Graduated approaches improved sleep without raising infant stress hormones
A randomised trial comparing graduated extinction, bedtime fading and education
Reviewed by Sian Trombley, CCCFounder, Thrive Family Company
Strong confidence
Source citation
Gradisar M., Jackson K., Spurrier N. J., Gibson J., Whitham J., Williams A. S., et al. (2016). Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial. Pediatrics. https://doi.org/10.1542/peds.2015-1486
Published 1 January 2016 · Added to Thrive 26 July 2026 · Reviewed 26 July 2026
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Few parenting topics are as loaded as infant sleep. This trial measured cortisol and attachment rather than opinions.
Published research findings
The study
Infants with sleep problems were randomised to graduated extinction, bedtime fading or sleep education, with cortisol sampling and attachment assessment at twelve months.
What researchers examined
Effects on sleep latency and night wakings, plus infant stress and attachment outcomes.
What they found
Both graduated extinction and bedtime fading reduced time to fall asleep and night wakings. Cortisol did not increase, and attachment and emotional outcomes at twelve months did not differ between groups.
Thrive editorial interpretation
What this may mean for families
Gentle, structured sleep approaches can be used without evidence of harm to the parent-child relationship.
What this doesn't tell us
Important limitations
A small sample from a single clinic, with families willing to be randomised.
Evidence confidence describes how much weight this study's design can carry — not how strongly the finding applies to any individual child or family.
Therapist perspective — Thrive interpretation, not a finding of the study
Therapist Perspective
Bedtime fading — starting later and moving earlier — is the option most families have never heard of, and often the one they can live with.
Practical family considerations
Try shifting bedtime later before making it earlier.
This research summary is educational and does not replace individualized medical, psychological or therapeutic advice.
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