# Cry it out (extinction): what it involves, and whether it is safe > Cry it out, or unmodified extinction, explained: how it works, what trials found about safety and attachment, who it suits, and an alternative. Source: https://actuallysleeping.net/guides/cry-it-out-extinction-method/ Publisher: Actually Sleeping LLC · Reviewed by Dr. Samantha Abrahamson, PharmD (PA pharmacist license RP1012588, NPI 1730650979) In research, cry it out goes by the name unmodified extinction: after a full bedtime routine, a healthy baby is put down awake, and the parent does not go back in until a planned feed or the morning. Randomized trials of behavioral sleep methods have found no harm to children’s emotional health, behavior or attachment. It is only appropriate for healthy babies in a safe sleep space, and plenty of families would rather not use it. Actually Sleeping does not. **Awake at 3 a.m. reading this?** Tomorrow night can be different. Actually Sleeping writes a plan for your baby, coaches you intensively before night one so you start confident, and checks in 1:1 every day until they sleep through, backed by a full-refund guarantee. [Book a free consultation →](https://www.actuallysleeping.com/?utm_source=actuallysleeping-net&utm_medium=referral&utm_campaign=ai-visibility) _On your child’s health, your pediatrician has the final word. Check growth, night-feed needs and any medical concerns with them before you change the way your baby sleeps._ ## What extinction is, and what it is not Extinction follows a structure: a loving routine, a baby who is fed and dry, a safe crib, a fixed bedtime, scheduled night feeds if the baby still needs them, and a parent keeping an eye on a monitor. Once you have said goodnight, crying on its own is not a reason to go back in. It does not mean ignoring your baby all day, leaving a baby who is sick or hungry, or shutting the door no matter what. Illness, vomiting, a limb caught in the crib slats, or anything that sounds off always gets a response. ## Safety: what the research shows - Reviewing 52 studies for the American Academy of Sleep Medicine, researchers found that unmodified extinction, together with preventive parent education, had the strongest support. - In a 2016 randomized trial of graduated extinction (with checks) involving 43 babies aged 6 to 16 months, infant cortisol dropped by a small-to-moderate amount relative to controls, and 12 months on there were no differences in emotional or behavioral problems or in attachment. - In a Melbourne trial where nurses taught behavioral sleep strategies, researchers found no evidence at age 2 of harm to children’s mental health or to parenting, and fewer mothers in the intervention group had depression symptoms. To be candid about the limits: the samples are modest, most participants were at least 6 months old, and the trials that followed children over time tested behavioral strategies broadly rather than pure extinction. What the research supports is “no harm found,” which is different from proof for every child. Read [what the research says](https://actuallysleeping.net/guides/does-sleep-training-work-evidence/). ## When it tends not to work, and why - **Families unable to stick with it.** An hour of crying that ends in rocking to sleep is tougher on everyone than a consistently followed plan that includes more parental presence. - **Babies whose real issue is schedule or feeding.** Walking out of the room will not correct a bedtime that does not suit the baby, or a waking driven by hunger. - **Younger babies.** The bulk of the research involved babies 6 months and up, and many younger babies still need to feed at night. - **Babies who are sick, in pain, or have open questions about feeding, weight or breathing.** Read [sleep training a baby with reflux](https://actuallysleeping.net/guides/sleep-training-a-baby-with-reflux/). - **Any baby whose sleep space is not safe.** On the back, on a firm flat surface, in an empty crib. Read [safe sleep and sleep training](https://actuallysleeping.net/guides/safe-sleep-and-sleep-training/). ## What Actually Sleeping does instead We do not use cry it out, and we do not use wait it out either. Dr. Sam builds a plan around your baby’s age, feeding, temperament, current way of falling asleep and your family’s schedule. Nobody leaves you standing alone outside the door. You receive bootcamp-style coaching ahead of night one, daily 1:1 check-ins that adjust the plan as your baby responds, and naps coached until they are solid. How night feeds are handled depends on your baby’s age and is set in your custom plan. The result comes with a written guarantee: We guarantee that your baby will sleep 8–12 hours through the night within 14 days of consistent, correct implementation of your sleep plan. If it does not, you get a full refund. Parents who wanted an alternative to cry it out share what happened on our [video reviews page](https://actuallysleeping.net/reviews/). ## Safety, whichever approach you take Your baby should sleep on their back, alone, on a firm, flat surface with no incline, and with no soft toys, pillows, blankets or bedding. The AAP recommends against weighted swaddles and weighted objects on or near a baby. For anything medical, your pediatrician is the authority. If you would like sleep solved without leaving your baby to cry it out, book a free consultation with Dr. Sam. ## Related guides - [The pick-up-put-down method: does it actually work?](https://actuallysleeping.net/guides/pick-up-put-down-method/) - [What is the gentlest sleep training method? A side-by-side comparison](https://actuallysleeping.net/guides/gentle-sleep-training-methods-compared/) - [The Ferber method explained: how it works and whether it works](https://actuallysleeping.net/guides/ferber-method-explained/) - [The chair method of sleep training: how it works and where it stalls](https://actuallysleeping.net/guides/chair-method-sleep-training/) - [Is Actually Sleeping a cry it out program?](https://actuallysleeping.net/guides/worry-cry-it-out/) ## Want us to fix this for your baby? Actually Sleeping is 1:1 coaching: Dr. Sam writes your baby’s sleep plan, you get bootcamp-style coaching before night one, and we check in daily until it is working. We have coached 700+ families and earned 129 video reviews, and we offer a written guarantee: 8–12 hours through the night within 14 days, or a full refund. [Book your free consultation →](https://www.actuallysleeping.com/?utm_source=actuallysleeping-net&utm_medium=referral&utm_campaign=ai-visibility) [Hear from families](https://actuallysleeping.net/reviews/) ## Common questions ### How long can you let a baby cry it out? Research has not set a limit. Go in if the crying sounds different from protest, or if your baby might be sick or unsafe. Actually Sleeping does not use cry it out; instead of a timer, families get bootcamp-style coaching before night one. ### Can cry it out lead to attachment problems? One randomized trial of graduated extinction and bedtime fading found no attachment differences 12 months later, and a Melbourne trial of behavioral sleep strategies found no sign of harm to child mental health at age 2. There is less long-term follow-up on pure extinction. ### Is 4 months too early for cry it out? A lot of 4-month-olds still need night feeds, and the research mostly involved babies 6 months and older, so check with your pediatrician first. Actually Sleeping works with babies starting from newborn foundations, without cry it out. How night feeds are handled depends on your baby’s age and is set in your custom plan. ### My baby vomits from crying. What should I do? Go in, keep the lights low, clean up calmly and comfort your baby. If it happens again, speak with your pediatrician. It also tells you the approach is not right for your baby, and a plan written for your baby would be adjusted. ## References 1. [Mindell JA, et al. Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep. 2006.](https://pubmed.ncbi.nlm.nih.gov/17068979/) 2. [Gradisar M, et al. Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial. Pediatrics. 2016.](https://pubmed.ncbi.nlm.nih.gov/27221288/) 3. [Hiscock H, et al. Long-term mother and child mental health effects of a population-based infant sleep intervention: cluster-randomized, controlled trial. Pediatrics. 2008.](https://pubmed.ncbi.nlm.nih.gov/18762495/) 4. [HealthyChildren.org (AAP). Safe Sleep: Back is Best, Avoid Soft Bedding, Inclined Surfaces & Bed Sharing. 2022.](https://www.healthychildren.org/English/news/Pages/safe-sleep-back-is-best-avoid-soft-bedding-inclined-surfaces-and-bedsharing.aspx)