Journal Article 2 Mentions
Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial
Michael Gradisar2016
Kate JacksonNicola Spurrier
Top 3% · 97th Percentile
140 citations · Endocrine and Autonomic Systems

TLDR

Teaching babies to fall asleep on their own using gentle methods helps them sleep better and does not cause stress or harm their bond with parents or their emotions later.

Summary

1 Study Aim

The main goal of this study was to find out if two behavioral sleep training methods—graduated extinction (where parents wait longer before responding to a baby's cries) and bedtime fading (where bedtime is gradually moved later)—improve infant sleep without causing stress or long-term problems in the child's emotions, behavior, or attachment to parents. The study wanted to see if gentle sleep training helps babies sleep better without causing harm.

2 Study Design

Researchers randomly assigned 43 infants aged 6 to 16 months to one of three groups: graduated extinction, bedtime fading, or a sleep education control group. Parents kept sleep diaries, and infants wore actigraphy devices (wristbands that track movement to measure sleep). Infant stress was checked by measuring cortisol (a stress hormone) in saliva samples, and mothers reported their own mood and stress. After 12 months, mothers filled out questionnaires about their children's emotions and behavior, and the parent-child bond was tested using the strange situation procedure (a standard way to assess attachment). The study compared two sleep training methods and a control group to see how they affected sleep, stress, and parent-child relationships.

3 Findings

The study reveals that both graduated extinction and bedtime fading led to babies falling asleep faster. Graduated extinction also reduced how often babies woke up at night and how long they stayed awake after waking. There were small to moderate drops in stress hormone levels for babies in both intervention groups, and mothers reported feeling less stressed in the first month. There were no changes in mothers' moods. After a year, there were no differences between groups in children's emotional or behavioral problems, and no differences in how securely children were attached to their parents. The authors conclude that these sleep training methods improve sleep without causing stress or long-term harm to children's emotions or relationships. Babies who learned to sleep on their own slept better, and this did not cause stress or harm their feelings or their bond with their parents.

Abstract

OBJECTIVES: To evaluate the effects of behavioral interventions on the sleep/wakefulness of infants, parent and infant stress, and later child emotional/behavioral problems, and parent-child attachment. METHODS: A total of 43 infants (6-16 months, 63% girls) were randomized to receive either graduated extinction (n = 14), bedtime fading (n = 15), or sleep education control (n = 14). Sleep measures included parent-reported sleep diaries and infant actigraphy. Infant stress was measured via morning and afternoon salivary cortisol sampling, and mothers' self-reported mood and stress. Twelve months after intervention, mothers completed assessments of children's emotional and behavioral problems, and mother-child dyads underwent the strange situation procedure to evaluate parent-child attachment. RESULTS: Significant interactions were found for sleep latency (P < .05), number of awakenings (P < .0001), and wake after sleep onset (P = .01), with large decreases in sleep latency for graduated extinction and bedtime fading groups, and large decreases in number of awakenings and wake after sleep onset for the graduated extinction group. Salivary cortisol showed small-to-moderate declines in graduated extinction and bedtime fading groups compared with controls. Mothers' stress showed small-to-moderate decreases for the graduated extinction and bedtime fading conditions over the first month, yet no differences in mood were detected. At the 12-month follow-up, no significant differences were found in emotional and behavioral problems, and no significant differences in secure-insecure attachment styles between groups. CONCLUSIONS: Both graduated extinction and bedtime fading provide significant sleep benefits above control, yet convey no adverse stress responses or long-term effects on parent-child attachment or child emotions and behavior.

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