Project

Assessing the discontinuities between research, parenting advice, and parenting practice on the use of extinction in infants under 6-months: A critical review of the literature

Goal: Existing parenting advice often recommends the use of extinction with infants as early as 3- to 4-months, however, virtually no research has been conducted on infants this young. What then is known about the use of crying before sleep with infants under 6-months?

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Macall Gordon
added a research item
This research reviews the literature on the use of extinction for sleep in infants with a special focus on parenting advice endorsing the preventive use of extinction (crying it out) in infants under six months. The paper compares claims in popular advice to existing research to evaluate the congruence of advice with research and real-world parenting practice. Results indicate that both parenting advice and empirical literature lack a developmental lens so that knowledge based on older children is applied to very young ones. As a result, very little is known about the necessity, effectiveness, or lack of side effect of unmodulated distress for infants under 6 months. This paper suggests that research inquiry needs to expand beyond the question of "does extinction work?"
Macall Gordon
added an update
A comparison of existing research to parenting advice in the top-selling sleep books reveals stark discontinuities. While research on behavioral sleep training in young infants employed only very minimal delays in responding, some advice suggests that parents can use graduated and in some cases, pure extinction, as early as 8-weeks. Further, differences between statistical significance in sleep improvements differ from what parents are told. Some improvements in nighttime sleep were minimal (18-minutes more nighttime sleep), while advice conveys that parents can expect all-night, uninterrupted bouts of sleep. Other research suggests that behavioral sleep training does not, in fact, affect infants' actual sleep behavior, but rather, mothers' perceptions of how much sleep the baby got. There are distinct bidirectional discontinuities between research and advice and between both and parents' real world experiences.
 
Macall Gordon
added an update
Documentation of evidence-based sleep interventions applicable to infants under a year (and under 6 months specifically) still relies heavily on research conducted with toddlers and preschoolers. Prevention-based interventions that suggest parents delay responding are often vague about how long to wait or wait times are very small (<5 min). This is in contrast to popular advice that suggests parents use extinction on very small infants (2-4 months) and that this will produce lasting effects on sleep. Research on the long-term effects of early intervention shows only limited effectiveness past 2- or 3-months post-treatment.
 
Macall Gordon
added an update
A review of the seminal works underpinning the use of extinction as an evidence-based practice for sleep problems reveals: 1) though popularly applied to infants across the first year, much of this research was conducted on toddlers and preschoolers; 2) work with younger infants frequently showed few if any differences on follow-up; 3) in practical terms, differences between intervention and control groups were frequently small in real-world terms (e.g. an additional 30 minutes of nighttime sleep or 1.5 wakings instead of 2.1); 4) interventions were routinely deployed in the context of assessment, an individualized plan and ongoing support. These effects were rarely considered as instrumental in outcomes. When compared to the real-world advice and application of extinction-based interventions, there are considerable discontinuities that may impact parents in their efforts to improve sleep.
 
Macall Gordon
added a research item
Three important questions are covered in this poster: • Does nightwaking that involves parental attention invariably constitute a sleep problem for children and parents? • Does a paradigm of independent, self-settling infant sleep patterns represent a solution or an added stressor? • Are children’s nighttime behaviors and parental sleep interventions related to parent-child well-being? The three research studies presented in this poster explore the possible challenges associated with a focus on various sleeping arrangements and routines. The poster also highlights the importance of alternative approaches and flexibility in mothers’ responses to nightwaking based on maternal perceptions of appropriate care and infants’ temperamental and physiological needs.
Macall Gordon
added a research item
NOTE: PLEASE SEE UPDATED RESEARCH POSTER ON THIS PAGE. This research is from 2006. I have updated this with a poster presented in 2022. ABSTRACT: The most empirically supported and endorsed approaches to preventing or ameliorating infant sleep problems involve various forms of extinction (crying it out). This approach is widely recommended by pediatricians and mainstream parenting publications for infants as young as 3- to 4-months. A review of the literature regarding the cry-it-out (CIO) approach to infant sleep reveals that empirical support for this early start date is lacking. Much of the existing literature used to validate the use of extinction with infants does not include infants under 1 year in the sample population. The subset of studies which include infants, do so as part of a much larger sample comprised of wide age ranges (e.g. 9-60 months). Results from these studies do not specify outcomes by age, and obscure the existence of differential effects for infants. Though CIO is recommended as the approach of choice for infant sleep, relatively little is known about its effects on infants under 1 year.
Macall Gordon
added a project goal
Existing parenting advice often recommends the use of extinction with infants as early as 3- to 4-months, however, virtually no research has been conducted on infants this young. What then is known about the use of crying before sleep with infants under 6-months?