Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children: An American Academy of Sleep Medicine report

Mayo Sleep Disorders Center, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Sleep (Impact Factor: 4.59). 11/2006; 29(10):1277-81.
Source: PubMed


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.
    Journal of the American Association of Nurse Practitioners 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.
    Paediatric respiratory reviews 04/2014; 15(4). DOI:10.1016/j.prrv.2014.04.011 · 2.20 Impact Factor
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    • "It has been demonstrated that sleep aids such as a pacifier and a cuddly object such as a teddy bear reduce the occurrence of sleep disorders, whereas prolonged breastfeeding and parental cosleeping interfere with the normal development of sleep14) though it has been debated that roomsharing in the presence of an active caregiver can reduce sudden infant death syndrome (SIDS) among some SIDS prone infants and the increased sensory contact and proximity between the mother and infant induces potentially beneficial behavioral and physiological changes in the infants15). In this study rocking, swinging, and holding until sleep had resumed were the most frequent inappropriate sleep onset associations (n=50), followed by nighttime feeding after 6 months of age (n=21), consistent with previous studies12,16,17). "
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    ABSTRACT: Sleep onset association disorder (SOAD) is a form of behavioral insomnia observed in children that is caused by inappropriate sleep training. SOAD typically disturbs the sleep of not only infants and children but also their parents. We investigated levels of depression and marital intimacy among parents of infants with typical SOAD, to understand the influence of SOAD on family dynamics, as well as examine ways for improving depression and marital intimacy through behavioral training. Depression and marital intimacy were assessed using the Beck Depression Inventory (BDI) and Waring Intimacy Questionnaire (WIQ). These measures were administered to 65 parents of infants (n=50) diagnosed with SOAD. We conducted sleep education and behavioral training for the parents and compared levels of depression and marital intimacy after 2-6 weeks of training. The 65 parents consisted of 50 mothers and 15 fathers. Depressive symptoms were higher among mothers than fathers (P =0.007). Marital intimacy was negatively correlated with depressive symptoms. Twenty-six parents were assessed again after sleep training. We found that mothers' depressive symptoms and marital intimacy improved post training. SOAD can be detrimental to both infants and parents, especially for parents who sleep with their infants. For instance, disruption of sleep patterns in such parents can reduce marital intimacy. However, behavioral modification is an effective treatment for infants with frequent nighttime waking, as well as for diminishing the depressive symptoms of sleep-deprived parents.
    Korean Journal of Pediatrics 05/2013; 56(5):211-7. DOI:10.3345/kjp.2013.56.5.211
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