Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep Intervention: Randomized Trial

BA(Hons), Centre for Community Child Health, The Royal Children's Hospital, Flemington Rd, Parkville VIC 3052, Australia. .
PEDIATRICS (Impact Factor: 5.47). 09/2012; 130(4):643-51. DOI: 10.1542/peds.2011-3467
Source: PubMed


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.
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.
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).
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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Available from: Anna Price, Feb 10, 2015
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    • "But recent publications seem to intentionally mislead parents about what is good for babies. Recently, the AAP's journal published a poorly wrought paper that claimed: " Behavioral sleep techniques have no marked long-lasting effects (positive or negative) " (Price et al., 2012). The authors drew this very strong conclusion even though they looked at only one and not all possible effects. "
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    ABSTRACT: Introduction: Children aged 3–5 who engage in daytime sleep are more likely to go to bed later and have more night waking than children who do not. Children's sleep disruptions can impact the family functioning and well-being so it is important to understand parental view points and the factors which influence parent preferences when reviewing daytime sleep/rest periods. In Australia, approximately 50% of children aged 3–5 attend an Early Childhood Education and Care (ECEC) settings, and a daytime sleep/rest period is a prominent feature of their daily routines. Previous research reports that parental decisions regarding children's sleep patterns are influenced by various factors, including financial conditions, family size, cultural practices and beliefs, parent work schedules and child factors, to name a few. To date, no research has been conducted to examine a) parental preferences towards the daytime sleep/rest period in ECEC settings and b) the underlying reasons behind these preferences. Method: We present data from a large, longitudinal project of preschool-aged children in Australia. Participants included Australian parents (N = 1302) of preschool aged children (aged 3–6.5) from metropolitan, regional and rural sites across two Australian states and included the diversity of social groups in Australia. Children participating in the study were enrolled in a range of ECEC services including long day care, kindergarten and family day care. Results: This study utilised both quantitative and qualitative data obtained from parent-report questionnaires to document parental preferences regarding the day sleep/rest period in ECEC settings and to obtain their rationale for their preference. The association of these responses with demographic indicators, family/child factors and systemic, contextual factors were explored to assess their influence on parental desires towards preschool children's day sleep routines. Conclusions: The results provide important information on the views of parents towards the sleep/rest period in ECEC settings. The data on parental preferences inform policy and practice in early childhood education and care.
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