The Ferber vs. Weissbluth CIO Smackdown

Ferber or Weissbluth?

You’ve gotten your head around what sleep training means and then possibly came to the conclusion that CIO is the answer to your particular sleep issues. The next big hurdle is figuring out which method of CIO is right for you? And by “right for you” I mean that it:
A) Solves the problem of having your child fall asleep without you
B) Is something you and your partner can successfully execute (minimal user error)
C) Involves the least amount of crying possible

Luckily the list of CIO options is rather short. In fact there are really only 2, which you are probably familiar with from reading Ferber and Weissbluth.

The Ferber Method

Check and console comes in many varieties but probably the most well-known is outlined by Dr. Ferber and in case you aren’t familiar, I’m including it here. You put baby in the crib and leave the room. However you make brief consoling visits (~15 seconds, a few kind words, back rub, then leave) according to the schedule below.

From Solve Your Child’s Sleep Problems, Richard Ferber, MD. (p. 74)

Day At First Wait Second Wait Third Wait Subsequent Waits
1 3 5 10 10
2 5 10 12 12
3 10 12 15 15
4 12 15 17 17
5 15 17 20 20
6 17 20 25 25
7 20 25 30 30

Vanilla CIO

AKA Weissbluth method, where you kiss baby on the head, tell them you love them, put them gently in their crib, and walk out of the room.

CIO Comparison

Name Ferberizing Weissbluth/CIO
Also known as… Graduated Extinction, Check and Console, Controlled Crying Extinction, no-peek
How to: Return to child every X minutes to console for ~15 seconds then leave. Put baby in crib, walk out, close the door. The end.
 Pros: Parents feel less guilty because they are providing some degree of soothing.  Less likely to unintentionally reinforce crying with ongoing intervention.
Cons: Intervention may lead to longer crying by sending mixed signals  Parents feel generally crappy about it.

Which Method is Best

For situations where CIO is appropriate, I’ve long been a staunch proponent of Weissbluth/CIO method over “Ferberizing” because I’ve observed that Ferberizing has two significant downsides:
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  1. Prolonged Crying

    Some (most?) babies tend to amp up when they see you. On a 10-point scale, if a baby is crying at level 7 and Mom walks in the door, that baby is often going to jump to level 11. So Mom’s well-meaning presence is often working against the goal of minimizing crying. Also going to your crying baby can also have the unintended consequence of reinforcing the crying. Psychology majors are probably familiar with the term intermittent reinforcement. The basic idea is that if you reinforce (by coming in to soothe) the negative behavior (crying) intermittently (every 5, 7, 10, 12 minutes) it will continue longer than if you never went back in to the room at all. Weissbluth also maintains that “full extinction” results in less crying overall.

  2. User Error

    The more times you go in to pick up your crying child the more opportunities for the dark well of parental guilt you are feeling to suck you in so that you go back to whatever soothing behavior (rocking, nursing, etc.) you were trying to get out of when you started down this path. And each time this happens you are vastly increasing the chance that the next time (and rest assured there WILL be a next time) you try CIO it will be a horrendous prolonged nightmare for all. When you see people on baby forums talking about how CIO for them was a total disaster, I can almost guarantee that the underlying issue was user error.

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For these reasons, I’ve generally been an advocate for the Weissbluth/extinction method of CIO. So as with most things I went on the Internet to look for validation of my own personal brilliance which included reading the most current academic research on CIO (links at end of post). What I learned from the academic research is this…

Research on Cry it Out

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  1. You are in good company.

    About 25-50% of babies over 6 months and 33% of toddlers/preschoolers have “sleep problems” (i.e. bedtime is a nightmare, they wake up repeatedly at night, or both).

  2. It’s not about food.

    Newborns ABSOLUTELY need to be and SHOULD be fed on demand, at night. But when your almost 1 year old is nursing all night long, you don’t have an unusually hungry kid. You have a sleep problem.

  3. Thing generally don’t get better by themselves.

    It would be awesome if kids would just outgrow the “terrible sleeper” phase all on their own. It would also be cool if they would make you a killer martini. However neither of these things is going to happen.

  4. Your non-sleeping baby/toddler will grow into a non-sleeping kid.

    You can deal with the issue now or three years from now because it’ll still be there.

  5. Not sleeping is a big deal to your kid.

    It impacts their mood, development, learning, performance and health. Seriously, it’s important.

  6. When your kid sleeps everything get’s better

    Kids who are sleeping are more secure, predictable, and less irritable. Also? Sleep training doesn’t impact consumption of breastmilk (yay!).

  7. Cry It Out Works

    Baby forums are bursting with CIO horror stories (was horrible! didn’t work! have to re-train every time the kid sneezes!). Which is a shame because the academic research on this sort of “behavioral modification treatment” shows that almost without exception, it does work.

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What I DIDN’T find was any evidence that one method works better than the other. But there is ample evidence that either method works just fine.

Least Amount of Crying

Of course the single most important question is: does one method result in less crying than the other? Because while “solves the sleep problem” is our #1 goal, minimal crying is easily the #2. I could find nothing that answered this question so I asked Dr. Jodi Mindell, psychologist who specializes in pediatric sleep medicine and is the associate director of the Sleep Center at Children’s hospital in Philadelphia. Because she was the primary investigator on much of the cry it out research and is also the author of the popular book Sleeping Through the Night. Her response?

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Unfortunately those studies comparing duration of crying have not been done, at least as far as I know. – Jodi
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Bummer.

So while I’ve been vocally pro-no-peek for years, apparently both work fine and you can choose whichever method works for you and your kid. But here are a few parting thoughts that may help you figure out which method is best for you.

Which CIO Method is Right for You?

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  • If you go to your child periodically will you be able to leave after JUST 15 seconds of soothing?
  • Does your baby cry more or less if you enter the room (and not pick them up, nurse, rock, etc.)?
  • Can you let your baby cry and resist the urge to peek/intervene?
  • Does not going in to your baby feel unimaginably wrong to you?
  • Have you dabbled with CIO before? (If yes then I strongly encourage you to go with the no-peek/intervention method).

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Anybody have any thoughts on one method vs. another? Experiences or lessons learned you care to share?
[box type=”blank” class=”border-dashed2″]Sources:
Behavior Management of Infant Sleep Disburbances
Efficacy of an Internet-Based Intervention for Infant and Toddler Sleep Disturbances
Practice Parameters for Behavioral Treatment of Bedtime Problems and Night Wakings in Infants and Young Children
Empirically Supported Treatments in Pediatric. Psychology: Bedtime Refusal and Night Wakings in Young Children[/box]