Journal Article 2 Mentions
Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep Intervention: Randomized Trial
Anna Price2012
Melissa WakeObioha C. Ukoumunne
Top 6% · 94th Percentile
145 citations · Experimental and Cognitive Psychology

TLDR

Teaching babies better sleep did not cause lasting harm or lasting benefits by age six. Families and health workers can use these methods to ease sleep troubles and reduce mothers’ depression in the months afterward.

Summary

1 Study Aim

The authors examined whether a behavioral infant sleep program (sleep-help methods that change bedtime routines) caused lasting benefits or harm by age six. They assessed children’s emotional health, sleep, daily functioning, stress responses, and relationships with parents. They also assessed mothers’ mental health and parenting. The study addressed concerns that these methods might damage emotional development or later well-being. The study asked whether helping babies sleep better would change children or families years later.

2 Study Design

The research was a five-year follow-up of a population-based cluster-randomized trial (a study assigning groups of families to different care approaches). The original sample included 692 infants from well-child centers. Researchers selected 326 infants with parent-reported sleep problems at seven months, including 173 receiving the program. Nurses provided behavioral techniques during one to three consultations at eight to ten months. Control families received usual care. Group assignments were concealed, and researchers did not know assignments. Parents did know. At age six, 225 families, or 69%, participated. Researchers measured child sleep, mental health, psychosocial functioning (how children manage feelings and relationships), stress, parent-child relationships, attachment, and maternal mental health and parenting. The researchers compared families who received the sleep help with families who received normal care.

3 Findings

The authors found no evidence of differences between groups across any measured outcome at age six. Emotional and conduct behavior, sleep problems, sleep habits, and psychosocial functioning were similar. Sleep problems affected 9% of intervention children and 7% of control children. Chronic stress affected 29% and 22%, respectively. Parent-child closeness, conflict, overall relationship quality, and disinhibited attachment (difficulty maintaining expected closeness with caregivers) also showed no differences. Mothers’ depression, anxiety, stress, and authoritative parenting (warm, firm, and responsive parenting) were similar. The authors concluded that these methods had no marked long-term positive or negative effects. They recommended using them to reduce infant sleep problems and maternal depression over the short to medium term. Helping babies sleep did not change children’s or mothers’ well-being several years later.

Abstract

BACKGROUND AND OBJECTIVES: Randomized trials have demonstrated the short- to medium-term effectiveness of behavioral infant sleep interventions. However, concerns persist that they may harm children's emotional development and subsequent mental health. This study aimed to determine long-term harms and/or benefits of an infant behavioral sleep program at age 6 years on (1) child, (2) child-parent, and (3) maternal outcomes. METHODS: Three hundred twenty-six children (173 intervention) with parent-reported sleep problems at age 7 months were selected from a population sample of 692 infants recruited from well-child centers. The study was a 5-year follow-up of a population-based cluster-randomized trial. Allocation was concealed and researchers (but not parents) were blinded to group allocation. Behavioral techniques were delivered over 1 to 3 individual nurse consultations at infant age 8 to 10 months, versus usual care. The main outcomes measured were (1) child mental health, sleep, psychosocial functioning, stress regulation; (2) child-parent relationship; and (3) maternal mental health and parenting styles. RESULTS: Two hundred twenty-five families (69%) participated. There was no evidence of differences between intervention and control families for any outcome, including (1) children's emotional (P = .8) and conduct behavior scores (P = .6), sleep problems (9% vs 7%, P = .2), sleep habits score (P = .4), parent- (P = .7) and child-reported (P = .8) psychosocial functioning, chronic stress (29% vs 22%, P = .4); (2) child-parent closeness (P = .1) and conflict (P = .4), global relationship (P = .9), disinhibited attachment (P = .3); and (3) parent depression, anxiety, and stress scores (P = .9) or authoritative parenting (63% vs 59%, P = .5). CONCLUSIONS: Behavioral sleep techniques have no marked long-lasting effects (positive or negative). Parents and health professionals can confidently use these techniques to reduce the short- to medium-term burden of infant sleep problems and maternal depression.

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