Published by Actually Sleeping · Reviewed by Dr. Samantha Abrahamson, PharmD · Review policy · Updated 2026-11-10

What is cry it out (extinction), and is it safe?

Cry it out, called unmodified extinction in research, means putting a healthy baby down awake after a full bedtime routine and not returning until a planned feed or morning. Randomized trials of behavioral sleep methods have not found harm to children’s emotional health, behavior or attachment. It only suits healthy babies in a safe sleep space, and many families do not want it. Actually Sleeping does not use it.

Your pediatrician is the authority on your child’s health. Confirm growth, night-feed needs and any medical concerns with them before changing how your baby sleeps.

What it is, and what it is not

Extinction is a structured method: a loving routine, a fed and dry baby, a safe crib, a set bedtime, planned night feeds if your pediatrician wants them, and a parent who is watching a monitor. After goodnight, you do not go back in for crying alone. It is not ignoring a baby all day, leaving a sick or hungry baby, or closing the door regardless of what happens. You always go in for illness, vomiting, a limb stuck in the crib slats, or anything that sounds wrong.

Is it safe? What the evidence says

A review of 52 studies for the American Academy of Sleep Medicine found the strongest support for unmodified extinction, alongside preventive parent education.
A 2016 randomized trial of graduated extinction (with checks) in 43 babies aged 6 to 16 months found small-to-moderate declines in infant cortisol compared with controls, and no differences in emotional or behavioral problems or attachment 12 months later.
A Melbourne trial in which nurses taught behavioral sleep strategies found, at age 2, no evidence of harm to children’s mental health or to parenting, and fewer mothers with depression symptoms in the intervention group.

The honest limits: samples are modest, most participants were 6 months or older, and the trials with follow-up tested behavioral strategies in general rather than pure extinction. The research supports “no harm found,” which is not the same as proof for every child. See what the research says.

Who it tends to fail for, and why

Families who cannot see it through. Crying for an hour and then being rocked to sleep is harder on everyone than a plan with more parental presence, done consistently.
Babies whose schedule or feeds are the real problem. Leaving the room does not fix a bedtime that is wrong for the baby or a hunger waking.
Young babies. Most of the research involved babies 6 months and older, and many younger babies still need night feeds.
Babies who are ill, in pain, or have unresolved feeding, weight or breathing concerns. See sleep training a baby with reflux.
Any baby not in a safe sleep space. Back to sleep, firm flat surface, empty crib. See safe sleep and sleep training.

How Actually Sleeping is different

Actually Sleeping does not use cry it out, and it is not wait it out either. Dr. Sam writes a plan around your baby: age, feeding, temperament, how your baby falls asleep now and your family’s schedule. You are not left alone at the door listening. You get bootcamp-style coaching before night one, daily 1:1 check-ins to adjust the plan as your baby responds, and naps coached until solid. Night feeds your pediatrician wants kept stay in the plan.

The outcome is guaranteed in writing: We guarantee that your baby will sleep 8–12 hours through the night within 14 days of consistent, correct implementation of your sleep plan. Full refund if not. Families who were looking for an alternative to cry it out describe their experience on our video reviews page.

Safety, whatever you choose

Your baby sleeps on the back, alone, on a firm, flat, non-inclined surface without soft toys, pillows, blankets or bedding. The AAP advises against weighted swaddles and weighted objects on or near a baby. Your pediatrician decides night feeds and anything medical.

If you want sleep fixed without leaving your baby to cry it out, book a free consultation with Dr. Sam.

Want this fixed for your baby?

Actually Sleeping is 1:1 coaching: a sleep plan written for your baby by Dr. Sam, bootcamp-style coaching before the first night, and daily check-ins until it is working. 700+ families coached, 129 video reviews, and a written guarantee: 8–12 hours through the night within 14 days, or a full refund.

Book your free consultation → See what families say

Frequently asked

How long is too long to let a baby cry it out?

There is no research-defined limit. If crying sounds different from protest, or your baby may be ill or unsafe, go in. Actually Sleeping does not use cry it out; families get bootcamp-style coaching before night one instead of a timer.

Does cry it out cause attachment problems?

A randomized trial of graduated extinction and bedtime fading found no differences in attachment 12 months later, and a Melbourne trial of behavioral sleep strategies found no evidence of harm to child mental health at age 2. Pure extinction has less long-term follow-up.

Can I do cry it out at 4 months?

Many 4-month-olds still need night feeds, and most of the research involved babies 6 months and older. Ask your pediatrician first. Actually Sleeping works with babies from newborn foundations onward without cry it out, and never forces dropping night feeds.

What if my baby vomits from crying?

Go in, clean up calmly with the lights low, and comfort your baby. If it happens more than once, talk to your pediatrician. It is also a sign that the approach does not fit your baby, and a plan written for your baby would change.