What to do about sleep? A survey of parents' experiences with infant sleep and popular advice.

Abstract

Background: At one time, sleep deprivation was synonymous with early parenting. Today, “sleeping through the night” has grown in importance and urgency and parents increasingly turn to the popular media for guidance (Simpson, 1997). Such sources, however, can be inconsistent and even inaccurate in matters concerning child health and development (Impicciatore et al., 1997). In fact, an examination of parenting books and magazines on infant sleep reveal stark differences in reported sleep milestones, appropriate age for starting, and amount of crying to allow. Further, advice content stresses the critical importance of extended sleep for infant brain and behavioral development. It is not surprising, then, that parents may be stressed and anxious about sleep. This survey aims to assess how popular advice influences what parents know and do about infant sleep, and whether there are differences in experience and outcomes based on their chosen approach. Methods: First-time parents of infants under 12 months were recruited via targeted email and search engine ads. The survey includes questions about the infant’s current sleep behavior, parental use of sleep advice, and implementation of the intervention. Parents’ perceived levels of infant sleep difficulties, as well as worry, stress or conflict around sleep were also assessed. Based on answers to key questions, respondents were placed into one of three groups: Crying approaches, No Cry approaches, or Cosleeping. Descriptive statistics for the sample as a whole were calculated. Intervention subgroups were compared for differences in parental perceptions of advice, implementation and experience. Results: Survey respondents (N=185) are predominantly white, married, well-educated mothers. 29.7% (N=51) were classified as Crying, 18.6% (N=45) as No Crying, and 51.8% (N=89) as Cosleeping. Preliminary data analysis revealed no significant differences between groups in parents’ use of sleep advice, knowledge of infant sleep development or the infant’s current sleep behavior. Significant differences, however, were found in the level of worry about managing sleep F(2, 169) = 21.58, p<.01), the goodness of fit with their parenting values F(2, 111=27.54, p<.01), and assessment of the approach’s effectiveness F(2, 111) = 6.698, p<.01). Conclusion: While infant nightwaking is a known stressor for parents, it appears that sleep interventions themselves—especially those that necessitate infant crying—are also a source of increased worry and stress for parents.

Full text

Information and Advice
Parents come to the task of parenting with
only limited preparation. Nearly 1 in 4
had never held a newborn prior to
their own. Almost 1 in 3 had never dia-
pered a baby. More than 1 in 3 lived too
far away from family to drive there and
nearly 40% are trying to parent “very
differently” from the way they were parented. Such factors are known to
contribute to parents’ increasing reliance on expert advice.
At one time, sleep
deprivation was
synonymous with early
parenting. Today, however, “sleeping through the night” has become
a benchmark for both infant development and parental competence.
Parents are increasingly turning to professionals and the media for
guidance. Little is known, however, about how the increasing
quantity of sleep information affects parental beliefs, behaviors
and experiences. This online survey examines parental perceptions
about sleep advice, beliefs about problematic sleep, and the various
approaches to sleep management.
Background Results
Participants: First-time parents
of infants under 11-months were
recruited via targeted email and
search engine ads.
The sample (N=289) is predomi-
nantly female (96.2%), 25-35 years
of age (69.5%), white (87.2%),
married (86.2%), well educated
(45.1% graduate degree) and
affluent (38.8% household incomes
over $100,000). 39.8% work full-
time outside the home and 43.3%
are unpaid, full-time at home.
The median age for infants is 6 months. 50.3% are male.
Instrumentation: Online survey included questions about the infant's current sleep
behavior, parental use of sleep advice, implementation of interventions, and
feelings, worry, stress, or conflict around sleep.
Intervention Groups: Based on answers to key questions about sleep intervention,
respondents were placed into one of the following groups:
Past Cry: Already completed a crying-based intervention 14 4.8
Past No Cry: Already completed a no crying intervention 7 2.4
Current Cry: Currently using a crying-based inter vention 44 15.2
Current No Cry: Currently using interventions that do not include crying 27 9.3
Cosleep: Currently cosleeping 71 24.9
Minimal: Currently making only minor adjustments for sleep 44 15.2
Nothing: Baby is currently sleeping well or parents are 82 28.4
using a wait-and-see approach
Comparisons between currently intervening subgroups: (Current Cry, Current No Cry,
and Cosleep, N=189) were conducted using a Kruskal-Wallis test. Follow-up tests
for pairwise comparisons utilized a Mann-Whitney U test and controlled for Type
1 error across comparisons by using the Holm’s Sequential Bonferroni approach.
Study limitations: The sample was heavily recruited via the internet, as a result
participants are overwhelmingly well-educated and affluent. Further, due to the
continuous nature of cosleeping (i.e. cannot be classified as a “past” intervention),
cosleepers were oversampled within the current intervention groups. Reports
of crying duration and length of intervention relied on parental estimates and were
not objectively measured.
Methods
Macall Gordon, Antioch University, Seattle Sheri L. Hill, Ph.D., Early Childhood Policy Specialist
mgordon@infantsleep.org hill@earlychildhoodpolicy.com
“Whenone reads how the
average baby is ‘supposed’
to sleep, it makes me feel like
there is something wrong with
my baby and/or my parenting
techniques.”
Survey Respondent:
Mom with a10-month-old
What are parents doing about sleep?
Cry Group
Typical wait time before responding
to bedtime crying:
Median: 5-10 minutes
Longest wait: 36.3% waited ≥1 hour
at least a few times.
Experience of waiting: 70% found it to be
“very difficult” (5 or 6 on a 1- 6 scale).
How long does it take? Popular advice suggests
that crying interventions can be successfully
completed in 5-7 days. Still, 44% have been
trying for longer than this.
Necessary to “re-do” the intervention?
22.7% re-initiated once, 15.9% 2-3 times
and 15.9% > 4 times.
No Cry Group
Common “No Cry” techniques:
Positive sleep routines (20.4%),
Following the baby’s cues for
sleeping and waking (19.4%),
White noise (15.3%), Getting
sunlight during the day (15.3%).
Typical wait time before responding:
Most (88%) responded in less than
5 minutes or immediately. The rest
waited between 5-10 minutes.
Cosleep Group
Nearly half of cosleepers (47.1%) made
this decision before their baby was born.
Only 8.6% decided to cosleep after the
first month.
What to do about sleep?
A survey of parents’ experiences with infant sleep and popular advice.
“Theinformation is totally
contradictory,andcan be
very guilt-inducing(i.e.,‘if
you don’tdox-y-z,you are
ruiningyourbabyforlife’).”
SurveyRespondent:
Momwith3-month-oldbaby
Most Used Sources of Information about Sleep
Percent Percent reported
Source Used “Not helpful”
Books 86.9% 6.3%
Friends 85.1% 16.7%
Websites 84.8% 6.5%
Family 80.6% 23%
Internet (Discussion/Support) 71.3% 6.5%
Pediatricians 66.8% 31.9%
Parenting Magazines 66.4% 21.8%
Discussion Parents in this survey reported both quantitatively and qualita-
tively that they were frustrated by the wealth of advice and information available on
sleep. Too much information that is not consistent, practical or well-suited to their
family or child, leaves parents still grappling with the worry that their baby is not
sleeping appropriately. Further research should examine whether current advice is
helping—or merely contributing to parents’ stress.
Parents who chose Cry or No Cry approaches appear particularly stressed about
sleep—with No Cry parents expressing the most concern. No Cry approaches are an
emerging—and less well-studied—technique. No Cry parents may feel that the ap-
proach fits their values, but are unsure about it as a viable alternative to Crying.
Parenting advice clearly needs to better account for parents’ individual context and
overall goals, as well as the impact of the advice itself on parental experience.
Perceptions about Mainstream Sleep Advice
What are the overall impressions of sleep advice? (Response modes shown)
Consistent?
Understandable?
Applicable?
Realistic?
Amount of AdviceNot enough Too much
Not at all Extremely
Not at all Extremely
Not at all Extremely
Not at all Extremely
N%
For a 3-month-
old, how many
hours of sleep
is “through
the night”?
At what age is
it okay to allow
30 minutes of
crying in order
to encourage
sleep?
5 hrs
73.5%
8 hrs
16.7%
4 hrs
5.5%
10 hrs
2.2%
No Age
59.4%
5-6 mos
21.5%
1-2 mos
1.1%
7-9 mos
2.7%
All ages
0.8%
≤3 hrs
1.5%
There were no significant differences between
intervention groups on the number of awakenings
or the duration of nighttime sleep. However, there
were differences in perceptions about sleep behavior
and the chosen intervention.
Problematic sleep: Cosleepers consider their baby’s
sleep behavior less problematic than either the
Cry or No Cry group.
Worry about sleep: Those using Cry or No Cry
were more worried both about sleep in general
and about how well they were managing sleep.
Effectiveness: Cosleepers rated their intervention
as more effective.
Fit with parenting values: There were significant
differences between all three groups. Cry
parents reported the lowest fit.
Adapting: Cry parents believed more than the other
groups that the infant should adapt to the parent.
CS: Different from Cosleep NS: Different from No Cry *=
p
<.05 **=
p
<.01, ***
p
=<.001
3-4 mos
12.3%
>9 mos
2.3%
Easy to get baby back to sleep? Median 3.5 22
(1 Very easy - 6 Very difficult) Mode: 42 1
Sleep problematic for baby? Median 22 1
(1 No problem - 6 Serious problem) Mode: 12 1
Sleep problematic for parent? Median 44 2
(1 No problem - 6 Serious problem) Mode: 25 2
Worry about baby’s sleep? Median 34 2
(1 Not worried - 6 Very worried) Mode: 25 1
Worry about managing sleep? Median 44 2
(1 Not worried - 6 Very worried) Mode: 45 1
Effective? Median 44 5
(1 Not working - 6 Working extremely well) Mode: 45 5
Fit with parenting values? Median 45 6
(1 Doesn’t fit - 6 Fits perfectly) Mode: 45 6
Responding to crying? Median 22 1
(1 Always respond quickly - 4 Always wait) Mode: 2 1, 2 1
Adapting Median 32 2
(1 Adapt to baby - 6 Adapt to parent) Mode: 2, 4 21
Cry (N=44) No Cry (N=27) Cosleep (N=71)
≤2 months 27.3% 28.0% 100%
3-4 months 40.9% 44.0% 0%
5-6 months 27.3% 20.0% 0%
≥7 months 4.6% 8.0% 0%
Age for beginning sleep training
“We were warned by our baby’s doctor
that unless we got her to sleep through
the night now (at 6 months), that these
patterns we were setting up would last
until she was 2. This scared us, so we
started to do what the book says
rather than following our baby’s cues
and individual nature. I personally
think this was bad advice.”
Survey Respondent:
Mom with an 9-month-old
CS
***
CS*
CS
***
CS**
CS
***
CS***
CS
***
CS**
CS*** CS**
CS** CS**
CS*** CS**
NC***
CS*** CS**
NC*
CS*** CS**
NC*
Cry (N=44) No Cry (N=27) Cosleep (N=71) Total
Yes 72.7% 40.7% 31.8% 46.6%
Other methods were 100% 81.8% 50% 80%
the opposite of cur rent
Have you tried other methods?
“It seems like so
much of the
information I read
conflicts, that I feel
alittle guilty no
matter what I do!”
Survey Respondent:
Mom with a 10-month-old
Differences
between
Interventions
(Group medians shown) Cry No Cry Cosleep
How influential has
the advice been in
choosing a method?
All groups report that
sleep advice was fairly
influential (Median: 4).
The Cry group, however,
reported feeling more
influenced by the
information than the
Cosleep group (p<.001).
Sleep Knowledge & Expectations
<5 min
25%
5-10 min
20.8%
Tried not
to respond
20.8%
45-1hr
4.2%
15-20 min
12.5%10-15
min
12.5%
2-3
days
20%
4-7
days
20%
>2 mos
20%
3-4
weeks
16%
2 mos
12%
1 month
8%
2-3 weeks
8%
Typical bedtime wait
How long has it taken?
12 hrs
0.7%
Cry (N=44) No Cry (N=27) Cosleep (N=71)
Cry (N=44) No Cry (N=27) Cosleep (N=71) Total
Percent Percent reported
Source Used “Not helpful”
Conclusions