21/01/2026
Infant sleep, “responsive” approaches, and why definitions matter
This post is shared to support informed decision-making for parents and to call for greater accountability in how infant sleep programs are promoted.
In Australia, many families are referred to infant sleep approaches described as responsive, gentle, or relationship-based. These terms sound reassuring and often suggest care that aligns with babies’ emotional and developmental needs.
From an infant mental health perspective, however, what matters is not the label used, but the mechanism.
AAIMH’s position – Extinction Based Behavioral Sleep Interventions:
“AAIMH is concerned that extinction based behavioural sleep interventions are not consistent with the infant’s needs for optimal emotional and psychological health and may have unintended negative consequences.
Extinction based behavioural sleep interventions have not been rigorously assessed in terms of the impact on the infant’s emotional development.
While arguably there is evidence to suggest these techniques do not harm infants, this does not mean there is evidence of no harm.
These type of sleep interventions are at odds with the overwhelming body of evidence that shows that the foundations for lifelong physical and psychological health are laid down in infancy when distress is responded to in a prompt and reliable way (National Scientific Council on the Developing Child 2020).
Although extinction based behavioural sleep interventions may reduce infant crying and increase caregiver perceived infant sleep time, they may also have the unintended effect of
teaching infants not to seek or expect support when distressed (Blunden, Thompson, & Dawson, 2011; Etherton et al., 2016). A lack of response to infant cries at night, and an inconsistent approach in responding to day and night distress signals may lead to increased infant stress (Porter, 2007).”
How infant mental health defines extinction-based sleep interventions:
The Australian Association for Infant Mental Health (AAIMH) groups the following approaches under the umbrella of extinction-based sleep interventions, because they share the same underlying mechanism:
changing infant behaviour by withholding or limiting responses to distress.
This classification is not about intent or tone.
It is about what the infant experiences.
How these approaches are defined:
·Unmodified extinction
Often referred to as “cry it out”.
In this approach, the baby is placed in bed and the caregiver does not respond to crying until a set wake time. All distress signals are ignored.
·Graduated extinction
Such as controlled crying, controlled comforting, The Ferber Method or quite a few 'gentle' sleep training methods.
Caregivers delay responding to crying for set periods of time (for example, every 2, 4, or 6 minutes), briefly return using limited settling techniques, and repeat the process until the baby falls asleep.
While responses occur intermittently, the baby continues to experience repeated periods of unresponded distress.
·Extinction with caregiver presence
Such as caregiver presence, camping out, fading, the chair method, hands-on settling, and comfort settling.
The caregiver remains in the room while the baby cries but intentionally limits comforting. Physical proximity is gradually reduced over time, even if the baby remains distressed.
Although the caregiver is present, responsiveness is still withdrawn or limited to things such as patting and shushing.
Why AAIMH classifies all of these as extinction:
AAIMH’s classification is based on the infant’s experience, not the caregiver’s intention or the language used to describe the approach.
Across all three methods:
·crying is not responded to promptly
·comfort is delayed, minimised, or withdrawn
·distress is tolerated as part of the process
·behavioural change is achieved through reduced signalling, not through co-regulation
From an infant mental health lens, this constitutes extinction, regardless of whether:
·responses are gradual
·the caregiver stays in the room
·the approach is described as gentle or responsive
Presence without responsiveness does not meet the definition of responsive care.
What this post is, and is not, about:·
This is not about blaming parents. Parents act with love and with the information available to them at the time.
It is also not an attack on frontline practitioners, many of whom work with care and integrity within complex systems and constraints.
It is a call for:
✔️clear and honest use of language
✔️alignment with infant mental health and neurodevelopmental evidence
✔️due diligence when sleep programs are promoted or publicly endorsed
When advice is described as responsive, it should reflect what responsiveness means for a baby’s nervous system: support that continues until the baby is calm and regulated, not simply acknowledged.
Clear definitions matter.
Transparency matters.
And accountability matters, especially when guidance is delivered with the authority of public health or professional endorsement.
Parents deserve informed choices.
Babies deserve care aligned with their developmental needs.
https://www.aaimh.org.au/media/website_pages/resources/position-statements-and-guidelines/sleep-position-statement-AAIMH_final-March-2022.pdf
