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Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial
Abstract
Objectives:
To evaluate the effects of behavioral interventions on the sleep/wakefulness of infants, parent and infant stress, and later child emotional/behavioral problems, and parent-child attachment.
Methods:
A total of 43 infants (6-16 months, 63% girls) were randomized to receive either graduated extinction (n = 14), bedtime fading (n = 15), or sleep education control (n = 14). Sleep measures included parent-reported sleep diaries and infant actigraphy. Infant stress was measured via morning and afternoon salivary cortisol sampling, and mothers' self-reported mood and stress. Twelve months after intervention, mothers completed assessments of children's emotional and behavioral problems, and mother-child dyads underwent the strange situation procedure to evaluate parent-child attachment.
Results:
Significant interactions were found for sleep latency (P < .05), number of awakenings (P < .0001), and wake after sleep onset (P = .01), with large decreases in sleep latency for graduated extinction and bedtime fading groups, and large decreases in number of awakenings and wake after sleep onset for the graduated extinction group. Salivary cortisol showed small-to-moderate declines in graduated extinction and bedtime fading groups compared with controls. Mothers' stress showed small-to-moderate decreases for the graduated extinction and bedtime fading conditions over the first month, yet no differences in mood were detected. At the 12-month follow-up, no significant differences were found in emotional and behavioral problems, and no significant differences in secure-insecure attachment styles between groups.
Conclusions:
Both graduated extinction and bedtime fading provide significant sleep benefits above control, yet convey no adverse stress responses or long-term effects on parent-child attachment or child emotions and behavior.
... Only 19% of mothers with infants aged 0-3 months received advice on infant sleep practices from their physicians (Krouse et al., 2012). Family-centred nursing interventions for infant sleep have shown positive effects on parental sleep and well-being (Gradisar et al., 2016;Hall et al., 2015;Thome & Skuladottir, 2005). Therefore, healthcare practitioners, particularly nurses, should be equipped to assess infant sleep and its impact on parents to promote the overall development of both infants and families (Keys & Benzies, 2018). ...
... Three of the 11 studies offered extinction-based behavioural interventions, which involved ignoring a baby's crying for a period of time at night (Gradisar et al., 2016;Sadeh, 1994), and eight studies incorporated parental education together with behavioural interventions (Galland et al., 2017;Hall et al., 2015;Santos et al., 2019;Stremler et al., 2006Stremler et al., , 2013Sweeney et al., 2020;Werner et al., 2015). Three extinction-based sleep interventions were conducted to address sleep problems in infants after 6 months of age (Gradisar et al., 2016;Sadeh, 1994). ...
... Three of the 11 studies offered extinction-based behavioural interventions, which involved ignoring a baby's crying for a period of time at night (Gradisar et al., 2016;Sadeh, 1994), and eight studies incorporated parental education together with behavioural interventions (Galland et al., 2017;Hall et al., 2015;Santos et al., 2019;Stremler et al., 2006Stremler et al., , 2013Sweeney et al., 2020;Werner et al., 2015). Three extinction-based sleep interventions were conducted to address sleep problems in infants after 6 months of age (Gradisar et al., 2016;Sadeh, 1994). ...
statement
What is already known about this topic? Strong evidence exists that behavioural interventions improve infant sleep.
Infant sleep interventions using actigraphy have gradually increased in paediatric sleep research.
What this paper adds: Behavioural interventions were found to be fairly effective for infants' sleep onset latency and night‐wakings.
Parental education programs were inconsistent in their effectiveness on infant sleep outcomes, compared to extinction‐based behavioural interventions. Infant behavioural sleep interventions also did not show consistent positive effects on parental variables.
The use of actigraphy with infants is challenging in terms of comparability across studies due to the lack of standardized criteria for defining and scoring daytime and nighttime sleep data, and unexpected external movement detection due to variability of infants' sleep conditions.
The implications of this paper: This study contributes to nursing knowledge and practice by increasing the feasibility of implementing infant behavioural sleep interventions using actigraphy and considering family contexts.
Meta‐analysis is needed to clarify the effectiveness of infant sleep interventions, and further studies should investigate the long‐term effects of infant sleep interventions.
In infant sleep intervention studies using actigraphy, it is necessary to use subjective and objective measures as complementary modalities. Follow‐up studies are needed to establish standards in actigraphic measurement and reporting methodology.
... Two studies analyzed bright light therapy [36,68] and only three studies used a combination of therapy with evidenced-based psychological intervention and bright light therapy [47,68,69]. Most of the studies used a control condition and only four studies showed an active control condition (EBPI, Sham Flash þ EBPI) [52,57,58,68]. Included studies focused on children and adolescents up to 18 years of age. ...
... No studies received "high risk" judgments in the first five domains. Only four studies received "high risk" judgments in overall bias [45,52,59,64]. Eight studies obtained "some concerns" in overall bias [43,44,48,54,55,60,61,63]. Of these studies, seven presented only one other domain with "some concerns" judgment while all other domains had a "low risk" [43,44,48,54,55,61,63]. ...
Sleep initiation and maintenance problems are common in the pediatric population and while behavioral interventions are recommended, their efficacy remains to be evaluated in clinical trials. We conducted a systematic review and network meta-analysis to assess the efficacy of non-pharmacological treatments and melatonin for sleep initiation and maintenance problems in healthy pediatric populations. We included 30 studies in the systematic review and 15 in the meta-analysis. Three network meta-analyses were conducted for sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). For SOL variable, the results support greater effectiveness of light therapy and melatonin than evidence-based psychological interventions, whether implemented in combination with light therapy or not. Regarding WASO variable, evidence-based psychological interventions and a combination of those techniques plus light treatment were the most efficacious. Finally, for TST variable, a larger effect was shown for the combined treatment of evidence-based psychological intervention with light therapy in comparison to other interventions. In conclusion, we found a high variability between study protocols likely impacting the results of the meta-analysis. Future randomized control trials studies, stratified by pediatric age classes, are needed in order to provide clear suggestions in clinical settings.
... interventions, attrition rates (including reasons why) are seldom reported (Gradisar et al., 2016;Reuter et al., 2020). This problematic reporting of research methodology has made reasons for treatment hesitation and treatment drop out, remarkably unclear. ...
... The clinical implications of J o u r n a l P r e -p r o o f these findings are significant considering many behavioural interventions for infant sleep problems require parents to delay their responses to their infant's cries. For example, in some modified extinction protocols, waiting times may start at 2-minutes(Gradisar et al., 2016), and a mean increase in PCT of over 25% (i.e., 34 seconds), could mean parents are more able to wait for the suggested timeframe (i.e., increasing the response time increases the probability that the child may stop crying).A study to test whether these strategies help parents to adhere to behavioural interventions is important, so that we can establish whether a relatively simple adjunct strategy can help parents regulate their emotions when implementing a reportedly stressful technique ...
Study objectives:
Infant sleep problems are one of the most common complaints of new parents. Research to date has demonstrated a relationship between low parental cry tolerance and infant sleep problems. The aim of this study was to explore whether three emotion regulation strategies could increase parental cry tolerance.
Methods:
This study utilised a quasi-experimental design. We recruited 83 females (Mage= 32, SD= 5.26) comprising 3 groups: mothers of good sleeping infants aged 6-24 months, mothers of poor sleeping infants aged 6-24 months, and good sleeping women aged 23-40 years without children. Participants were instructed to listen to crying audio segments and indicate when they felt the child needed to be tended to (measured in seconds). This crying audio was paired with one of three emotion-regulation strategies (i.e., music, gaming, reappraisal). Each participant completed all 4 cry conditions which were counterbalanced to control for order effects.
Results:
We found that all three strategies yielded significantly longer reaction times (indicating higher cry tolerance) compared to the control condition (p <.001). We also found that mothers of poor sleepers and good sleeping women benefitted from all three emotion regulation strategies compared to control (p <.001 and p= <.05, respectively). The cry tolerance of mothers of good sleepers, on the other hand, did not differ between the control condition and any of the strategies (all ps >.05).
Conclusions:
This demonstrates that cry tolerance can be increased using emotion regulation strategies, such as distraction via music or gaming, and reappraisal. This has clinical implications for families implementing behavioural sleep interventions.
... Behavioral techniques: Experts recommend empiricallyvalidated sleep learning methods: complete extinction [34][35][36], graduated extinction [48][49][50][51] and reducing parental presence [52,53]. Of the 19 self-help books that mention using behavioral techniques to treat insomnia, 63% are compliant with expert advice by recommending (n=12) this practice. ...
... Experts recommend the graduated extinction method [48][49][50][51] as a sleep training technique, which consists of progressively reducing parental presence at the time of falling asleep. Of the 19 self-help books that mention the graduated extinction method, 74% are compliant with expert advice by recommending (n=14) this practice. ...
The present study aims to assess the quality of self-help books on the subject of children’s sleep.
Method: An international committee of specialized pediatricians and psychologists established 37 criteria in terms of quality and recommendations on children’s sleep development and treatment for sleep disorders. Thirty-three self-help books written in French language were assessed on exhaustiveness regarding quality criteria and on authors’ compliance with expert advice.
Results: Half of the authors had no health care qualifications, the other half were health professionals. A few authors were specialists in sleep. Nearly 82% self-help books were not exhaustive. Only 15% of all the self-help books in the sample were more than 50% compliant with expert advice. One-third of self-help books obtained higher than a 50% total weighted score combining exhaustiveness and compliance with the criteria. The majority of self-help books do not mention at all the following criteria: risk of sudden infant death syndrome (SIDS), recommended methods for treating insomnia, and the impact of screens on sleep.
Conclusion: The heterogeneity of self-help books raises questions about the appropriateness of their proliferation: readers have a 50/50 chance of reading a book that follows expert advice, and those who read two books have a high risk of encountering conflicting advice. This variability and the lack of legitimacy of some of the authors to publish health recommendations are detrimental to the cause of preventive health, as well as to guiding parents seeking a care solution for their children with sleep disorders.
... A number of techniques are designed to condition infants and toddlers to sleep for longer periods at night. 76 They are based on reducing the infant's expectation of a specific behavior associated with sleep onset and conditioning infants to ''soothe themselves'' back to sleep, alone, without adult intervention, when they have normal sleep cycle awakening. 76,77 Training young infants to sleep alone by failing to respond to their crying in a distant crib causes significant infant stress, as indicated by elevated infant cortisol levels, which persist on the nights when the infant is no longer crying. ...
... 76 They are based on reducing the infant's expectation of a specific behavior associated with sleep onset and conditioning infants to ''soothe themselves'' back to sleep, alone, without adult intervention, when they have normal sleep cycle awakening. 76,77 Training young infants to sleep alone by failing to respond to their crying in a distant crib causes significant infant stress, as indicated by elevated infant cortisol levels, which persist on the nights when the infant is no longer crying. 12 Parents often experience distress at not responding to their infant's cries, 78,79 and often find sleep training is not effective. ...
A central goal of the Academy of Breastfeeding Medicine (ABM) is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The ABM empowers health professionals to provide safe, inclusive, patient-centered, and evidence-based care. Pregnant and lactating people identify with a broad spectrum of genders, pronouns, and terms for feeding and parenting. There are two reasons ABM's use of gender-inclusive language may be transitional or inconsistent across protocols. First, gender-inclusive language is nuanced and evolving across languages, cultures, and countries. Second, foundational research has not adequately described the experiences of gender-diverse individuals. Therefore, ABM advocates for, and will strive to use language that is as inclusive and accurate as possible within this framework. For more explanation, please read ABM Position Statements on Infant Feeding and Lactation-Related Language and Gender (https://doi.org/10.1089/bfm.2021.29188.abm) and Breastfeeding As a Basic Human Right (https://doi.org/10.1089/bfm.2022.29216.abm).
... Beispielweise finden Eltern-Trainingsprogramme zur Verbesserung kindlicher Schlafprobleme in Elterngruppen statt (z. B. Gradisar et al., 2016). ...
Regulation disorders in early childhood and postpartum mental disorders of parents can be effectively treated by interventions that involve parents and child (so-called parent-infant psychotherapy, PIP). Availability of PIP in routine care remains low, even though the intervention is in high demand. This study aims to map the current situation of psychotherapy training in PIP in Germany, to record existing obstacles from the perspective of the institutes, and to obtain indications for improving training. Contact persons of training institutes all over Germany were invited to participate in an online survey. N = 95 persons answered questions about possible training in PIP and related advantages and hurdles as well as conditions for a future implementation. Nineteen (22.4 %) of the institutions indicated that PIP was part of their training concept. In 84.2 % of the cases this was aimed at child and adolescent psychotherapists. In 63.6 % of the institutes PIP was treated comprehensively. On average, 2.55 barriers were perceived, most frequently of an organizational nature. 75.9 % of the institutes that did not yet offer PIP would be willing to do so in the future under at least one condition. Among those conditions, information on PIP curricula and specific training content was most frequent (40.7 %).The low implementation of PIP in training seems to be mainly due to barriers of an organizational nature that can be overcome by some simple means, such as the dissemination of model curricula.
... Hence, they can facilitate extinction protocols, which the child may embark with both higher motivation and elevated sleep pressure. Recent work has correspondingly demonstrated the benefits of sleep restriction or bedtime fading in young children with insomnia, 71-73 yet additional research is needed to establish their efficacy in pediatric populations. ...
Insomnia is the most prevalent sleep disorder in youth, tends to persist over time, and is associated with a myriad of adverse outcomes. This paper synthesizes the current evidence regarding the phenomenology, prevalence, assessment, consequences, etiology, and treatment of pediatric insomnia, highlighting areas that warrant further research, and addressing the unique characteristics of this disorder in infants, children, and adolescents.
Infant sleep problems are prevalent and have a negative impact on infant growth and development, maternal sleep, and maternal mood. The effects of psychosocial sleep interventions on infant sleep and maternal sleep and mood are unclear. This study aimed to systematically evaluate the effects of psychosocial sleep interventions on improving infant sleep, including nocturnal total sleep time, daytime total sleep, total sleep time, night wakings, and maternal sleep and mood problems (ie, depression and fatigue). We searched PubMed, Web of Science, Cochrane Library, Embase, EBSCO, OpenGrey, DeepBlue, China National Knowledge Infrastructure, and Wanfang databases. We focused on randomized controlled trials examining the effectiveness of psychosocial sleep interventions on infant sleep. The study was preregistered at the International Prospective Register of Systematic Reviews (CRD42022301654). Thirteen studies from 5889 articles were included in the review, which found that psychosocial sleep interventions improved infant nocturnal total sleep time (0.28 [0.04-0.52], p < 0.05, I2 = 83.9%) and maternal depression (-0.10 [-0.28 to -0.08], p < 0.05, I2 = 8.7%). To test and explore heterogeneity, we used the I2 statistic, influence analysis, subgroup analyses, and subgroup meta-analyses. Funnel plots and Egger's tests revealed no evidence of publication bias. Psychosocial sleep interventions improved infant nocturnal total sleep time and maternal depression. Future research should include more randomized controlled trials examining the effect of psychosocial sleep interventions on the improvement of maternal sleep and fatigue.
Objectives
To establish unconditional reference centiles for sleep parameters in infants 4–16 weeks of age.
Design and setting
Secondary data analysis of sleep parameters recorded at 4–16 weeks of age in a longitudinal randomised controlled trial (RCT) (BabySMART).
Patients
Healthy term infants assigned to the non-intervention arm of the RCT.
Main outcome measures
Infants’ sleep duration was recorded by parents/guardians daily, from week 2–16 of age using a sleep diary. Reference centiles for total, daytime, night-time and longest sleep episode duration were estimated using multilevel modelling.
Results
One hundred and six infants, mean (SD) gestational age of 39.9 (1.2) weeks and mean (SD) birth weight of 3.6 (0.5) kg had sleep recorded contributing 1264 measurements for each sleep parameter. Between 4 and 16 weeks of age total sleep duration in a 24-hour period, night-time sleep duration in a 12-hour period and infant’s longest sleep episode duration increased, while daytime sleep duration in a 12-hour period decreased.
Conclusions
Reference centiles up to 4 months of age in infants highlight the gradual decrease in daytime sleep and large increases in night-time sleep, which occur in tandem with increasing lengths of sleep episodes. These reference centiles provide useful sleep values for infant sleep trajectory occurring in early life and may be helpful for parents and clinicians.
Trial registration number
NCT03381027 .
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 unmodifi ed 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.
Cortisol concentrations in plasma display a circadian rhythm in adults and children older than one year. Earlier studies report divergent results regarding when cortisol circadian rhythm is established. The present study aims to investigate at what age infants develop a circadian rhythm, as well as the possible influences of behavioral regularity and daily life trauma on when the rhythm is established. Furthermore, we determine age-related reference intervals for cortisol concentrations in saliva during the first year of life.
130 healthy full-term infants were included in a prospective, longitudinal study with saliva sampling on two consecutive days, in the morning (07:30-09:30), noon (10:00-12:00) and evening (19:30-21:30), each month from birth until the infant was twelve months old. Information about development of behavioral regularity and potential exposure to trauma was obtained from the parents through the Baby Behavior Questionnaire and the Life Incidence of Traumatic Events checklist.
A significant group-level circadian rhythm of salivary cortisol secretion was established at one month, and remained throughout the first year of life, although there was considerable individual variability. No correlation was found between development of cortisol circadian rhythm and the results from either the Baby Behavior Questionnaire or the Life Incidence of Traumatic Events checklist. The study presents salivary cortisol reference intervals for infants during the first twelve months of life.
Cortisol circadian rhythm in infants is already established by one month of age, earlier than previous studies have shown. The current study also provides first year age-related reference intervals for salivary cortisol levels in healthy, full-term infants.
Although there is improved recognition of the pernicious long‐term harm that stems from living with neglect during childhood, neglect is rarely associated with child fatality. This article offers a re‐analysis of neglect in serious case reviews (cases of child death or serious injury related to maltreatment) in England (2003–11) from four consecutive government‐commissioned national two‐yearly studies. It draws on anonymised research information from 46 cases out of a total of over 800 cases. Each case was examined in depth using an ecological transactional approach, grounded in the child's experience, which promotes a dynamic understanding and assessment of the interactions between children and their families and the helping practitioners. The qualitative findings reported explore how circumstances came together when neglect had a catastrophic impact on the child and family presenting in six different ways (deprivational neglect, medical neglect, accidents with elements of forewarning, sudden unexpected deaths in infancy, physical abuse combined with neglect and young suicide). Each of the six categories raised particular issues over and above a common core of concerns around the relationship between the child and his or her parent or carer, and between parents/carers and professionals. © 2014 The Authors. Child Abuse Review published by John Wiley & Sons Ltd.
‘neglect is rarely associated with child fatality’
‘Each of the six categories raised particular issues’
Key Practitioner Messages
There are no easy answers to curbing potentially fatal neglect – practitioners should be supported to make careful well‐reasoned judgements.
That neglect is not only harmful but can also be fatal should be part of any practitioner's mindset, as with other maltreatment.
To guard against catastrophic neglect, children need to be physically and emotionally healthy and have a safe, healthy living environment.
Practitioners need to be compassionate and sensitively attuned to the relationship between parents and children.
‘practitioners need to be compassionate and sensitively attuned to the relationship between parents and children.’
This article examines Australian legal responses to filicide in circumstances where
mothers have killed their young children. We consider the potential legal defences that
may be raised where postnatal depression (‘PND’) and other psychiatric disorders are
present in cases of filicide: insanity/mental impairment, diminished responsibility/
substantial impairment by abnormality of mind, and infanticide. We then examine 28
cases of filicide, including both cases where PND evidence was adduced, and cases where
PND evidence was not adduced but other mental health issues were considered. We look
at the forensic use of and judicial responses to PND and other evidence of mental illness:
how do medical practitioners and judicial officers present impairment of the defendant’s
mental capacity? We also speculate on differences in sentencing outcomes and consider
the policy and research implications of our findings.
This article examines Australian legal responses to filicide in circumstances where mothers have killed their young children. We consider the potential legal defences where postnatal depression (PND) and other psychiatric disorders could be raised in cases of filicide – insanity/mental impairment, diminished responsibility/substantial impairment by abnormality of mind, and infanticide. We then examine 28 cases of filicide, both in cases where there was PND, and cases in which there was no PND evidence adduced, but other mental health issues were considered. We look at the forensic use of and judicial responses to PND and other evidence of mental illness. How do medical practitioners and judicial officers present impairment of the defendant’s mental capacity? We also speculate on differences in sentencing outcomes and consider the policy and research implications of our findings.
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.
Objective
Insufficient and poor quality sleep is prevalent in children, and is a significant public health concern due to the negative consequences for health. Certain sleep-related behaviours are associated with improved sleep, and sleep behaviours are amenable to efforts targeted towards behaviour change. Parental educational interventions have been successful at improving parents’ knowledge and children’s health outcomes in some areas of health, but no population-based educational interventions have been designed to improve parents’ knowledge of healthy children’s sleep. This study aimed to design and test an educational tool to increase caregivers’ knowledge of healthy children’s sleep in a primary care setting.
Setting
A hospital-based pediatric primary care clinic where children attend for well-child and sick visits.
Method
Parents of 95 children aged three months to 12 years completed two surveys, one prior to and one after receiving the intervention. The surveys assessed children’s sleep habits (pre-intervention) and parental sleep beliefs and sleep knowledge (pre- and post-intervention). The intervention was a short, informational brochure.
Results
Following the intervention there was a significant increase in parents’ knowledge regarding children’s healthy sleep, and in the number of parents who planned to make positive behaviour changes regarding their child’s sleep practices.
Conclusion
Simple written educational interventions may be effective tools with which to increase parents’ knowledge and promote healthy sleep behaviours in children.
Data drawn from the Australian Homicide Project were used to examine whether and how maternal and paternal filicide perpetrators differ in terms of motivations for filicide and childhood and adulthood adversities. In addition, key differences between filicide and non-filicide perpetrators were examined. Data were collected across a number of states and territories in Australia between 2010 and 2013 through interviews with 231 men and women convicted of murder or manslaughter. Of these participants, 14 had perpetrated filicide. Detailed information on the developmental background of the perpetrators, as well as motives and situational contexts of the homicide incidents, was gathered through the interviews. Findings from the current study reveal some important gender differences among filicide perpetrators. For example, filicidal fathers are more likely to perpetrate accidental filicide, and to report unemployment, alcohol and drug problems and previous engagement in child abuse, while filicidal mothers are more likely to perpetrate altruistic or neglectful filicide, and to report mental health problems. In addition, male filicide perpetrators report a greater number of adversities compared to male non-filicide perpetrators, while female filicide perpetrators display fewer adversities compared to their non-filicide counterparts. ‘Findings from the current study reveal some important gender differences among filicide perpetrators’ ‘Health and social service providers are ideally placed to screen parents seeking support to uncover early warning risks’
Objectives To investigate the emergence of biological rhythms in the first months of life in human infants, by measuring age-related changes in core body temperature during night-time sleep, hormones (cortisol and 6-sulfatoxymelatonin) and the expression of a clock-controlled gene H3f3b in oral epithelial cells.
Design Observational longitudinal study.
Setting We measured overnight core body temperature, actigraphy, day–night urinary cortisol and 6-sulfatoxymelatonin, as well as circadian gene expression, in infants at home from March 2007 to July 2008 in Leicester.
Participants We recruited 35 healthy Caucasian infants who were born at term. They were monitored from 6 to 18 weeks of age.
Results At 8 weeks of age the day–night rhythm of cortisol secretion was the first to appear followed by 6-sulfatoxymelatonin 1 week later; at the same time that night-time sleep was established. At 10 weeks, the maximum fall in deep body temperature occurred with the onset of night-time sleep, followed at 11 weeks by the rhythmical expression of the H3f3b gene.
Conclusions In human infants, there is a clear sequential pattern for the emergence of diurnal biological rhythms between 6 and 18 weeks of postnatal age, led by the secretion of cortisol and linked with the establishment of consolidated night-time sleep. It is likely that this represents part of a maturation and adaption process as infants gain equilibrium with their external environment after birth.