Best Sleep Training Method for Infants and Young Children
Implement a consistent nightly bedtime routine starting as early as possible in infancy, which should include a predictable sequence of calming activities (such as bath, massage, and quiet time) performed at the same time each night, combined with stimulus control principles and age-appropriate sleep schedules. 1, 2, 3
The Evidence-Based Approach
Primary Intervention: Consistent Bedtime Routine
A structured bedtime routine is the most effective and safest sleep training method for infants and young children, with research demonstrating significant improvements in sleep onset latency, reduced night wakings, increased sleep duration, and decreased parental perception of sleep problems. 1, 2
The benefits occur rapidly—most improvement happens within the first 3 nights of implementation, with continued smaller gains over the following two weeks. 3
There is a dose-dependent relationship: the more consistently the routine is performed and the younger it is started, the better the outcomes. 1
Core Components of the Routine
The bedtime routine should include:
A warm bath 90 minutes before bedtime to facilitate the natural drop in core body temperature that promotes sleep. 4, 3
Calming activities such as gentle massage, quiet reading, or lullabies performed in the same sequence each night. 2, 3
A consistent bedtime and wake time maintained 7 days per week, regardless of how much sleep was obtained the previous night. 4
Essential Stimulus Control Principles
Integrate these behavioral strategies from the outset:
Use the bedroom only for sleep (and feeding in infancy)—no play, television, or stimulating activities in the sleep space. 4
Put the infant to bed drowsy but awake rather than fully asleep, to establish independent sleep initiation skills. 4, 5
Maintain a 12-hour light/12-hour dark schedule to support circadian rhythm development, with exposure to bright light during the day and darkness at night. 4
Establish consistent feeding times that align with the sleep schedule, as feeding timing influences circadian synchronization in infants. 4
Age-Specific Sleep Duration Targets
Structure the routine to achieve these evidence-based sleep durations:
Newborns (0-3 months): 14-17 hours distributed throughout 24 hours in multiple sleep bouts. 6
Infants (4-11 months): 12-15 hours with progressive consolidation toward longer nighttime sleep (10-12 hours) and shorter daytime naps (3-4 hours). 4, 6
Toddlers (1-2 years): 11-14 hours total. 6
Preschoolers (3-5 years): 10-13 hours total. 6
What NOT to Do
Avoid graduated extinction or "cry it out" methods as first-line approaches when a consistent bedtime routine alone has not been tried, as the routine itself produces significant improvements without distress. 1, 2
Do not use antihistamines like diphenhydramine for infant sleep problems—they lack efficacy data, cause problematic side effects, and tolerance develops rapidly. 7
Avoid inconsistent schedules and on-demand nighttime feeding beyond early infancy, as these delay circadian rhythm organization. 4
Do not allow screen time or stimulating activities near bedtime, as these interfere with sleep onset. 4, 5
Implementation Timeline
Week 1: Establish the routine components and consistent timing, even if sleep doesn't immediately improve. 2
Nights 1-3: Expect the most rapid improvements in sleep onset and night wakings. 3
Weeks 2-3: Continue the routine consistently to consolidate gains and see additional improvements in sleep quality and duration. 2, 3
Common Pitfalls to Avoid
Inconsistency is the primary reason routines fail—the routine must be performed every single night, not just when convenient. 1
Starting too late—begin establishing routines in the first weeks of life rather than waiting until sleep problems develop. 4, 1
Overly complex routines—keep it simple with 3-4 predictable steps that can be maintained long-term. 2
Ignoring environmental factors—ensure the sleep space is dark, quiet, cool, and free from screens and stimulating toys. 4, 5
When to Escalate
If a consistent bedtime routine implemented correctly for 3-4 weeks does not produce adequate improvement, consider:
Formal sleep restriction therapy (limiting time in bed to match actual sleep time) under guidance, though this is typically reserved for older children and adults. 4, 8
Evaluation for underlying medical conditions such as sleep apnea, reflux, or allergies that may be fragmenting sleep. 5
Assessment of parental factors including maternal mood disorders, which both affect and are affected by infant sleep problems. 2