Article

Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children

Mayo Sleep Disorders Center, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Sleep (Impact Factor: 5.06). 11/2006; 29(10):1277-81.
Source: PubMed

ABSTRACT Bedtime problems and frequent night wakings are highly prevalent in infants, toddlers, and preschoolers. Evidence suggests that sleep disruption and/or insufficient sleep have potential deleterious effects on children's cognitive development, regulation of affect, attention, health outcomes, and overall quality of life, as well as secondary effects on parental and family functioning. Furthermore, longitudinal studies have demonstrated that sleep problems first presenting in infancy may become chronic, persisting into the preschool and school-aged years. A solid body of literature now exists supporting the use of empirically-based behavioral management strategies to treat bedtime problems and night wakings in infants, toddlers, and preschoolers. The following practice parameters present recommendations for the use of behavioral (i.e., non-pharmacological) treatments of bedtime problems and night wakings in young children (aged 0 - 4. years 11 months). A companion review paper on which the recommendations are based was prepared by a taskforce appointed by the Standards of Practice Committee (SPC) of the American Academy of Sleep Medicine (AASM), and summarizes the peer-reviewed scientific literature on this topic. The authors of the review paper evaluated the evidence presented by the reviewed studies according to modified Sackett criteria. Using this information and a grading system described by Eddy (i.e., standard, guideline or option), the Standards of Practice Committee and Board of Directors of the American Academy of Sleep Medicine determined levels of treatment recommendation presented in the practice parameters below. These practice parameters provide 3 types of recommendations. First, recommendations are provided indicating that behavioral interventions are effective in the treatment of bedtime problems and night wakings in young children, producing reliable and significant clinical improvement in sleep parameters. Second, recommendations are made regarding specific behavioral therapies, including: (1) unmodified extinction, extinction with parental presence, and preventive parent education are all rated as individually effective therapies in the treatment of bedtime problems and night wakings (Standards), and (2) graduated extinction, bedtime fading/positive routines and scheduled awakenings are rated as individually effective therapies in the treatment of bedtime problems and night wakings but with less certainty (Guidelines). There was insufficient evidence to recommend standardized bedtime routines and positive reinforcement as single therapies. In addition, although behavioral therapies for bedtime problems and night wakings are often combined, there was insufficient evidence available to recommend one individual therapy over another or to recommend an individual therapy over a combination of therapies. Finally, recommendations are provided regarding the beneficial effects of behavioral treatments on secondary outcomes, including daytime functioning (child) and parental well-being.

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    • "In regard to infant nighttime care, the lack of consensus regarding what constitutes best care practice approaches can create a challenge for parents (Sobralske & Gruber, 2009; Morgenthaler et al., 2006). NPs can help parents understand what normative sleep patterns are like, to make decisions about nighttime care and to feel comfortable about their choices. "
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    ABSTRACT: PurposeReview infant sleep research with a focus on understanding the elements related to infant safety and infant and maternal well-being during nighttime care.Data sourcesThis review summarizes current research and addresses the controversies and conflicting outcomes reported in infant nighttime care. This review addresses current literature on infant sleep patterns, as well as factors that influence infant sleep and are consequences of different care routines. Conversation points are provided to help nurse practitioners (NPs) address safety and practice concerns.Conclusions Shared information can help parents provide a safe and healthy environment for infants and help to facilitate communication ties between the healthcare providers and the families.Implications for practiceNPs need to help parents understand infant sleep patterns norms, what is current knowledge about infant nightwakings and parental presence, as well as about approaches to altering infant sleep patterns. Integrating this knowledge with parent preferences that are influenced by cultural practices and individual differences is crucial in helping parents develop a strong sense of competence and comfort with their choices and behaviors.
    07/2014; 27(6). DOI:10.1002/2327-6924.12159
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    • "The impact of successful treatment often goes beyond improvements in child sleep, extending to better overall child and family functioning. This paper provides an overview of conceptualisation, assessment, and treatment options, focusing on findings published since the 2006 American Academy of Sleep Medicine Review and Standards Practice Parameters papers [4] [5]. "
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    ABSTRACT: Night wakings and bedtime problems in infants and young children are prevalent, persistent, and associated with a variety of impairments in youth and their families. Assessment strategies include clinical interview, sleep diaries, actigraphy, and subjective measures. A number of treatment approaches with varying degrees of empirical support are available, and several novel strategies have been evaluated in recent years. Appropriate sleep scheduling and a bedtime routine are important components of any treatment program.
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    • "Parents of children with AS report higher levels of psychological distress compared to parents of other children with rare genetic syndromes (Griffith et al., 2011). Behavior therapy is currently the consensus ''first-line'' treatment for pediatric sleep disturbance, with numerous studies showing that this approach produces durable changes in more than 80% of young children (Mindell et al., 2006b; Morgenthaler et al., 2006). Parents serve as the active change-agent (Owens, 2006), and are coached in how to implement these principles to shape healthier sleep habits in their children. "
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    ABSTRACT: The purpose of this investigation was to evaluate the effectiveness of a behavioral treatment package to reduce chronic sleep problems in children with Angelman Syndrome. Participants were five children, 2-11years-of-age. Parents maintained sleep diaries to record sleep and disruptive nighttime behaviors. Actigraphy was added to provide independent evaluations of sleep-wake activity. The treatment package targeted the sleep environment, the sleep-wake schedule, and parent-child interactions during sleep times. Treatment was introduced sequentially, across families, and evaluated in an interrupted time series, multiple baseline design. Data show that prior to treatment, baseline rates of nighttime disruptive behavior were stable or increasing and none of the participants were falling to sleep independently. With the introduction of treatment, all participants quickly learned to initiate sleep independently. Gradual reductions were reported in disruptive behaviors and these improvements were sustained over time. Results were replicated with two participants when treatment was withdrawn and reinstated. Changes in disruptive bedtime behaviors and in sleep onset were found to be statistically significant. Parents indicated high satisfaction with the treatment. A behavioral treatment package was found to be effective with five children with long histories of significant sleep-related behavior problems. These results suggest that behavioral treatment may be a reasonable way to address sleep problems in some children with Angelman Syndrome.
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