Behavioral treatment of bedtime problems and night wakings in infants and young children—An American Academy of Sleep Medicine review

Department of Psychology, Saint Joseph's University, 5600 City Avenue, Philadelphia, PA 19131, USA.
Sleep (Impact Factor: 4.59). 11/2006; 29(10):1263-76.
Source: PubMed


This paper reviews the evidence regarding the efficacy of behavioral treatments for bedtime problems and night wakings in young children. It is based on a review of 52 treatment studies by a task force appointed by the American Academy of Sleep Medicine to develop practice parameters on behavioral treatments for the clinical management of bedtime problems and night wakings in young children. The findings indicate that behavioral therapies produce reliable and durable changes. Across all studies, 94% report that behavioral interventions were efficacious, with over 80% of children treated demonstrating clinically significant improvement that was maintained for 3 to 6 months. In particular, empirical evidence from controlled group studies utilizing Sackett criteria for evidence-based treatment provides strong support for unmodified extinction and preventive parent education. In addition, support is provided for graduated extinction, bedtime fading/positive routines, and scheduled awakenings. Additional research is needed to examine delivery methods of treatment, longer-term efficacy, and the role of pharmacological agents. Furthermore, pediatric sleep researchers are strongly encouraged to develop standardized diagnostic criteria and more objective measures, and to come to a consensus on critical outcome variables.

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    • "As outlined in this review, it is important to note, that in many studies the effects of the sleep interventions manifested beyond sleep, benefitting other behavioural domains such as a child's increased sense of security, lower irritability and reduced crying (Mindell et al., 2006). However, it has also been argued that early infant sleep interventions, during the first 6 months do not lead to persistent or established improvement in infant outcomes (Douglas & Hill, 2013). "
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    • "Extinction, while shown to be effective, was not included due to difficulties with parental compliance in previous research (C. M. Johnson, 1991; Mindell et al., 2006; Trilling, 1989). Additional hesitations are also associated with extinction such as possible response bursts in the form of temper tantrums and concerns regarding possible child abuse during tantrums or crying episodes as indicated by the American Academy of Pediatrics (2001). "
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