Pick up, put down method: steps, ages and does it work?

Pick up, put down is a hands-on way of settling your baby in their cot. When your baby cries, you pick them up and cuddle them until they're calm, then put them back down on their back, and you repeat this until they fall asleep. You stay with your baby throughout, so it sits between holding your baby to sleep and leaving them to settle alone. Australian parenting services teach a very similar approach, but no published trial has tested the method on its own.

What is the pick-up-put-down method?

The idea is simple: your baby goes into the cot awake or drowsy, and you respond to crying by lifting them out for comfort, but return them to the cot as soon as they're calm. Over time, the aim is for your baby to need fewer pick ups and to do more of the falling asleep in the cot.

It closely matches what Tresillian's responsive settling tip sheet calls hands-on settling: put your drowsy baby on their back in the cot, comfort them there with "ssshhh" sounds, patting, rocking or stroking, and if they start to fuss loudly, pick them up for a cuddle until calm or asleep before putting them back. Tresillian notes your baby may need a few pick ups.

Karitane's stepped approach to settling frames it as a ladder: start small with soothing words, then sit beside the cot, then gentle patting or rocking, with picking up and cuddling at the top. If your baby is calming, you step back down the ladder; if they're getting more upset, you can skip straight to picking up.

Where does pick up, put down come from?

The name is linked to British nurse Tracy Hogg, who described a sleep strategy she called "P.U./P.D." in The Baby Whisperer Solves All Your Problems, written with journalist Melinda Blau and published in 2005, according to a Publishers Weekly review. The same book uses the E.A.S.Y. routine (eat, activity, sleep, you); see daily rhythm for how eat-play-sleep works.

You don't need the book to use the approach. Australian child health services such as Tresillian and Karitane teach their own versions under names like hands-on settling and responsive settling.

What age is pick up, put down used from?

There's no official starting age for this method. Here's what Australian services describe for picking up and settling at different ages:

Pregnancy, Birth and Baby says settling in arms suits all babies but is most helpful up to around 3 to 6 months, that babies up to 6 months may respond best to hands-on settling, and that comfort settling is generally recommended from 6 months. Karitane describes its responsive settling for babies aged 3–12 months.

For younger babies, keep expectations low. A systematic review by Douglas and Hill found behavioural sleep interventions in the first 6 months hadn't been shown to reduce crying or prevent later sleep problems. Using pick up, put down gently, as one way to comfort your baby, is different from a strict program. The NCT advises against sleep training before 6 months.

How do you do pick up, put down, step by step?

1. Start with a short, calm routine such as a nappy change, a story and a cuddle. Pregnancy, Birth and Baby suggests making sure your baby isn't hungry, has a dry nappy, is calm and isn't too hot or cold.
2. Watch for tired signs such as yawning, jerky movements, grimacing or rubbing eyes, and start settling before your baby is overtired.
3. Put your baby in the cot on their back, drowsy or awake.
4. Comfort them in the cot first. Try "shh" sounds, a hand on their chest or tummy, or gentle rhythmic patting. Many babies grizzle on the way to sleep, and Pregnancy, Birth and Baby says babbling, whinging and brief cries are common while settling.
5. If crying builds, pick your baby up and cuddle them until they're calm.
6. Put them back down once they're calm, on their back, before they're deeply asleep if you can.
7. Repeat as needed. Tresillian says to try to balance this so you're not overstimulating your baby with too many pick ups.
8. Stay until your baby is nearly asleep or asleep, then leave quietly.
9. Use the same approach each time. Tresillian advises using the same settling technique every time you put your baby to bed if sleep is difficult, and reminds parents that change takes time.

If you've had enough or your baby isn't calming, Pregnancy, Birth and Baby says it's OK to stop and try something else, such as settling in arms.

What does a typical first week look like?

There's no reliable night-by-night pattern. Early sessions can be long, with many pick ups, and it's common for some nights to be harder than others. Karitane points out that it takes anywhere from about 30 seconds to 30 minutes for children and adults to fall asleep, so a few minutes of grizzling in the cot isn't a sign it's failing.

What families tend to look for is a trend: fewer pick ups, shorter cuddles, or your baby calming more quickly in the cot. A simple note of how long settling took and how many times you picked your baby up makes this easier to see than relying on memory at 3 am.

Does pick up, put down work? What the evidence says

Honestly, nobody knows for sure. We found no published trial that tested pick up, put down as a method.

• The American Academy of Sleep Medicine's 2006 practice parameters found behavioural sleep methods effective overall, but pick up, put down wasn't among the methods it assessed, and it found insufficient evidence to recommend any single method over another.
• The hands-on and responsive settling approaches it resembles are taught by Australian child and family health services such as Tresillian and Karitane, but we found no trial that measured this specific method.

So it's reasonable to try if it fits your family, but there's no research to say how well it works or how long it takes.

Who does pick up, put down suit, and who doesn't it suit?

It may suit you if:

• you want to stay with your baby and respond each time they're upset
• crying-based methods don't feel right for your family
• your baby calms quickly when held and is happy to be put down again

It may not suit:

• babies who get more wound up by being lifted. Tresillian cautions against too many pick ups, and HealthyChildren.org warns that trying strategies too quickly in a row can overstimulate a baby. Comforting in the cot or gradual retreat may work better.
• older, heavier babies. HealthyChildren.org notes calming strategies need to change as babies grow and get heavier, and lifting a large baby over and over is hard on your back.
• babies who are unwell or in pain. Comfort them however they need, and come back to settling once they're well.
• very young newborns, who often settle best in arms. See shush-pat and soothing crying.

What safety rules apply?

Every time you put your baby down, follow safe sleep advice from NICHD Safe to Sleep and Red Nose:

• on their back, every sleep, with head and face uncovered
• a firm, flat mattress with a fitted sheet, and nothing soft or loose in the cot
• their own safe sleep space in your room for at least the first 6 months
• smoke-free, before and after birth

If you're settling in arms, don't sit or lie down on a sofa or armchair where you might fall asleep with your baby. Move your baby to their cot on their back once they're calm or asleep.

Karitane warns that shaking a baby is dangerous. If you notice you're getting frustrated or angry, put your baby down safely in the cot, take a short break to calm yourself and call a parenting support service (Tresillian or Karitane in Australia, your health visitor in the UK, your pediatrician's office in the US). If you have thoughts of harming yourself or your baby, call a crisis line (Lifeline on 13 11 14 in Australia, Samaritans on 116 123 in the UK, 988 in the US) or your local emergency number (000 in Australia, 999 in the UK, 911 in the US).

Stop settling and get help if your baby seems unwell. Using the NHS urgent help guide, call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) if your baby is struggling to breathe, has blue, grey or blotchy skin or lips, is floppy or hard to wake, is having a seizure, has a weak, high-pitched or continuous cry, or is under 3 months with a temperature of 38°C (100.4°F) or higher.

How does pick up, put down compare with other methods?

For a full comparison, see the sleep training overview, and for gently practising settling in the cot, see drowsy but awake.