Graduated extinction and bedtime fading may provide significant sleep benefits for infants and have no long-term effect on parent-child attachment or child emotions or behavior, according to research published in Pediatrics.

Michael Gradisar, PhD, Associate Professor at the School of Psychology at Flinders University in Adelaide, Australia, and colleagues conducted a randomized controlled trial of 43 infants between the ages of 6 and 16 months to evaluate the effects of behavioral interventions on the sleep/wakefulness of the infants, as well as the potential for later emotional or behavioral problems and parent-child attachment.

The infants were randomized to receive either graduated extinction (n=14), bedtime fading (n=15) or sleep education control (n=14). Data were collected via parent-reported sleep diaries and infant actigraphy; infant stress was measured via salivary cortisol sampling in the morning and the afternoon, and maternal stress was self-reported. At 12 months, mothers completed an assessment of their child’s emotional and behavioral problems.

Continue Reading

The researchers found significant interactions for sleep latency, number of awakenings, and wake after sleep onset; large decreases in sleep latency were found in the graduated extinction and bedtime fading groups. Salivary cortisol analysis showed small-to-moderate declines in the graduated extinction and bedtime fading groups when compared with controls.

“At the 12-month follow-up, no significant differences were found in emotional and behavioral problems, and no significant differences [were observed] in secure-insecure attachment styles between groups,” concluded Dr Gradisar.


  1. Gradisar M, Jackson K, Spurrier NJ, et al. Behavioral interventions for infant sleep problems: A randomized controlled trial. Pediatrics. 2016;137(6); doi: 10.1542/peds.2015-1486