University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Family Medicine


Lawrence Herman, DMSc, MPA, PA-C


Objective: The objective of this article is to review recent evidence on the safety and efficacy of graduated extinction as an alternative behavioral intervention in otherwise healthy infants with sleep disturbances.

Methods: PubMed Clinical Queries (broad therapy filter), basic PubMed, MEDLINE, and Cochrane Library searches were conducted for articles written within the past 5 years using the following keywords: graduated extinction, modified extinction, extinction, controlled crying, infant, sleep. A total of 5 appropriate articles resulted and were used as the basis for this review.

Results: The limited available evidence is consistent with graduated extinction being a safe and effective alternative to traditional behavioral interventions for pediatric sleep disturbances.

Conclusion: Sleep disturbances are common in infancy but, if persistent throughout childhood, can be associated with physical and mental health consequences. Extinction, or “cry it out,” is commonly recommended in primary care, but often not well received by parents, so there is a need for new recommendations that are both safe and effective. Graduated extinction appears to be a safe and effective alternative to extinction for treating infant sleep disturbances, but more updated, higher-quality research is needed to better determine its efficacy.


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