether you are. If your child is more important, then you won't let them cry for 10 minutes without comforting them. Their needs are greater than yours. However if you're more important, and you can't accept the disruption that children bring to your life, then of course you'll ignore them, so they learn self-reliance, and 'normality' can be restored to your household. After all, it's your house, not theirs. So make your choice. Who's the centre of your life? You - or your baby?

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mumsboys said on 04 December 2011

This debate has spurred me on to register to this website as i feel there is a happy medium here. Our children need our guidance and patience in teaching them from right and wrong. I agree with slinkyhyena, we would much rather run the risk of making our child cry in order to steer them from danger than to be afraid of startling them and them possibly hurting themselves. Babies cry as a way of communicating and i dont think it is right to leave them to cry for long periods of time but the cc method is as it says "controlled" the babies arent in any danger and almost always after a week or so they stop crying and are contented in their new routine therefore it hasnt done them any harm. From personal experience, i tried the cc method with my eldest son and it worked, he is a very bright and happy boy with all the love he could ever ask for. i havent tried the cc method with my 9 month old son and he very rarely sleeps for more than 2 hours and always wakes up distressed and tired therefore i feel he is suffering because he hasnt managed to get himself into a good sleeping routine yet and this is after making sure temperature is ok, he isnt hungry etc he might need guidance like my son with the cc method. I understand where some people are coming from on here that it is dangerous but that is in extreme cases where children are maybe left in uncontrollable despair for long periods of time, any of us who are on reading professional advice are doing it because we care.

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aps1234 said on 02 December 2011

I used a cry-it-out method with my son. Would I do it again? I dont' know, but I will say that he would sleep well enough and then wake up elated--not just happy--elated. Do I think I psychologically damaged my son? No. I know there are studies that say it can damage a child. In angst, I began doing my own research because I was scared that I had done something to my son that I couldn't turn back. I am happy to conclude that I dont' think I damaged my son. In researching the issue--the problem was parents who let their children cry it out for long periods of time, and also parents who weren't loving during waking time or did other things that can damage a child's trust (hitting their children, belittling their emotions ("You're not hurt"). I think some crying is not going to damage a child. While I can appreciate how caring the mothers on here are in now allowing their child to cry it out, I think their making anyone feel badly about allowing their child to cry it out to some extent is blowing it out of proportion. This is merely my opinion. I was panicked that I had damaged my son. But in the end, I do not think I have. I treat him with respect. I have never spanked him, nor will I ever.

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PomiBex said on 01 December 2011

I think it's absolutely appalling that the NHS advocates cry it out and sleep training. A battery of research and studies have been undertaken into the lifelong biochemical brain damage inflicted when a baby/child is left of cry to extended periods of time. It's absolutely despicable that in this day and age children are still seen as not much more than an animal requiring domination and training. If a baby cries it's for a reason. I have never imposed any kind of routine on my daughter where she is isolated from the family - I treat her with the compassion and respect I expect from her and as a mother I attend to her needs. At two years old, she has slept through the night almost from day one and she only cries with good reason. I would like to see an adult treated in this way and not be affected by it.

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lizsmith1256 said on 01 December 2011

I have always stood up for the NHS and thought great service and advice, but after reading this I am embarrassed by it. Please rewrite this page. Awful awful advice :-(

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normalisecosleeping said on 01 December 2011

I am very sad that the NHS has decided to include controlled crying techniques as part of their advice. This is known to be psychologically damaging. Children naturally want to be with their parents at night - they have evolved to do so and it is the only reason we are a successful species. The child that didn't mind being left alone in the jungle would be the one that was eaten by tigers. Our babies cry because that is an effective survival method and their only means of communication. I would be loathe to follow controlled crying or cry-it-out advice with a dog, never mind with a human baby with a human soul that deserves to be loved and accepted. My advice to people struggling with 'sleep problems' is: ask yourself whether it really is a problem or whether you have just been convinced that it is by articles such as the above, that make ridiculous claims about it being 'normal' for 6 month old babies to sleep through the night.

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User621252 said on 01 December 2011

Waking in the night is perfectly normal. It is tiring for everyone and especially when your child may have developed a routine it is often puzzling why their routine is disrupted. it can feel frustrating.
Although I wouldn't run up the stairs to every whimper, a crying child needs your attention. Whatever the reason you need to be responsive to keep them feeling secure - which is what all parents are aiming for.
I read you can't make an insecure child feel secure by leaving them to cry. As an adult if we were upset n no one took notice. How would we feel. This can only be much much worse for small children struggling to make sense of it all.
In terms of all the challenges we face as parents. There sleeping routines and associated difficulties are very short term. I accept its tiring but dealing with insecure n poorly attached children is a huge problem which will cause us all more stress and it can be whole life affecting for those who are insecure.

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BxC said on 01 December 2011

I am outraged that the NHS are advising leaving a baby to cry when it has many potential negative effects including on the development of a child's brain.
I am also saddened to see that this article is advising parents that a baby of six months old should be sleeping through the night - this is incredibly unrealistic and only serves to make new parents feel like they're doing something wrong if their baby doesn't conform to this "rule".
All children will sleep through the night in their own time, until then they need to know that their main carer is there for them whenever they need them - whatever time of night that may be!

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cornucopia said on 01 December 2011

So sad to read that the NHS are encouraging cc and cio. Any new mums/dads please please please read this link, it has a long list of links that explain why cc and cio is a bad thing for your child.
https://www.facebook.com/topic.php?uid=51979053447&topic=8773

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sghp said on 01 December 2011

My experience is that natural sleeping through is not a given until three years or so. I wonder where the idea comes from that at six months they will sleep through; common sense suggests that this cannot possibly be a uniform expectation. I would like the NHS to represent a more balanced view of babyhood based on reality and not on a popular twentieth century mindset full of 'shoulds'. A cultural shift in expectation is needed which allows a child to develop to its own timescale.

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milkymumma said on 01 December 2011

I am seriously concerned that the NHS as a reputable source to which parents which refer for information and guidance, is recommending a technique to parents which involves great distress to the child. If I am tired/poorly/hungry/scared etc I communicate that with those around me. Why should we expect a baby to just put up with it and fall asleep? Sometimes I don't want to be on my own and want company - even if it's just a cuddle!
It is so important for Child Development that a child be securely attached to their parents - any trust is eradicated if parents don't come when baby cries/come in, cuddle, then go again.
Parents who are struggling with a child's sleep are far better to safely co-sleep (guidelines widely available on the Net) or if necessary, use the No Cry Sleep Solution.
My daughter will sleep through when she is ready, and I'll be using cuddles to get her there, not tears. I will always be there when she needs me for comfort. That's why I had her.

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quirkyfae said on 01 December 2011

I am also very concerned by this advice, given by a body that are in general respected and looked to for advice and support by many parents.
Controlled crying and cry it out techniques are well known to be damaging to children's brains. Being left to cry for 5 minutes raises the cortisol levels in brains, which actually prevents links across the two sides of the brain from being made.
Someone pointed out that babies cry at all sorts of things: nappy changes, going in the car, etc. In my opinion this is very different from leaving a baby to cry. It is important for babies and children to be allowed to cry as this is their only way to express themselves, and they also need to learn to express their emotions in different situations. However they should not be left to do this alone. Crying in arms or with a loving adult close by talking to them is very different from crying alone.
I'd like to ask; How would you as an adult feel if you were upset or afraid and crying, and someone you loved simply left you to get on with it?
I'd also like to point out that is 50% of children do not sleep through the night between 6 months and 5 years old, why is it reasonable to expect a 6 month old to sleep through? As a matter of fact, I don't sleep through the night and neither does my mum, my sister or my son. Its normal to wake sometimes in the night. Neither do I like to sleep alone. I prefer to be snuggled up with my husband. So why is it wrong for a child to "demand company"?

NHS: Please sort this out. Bother to read the scientific evidence, and find another way to support parents with babies and children at night.

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asw97uk said on 30 November 2011

This advice sounds very outdated. I don't think many parents are comfortable deliberately leaving their baby to cry in distress for as long as 5-10min. Maybe 1min to go to the loo or something but 10min is an awfully long time for a baby. Leaving them may also teach them Learned Helplessness: that there is no point in crying even if they're scared or want their mum etc.
All babies sleep through when they're ready. Parents can get more sleep by co-sleeping safely. Bedtimes can be very simple and tear free if you're breastfeeding as many babies can't stay awake during a feed. There are other far less distressing methods to try than leaving a baby to cry - this method often has the mum in tears too - not good.

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nickytwotimes said on 30 November 2011

It is so disappointing that the NHS is advocating an outdated, unsafe and non-evidence based method of 'teaching' children to sleep through the night. We do not teach our babies to roll/sit. stand or walk; rather we create a safe and comfortable environment in which to develop these skills at their own pace. So it should be with sleep. Would any parent consider 'teaching' a child any other skill through crying? I don't think so.
Many kind and loving parents come to this website or go to their HCPs looking for help and are presented with this option.. There are many, many ways to help your child to sleep better, but they do not involve crying alone.
I feel very sorry for the children and for their parents too.

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Emsels said on 30 November 2011

I'm 34 and don't sleep through the night. What is so magical about being 6 months old that suddenly it is possible to sleep through? What about babies who are breast fed?
A lot of people rely on the NHS to provide good, evidence based information. I cannot understand why "cry it out" (CIO) is being advised at all. Yes, babies cry. They cry to let you know there is something they need attending to, they are communicating. A baby who is left to CIO will learn that their cries mean nothing, they will be ignored. There is evidence to show this affects a person's brain development. See:
1) A Harvard University study by Dr M Teicher and five colleagues, published in Biological Psychiatry
2)The Science of Parenting by Dr Margot Sunderland (Dorling Kindersley, 2006)
3) University of Pittsburgh study by Dr M DeBellis and seven colleagues, published in Biological Psychiatry in 2004
Lobotomies used to be the way to do things, we now know better. I ask that the NHS update their content to reflect the evidence. It has a duty to provide evidence-based information to its customers who may well be here during a stressful time looking for supportive information. In my opinion, based on the evidence provided, CIO is tantamount to child abuse.

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Gwened said on 30 November 2011

I am concerned by the advice that is given above as it is not evidence based in any way. Recent research shows the effects of controlled crying increasing cortisol levels in the brain, tHis is the stress hormone. This has been linked to a lack of empathy in older children and depression in children and adults. Please do your own research before you use this technique and make a decision based on the evidence. There are other ways to help your child to sleep.

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MyrtleFurtle said on 30 November 2011

It's not "reasonable" to expect a six month old breast fed baby to sleep through most nights. Kellymom has a good list of sleep studies, including one that showed only 16% of babies sleeping through the night at six months. Each child is different and parents should to respond to the needs of their individual child http://www.kellymom.com/parenting/sleep/sleepstudies.html

Scientific research shows that controlled crying can be harmful. Yes, not every child may be affected in the same way, but I trust scientific research not anecdotal evidence that "it worked for me so it must be ok". Dr Sears has a good summary of some of the evidence http://www.askdrsears.com/topics/fussy-baby/science-says-excessive-crying-could-be-harmful and the book "What every parent needs to know" by Margot Sutherland also covers the science.

Why is the NHS (a) giving parents unreasonable expectations on what is reasonable, and (b) giving advice not based on the latest evidence?

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TerriStorer said on 30 November 2011

CIO/CC is horrible advice. If the situation were an adult (your significant other) people would be clamoring for charges being pressed.

I have an almost nine month old and the thought that CIO/CC is a good thing is appalling. It is NOT GOOD to let a baby cry it out. All the baby has is its cries to let them know if they are hungry, tired, scared, hurt, need changed, etc.

Doctors need to give more than just the CIO method as a method.

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Laria said on 30 November 2011

slinkyhyena, you may be confusing anecdotal evidence with detailed scientific study. My grandfather smoked 20 a day for 60 years and never got cancer. Does that mean that smoking doesn't cause cancer? Of course not!
Several studies have shown that extended periods of crying alone can damage babies' brains. This is FACT. How long a period it takes to cause damage is less clear and may depend on the baby, which is why I would never risk it with my son. Of course my son cries, but when he does I pick him up, comfort him, and try to work out what's wrong. He is never, ever, left to cry alone and that is the big difference between CC and 'normal' crying.
There are numerous ways to settle a child to sleep without leaving them to cry. Sadly, none of them are mentioned on this page. How is it that The Association of Infant Mental Health in Australia recommends not to use CC or CIO, while the NHS promotes it? I would very much like to know the NHS's reasoning for this.

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Carly3456 said on 30 November 2011

This is really bad advice that encourages parents to be cruel to children. Normal baby behavior is to cry and parents need to respond to this need. A baby that has their needs met will be much happier all around, and will grow out of it, becoming a healthy, happy toddler and older child. A child that doesn't have their needs met will may learn to not trust those around her, and may not be as happy or confident.

Also, letting a baby cry goes against the instincts of parents. Parents who do this are really hurting themselves too, and articles like this really just give them permission to do it. It's what parents WANT to hear. But the truth is that being a parent is hard sometimes but that hard work will pay off when you see a happy and healthy child who is content....

Parents who are tired and need sleep just need encouragement to hang in there... they don't need encouragement to ignore their child.

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wowbabies said on 30 November 2011

i was saddened and disappointed when i was recently told by two separate health visitors/breastfeeding supporters to leave my 11months old breastfed daughter to cio/cc... especially as i hadn't even asked for any help re her sleeping/feeding! i am even more disappointed to see where they've got this 'advice' from! the nhs is really letting mothers and babies down with such poor and archaic advice! breastfed babies are quite naturally going to wake in the night for feeds, regardless of whether they're older than the magic six month mark! i also question the integrity and qualifications of who ever wrote this article... filling a child full of cereals in order to get them to sleep to your time table is nothing but absurd! if i wake in the night thirsty, i will have a drink! why does the same courtesy not apply to a baby or young child? this article does nothing but reinforce the idea that babies are meant to fit into neat little boxes and develop at a much faster rate than is natural for them to do so... it's articles such as this that cause mum's of newborns to delight when their two day old baby slept 7hours straight, and rejoice that they have a 'good' baby... that is not good... that is, infact, very worrying! too long have all babies been boxed into a formula fed pattern, the natural state is breastfed, and breastfed babies, on the whole, do not sleep through by six months (especially as solids are not to be started to be introduced until 6months+ - contradiction? much!) ... research, research, research, and make an informed decision yourself... my worry is that the nhs is a trusted source of medical info, and this article truely breaches that trust!

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pixie11 said on 30 November 2011

There is so much research to back up the fact that controlled crying has effects on children not only in childhood but into adulthood too.

A policy statement on controlled crying issued by the Australian Association of Infant Mental Health (AAIMHI) advises, "Controlled crying is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences."

Leaving a baby to cry evokes physiological responses that increase stress hormones. Crying infants experience an increase in heart rate, body temperature and blood pressure. These reactions are likely to result in overheating and, along with vomiting due to extreme distress, could pose a potential risk of SIDS in vulnerable infants. There may also be longer-term emotional effects. There is compelling evidence that increased levels of stress hormones may cause permanent changes in the stress responses of the infant's developing brain. These changes then affect memory, attention, and emotion, and can trigger an elevated response to stress throughout life, including a predisposition to later anxiety and depressive disorders.

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littlelittle said on 14 November 2011

Controlled crying is "dangerous" and effects brain development due to the raised cortisol levels. It causes distress to the baby. This is backed up by research. The NHS is meant to be evidenced based. There is no research which says how long it is safe to leave a baby to cry for. Babies stop crying with controlled crying due to learned helplessness, they do not learn to "self settle". Self settling in brain development terms is when babies learn to settle themselves with our consistent help, not because we abandon them.

Babies cry for a reason, it is thier only way to communicate. We need to care for and nuture the most vulnerable members of society not manipulate them for our convenience.

For gentle sleep techniques, see books and websites by Elizabeth Pantley, Sears and Pinky McKay amongst others.

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slinkyhyena said on 25 September 2011

I used controlled crying with my Daughter when she was 9 months old. I gradually extended the time I was away from her, until she eventually fell asleep, in her cot, on her own. On the fourth night, I laid her in her cot, kissed her good night and that was it, no more fussy bedtimes.Babies cry, they cry if they don't want their nappy changing, if they don't want to be strapped into something, if they are given a jab, yes you got it, they usually cry. Are the above writers suggesting that we, as parents, must NEVER do anything that may make a child cry, even if it is for their own good, health and wellbeing? And the outcome for my daughter of this 'cruel, unloving act of controlled crying'? She is a well adjusted, loving, intelligent 23 year old who is just finishing a teaching degree. Would I recommend controlled crying? YES, if you fully understand the technique and apply it correctly. Is it dangerous? NO. Would you shout at a child to prevent them burning themselves (at risk of making them jump and scaring them) or just let them go ahead and burn themselves?? Apply some common sense . . . .please

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moogyboobles said on 04 July 2011

I'm with Bundle on this. I am really concerned with this advice...and treated as one of the first things to try. I thought NHS advice was evidence based?
The Association of Infant Mental Health in Australia treats controlled crying it as a last resort...and only to be used in children over 3 years old if you really must do it. There are so many other ways to deal with sleep issues that don't have the possibly negative outcomes that you get with detached sleep training methods.
There is a neuroscientific basis to these concerns.
"It's important to be firm and not to give in." really annoys me. Give in to a child's need for love and security? What's wrong with that? Heard of attachment theory?
Thing is usually babies don't have the sleep problem, it's just our warped perception of how babies should behave. We have the problem and we need educating. Babies are just being normal.

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Bundle said on 04 April 2011

I'm not sure who wrote this page, what their qualifications are, or how much of the current research they are aware of... however, I would strongly recommend that all parents make themselves aware of the very real impact that using "cry it out" or "controlled crying" techniques, techniques that (for some inexplicable reason) seem to be heavily promoted on this page, could potentially have on their child's long term psychological health. There are very real risks and dangers associated with these methods.

Please, do not confuse the location of this page with a unanimous medical "seal of approval" for this technique and, at the very least, make yourself aware of the mounting evidence against these techniques before deciding that they are best - or even healthy - for you, and most importantly, your child.

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