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Behavioural sleep treatments and night time crying in infants: Challenging the status quo
... Ramos and Youngclarke [31] analyzed advice on bed sharing (not recommended beyond the first few months of life to prevent the risk of Sudden Infant Death Syndrome, SIDS) [32,33] and the extinction method (recommended for treating behavioral insomnia) [34][35][36] in 40 English-language self-help books on children's sleep. One out of three books (n=11; 28%) promotes bed sharing and one out of three books (n=12; 30%) rejects the extinction-based learning method. ...
... 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. ...
... Indeed, few self-help books do mention it, a large number of authors oppose it, some authors do not take sides and some others propose alternative methods that have not been empirically validated. However, the scientific literature advocates interventions that support sleep onset independence, which is the learning method recommended by experts with the largest amount of evidence [34][35][36]. Our study shows that many self-help books are not compliant with expert recommendations on these criteria, often stating that children should not be left to cry. ...
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.
... Par conséquent, cet article fournit un guide de lecture critique en soulignant les divergences entre les études concernant les bénéfices des interventions comportementales du sommeil (sur le comportement et l'humeur de l'enfant, et le fonctionnement familial). Nous portons une attention particulière aux méthodes de type extinction car des études ont rapporté des bénéfices à utiliser ce type d'interventions (Mindell, Kuhn, Lewin, Meltzer et Sadeh, 2006;Rickert et Johnson, 1988) alors que d'autres les remettent en question sur les plans éthique, moral, et social (Blunden, Thompson et Dawson, 2011;Etherton et al., 2016). ...
... Par conséquent, ces questionnements ont conduit à des points de divergence dans la littérature scientifique. En effet, dernièrement, des auteurs (e.g., Blunden et al., 2011;Douglas et Hill, 2013) ont contesté certaines interventions comportementales du sommeil reconnues comme efficaces en s'appuyant sur des arguments étayés sur les plans éthique, moral, social et développemental. ...
... Peur des répercussions Certains parents craignent des conséquences négatives dues aux pleurs prolongés. La littérature diverge sur ce sujet: certains chercheurs (Blunden et al., 2011;Douglas et Hill, 2013) signalent l'existence d'effets secondaires négatifs tandis que d'autres les démentent (Hiscock, Bayer, Hampton, Ukoumunne et Wake, 2008;Price, Wake, Ukoumunne et Hiscock, 2012). ...
Il est bien établi dans la littérature que les troubles du sommeil
chez l’enfant ont des répercussions sur son fonctionnement
actuel, sur d’autres sphères développementales ainsi que sur le
contexte familial (Byars et Simon, 2016 ; Sadeh, 2005; Stores,
2014). Il est donc crucial de disposer de traitements appropriés
afin d’améliorer le sommeil des enfants. Cette revue de littérature
vise à évaluer plusieurs types d’intervention comportementale du
sommeil en fonction de leurs efficacités et leurs limites. Il ressort
de la littérature des limites méthodologiques (type de mesure et
manque de suivi) et l’absence de consensus sur l’âge
d’application de ces interventions. En revanche, il existe
différents types d’intervention comportementale du sommeil et
elles n’ont pas toutes reçu le même soutien empirique. Par
conséquent, cet article fournit un guide de lecture critique en
soulignant les divergences entre les études concernant les
bénéfices des interventions comportementales du sommeil (sur
le comportement et l’humeur de l’enfant, et le fonctionnement
familial). Nous portons une attention particulière aux méthodes
de type extinction car des études ont rapporté des bénéfices à
utiliser ce type d’interventions (Mindell, Kuhn, Lewin, Meltzer
et Sadeh, 2006; Rickert et Johnson, 1988) alors que d’autres les
remettent en question sur les plans éthique, moral, et social
(Blunden, Thompson et Dawson, 2011; Etherton et al., 2016).
... 38 Some studies report that Parental Presence at sleep time is 'maladaptive and… intrusive' 39 and an accepted part of neo-liberal Western childrearing practices which may place proportionally greater importance on individualist parenting approaches. 36,40 Indeed the majority of work in this field has been undertaken in these urban Western samples. 35 By contrast, the second theoretical perspective considers increased maternal bedtime availability, and has its roots in attachment theory 31 and is equally dependent on parental cognitions and perceptions although originating from an opposing view. ...
... As noted, how to reduce this dependency in sleep interventions is intensely debated. 22,40,45,46 Indeed, Blunden et al. 40 suggest that immediateresponding and ignoring-based approaches share many common features in terms of preparation for bedtime especially and what might broadly be called stimulus control or reduced parental assistance. However, Ramos and Youngclarke, remind us that extinction is 'systematic parental non-responsiveness in order to teach the children how to sleep independently'. ...
... As noted, how to reduce this dependency in sleep interventions is intensely debated. 22,40,45,46 Indeed, Blunden et al. 40 suggest that immediateresponding and ignoring-based approaches share many common features in terms of preparation for bedtime especially and what might broadly be called stimulus control or reduced parental assistance. However, Ramos and Youngclarke, remind us that extinction is 'systematic parental non-responsiveness in order to teach the children how to sleep independently'. ...
In families with infants between the ages of 6 and 18 months, sleep disruption can be significant, often putting parents at risk of a range of negative psychological and psychosocial consequences. Commonly prescribed sleep interventions typically involve ‘extinction’ methods, which require parents to completely or periodically ignore their infant's overnight cries. These methods can be effective in many, but not all cases. For over 40 years 30–40% of parents have consistently reported difficulty ignoring their child. For this group, ignoring their child is behaviourally and/or ideologically difficult with attrition often leading to a perceived sense of failure. For these parents the treatment may be worse than the problem. On the other hand, there is emerging evidence to support the use of more responsive methods for those who find extinction approaches behaviourally or ideologically challenging. In this paper we propose an integrated, less polarised approach to infant behavioural sleep interventions that better caters to those who have difficulty with extinction methods – our so‐called ‘Plan B’. This approach potentially resolves the often opposing ideological and theoretical perspectives of extinction versus responsiveness into a practical, complementary and pragmatic treatment framework. Recommendations on how best to implement Plan B are also presented. In our view, Plan B could provide practitioners with a logically integrated well‐targeted suite of clinical interventions that could potentially improve compliance, reduce attrition and ultimately benefit the sleep and well‐being of all infants and their parents, especially those who struggle with traditional extinction methodologies.
... Recent years have shown accumulating evidence to the efficacy of behavioral interventions in improving infant sleep and parental well-being both in the short-and long-term [16][17][18]. Furthermore, despite concerns raised by some [19], as yet no evidence of harm has been documented as a result of these treatment protocols [20,21]. Accordingly, they have been recommended for the treatment of bedtime and night waking problems by the Standard of Practice Committee of the American Academy of Sleep Medicine [13,22]. ...
... There was no significant difference in drop-out rates between groups (χ 2 (1) = 1.47, p = 0.22). In addition, no differences were found between families that continued and families that discontinued therapy in parent age, years of education or workload, or in infant age, sex, sleep measures or separation anxiety (all ps > 0. 19). The study was approved by the local Institutional Review Board and all parents provided written informed consent. ...
... These results suggest that interventions involving lower degrees of separation from parents may be more beneficial for infants who exhibit heightened separation anxiety. Such infants may be prone to exhibit higher levels of distress upon parents' attempts to reduce their involvement, which may both increase arousal and deter parents from following through with the protocol [19,46]. Our results correspond with previous findings demonstrating the role of separation anxiety in the treatment of anxiety disorders. ...
Study Objectives
Behavioral interventions for pediatric insomnia are cost-effective and benefit most families, but there is no evidence indicating which treatments are most suitable for specific patient populations. This randomized controlled trial evaluated the moderating role of infant separation anxiety in two brief interventions for infant sleep problems.
Methods
Ninety-one infants aged 9–18 months (61% boys) with pediatric insomnia were randomized to either Checking-in, a Graduated extinction protocol which involves gradual separation from parents, or to the Camping-out intervention, in which parental presence is maintained. Sleep was measured using actigraphy and parent reports. Infant separation anxiety was observed in the laboratory. Assessments were completed at baseline, post-treatment and 6-month follow-up.
Results
Improvement in sleep was demonstrated following both interventions and maintained at follow-up. Separation anxiety did not change significantly following treatment. Infant separation anxiety moderated treatment efficacy, with greater benefit for infants with high separation anxiety in the Camping-out compared to the Checking-in intervention.
Conclusions
This study provides support for considering infant separation anxiety in the effort to personalize treatment for pediatric insomnia. Pediatricians should incorporate evaluation of infant separation anxiety to assessment processes, and favor more gentle treatment approaches, such as Camping-out, over Graduated extinction for highly anxious infants.
... The birth of a new child is a critical period that requires that parents provide infant care, create a safe environment for the infant, communicate with the infant, learn new roles, develop family sensitivity, and deal with problems related to the infant. The participation of an infant in the family can be a period that is positive for the family, provides satisfaction, and strengthens the family ties; however, it also can be perceived as a period of crisis for the mother and family (Blunden, Thompson, & Dawson, 2011;Karp, 2003). Sleeping, crying, and feeding problems are among the health complaints with which parents most frequently consult health professionals in relation to their infant (Kaley, Reid, & Flynn, 2012;Meyer & Erler, 2011). ...
... Sleeping, crying, and feeding problems are among the health complaints with which parents most frequently consult health professionals in relation to their infant (Kaley, Reid, & Flynn, 2012;Meyer & Erler, 2011). In the literature, it has been determined that mothers who cannot respond to their infants' sleeping, crying, and feeding needs feel inadequate and have increased levels of anxiety and that mother and infant attachment is affected negatively (Bilgin & Wolke, 2017;Blunden et al.). Recent studies have shown that the failure to resolve regulatory problems during infancy (excessive crying, sleeping, and feeding problems) in the early period is associated with emotional, behavioral, and cognitive impairment in childhood and later periods (Bilgin & Wolke;Santos, Matijasevich, Capilheira, Anselmi, & Barros, 2015). ...
... The Mother and Infant Description Form was created for the purpose of describing the characteristics of mother and infant by examining the literature (Blunden et al., 2011;Kaley et al., 2012;Richardson et al., 2010). This form included 22 questions about the age, educational status, income status, smoking status of the mother, whether the mother had a problem with breastfeeding, and about the birth week, sex, and weight of the infant. ...
Abstract
Aim
To determine the effect of teaching 4S soothing techniques (swaddling, holding at side or stomach position, shushing‐white noise, swinging) on parent‐reported infants’ self‐regulation behaviors with respect to sleeping, crying, and feeding.
Methods
This research is a pretest–post‐test, single‐blind randomized experimental study with 6 month follow‐ups. An intervention group (IG) and a control group (CG) were formed, each consisting of 21 mother–infant dyads. A 90 min training program was applied to the mothers in the IG during the home visit in the fourth week after birth. For both groups, the dependent variables of the study are the parent‐reported self‐regulation behaviors of the infants in weeks 3, 7, 11, and 23.
Results
No significant difference was found between the two groups before the intervention in the pretest in terms of the mean sleep duration, mean crying duration, frequency of feeding, and frequency of waking at night. After the teaching of the 4S soothing techniques had been conducted, it was determined that the mean frequency of waking at night, the mean frequency of daily feeding, and the mean daily crying duration of the infants in the IG was statistically significantly lower in all follow‐ups, compared to the infants in the CG. In weeks 7 and 11 after the intervention, the mean daily sleep duration of the infants in the IG was found to be statistically significantly higher, compared to the infants in the CG.
Conclusion
Health professionals can use the 4S soothing techniques to develop self‐regulation behaviors of infants during the first 12 weeks of the infancy period.
... Therefore, overall wellbeing could also be part of the gut health indicators. This could be indicated by a normal quality of life [5] in adulthood, a happy and smiling baby [8], or a long night's sleep in young infants [9]. ...
... An example of the full questionnaire has been previously published [9]. The questions addressed in the current paper, including all response options, can be found in Appendix A. ...
A healthy gut during early childhood is important. However, it seems that there are no standard indicators used to assess it. Healthcare professionals (HCPs) were asked via an electronic survey question about gut health indicators (GHIs) for infants and toddlers, in addition to an estimated prevalence of infant’s functional constipation (FC) and its management. HCPs from eight countries participated in the survey (Russia (66.0%, 1449), Indonesia (11.0%, 242), Malaysia (6.0%, 132), Mexico (5.7%, 125), KSA (5.1%, 113), Turkey (3.0%, 66), Hong Kong (2.2%, 49), and Singapore (1.0%, 23)). The 2199 participating respondents were further classified into three continents (Asia (20.2%), Europe (68.8%), and others (11.0%)). Most of them were pediatricians (80.3%), followed by pediatric gastroenterologists (7.0%), general practitioners (6.4%), and others (6.3%). The top three preferred GHIs were similar for infants and toddlers: an absence of gastrointestinal (GI) symptoms, effective digestion/absorption as assessed by normal growth, and a general feeling of well-being. The absence of GI-related infection was the least preferred indicator. Most of the respondents reported the prevalence of FC among infants was less than 5%, with the peak incidence between the ages of 3 and 6 months. The reported choices of intervention to manage FC in infants were a change to a specific nutritional solution from a standard formula (40.2%), parental reassurance (31.7%), and lactulose (17.0%). Conclusion: The HCPs in the eight countries preferred the absence of GI symptoms, normal growth for effective digestion and absorption, and general well-being as the gut health indicators in infants and toddlers. The reported prevalence of FC in infants was less than 5%.
... According to the triad of symptoms, parental distress is essential to early childhood regulatory disorders [5]. Various studies showed associations of increased parental distress with child sleep problems [36,37], crying problems [20,36], and feeding or eating problems [36,38], as well as with the co-occurrence of these regulatory problems [10,37,[39][40][41]. Although many studies have focused on maternal distress, there is also evidence that fathers are burdened by a child's sleep and crying problems [37,41]. ...
... In addition, parents of young children consult professional help mostly due to sleep, crying, and feeding or eating problems [45,46]. As the co-occurrence of sleep, crying, and eating problems are highly distressing for parents [10,[39][40][41], it is also a risk factor for child endangerment, such as shaken baby syndrome [47,48]. In addition, the co-occurrence of regulatory problems increases the likelihood of their persistence [18,49]. ...
Background
Early sleep problems co-occur with crying, eating problems, and parental distress. This study investigates the impact of a parent-focused intervention to improve child sleep with the following aims: (1) To assess the impact on child sleep (sleep onset latency, frequency and duration of nighttime awakenings, frequency of bed-sharing, and nighttime food intake, total nighttime sleep duration, and sleep efficiency), child crying (frequency of crying episodes, of unexplained and unsoothable crying and of crying out of defiance), child eating difficulties, and parental distress of mothers and fathers. (2) To assess the maintenance of any changes in these areas longitudinally, at 3-month, 6-month, and 12-month follow-ups. (3) To explore at the within-subjects level, how children’s sleep, crying, eating, and parental distress changed together across all study measurement points.
Methods
In this single-arm pilot study, the parents of 60 children participated in six individual sessions of a parent-focused multimodal age-adjusted cognitive-behavioral intervention to improve child sleep. Parents of 39 children (46% girls, age in months M = 22.41, SD = 12.43) completed pre- and at least one measure after the intervention. Sleep diary, questionnaire for crying, feeding, sleeping, and parental stress index (short-form) were assessed pre, post, three, six, and 12 months after the intervention.
Results
Significantly, sleep (decreased sleep onset latency, frequency, duration of nighttime awakenings, bed-sharing, nighttime food intake; increased total nighttime sleep duration, sleep efficiency), crying (reduced frequency of crying episodes, unexplained and unsoothable crying), and parental distress (reduced) changed, which remained partially stable over follow-up. The frequency of crying episodes decreased with fewer nighttime awakenings; morning crying with increased nighttime feeding; unexplained and unsoothable crying with higher sleep efficiency; crying due to defiance with more nighttime awakenings, sleep efficiency, and bed-sharing. Eating problems decreased with shorter night awakenings and time; maternal distress with fewer nighttime awakenings, paternal with less child’s nighttime feeding, unexplained and unsoothable crying, and time.
Conclusions
A parental sleep intervention for sleep-disturbed young children could be promising to reduce children’s sleep problems, crying, eating problems and parental distress. Future studies should consider more personal contact during the follow-up to reduce the drop-out rate and a randomized-controlled design.
Trial registration
The study was retrospectively registered at the German Clinical Trials Register (ID: DRKS00028578, registration date: 21.03.2022).
... Pregnancy/delivery is a life-altering event, and everybody is supposed to be aware of that raising baby is not a piece of cake. However, night time waking and crying have been frequently culturally constructed as behavioural sleep "problems" [9,10]. Mothers are usually the principal caregivers, providing extensive body contact day and night and prolonged breastfeeding with immediate nurturant response to crying. ...
... ularly, because education related to sleep enhancement has seemed to have no effect on baby crying time [9][10][11]. To date, there has been some evidence of a strong relationship between sleep disturbance and postpartum depression mainly in intermediate and above mothers who are considered low risk [12]. ...
... Such babies may be medicalised (Douglas and Hill 2011), medicated (Owens et al. 2003), punished and, in extreme cases, abused (Reijneveld 2002) for displaying speciestypical infant behaviour, that is waking at night, frequent night-feeding, and crying when left alone (Ball 2013;Ball and Russell 2012). Increasingly babies are subjected to clinic-based (Australia) or parentally imposed (US) sleep-training programmes from an early age (Blunden et al. 2011;Douglas and Hiscock 2010;Hiscock et al. 2007;Mindell et al. 2006), a practice that is not only controversial but developmentally inappropriate for young infants (Blunden et al. 2011) and potentially harmful for parent-infant well-being by increasing maternal anxiety, prematurely terminating breastfeeding, increasing the risk of sudden infant death syndrome (SIDS), increasing infant crying and potentially decoupling maternal-infant physiological synchrony (Douglas and Hill 2013;Middlemiss et al. 2012;Whittingham and Douglas 2014). ...
... Such babies may be medicalised (Douglas and Hill 2011), medicated (Owens et al. 2003), punished and, in extreme cases, abused (Reijneveld 2002) for displaying speciestypical infant behaviour, that is waking at night, frequent night-feeding, and crying when left alone (Ball 2013;Ball and Russell 2012). Increasingly babies are subjected to clinic-based (Australia) or parentally imposed (US) sleep-training programmes from an early age (Blunden et al. 2011;Douglas and Hiscock 2010;Hiscock et al. 2007;Mindell et al. 2006), a practice that is not only controversial but developmentally inappropriate for young infants (Blunden et al. 2011) and potentially harmful for parent-infant well-being by increasing maternal anxiety, prematurely terminating breastfeeding, increasing the risk of sudden infant death syndrome (SIDS), increasing infant crying and potentially decoupling maternal-infant physiological synchrony (Douglas and Hill 2013;Middlemiss et al. 2012;Whittingham and Douglas 2014). ...
... Despite this, many parents are reluctant to try these interventions, or find it difficult to follow through with them [14,15]. As will be outlined in the current paper, a number of socio-cultural, infant, and parent factors may stand in the way of parents successfully implementing EBM. ...
... Interestingly, parents who are resistant to trying EBM report concerns around "ignoring" their infant's cries [3]. Similar concerns are also raised by some researchers who theorise EBM could negatively impact upon childparent bonding (ie, attachment), cause stress in the infant, and negatively affect the infants' mental and emotional health [15,44]. However, studies have yet to report data that show such repercussions exist [1,12,45]. ...
Behavioural sleep interventions (e.g., extinction-based methods) are among the most efficacious evidence-based techniques in the treatment of infant sleep problems. However, behavioural sleep interventions can be challenging for families to successfully implement. This review aims to summarise current research surrounding the potential barriers that arise when clinicians attempt to implement extinction-based methods with parents of infants. We provide a model that summarises 3 types of contextual-barriers; socio-cultural barriers, parent barriers, and infant barriers. Based on the current evidence, we propose that adopting a stepped care approach, planning ahead, increasing support, motivational interviewing, and/or emotional regulation may serve as useful tools for parents when implementing extinction-based methods. By considering these techniques, more families may receive the benefits of improved infant sleep.
... Since the literature has shown considerable inter-individual variability in the sleep consolidation process (Henderson et al. 2010;Pennestri et al. 2018), parents' interpretations play a role when describing infant sleep-wake patterns. Even among professionals, there is a lot of controversy on the subject (Blunden et al. 2011;Ramos and Youngclarke 2006;Sadeh et al. 2011). ...
... It should be noted that randomized control trials of behavioral sleep interventions have shown mainly positive results and that many psychologists and health professionals advocate for their use (Gradisar et al. 2016;Hall et al. 2015;Mindell et al. 2011). At the same time, other researchers argue that the interventions are unnecessary and that the studies conducted were methodologically flawed (Blunden et al. 2011;Douglas and Hill 2013). In sum, this is still a highly controversial topic. ...
Sleep is a necessary function of life and plays a key role in development. This chapter will discuss the association between prenatal stress and children’s sleeping behaviors. First, a description of the development of sleep-wake patterns in infancy will be provided. Second, an overview of the literature on the link between prenatal stress and sleep-wake behaviors will be presented from a developmental perspective. Then, key confounding variables that influence the association between prenatal stress and children’s sleep will be discussed. A few of the proposed mechanisms that could explain the relationship between prenatal stress and child sleep outcomes will also be reviewed. Lastly, clinical interventions targeting maternal stress and infant sleep will be discussed.
... [26][27][28] 1.2 Infant sleep issues as normative In response to these concerns, some researchers have suggested an alternative paradigm to infant sleep; that night awakenings and erratic daytime sleep patterns are normative and biologically adaptive and frequent arousals serve as an evolutionary based survival mechanism. [10,[29][30][31] For example, a newborn's stomach capacity is very limited and frequent feedings are thus necessary. [10,32] Frequent arousals may also protect from Sudden Infant Death Syndrome (SIDS), as they keep the infant from falling into deep sleep. ...
... Proponents also suggest that the perception that frequent night awakenings and erratic daytime sleep are problematic is a socially constructed concept. [30] When parents are given realistic information on normative infant sleep and its biologically driven development, they may be more able to accept their infant's sleep behaviors. [29] Although this approach addresses some of the concerns associated with behavioral sleep interventions, it does not empathize with parents' basic need for restorative sleep or selfcare. ...
The first year with a child is one of the most challenging times for mothers due to repeated awakenings typical for young infants. Research has shown that persistent fragmented sleep increases a mother’s risk for low overall well-being, which can challenge the mother-infant relationship. In an effort to improve sleep for both mother and infant, healthcare providers often recommend infant behavioral sleep interventions. The primary focus of this pilot study was to assess the feasibility of the Possums Sleep Intervention, a psychoeducational group workshop for women with infants between the ages of 0-6 months. A second goal of the study was to evaluate the potential of the Possums curriculum in improving maternal and infant sleep and self-reported mother-infant emotional availability. Participants were 24 mothers with their 0-6 month old infants assessed at the start of the study and again at the completion of the 4-week workshop. Results showed improvements in the perceived emotional availability in the mother-infant relationship; however, positive effects related to maternal or infant sleep were only on a trend level.
... For sleep, many parents may try many different techniques such as pacifiers, stopping breastfeeding, or placing the infant in the other room-none of which have a consistent impact on improving infant sleep (Brown & Harries, 2015;McKenna et al., 2007;Tomori, 2018). Likewise, interventions to reduce infant crying that involve reduced response to the infant do not have consistent results (Blunden, Thompson, & Dawson, 2011;Douglas & Hill, 2013). ...
... However, although they do reassure some, many others who read them feel they have no impact and end up feeling increasingly confused, anxious, and as if they have failed, lowering their parenting self-efficacy and increasing their risk of postnatal depression (Harries & Brown, 2017). Likewise, attempting to instigate approaches that claim to solve infant sleep and crying issues can lead to increased maternal dissatisfaction and anxiety if they do not work (Blunden et al., 2011). Moreover, we know that when mothers stop breastfeeding before they are ready (a potential impact of following this strict feeding advice), they have an increased risk of postnatal depression (Brown, Rance, & Bennett, 2016;Dias & Figueiredo, 2015). ...
Baby care books that promote strict infant care routines are popular but little research has considered their impact upon maternal infant care behaviours. We explored whether mothers who have read these books guide their infant care behaviours based on their concepts, and how this is associated with infant feeding, night time care, and response to infant's needs. Three hundred and fifty‐four UK mothers with a baby aged 0–12 months completed an online questionnaire exploring use of baby care books, motivations for use, whether guidance was followed, and infant care behaviours. Mothers who read the books were drawn to them for information about how to settle their infant, infant sleep and infant feeding behaviour. Those who read the books were less likely to breastfeed, feed responsively, have their infant sleep in the same room, cuddle their infant to sleep, or respond promptly to infant cries. Although the causality between reading these books and care cannot be determined through this study design, and is likely bidirectional with some reading the books to confirm existing preferences, around 25–40% of mothers noted the information determined their care decisions. Regardless of specific causal pathways, there is an association between these books and behaviours that go against infant feeding and responsive care recommendations. Understanding what drives mothers to follow these books, and increasing support for new mothers in these areas is important. The findings will be important for those supporting mothers in the perinatal period in starting conversations around responsive infant care.
... Among the most common concerns raised by caregivers are those where parents experience difficulties managing their children's sleep and settling behaviours at the beginning of the night and overnight. 2 Some young children need parental assistance to re-settle, often up to 5 times per night. These sleep problems, when left unresolved, can result in significant and serious consequences for the child, including sleep problems in later childhood, 3 increased behaviour problems, learning difficulties, 4 and elevated risk of injury. ...
... 16 This has been shown in the general health literature when the dissemination of generalisable health information is encompassed within the stepped care Evaluating Accessible Sleep Health Information in Rural and Urban Contexts: Delivery Face-to-Face or Online? 2 Clinical Medicine Insights: Pediatrics model, 17 where information and preventive treatment delivered at a primary health care level (at the first tier of the model) can provide a degree of assistance to ameliorate health problems, avoiding the need for more specialised services and significantly reduce costs. The stepped care model has been used to deliver preventive sleep information to adult insomniacs 18 to avoid ongoing problems, so it may be that sleep information can be similarly preventive for infant sleep behaviours despite the complexities associated with early parenthood and the parent-child relationship. ...
Objective
New parents need education about infant sleep but is not universally available especially not in regional and rural areas. We delivered sleep education both face-to-face and online to test sleep knowledge acquisition for parents wherever they reside. Best practice delivery of accessible sleep health information for new families needs to be investigated more carefully in order for specialist services to be universally available.
Methods
Pre- and post-information session questionnaires (n = 32) assessed levels of knowledge acquisition and comparisons tested differences between face-to-face seminars compared with an online webinar.
Results
Sleep knowledge across participants was low (69% scoring < 50%). Sleep knowledge significantly increased for both the webinar delivery group (P = .002) and face-to-face delivery group (P = .001). No significant differences in knowledge acquisition were found between face-to-face vs online delivery (P = .170), suggesting both modes of delivery were sufficient to improve parental sleep knowledge.
Conclusions
Parental sleep knowledge, while low, increased with education. Online delivery was similar to face-to-face delivery suggesting ease of access for rural and remote communities needing specialist sleep information.
Implications for public health
Information delivered online is effective and offers a health delivery solution to regional and remote parents unable to access sleep services and rendering sleep service accessibility more equitable.
... 19,20 However, the idea of night awakenings as being problematic in early development is not unanimous, leading to conflicting advice from professionals. 10,21,22 To get infants to sleep through the night, interventions such as delayed response and feeding during the night have been proposed. 12,23 However, many parents report that these methods are incongruent with their personal beliefs and find sleep interventions too difficult, particularly attempts to ignore infant crying. ...
... Some authors have questioned the use of sleep behavioral techniques in young infants because sleep consolidation is a developmental process that is influenced by interindividual variations. 22 Moreover, some mothers have reported feeling tense and depressed when they tried to get their infant to sleep through the night, explaining that for them rapid sleep consolidation was not a priority. 54 In addition, authors have proposed that because parents are routinely asked about sleep consolidation at medical follow-up meetings, this may implicitly suggest that infants should sleep through the night. ...
OBJECTIVES
Contrary to the importance of total sleep duration, the association between sleeping through the night and development in early infancy remains unclear. Our aims were to investigate the proportion of infants who sleep through the night (6- or 8-hour sleep blocks) at ages 6 and 12 months in a longitudinal cohort and to explore associations between sleeping through the night, mental and psychomotor development, maternal mood, and breastfeeding.
METHODS
At 6 and 12 months of age, maternal reports were used to assess the longest period of uninterrupted infant sleep and feeding method (n = 388). Two different criteria were used to determine if infants slept through the night: 6 and 8 hours of uninterrupted sleep. Mental and psychomotor developmental indices (Bayley Scales of Infant Development II) and maternal mood (Center for Epidemiologic Studies Depression Scale) were measured at 6, 12, and 36 months of age.
RESULTS
Using a definition of either 6 or 8 hours of uninterrupted sleep, we found that 27.9% to 57.0% of 6- and 12-month-old infants did not sleep through the night. Linear regressions revealed no significant associations between sleeping through the night and concurrent or later mental development, psychomotor development, or maternal mood (P > .05). However, sleeping through the night was associated with a much lower rate of breastfeeding (P < .0001).
CONCLUSIONS
Considering that high proportions of infants did not sleep through the night and that no associations were found between uninterrupted sleep, mental or psychomotor development, and maternal mood, expectations for early sleep consolidation could be moderated.
... Sleep patterns among infants is undergoing intense study worldwide, particularly in Western cultures, where the norm is to establish a pattern of sleeping through the night in early infancy (Blunden et al., 2011). Despite the fact that normal brief arousals occur as the result of ultradian NREM-REM cyclical sleep patterns (Anders, 1994), frequent night waking after the age of 6 months is perceived as problematic sleep (Thunstörm, 1999). ...
Parental behavior and infant sleep patterns can vary widely both within and between cultures and settings. Breastfeeding during the second half-year of infancy has been associated with frequent night waking, which is perceived as sleep problem among the Western societies. An understanding of sleeping patterns among breastfed infants during the second half-year of infancy is important in supporting continued breastfeeding.
The study aimed to investigate the sleeping patterns among breastfed infants during second half-year of infancy.
This is a cross-sectional study. Three hundred and forty-two mothers of 6–12 months old breastfed infants completed the questionnaires on socio-demographic factors, breastfeeding practices, and infant sleeping patterns, which were assessed by using the Brief Infant Sleep Questionnaire (BISQ). The Cox regression model was used to assess the factors that were associated with night sleep duration whereas demographic factors and breastfeeding practices that were associated with night waking frequency were investigated using the Poisson regression model.
On average, the breastfed infants slept for 11 h during the night and most infants were reported to have night waking (96.8%) and were breastfed at least once at night (93.5%). In the adjusted analyses, infants in the age group 9–12 months were less likely to sleep longer compared to infants in the 6–8 months age group [HR 1.52 95% CI (1.17, 1.98)]. A one-hour increase in daytime sleep and in night wakefulness increased the likelihood of waking up at night by 19% and 24%, respectively. Infants who had been vaccinated within the last 7 days and infants who were breastfed to sleep were more likely to have a shorter nighttime sleep duration. Nighttime breastfeeding frequency was significantly associated with a 17% increase in the likelihood of night waking [IRR 1.17 95% CI (1.13, 1.22)]. Infants who slept on their parents’ bed were 1.28 times more likely to wake up at night compared to infants who slept in a separate room [IRR 1.28 95% CI (1.05, 1.59)]. Infants of parents who reported that their infants’ sleep was not a problem were 34% less likely to wake up compared to infants of parents who reported that their infants’ sleep was a problem [IRR 0.66 95% CI (0.49, 0.87)].
Frequent night waking, bed sharing and night breastfeeding were common among 6–12 months old breastfed infants. Frequent night breastfeeding may lengthen an infant’s nighttime sleep duration. The study findings indicate that adequate information and support should be given to breastfeeding mothers in relation to the sleeping pattern of breastfed infants in order to promote continued breastfeeding practices.
... If contemporary huntergatherer patterns match those of ancestral populations, then spending substantial amounts of time without cues of caregiver presence is likely an evolutionarily novel situation; this may explain why infants can find separation so distressing (Zeifman, 2001). Some psychologists have stressed that we should eliminate culturally constructed notions that crying when alone is abnormal or a pathology to be rectified (Blunden et al., 2011). ...
... 3 Ailenin eğitim ve sosyoekonomik durumu, fiziki çevre (aydınlatma, gürültü, odada televizyon bulunması), oda ve yatak paylaşımı, ilk çocuk olma, diş çıkarma ya da kolik sancısı, çeşitli akciğer hastalıkları, doğum sonrası depresyon, uyku apnesi, nörolojik problemler, bakım vericilerin geleneksel uygulamaları, uyuma-uyanma periyotları ve uyuma saatleri gibi faktörler uyku kalitesini etkilemektedir. 4,5 Hastanede acı veren invaziv girişimlerin olması, ayrılık anksiyetesi, alışık olmadığı ortamda hemşireler ile karşılaşmak çocukların uyku alışkanlıklarını etkileyebilir. Uyku problemleri, çocukta çeşitli davranış problemlerine sebep olan akut veya kronik hastalık, tedavi süresinin uzaması gibi durumlarda da görülmektedir. ...
ZET Amaç: Çalışmanın amacı, hastanede yatan 1-36 aylık bebekle-rin hastane ve evdeki uyku alışkanlıkları ve uyku sorunlarını etkileyen faktörleri belirlemektir. Gereç ve Yöntemler: Araştırmaya çocuk has-tanesinde yatan 1-36 aylık bebeğe sahip 200 anne katıldı. Çalışmada bebeklerin klinik ile evdeki uyku süreleri çeşitli değişkenler açısından incelenmiştir. Araştırmada "Bebek (Kısa) Uyku Sorunları Tanılama Formu" ve literatür doğrultusunda araştırmacı tarafından hazırlanan "Bebek ve Uyku Bilgi Formu" anketi kullanıldı. Bulgular: Bebeklerin yaş ortalaması 13,95±9,406 aydı. Bebekler evde toplam 8,25±1,784 saat, klinikte 7,21±1,792 saat uyuyordu. Klinikteki ebeveynlerin %69'u evden uyku objesi getirmiş olup, uyku objesi ile uyku süresi 7,37±1,644 saat iken, obje olmadan uyku süresi 6,85±2,055 saat bulundu. Bebek-lerin klinikte uykusunu etkileyen olumsuz faktörlerin %42,5'ini tedavi saatinde hareketlilik-ses ve %14'ünü ziyaretçilerin giriş-çıkış sesleri oluşturdu. Bebeklerin klinikte uyku sorunu yaşadığı ve klinikteki uyku sürelerinin evdeki uyku sürelerine oranla daha az olduğu saptandı (p<0,001). Klinikte uyku objesi ile uyuyan bebeklerin uyku süreleri ile uyku objesi olmadan uyuyan bebeklerin uyku sürelerinde de anlamlı fark vardı (p<0,05). Sonuç: Bu çalışmada, bebeklerin klinikteki uyku sürelerinin daha az olduğu, uyku sorunu yaşadıkları, evden getirilen uyku objesinin bebeklerin uyku sürelerinin artmasına olumlu etki yap-tığı bulundu. Bebeğin uykusunu olumsuz etkileyen faktörün en fazla klinikte tedavi saatinde hareketlilik-ses ve ziyaretçilerin giriş-çıkış ses-leri olduğu görüldü. Klinikte bebeklerin uyku sorununu azaltmada te-davi ve takip saatlerinin, gece bebeklerin rutin uyku saatleri ile aynı zamanda olmaması önerilir. Anah tar Ke li me ler: Çocuk; hastaneye yatan çocuk; uyku; çocuk hemşireliği ABS TRACT Objective: The aim of the study was to determine the home and hospital sleeping habits and affecting factors of sleep problems of 1-36 month-old hospitalized infants. Material and Methods: Two hundred mothers with infants aged 1-36 months in the Children's Hospital participated in the study. "Brief Infant Sleep Questionnaire" and the "Baby and Sleep Information Form" prepared by the researcher were used. Results: Babies slept 8.25±1.784 hours at home and 7.21±1.792 hours in the clinic. 69% of the parents in the clinic brought sleep products from home, and the sleep time with the sleep product was 7.37±1.644 hours, without the product was 6.85±2.055 hours. 42.5% of the negative factors affecting the sleep were sound at the time of treatment and 14% of them were the sounds of visitors. It was determined that the babies had sleep problems in the clinic and the sleep time was less than at home (p<0.001). There was also a significant difference in the sleep duration who slept with sleep product and the sleep times of babies who slept without sleep product (p<0.05). Conclusion: It was found that the babies had less sleep time, sleep problems in the clinic. The sleep product had a positive effect on the increase in the sleep time. It was observed that the factors affecting the baby's sleep negatively were the mobility-sound and visitor's entrance-exit sounds during the treatment hour. In the clinic, it is recommended that the treatment and follow-up hours should not be at the same time as the routine sleep hours of the babies in order to reduce the sleep problem of babies.
... Given that sleep in the early stages of life is typically fragmented due to the immature physiology governing sleep (ie, the homeostatic and circadian processes), 25 it has been argued that the classification of infant sleep difficulties as insomnia discounts the normal biological developmental progression of sleep and serves twenty-first century western industrialized lifestyles, rather than infants themselves. 26,27 Infant insomnia symptoms may be adverse primarily for parents, posing the question of whether diagnosis is called for, and if so, is it the infant, the parent, or the dyadic/family system that should be diagnosed? Caregivers are usually the ones deciding whether or not to seek assessment and treatment of older children's insomnia symptoms as well. ...
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.
... In the UK, for most common CSPs, first-line treatments recommended by HCPs would be based (Meltzer & Mindell, 2014;Mindell et al., 2006). However, not all parents may want or be capable of successfully implementing these types of sleep interventions (Blunden et al., 2011;Cook et al., 2020;Tse & Hall, 2008). Yet, it is uncertain what aspects of the sources themselves encourage or discourage parents from using certain resources for child sleep. ...
Child sleep is a common parental concern and there is an array of resources available to parents. However, an exploration of UK parents' help-seeking behaviours around child sleep is lacking. This study sought to identify the resources parents use to seek information and help for child sleep, as well as to explore what factors parents prefer about certain sources and their reservations about using other resources. Parents of 6-36 month old children residing in the United Kingdom (UK) completed an online questionnaire between October 2015 and October 2016 about their use, opinions and experiences regarding resources for child sleep. Quantitative data were descriptively analysed and thematic analysis was conducted on parents' open-ended text responses. Participants were 266 UK parents (97% mothers). Parents' ages ranged from 21 to 45 years (M = 33.49 years, SD = 4.71) and all resided in the United Kingdom (UK). General Internet searches were the most commonly reported source used by 47% of parents with a range of other informal resources also frequently consulted. Health Visitors (HVs) were the most accessed healthcare professional reportedly consulted by 38% of parents. Seven themes represented parental preferences for their resource use. Most strongly endorsed included a desire for information from other parents, particularly those with practical experience and accessing information that aligned with their parenting values. Parents preferred sources that provided support and reassurance, as well as those that afforded parents the ability to select relevant elements from a range of information. Seven themes represented parents' reservations about resources. Most strongly endorsed were concerns about reliability, being judged and challenges associated with filtering vast amounts of information. Parents reported having reservations towards sources if they had a previous negative experience with the source. Possible implications of the findings and specific suggestions about how existing and future resources could be adapted to better meet parents' needs are highlighted.
... Parents' presence works as an external regulator and can reduce infants' distress and fears at night. Co-sleeping and holding the child during the transition to sleep were associated with a decrease in night-time crying, as well as with the absence of thumb sucking and less use of a transitional object such as a blanket or a doll (Blunden, Thompson, & Dawson, 2011;Green, Groves, & Tegano, 2004;McKenna & McDade, 2005;Ozturk & Ozturk, 1977;Wolf & Lozoff, 1989). Some of these authors argue that infants who experience support and closeness in stressful situations do not need transitional objects or thumb sucking for selfregulation. ...
... Nocturnal crying is a common pediatric sleep disturbance for which medical assistance is frequently sought by parents (3). Not only does nocturnal crying disturb sleep patterns and potentially cause significant stress for parents, but disturbed sleep in children may also result in irritability and behavioral problems (4). Medical assistance for this type of sleep disturbance generally involves conservative behavioral techniques and rarely involves medications (5). ...
Background: Nocturnal crying is a common condition in which children intermittently or continuously cry and fuss during the night, at certain times or throughout the night. It is a common pediatric sleep disturbance for which medical assistance is highly sought by parents, and one of the non-pharmacologic treatments for nocturnal crying is pediatric acupuncture. This review aimed to review the literature about the effectiveness and safety of pediatric acupuncture for nocturnal crying.
Methods: Literature searches were performed on PubMed, the Cochrane Controlled Register of Trials (CENTRAL), Allied and Complementary Medicine Database (AMED), Chinese National Knowledge Infrastructure Database (CNKI), Wanfang Database, and Chinese Science and Technique Journals Database (VIP), OASIS, the Research Information Service System (RISS), and National Digital Science Library (NDSL) from the available date of inception until December 28, 2020. Two review authors independently screened the titles and abstracts of all relevant articles from the search to select eligible articles. All variants of clinical studies on acupuncture treatment for nocturnal crying, including case reports and case studies, were eligible. Data were independently extracted by two review authors using a standard data extraction form. Retrieved data are presented in a tabular form and narratively discussed.
Results: We included 12 studies (10 case series and two case reports) with a total sample size of 2,324 children recruited from the hospital outpatient department. All of the included studies were conducted in mainland China and administered acupuncture as the sole intervention. For the primary outcome, the total efficacy rate of acupuncture treatment for nocturnal crying was reported as 100% in 9 studies, 95% in one study, 94% in another study, and 86% in the remaining study. For the secondary outcome, one study reported a 14% recurrence rate, whereas another study reported an 11% recurrence rate after treatment. There were no follow-ups in most of the studies. None of the studies reported possible adverse events. Most children recovered after one treatment. Generally, the acupoints that were most frequently selected were acupoints EM30 and PC9.
Conclusions: This comprehensive review suggested that pediatric acupuncture may be an effective treatment for nocturnal crying, which could be worth investigating further.
... This could entail other ways to soothe infants, often in conjunction with a larger responsive parenting curriculum (12,32); some, conversely, encourage caregivers not to respond to night wakings at all, which is thought to encourage longer sleep durations and fewer night wakings(33, 34) but is not without controversy. (35)(36)(37) However, reducing night feeding may be one of the simpler parenting interventions to follow, since caregivers do not have to learn to recognize cues to reduce the frequency they feed their infants at night. ...
Teaching caregivers to respond to normal infant night awakenings in ways other than feeding is a common obesity prevention effort. Models can simulate caregiver feeding behavior while controlling for variables that are difficult to manipulate or measure in real life.
We developed a virtual infant model representing an infant with an embedded metabolism and his/her daily sleep, awakenings, and feeds from their caregiver each day as the infant aged from 6 to 12 months (recommended age to introduce solids). We then simulated different night feeding interventions and their impact on infant body mass index (BMI).
Reducing the likelihood of feeding during normal night wakings from 79% to 50% to 10% lowered infant BMI from the 84th to the 75th to the 62nd percentile by 12 months, respectively, among caregivers who did not adaptively feed (e.g., adjust portion sizes of solid foods with infant growth). Among caregivers who adaptively feed, all scenarios resulted in relatively stable BMI percentiles, and progressively reducing feeding probability by 10% each month showed the least fluctuations.
Reducing night feeding has the potential to impact infant BMI, (e.g., 10% lower probability can reduce BMI by 20 percentile points) especially among caregivers who do not adaptively feed.
Teaching caregivers to respond to infant night waking with other soothing behaviors besides feeding has the potential to reduce infant BMI.
When reducing the likelihood of feeding during night wakings from 79% to 50% to 10%, infants dropped from the 84th BMI percentile to the 75th to the 62nd by 12 months, respectively, among caregivers who do not adaptively feed.
Night-feeding interventions have a greater impact when caregivers do not adaptively feed their infant based on their growth compared to caregivers who do adaptively feed.
Night-feeding interventions should be one of the several tools in a multi-component intervention for childhood obesity prevention.
... The primary outcomes of these interventions include teaching infants to self-soothe to sleep, enabling them to have less fragmented nighttime sleep, and longer nighttime sleep periods [9]. Growing evidence supports the use of more responsive methods [12][13][14]. New interventions focusing on meeting infants' needs which enable mothers to continue breastfeeding are needed. ...
For infants and their families, sleep consolidation is important in maturing neural and circadian rhythms, and in family dynamics. The Possums Infant Sleep Program is a cued care approach to infant sleep, responding to infant cues in a flexible manner, dialing down the infant’s sympathetic nervous system. The current study evaluated the effect of the Possums program on infant sleep and breastfeeding in infants (6–12 months) from a well-child outpatient clinic in Turkey, with the program intervention group (n = 91) compared with usual care (n = 92). In total, 157 mother-infant dyads completed the study. Infant sleep and breastfeeding rates were assessed at baseline and after 3 months. Nocturnal wakefulness, daytime sleep duration, naps, and night wakening decreased in both groups. Nocturnal sleep duration and the longest stretch of time the child was asleep during the night increased significantly in both groups without any change in total sleep duration. Night wakening was significantly lower and nocturnal sleep duration was significantly higher in the intervention group. However, mixed effects model analyses indicated no significant differences between the groups on any of the sleep outcomes after adjusting for confounders. Despite this, breastfeeding rates were significantly higher in the intervention group compared with those in the usual care group at follow-up.Conclusion: The Possum infant sleep program provided equivalent positive results on sleep parameters compared to usual care while advocating a more cued response. The critical difference was evident in sustained breastfeeding.
What is Known:
• Responsive sleep programs produce sleep consolidation, by responding to the infant’s cues without ignoring, and then gradually reducing parental interaction.
• Breastfeeding to sleep may be considered an undesirable sleep association in some infant sleep interventions.
What is New:
• The Possums Infant Sleep Program provided equivalent positive results to usual care while advocating a more cued response.
• The critical difference was in sustaining breastfeeding, and the program was associated with better breastfeeding rates.
... Night crying is defined as a condition in infants and toddlers involving sleeping for <5 h with waking and signaling (fussing/crying with a high voice) at night. 8,19 An episode of night crying was defined as an event from the onset of night crying that was not attenuated by merely leaving the sickrooms until the infant or toddler goes back to sleeps. Children who presented with NREM-related parasomnias or night crying for at least 5 days a week were included. ...
Objective
The lack of an established treatment standard prompted an examination of whether kambakutaisoto, an herbal formula, is effective for non–rapid eye movement (NREM)–related parasomnias and night crying (provisionally defined as an infantile form of arousal parasomnia).
Methods
This study included 137 children aged median 4.1 years (range, 0.02–18.5) who were admitted for hematological and oncological diseases.
Results
Of 137, 3 children developed recurrent episodes of NREM-related parasomnias, and 3 developed night crying. The proportion of children with night-crying/parasomnia receiving invasive procedures was significantly higher than those without (100% vs. 47%, P = .013). All 6 children with night crying/parasomnia received kambakutaisoto at a dose of 0.13–0.22 g/kg per os and responded from the start of administration with a significant reduction in the number of episodes. No adverse effects were observed.
Conclusion
Kambakutaisoto may be a safe and promising therapy for night crying and NREM-related parasomnias in children.
... A good night's sleep is important for everyday functioning, especially because parents usually have to work and perform other tasks the following day. 24 Shorter sleep duration may influence mothers' functioning and their psychological well-being and mood. 16 Second, putting the child to sleep can be a challenging and stressful task for parents, especially if the child resists and fusses. ...
Objective:
Infants' sleeping patterns can influence parents' sleep and their well-being. Infants' sleeping problems can evoke negative emotions from their parents because of the influence the problems have on parents' lives. However, little is known regarding the associations between infants' night sleep patterns and parents' overall negativity toward their children. The objective of this study was to study this association.
Methods:
In a longitudinal design, we followed infants and their parents from 9 to 18 months. Overall, 392 families participated in the study. Parents' negativity and children's sleeping patterns were assessed with questionnaires.
Results:
Parents' negativity and children's sleeping problems showed moderate continuity through the study's 9-month period. Children's sleeping problems at 9 months predicted an increase in mothers' (but not fathers') negativity at 18 months. Parents' negativity was not associated with infants' sleep problems.
Conclusion:
The results of this study suggest that already in infancy, children's tendencies, in this case sleep, can evoke negative emotions in their mothers and highlight infants' roles in the intricate parent-child relationship.
... Among these factors are socio-economic status of families, education levels of parents, traditional practices of caregivers, behavior of putting infants into sleep, being the first child, physical environment (noise, lights, presence of a TV set), sharing bed and room with infants, colic or teething discomfort, gastroesophageal reflux, sleep apnea, various lung diseases, maternal postpartum depression, neurological problems, time to go to bed and wake up and sleeping periods. [4][5][6][7] There is not a universal definition of sleeping problems in the infantile period. This is because duration of sleep needed is shaped by various cultural and social values and has not been clearly determined yet. ...
... However, not all professionals believe that night-time awakenings in infancy are problematic, which sometimes leads to incongruent advice from healthcare professionals. 3 Moreover, several studies have found that there is considerable interindividual variability in the age at which infants learn to sleep through the night and that this variability reflects a normal development of infant sleep physiology. 2,4 In studies of typically developing infants, the proportion of infants who do not sleep through the night naturally decreases with age. 4 Given the natural and considerable interindividual variability ob- ...
Infant sleep patterns evolve rapidly over the first year of life and are characterized by substantial changes in sleep duration and fragmentation (1). As such, pediatric health professionals frequently address parents' concerns about infant sleep (2). Parents are particularly concerned about the age at which their infant will consolidate their sleep during a consecutive period, a process often referred to as “sleeping through the night”. While many definitions of sleeping through the night exist in the literature, 6‐ or 8‐hour blocks of uninterrupted sleep are commonly adopted definitions (2).
... We used a Social Sciences and Humanities Research Council Connection Grant to support the development of program materials and tools. The team negotiated tensions about co-sleeping, breastfeeding support, and use of behavioral strategies for managing infants' sleep problems [31,32]. The team members used empirical evidence to support informed parental decision-making based on a clear understanding of evidence, implications, and consequences [33]. ...
Background/objective
This paper describes evidence-based strategies for the dissemination of empirically supported interventions for infant behavioral sleep problems.
Methods
To identify parents' needs, a survey sampled 1022 parents in the Niagara region about use of health resources, tracking occurred of public health nurses' consultations with parents about infant sleep, and nurses obtained sleep workshop evaluation data from 18 parents. A focus group with 10 participants, a survey of Niagara Region Public Health and Emergency Services (NRPH&ES) employees, and consultations with external stakeholders identified gaps in parents' and infants' care and public health nurses' training needs. We developed solutions by creating evidence-based tools and a program for parents and public health nurses. We implemented and disseminated information via sharing tools on the NRPH&ES website, and workshops for community agencies and public health nurses.
Results
Seventy childhood educators, support workers, and social and public health professionals attended our community workshop. Twenty-three public health nurses attended our training workshop. In guided discussion, nurses evaluated the workshop as addressing gaps in knowledge and enhancing NRPH&ES interventions to manage infants' behavioral sleep problems. Fifteen parents attended a sleep workshop pilot, with seven parents indicating a preference for follow-up telephone support. Fifty individuals attended our oral presentation at the Ontario Public Health Convention.
Conclusions
For next directions, community and other public health agencies want access to our tools and program components. We received a research grant to design, implement, and evaluate sharing tools and program components with community agencies (daycares and childcare centres).
... The participation of an infant in a family is a period that is very positive and satisfying for the family and strengthens the family bonds in addition to being a critical period that requires that parents care for their infants, create a safe environment for the infant, communicate with the infant, and deal with problems related to the infant (Blunden, Thompson, & Dawson, 2011;James-Roberts, 2001;Karp, 2003). One of these problems is the inability to control infant crying. ...
The aim of this review is to identify the behavioural soothing interventions (BSIs) used for reducing infant crying and to determine their effect. Studies had to describe an experimental study addressing infant crying and BSIs in the first six months after birth. Searches were performed in Web of Science, Pubmed, Science Direct, EBSCOhost, PsycINFO, and COCHRANE. It was determined from the studies that massage, spinal manipulative therapy, and occipito-sacral decompression have a positive effect on the soothing of crying behaviour in infants. It was determined that BSIs are most effective when applied before the 8th week and that certain BSIs are effective in reducing the crying duration. It was revealed that there is a need for a standard data collection tool for the determination of the crying duration. Professionals interested in child health should be aware of irregularities in the crying of infants in the early period.
Objectives
To compare the real-world frequency, timing, duration, difficulty, and helpfulness of three infant Behavioral Sleep Intervention (BSI) approaches: Unmodified Extinction, Modified Extinction, and Parental Presence, and to examine the effectiveness and safety of these approaches by comparing infant sleep, parent sleep, daytime sleepiness, depression, and parent-infant bonding between parents who had and had not implemented these interventions.
Study design
Participants were 2090 parents (75% mothers, 79% White/Caucasian) of US infants (49% girls) aged 3-18 months (M=9.1, SD=4.1). Parents completed online questionnaires regarding their infant's sleep, their own sleep, daytime sleepiness, depression levels, and parent-infant bonding. Infant sleep was assessed via objective– albeit exploratory– auto-videosomnography data obtained from the 14-days prior to survey completion.
Results
64% of parents reported implementing BSIs. The average age at intervention was 5.3 months (SD=2.6). Unmodified and Modified Extinction were rated as significantly more difficult to implement compared with Parental Presence, but also as more helpful, shorter, and quicker to show improvements. Infant nighttime sleep was longer and more consolidated in the Unmodified and Modified Extinction groups compared with the Parental Presence and no-BSI groups. No differences were found between BSI groups in parent sleep, sleepiness, depression, or parent-infant bonding.
Conclusions
Implementation of BSIs outside clinical settings is pervasive and occurs earlier than generally recommended. Unmodified and Modified Extinction were associated with longer and more consolidated infant sleep. Despite concerns regarding the potential harm of BSIs, implementation of these approaches was not linked with negative outcomes, providing additional evidence for their safety and effectiveness.
Human infants spend most of their time sleeping, but over the first few years of life their sleep becomes regulated to coincide more closely with adult sleep (Galland et al., 2012; Paavonen et al., 2020). Evidence shows that co-sleeping played a role in the evolution of infant sleep regulation, as it is part of an ancient behavioral complex representing the biopsychosocial microenvironment in which human infants co-evolved with their mothers through millions of years of human history (Ball, 2003; McKenna 1986, 1990). This paper is a conceptual, interdisciplinary, integration of the literature on mother-infant co-sleeping and other mother-infant co-regulatory processes from an evolutionary (biological) perspective, using complexity science. Viewing the mother-infant dyad as a “complex adaptive system” (CAS) shows how the CAS fits assumptions of regulatory processes and reveals the role of the CAS in the ontogeny of mother-infant co-regulation of physiological (thermoregulation, breathing, circadian rhythm coordination, nighttime synchrony, and heart rate variability) and socioemotional (attachment and cortisol activity) development.
Despite repeated calls regarding the need to target parental accommodation and overcontrol in child anxiety treatment, brief protocols specifically targeting these behaviors in parents of clinically anxious youth are currently limited in number. The present investigation piloted and refined a theoretically informed, internet-delivered, single-session intervention (SSI) specifically aimed at reducing parental accommodation and overcontrolling behaviors. Socioeconomically and racially diverse parents of clinically anxious children (N = 12; Mage =10.08 years, SD = 1.74, range = 7–14 years) were recruited in two phases. In Phase One, three online focus groups with two parents each (n = 6) received the intervention and provided qualitative and quantitative feedback on the feasibility and acceptability of the intervention program. Parental feedback from the focus groups was used to revise the program. In Phase Two, the revised program was administered to six new parents to examine the program’s acceptability and feasibility for increasing psychoeducational knowledge regarding child anxiety, parental accommodation, and overcontrol. Across both phases, the intervention was well-received by parents in terms of relevance, acceptability, and feasibility. Parents demonstrated significant increases in knowledge of parental accommodation, overcontrol, and child anxiety from pre- to post-intervention. Qualitative data indicated that parents benefited from the unique online format as well as the content. Findings support the feasibility and acceptability of an accessible and time-efficient SSI designed to target problematic parenting behaviors among parents of clinically anxious children.
Objective
To characterize family and environmental correlates of sleep patterns that may contribute to differences in infant sleep.
Methods
We studied 313 infants in the Rise & SHINE (Sleep Health in Infancy & Early Childhood study) cohort. Our main exposures were the parent-reported sleep environment, feeding method and sleep parenting strategies at infant age one month. The main outcomes were nighttime sleep duration, longest nighttime sleep and number of awakenings measured by actigraphy at age six months. We used multivariable linear regression models to examine associations, and secondarily also explored the role of sleep-related environmental exposures in mediating previously observed associations of racial/ethnicity and parental education with infant sleep characteristics.
Results
In adjusted models, a non-dark sleep environment (versus an always dark sleep location) and taking the baby to parent’s bed when awake at night (versus no co-sleeping) were associated with 28 (95% CI, -45, -11) and 18 (95% CI, -33, -4) minutes less sleep at night, respectively. Bottle feeding at bedtime was associated with 62 (95% CI, 21, 103) minutes additional longest nighttime sleep period. Exploratory mediation analyses suggested a modest mediating role of a non-dark sleep environment on racial/ethnic and educational differences in sleep duration.
Conclusions
Infant sleep duration was positively associated with a dark sleep environment and a focal feed at bedtime while taking the baby to the parent’s bed was associated with reduced infant sleep. Modifying the sleep environment and practices may improve infant sleep and reduce sleep health disparities.
Methods to improve sleep in infants commonly involve some ignoring (extinction) but are often unpopular with mothers worried about infant distress when left to cry. Alternative more responsive methods are needed. This pilot study evaluated stress, maternal depressive symptomology and sleep in mother/infant dyads, between Responsive, Controlled Crying and Control groups. From 199 mother/infant dyads from any cultural background, 41 infants 4–12 months were randomly allocated to Responsive (RG, n = 15), Controlled Crying (CCG, n = 18) or Controls (Treatment as Usual, TAUG, n = 8), with 10 withdrawing after randomisation. Infant sleep (7-day sleep diaries) and stress (oral cortisol on two nights), maternal self-reported stress (Subjective Units of Distress, SUDS), maternal perceived infant distress (MPI-S) and symptoms of maternal depression (Edinburgh Post-natal Depression Scale, EPDS) were measured four times across 8 weeks. Sleep duration was not different between groups but Responsive woke less ( p = .008). There were no differences in cortisol between groups across time points. Maternal SUDS was positively correlated with infant cortisol and MPI-S ( p < 0.05) and mothers in the Responsive group were significantly less stressed ( p = 0.02) and reported less symptoms of depression ( p < 0.05) . Findings in this small sample show Responsive methods are comparable to the extinction (Controlled Crying) in sleep outcomes but from a relational and maternal mental health perspective, are less stressful, offering families potential choices of sleep interventions.
Bedsharing is controversial for nighttime caregiving in the U.S. today, as in most of the West. However, from the standpoint of evolutionary pediatrics, anthropology, and cultural psychology, bedsharing is not controversial at all, representing the context for human infant evolution and conferring a host of physiological benefits to the infant as well as the mother. In an effort to understand the rise in Western bedsharing in recent decades (and following Ball, 2002; McKenna & Volpe, 2007), Salm Ward (2015) systematically reviewed the literature on mother-infant bedsharing and identified ten reasons why mothers choose to bedshare: (1) breastfeeding, (2) comforting for mother or infant, (3) better/more sleep for infant or parent, (4) monitoring, (5) bonding/ attachment, (6) environmental reasons, (7) crying, (8) cultural or familial traditions, (9) disagree with danger, and (10) maternal instinct. The current paper offers the “review behind the review,” highlighting the scientific evidence behind the reasons mothers give for their decision to bedshare, focusing on how mothers’ decisions about infant sleep location influence infant behavior and development.
Insomnia is a sleep disorder characterized by difficulty falling or staying asleep. In young children insomnia often presents as bedtime resistance and/or sleep onset associations, impacting an estimated 20%–30% of infants, toddlers, and preschoolers. When left untreated, insomnia can become chronic and can negatively affect child and family functioning. However, early intervention and behavioral treatments are available, yielding effective and lasting results.
Importance
Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years.
Objective
To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support.
Evidence Review
The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument.
Findings
Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5).
Conclusions and Relevance
When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline.
Infants evolved in the context of close contact (including co-sleeping). Evolutionary context is rarely considered in psychological infant sleep research, and Western sleep researchers make assumptions about what optimal “normal” infant sleep is and how to achieve early, deep, infant sleep consolidation and avoid infant sleep problems. However, an evolutionary and anthropological view of infant sleep as species-typical recognizes that human evolution likely prepared the infant brain for optimal development within its evolutionary context – co-sleeping. Thus, “normal” infant sleep, sleep consolidation, and sleep problems should all be understood within the framework of co-sleeping infants, not the historically new-phenomenon of solitary-sleeping infants. Much work needs to be done in order to understand “normal” infant sleep as species-typical and how adaptive infants are to environments that stray from their evolutionary norm.
This study was conducted to determine the correlation between mothers’ thoughts about infant crying and breastfeeding motivation. The research had a cross-sectional, descriptive, correlational survey model. The population of the research consisted of mothers of infants who were aged between 3 weeks and 6 months and brought to the Pediatric Outpatient Clinic of a hospital in Turkey due to excessive crying complaints. The sample consisted of 210 mothers who met the inclusion criteria and agreed to participate in the study. Data were collected using the Infant Crying Questionnaire (ICQ), and the Breastfeeding Motivation Scale (BMS). In our study, there was a positive weak correlation between the Attachment, Minimization, Directive Control, and Spoiling subscales of the ICQ and Intrinsic Motivation and Integrative Regulation, Identified regulation, Introjected regulation, External regulation-infant health subscales of the BMS (r = 0.26–0.49). Those who had positive thoughts about infant crying had significantly higher breastfeeding motivation..
Infant sleep problems are among the most common issues reported by parents in the postnatal period. Yet, infant sleep and infant sleep interventions remain controversial. This study evaluated health professional training in a novel approach to parent-infant sleep: the Possums Sleep Intervention. Health professionals (n = 144) completed a short survey before and after the training, which focused on the sleep component. The Possums Sleep Intervention training included the following topics: sleep science, cued care, sleep hygiene, relaxation for parents and babies, problem solving, and acceptance and commitment therapy (ACT). Health professionals reported: improvements in knowledge on infant sleep regulation, the mother-infant relationship and ACT; improvements in health professionals' own sleep quality; improvements in psychological flexibility; and a reduction in professional burnout and secondary traumatic stress. Moreover, the health professional training was received positively. Overall, this study is supportive of the Possums Sleep Intervention health professional training.
The human need for sleep is universal and unquestioned; however, humans vary in their sleep needs according to age, individual differences, as well as cultural and social norms and practices. Therefore, what is “normal” in infant sleep and the development of sleep architecture in humans is highly dependent on biological and sociocultural variables as well as socially constructed assumptions about what infant sleep “should” look like. This paper uses a multidisciplinary approach to review papers from fields including pediatrics, anthropology, psychology, medicine, and sociology to understand “normal” infant sleep. Because human culture and behavioral practice changes much more quickly than evolved human biology, and because human evolutionary history occurred in the context of breastfeeding and cosleeping, new work in the field of infant sleep architecture development would benefit from a multidisciplinary approach. To come to a consensus about what is “normal” infant sleep, researchers must agree on underlying basic assumptions of infant sleep from which to ask question and interpret findings.
Objective:
The primary objective was to identify the characteristics of parents and infants and parenting practices associated with delayed responsiveness to infant crying during the first year of infant life. A secondary objective was to evaluate, in a subsample of maternal-infant pairs, the associations between delayed responsiveness to infant crying and observational measures of maternal-infant interaction and infant-maternal attachment.
Method:
This is a secondary analysis of the data from a community sample of pregnant women recruited to the Alberta Pregnancy Outcomes and Nutrition study. Mothers completed questionnaires during the first year of infant life (n = 1826), and a convenience subsample of maternal-infant pairs (n = 137) participated in laboratory assessments of maternal-infant interaction at 6 months of age and infant-maternal attachment at 20 months.
Results:
Parental use of "cry out" as a strategy to deal with a crying infant was associated with parental characteristics (being white and having a relatively higher income), infant characteristics (higher problematic behavior at 3 months and reduced problematic behavior at 12 months), sleep ecology (infants sleeping alone), and parental soothing strategies (less frequently taking the infant into the parent's bed, cuddling, or carrying the crying infant). Cry out was not associated with observational measures of maternal sensitivity or infant-maternal attachment.
Conclusion:
When used selectively and in response to the specific needs and characteristics of the infant, delayed responsiveness may reduce problematic behavior and does not harm the infant's socioemotional development.
Background:
Healthcare professionals (HCPs), largely doctors, paediatricians, health visitors, midwives, and practice nurses, are in a good position to provide information, help, advice, or guidance to parents for child sleep. However, evidence suggests that there is a gap between the number of parents who desire assistance from HCPs and those that make use of these sources, yet very little is known about the reason for this apparent disparity. The aim of this study was to understand the barriers reported by parents to consulting HCPs about child sleep.
Methods:
In this study, 266 U.K.-based parents of children aged 6-36 months old completed an online questionnaire (between October 2015 and October 2016) about their help-seeking behaviours in relation to child sleep. This included reporting perceived barriers to consulting HCPs for child sleep information and advice about problems.
Results:
Thematic analysis highlighted five themes, which parents reported acted as barriers to them consulting HCPs. Specifically, parents perceived HCPs to have a lack of knowledge or training around the topic of child sleep and that advice would be limited in terms of breadth of information or management options that would be offered. Parents were also concerned about wasting their own or HCPs' time, perceived there was a lack of continuity in the information they received, and held concerns about possible negative consequences for their family if they shared details about any child sleep difficulties.
Conclusions:
Possible practical approaches to address the barriers reported by parents are highlighted. This includes improving training around the topic of child sleep for HCPs and adapting the content or manner in which the topic of child sleep and any associated issues are addressed with parents.
Co-sleeping is a complex familial phenomenon that has yet to be well understood by Western scientists. This paper provides an interdisciplinary review of research from anthropology, nursing, pediatrics, sociology, social work, public health, family studies, and psychology to focus on the role of physical touch in the context of co-sleeping, and how close physical contact in this context affects infants and their caregivers. Including an anthropological, evolutionary view of co-sleeping with other perspectives highlights it as an experience-expectant proximal context for infant growth and development. From this view, the importance of physical contact and touch in the nighttime caretaking microenvironment of co-sleeping becomes a central question, rather than an artifactual byproduct of "unhealthy" sleep arrangements. Rather than trying to eliminate co-sleeping, public health messages for parents would likely benefit from a more culturally-sensitive approach that focuses on advising how to co-sleep safely for families choosing it. For families trying to retain physical closeness between parent(s) and infants in the context of modern (especially Western) infant care practices that have reduced this physical contact, co-sleeping can be an important developmental context for encouraging and engaging in sensitive and responsive caregiving and providing a context for maternal-infant physiological synchrony and regulation.
Following their infant’s birth, parents in many societies in the global North experience acute sleep disruption for which few are adequately prepared, and which may result in profound and enduring negative outcomes such as parental depression and anxiety. For some babies, their parent’s inability to cope with sleep disruption results in harmful short-term outcomes (such as infants being medicalised, medicated, and abused); long-term consequences are more difficult to identify and therefore are understudied. Yet other parents, and indeed whole nations of parents, seem resilient to infant-related sleep disruption and take it all in their stride—so what differs? This chapter considers parental perceptions and experiences of night-time infant care and the strategies that are promoted and used for coping with infant-related sleep disruption. The potential consequences of these for parents, their babies, and society in general will be explored with suggestions for future research to fill current evidence gaps.
The Parenting Premmies Support Program: developing and piloting a mobile health intervention for mothers of preterm infants. The study presented in this thesis aimed to investigate the use of contemporary mobile health technology as a vehicle to support and promote the health and wellbeing of mothers of preterm infants during the transitional time following their infant’s discharge from hospital. An exploratory, mixed methods approach with a three phase design was used to understand maternal experience, challenges and issues in this context, develop an mHealth protocol that formed the program, and finally, pilot the program.
There is a growing concern in relation to the problem of insufficient sleep, particularly in the United States. In the early 1990s a Congressionally mandated commission noted that insufficient sleep is a major contributor to catastrophic events, such as Chernobyl and the Exxon Valdez, as well as personal tragedies, such as automobile accidents. Adolescents appear to be among the most sleep-deprived populations in our society, though they are rarely included in sleep assessments. This book explores the genesis and development of sleep patterns in adolenscents. It examines biological and cultural factors that influence sleep patterns, presents risks associated with lack of sleep, and reveals the effects of environmental factors such as work and school schedules on sleep. Originally published in 2002, Adolescent Sleep Patterns will appeal to psychologists and sociologists of adolescence who have not yet considered the important role of sleep in the lives of our youth.
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.
The authors review several key areas of early cognitive development in which an abrupt shift in ability at the end of the second year of life has been traditionally assumed. These areas include deferred imitation, self-recognition, language, and categorization. Contrary to much conventional theorizing, the evidence shows robust continuities in all domains of early cognitive development. Where there is evidence of a reorganization of behavior that makes a new level of performance possible, dynamic-systems analyses indicate that even these may be driven by underlying processes that are continuous, Although there remain significant definitional and methodological issues to be resolved, the outcome of this review augers well for newer models in which cognitive development is viewed as a continuous, dynamic process.
I explore how some aspects of Foucoult's work on power can be applied to human/animal power relations. First, I argue that because animals behave as "beings that react" and can respond in different ways to human actions, in principle at least, Foucoult's work can offer insights into human/animal power relations. However, many of these relations fall into the category of "domination," in which animals are unable to respond. Second, I examine different kinds of human power practices, in particular, ways in which humans construct animal constitutions and animal subjectivities. Finally, I use a case study of a pet cat to show how such power practices may come together in a single instance.
Examines the decisions of middle-class US and Highland Mayan parents regarding sleeping arrangements during their child's 1st 2 yrs and their explanations for their differing practices. All 14 Mayan children slept in their mothers' beds into toddlerhood. None of the 18 US infants slept in bed with their mothers on a regular basis as newborns, although 15 slept near their mothers until age 3–6 mo, when most were moved to a separate room. The Mayan parents explained their practices in terms of the value of closeness with infants; US parents explained their practices in terms of the value of independence for infants. US families, but not Mayan families, used bedtime routines and objects to facilitate the transition to sleep. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Lay opinion and extensive survey data indicate that crying is a cathartic behavior that serves to relieve distress and reduce arousal. Yet laboratory data often indicate that crying exacerbates distress and increases autonomic arousal. In this article, we present a framework for explaining variations in the psychological effects of crying as a function of (a) how the effects of crying are measured, (b) conditions in the social environment, (c) personality traits of the crier, and (d) the affective state of the crier. Recognizing the heterogeneity of crying effects represents a step toward a more nuanced understanding of this behavior, including its implications for psychosocial adjustment.
Animal and human studies suggest that stress experienced early in life has detrimental consequences on brain development, including brain regions involved in cognitive function. Cognitive changes are cardinal features of depression and posttraumatic stress disorder. Early-life trauma is a major risk factor for these disorders. Only few studies have measured the long-term consequences of childhood trauma on cognitive function in healthy adults.
In this pilot study, we investigated the relationship between childhood trauma exposure and cognitive function in 47 healthy adults, who were identified as part of a larger study from the general population in Wichita, KS. We used the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Wide-Range-Achievement-Test (WRAT-3) to examine cognitive function and individual achievement. Type and severity of childhood trauma was assessed by the Childhood Trauma Questionnaire (CTQ). Data were analyzed using multiple linear regression on CANTAB measures with primary predictors (CTQ scales) and potential confounders (age, sex, education, income).
Specific CTQ scales were significantly associated with measures of cognitive function. Emotional abuse was associated with impaired spatial working memory performance. Physical neglect correlated with impaired spatial working memory and pattern recognition memory. Sexual abuse and physical neglect were negatively associated with WRAT-3 scores. However, the association did not reach the significance level of p < 0.01.
Our results suggest that physical neglect and emotional abuse might be associated with memory deficits in adulthood, which in turn might pose a risk factor for the development of psychopathology.
The pros and cons of parent-infant bed-sharing have been hotly debated in both the academic and professional literature concerning infant health and early parenting. Much of the debate has focused on data from the US, and little research has examined parents' motives for sleeping with their infants. This paper examines parental bed-sharing practices with young infants in North Tees, UK. We found that bed-sharing was a common night-time care-giving strategy, and the reasons articulated by parents for bed-sharing with their small infants were varied. There was a particularly strong association between bed-sharing and breastfeeding; however, infant irritability or illness was also a frequently given reason for bed-sharing, and a number of other reasons emerged.We conclude it is important that circumstance and motivation are considered in assessments of bed-sharing safety, and parental reasons for bed-sharing are acknowledged in formulating advice for parents regarding bed-sharing.
Evidence suggests that infant-parent co-sleeping represents the species-wide pattern of sleep in which human infant physiology evolved. The hypothesis evaluated in this manuscript is that the co-sleeping environment may foster development of optimal sleep patterning in infants and confer other benefits, including reducing the risk of the sudden infant death syndrome (SIDS). These postulations by McKenna are considered from different perspectives by the coauthors. Using evolutionary, cross-species, crosscultural, physiological and behavioral data, our objective was to present a conceptual framework for assessing the developmental consequences of solitary sleeping and infant-parent co-sleeping.
The authors review several key areas of early cognitive development in which an abrupt shift in ability at the end of the second year of life has been traditionally assumed. These areas include deferred imitation, self-recognition, language, and categorization. Contrary to much conventional theorizing, the evidence shows robust continuities in all domains of early cognitive development. Where there is evidence of a reorganization of behavior that makes a new level of performance possible, dynamic-systems analyses indicate that even these may be driven by underlying processes that are continuous. Although there remain significant definitional and methodological issues to be resolved, the outcome of this review augers well for newer models in which cognitive development is viewed as a continuous, dynamic process.
This review covers the literature on behavioural and cognitive-behavioural treatments for sleep disturbance in infants, pre-school, and school-age children. Treatment areas are dyssomnias (disorders of initiating, maintaining, or excessive sleep) and parasomnias (behaviours which occur predominantly during sleep). Interventions aimed at preventing sleep disorder through targeting infant sleep patterns are also examined. Controlled experimental studies are the main focus of this review but case studies and clinical reports are also included. It is concluded that, for families willing to undertake behavioural and cognitive-behavioural interventions, some treatments appear effective for some infant and child sleep problems, in the short term at least. The adequacy of current research is discussed, and suggestions for future research are given.
Pediatricians provide a major source of knowledge for parents about children's behavior and development, although their advice is largely based on their own cultural values and beliefs in interaction with their personal and clinical experience. This review presents cross-cultural aspects of children's sleep behavior in industrialized and complex modern societies and provides a basis for understanding dimensions and mechanisms of cultural differences. We submit that it is the interaction between culture and biology that establishes behavioral and developmental norms and expectations regarding normal and problematic children's sleep. Pediatricians need to recognize the cultural environment in which children live and be knowledgeable about how cultural beliefs and values of both families and physicians interact with the needs and biological characteristics of individual children.
Western parents are given conflicting advice about whether to introduce a "scheduled" approach to infant care or to follow their infants' demands. Attempts to address this issue using randomized, controlled trials have been unsuccessful. This comparative study collected evidence about methods of parenting and associated infant crying and sleeping in 2 communities with substantially different approaches to infant care (London, United Kingdom, and Copenhagen, Denmark) and in a "proximal care" group, where parents planned to hold their infants > or =80% of the time between 8 am and 8 pm, breastfeed frequently, and respond rapidly to infant cries.
Validated behavior diaries were used to measure parental behavior and infant crying and night waking longitudinally at 8 to 14 days, 5 to 6 weeks, and 10 to 14 weeks of age. Feeding and sleeping practices were measured by questionnaire.
Proximal care parents held infants for 15 to 16 hours per 24 hours and coslept with them through the night more often than other groups. London parents had 50% less physical contact with their infants than proximal care parents, including less contact when the infants were crying and when awake and settled. London parents also abandoned breastfeeding earlier than other groups. Copenhagen parents fell in between the other groups in measures of contact and care. These differences in caregiving were associated with substantial differences in several aspects of infant crying and settled behavior at night. London infants cried 50% more overall than infants in both other groups at 2 and 5 weeks of age. However, bouts of unsoothable crying occurred in all 3 of the groups, and the groups did not differ in unsoothable bouts or in colicky crying at 5 weeks of age. Proximal care infants woke and cried at night most often at 12 weeks. Compared with proximal care infants, Copenhagen infants cried as little per 24 hours, but woke and cried at night less often at 12 weeks of age.
"Infant-demand" care and conventional Western care, as practiced by London parents, are associated with different benefits and costs. As used by proximal care and Copenhagen parents, infant demand parenting is associated with less overall crying per 24 hours. However, the proximal form of infant-demand parenting is associated with more frequent night waking and crying at 12 weeks of age. Copenhagen infants cry as little per 24 hours as proximal care infants but are settled at night like London infants at 12 weeks of age. Colicky crying bouts at 5 weeks of age are unaffected by care. The findings have implications for public health care policy. First, they add to evidence that bouts of unsoothable crying, which are common in early infancy, are not much affected by variations in parenting, providing reassurance that this aspect of infant crying is not parents' fault. Second, the findings provide information that professionals can give to parents to help them to make choices about infant care. Third, the findings support some experts' concerns that many English parents are adopting methods of care that lead to increased crying in their infants. There is a need for informed debate among professionals, policy makers, and parents about the social and cultural bases for the marked differences between London and Copenhagen parents' approach to care.
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 unmodified 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.
In contrast to school-aged children, the impact of sleep problems in preschool-aged children is not well documented. We aimed to determine relationships between preschool-aged child sleep problems and child behavior; health-related quality of life; verbal, preliteracy, and early numeracy skills; diagnosis of attention-deficit/hyperactivity disorder; and injury.
Participants included families (n = 4983) participating in the first wave of the Longitudinal Study of Australian Children, a nationally representative study of Australian children aged 4 to 5 years surveyed from March to November 2004. Measures consisted of a primary caregiver's report of whether their child had a sleep problem (none versus mild versus moderate/severe); specific sleep patterns occurring > or = 4 nights per week; health-related quality of life (by using the Pediatric Quality of Life Inventory 4.0); behavior (by using the Strengths and Difficulties Questionnaire) and parent-reported diagnosis of attention-deficit/hyperactivity disorder; and injury requiring medical attention in the past 12 months. Tests of receptive vocabulary and preliteracy/numeracy skills (by using the Who Am I? developmental assessment and the adapted Peabody Picture Vocabulary Test, 3rd Edition) were directly administered to each child.
Sleep problems were common, and compared with children without sleep problems, children with sleep problems had poorer child health-related quality of life, more behavior problems, and higher rates of attention-deficit/hyperactivity disorder. Difficulty going to sleep and morning tiredness had greater adverse associations than snoring or night waking.
Given that sleep problems are very common, the adverse outcomes shown here could affect the transition to school for a very large number of preschoolers.
We try to keep in mind cultural influences on the advice we give. We remind ourselves that much of what comes to the pediatrician’s attention, as problematic sleep behavior- children who have difficulty falling asleep alone at bedtime, who wake at night and ask for parental attention, or who continue to nurse at night-is problematic only in relation to our society’s expectations, rather than to some more general standard of what con- stitutes difficult behavior in the young child. Our pediatric advice on transitional objects, breast feeding, cosleeping may be unknowingly biased toward traditional Euro Amer- icanviews of childrearing, especially those about bedtime and nighttime behavior. Thus, in giving advice about sleep, pediatric health professionals might dowell to be aware of their own cultural values, to examine closely their patients cultural and family contexts, and to assess parental reactions to children’s sleep behaviors. (1) Who sleeps by whom is not merely a personal or private activity. Instead it is social practice, like burying the dead or expressing gratitude for gifts or eating meals with your family, or honoring the practice of a monogamous marriage, which (for those engaged in the practice) is invested with moral and social meaning for a person’s reputation and good standing in the community. (2) Inclinical pediatrics, cosleeping is thepolitical third rail. If you touch it, youdie. (3) In this chapter, we have contributed a new conclusion to the first version pub- lished in the earlier edition, slightly modified and updated recent developments as regards research into mother-infant cosleeping in the form of bedsharing, and have contributed a new last section that critiques recommendations against any and all bedsharing. But mostly, we provide here (without modification) a cultural background to our thinking about what constitutes “normal, healthy, and desirable” infant sleep and show the interconnectedness between scientific research, cultural values, concerns for morality, and sleeping arrangements that are characteristic of Western society. Specific biological and psychological evidence is put forth supporting the views of Sadeh and Anders (4,5) and Anders (6) on the importance of understanding what is “appropriate” infant sleep on the basis of the overall social and physical context within which it occurs.
The formation of functional attachments is a critical developmental task of infancy and early childhood. Attachments play a significant role in the development of a child’s enduring beliefs about self, other and world (Attachment Representations). Infants become attached to the people who provide physical and emotional care on a continuous and consistent basis. Quality of care and the infant’s early experiences influence the type of attachment the infant develops. When care is grossly deficient and early experiences are characterised by physical and emotional distress, the infant’s attachment to its caregiver is also disturbed. Children who display markedly disturbed and developmentally inappropriate social relatedness in most contexts, and who have experienced grossly deficient care, might accurately be diagnosed with Reactive Attachment Disorder (RAD) or Disinhibited Attachment Disorder (DAD). Attachment-disordered children pose a substantial care and management challenge to all who care for and work with them in the home and educational contexts. Successful management of these children and the remediation of their attachment difficulties are predicated on understanding what function their apparently antisocial and defensive tendencies serve and approaches that support the development of functional attachments. Key roles are attributed to cortical arousal, attachment representations and beliefs about accessibility to needs provision in the diagnosis and remediation of attachment disorders. Drawing from observations of caregiving practices that promote functional attachments in infancy, strategies are presented for the home and classroom that address elevated cortical arousal levels, promote secure attachment representations and reassure the child regarding accessibility to needs provision.
Seeing Through Tears is a groundbreaking examination of crying behavior and the meaning behind our tears. Drawing from attachment theory and her own original research, Judith Nelson presents an exciting new view of crying as a part of our inborn equipment for establishing and maintaining emotional connections. In a comprehensive look at crying through the life cycle, this insightful volume presents a novel theoretical framework before offering useful and practical advice for dealing with this most fundamental of human behaviors.
The distinction between norms and facts is long-standing in providing a challenge for psychology. Norms exist as directives, commands, rules, customs and ideals, playing a constitutive role in human action and thought. Norms lay down ‘what has to be’ (the necessary, possible or impossible) and ‘what has to be done’ (the obligatory, the permitted or the forbidden) and so go beyond the ‘is’ of causality. During two millennia, norms made an essential contribution to accounts of the mind, yet the twentieth century witnessed an abrupt change in the science of psychology where norms were typically either excluded altogether or reduced to causes. The central argument in this book is twofold. Firstly, the approach in twentieth-century psychology is flawed. Secondly, norms operating interdependently with causes can be investigated empirically and theoretically in cognition, culture and morality. Human development is a norm-laden process. © Cambridge University Press 2006 and Cambridge University Press, 2009.
Beginning in 1956, Stella Chess and Alexander Thomas tracked the lives of 133 children from infancy to young adulthood, examining in detail their psychological development over a twenty-five-year period. The result was the groundbreaking New York Longitudinal Study. This book, first published in 1984, presents a complete report of the study, including analyses of the data and exploration of such fundamental questions as gender differences, antecedents of adult behavior patterns, and factors that contribute to depression and other disorders. Special emphasis is given to the clinical evaluation and treatment of patients with behavioral abnormalities. The authors discuss key findings: the important role of parental guidance, the continuities and discontinuities across developmental stages, the crucial effects of temperament on psychological development, and the usefulness of a goodness of fit model for understanding the relationship between person and environment and for describing the evolution of behavior disorders."
This study examines the family environments and hormone profiles of 316 individuals aged 2 months-58 years residing in a rural village on the east coast of Dominica, a former British colony in the West Indies. Fieldwork was conducted over an eight-year period (1988–1995). Research methods and techniques include radioimmunoassay of cortisol and testosterone from saliva samples (N=22,340), residence histories, behavioral observations of family interactions, extensive ethnographic interview and participant observation, psychological questionnaires, and medical examinations.
Analyses of data indicate complex, sex-specific effects of family environment on endocrine function. Male endocrine profiles exhibit greater sensitivity to presence of father than do female endocrine profiles. Father-absent males tend to have (a) low cortisol levels during infancy, (b) high or abnormal cortisol profiles during childhood and adolescence, and (c) high cortisol and low testosterone levels during adulthood compared with those of males raised with a resident father. These results indicate that early family environment has significant effects on endocrine response throughout male life histories.
Chronic disturbed sleep is a common problem in preschool children. Treatment by extinction is successful but may be accompanied by side-effects such as post-extinction response bursts which make the treatment aversive to parents and which impairs their compliance. This study evaluated a modified procedure, graduated extinction, which required parents gradually to reduce attention to bedtime disturbance and night waking from average baseline levels to zero over 28 days. Baseline measures of frequency and duration of night waking, sleep-onset latency, and bedtime delay were made for six children (6- to 14-months-old). Parents were then instructed to use graduated extinction using a multiple-baseline-across-subjects design. Following treatment, three out of six children showed clinically significant reductions in the frequency and duration of night waking, and a fourth child substantially reduced the duration of her wakings. These gains were maintained at followup. Lack of improvement was associated with parental noncompliance with treatment and childhood illness. Two subjects showed some evidence of post-extinction response bursts despite the gradual withdrawal of parental attention. Parents reported high satisfaction with the procedures but half found the procedure mildly to moderately stressful. While graduated extinction was an effective treatment, regular extinction offers practical and clinical advantages in most cases.
Clinicians are commonly consulted by the parents of infants aged 6–24 months who are distressed by their infant's sleep disturbance. Infant sleep disturbance (ISD) presents as frequent night awakening, delays in sleep onset and co-sleeping that is not of the parents’ choice. Conflicting advice leaves parents unsure regarding management. Recent research has described treatment approaches as well as models describing the complexity of variables that appear to control ISD. In this article, we describe the learning principles underlying the development of ISD and summarize empirically validated treatments. Practitioners are advised on the importance of appropriate assessment and support, as well as on suggestions they can make about prevention.
This article examines the spatialization of sleep in Victorian Britain across a range of institutions, including homes and dormitories. It situates the emergence of modern sleeping space at the intersection of two key narratives regarding the history of the body: Elias's `civilising process' and Foucault's account of the realization of a `disciplinary society'. Beginning in the early modern period, sleeping bodies were gradually accorded their own space set apart from others, and by the end of the 19th century the individual bed was regarded as an essential ingredient of civilized society. However, the evolution of modern sleeping space was only in part informed by ideas of privacy and civility: it was also animated by ideas concerning the functioning of `normal' bodies and minds, the governmental agency of space and the moral integrity of nuclear families. Furthermore, the bed remained a highly problematic, indeterminate space, facilitating deviant as much as civilized behaviour, and giving rise to all manner of pathologies, perversities and phobias. In this respect, the history of sleeping space also sheds light on the reciprocities of rule and resistance, pleasure and power, which at once constitute and imperil the integrity of the modern body.
To assess the prevalence of parental behaviors and other factors of sleep ecology and to analyze their relationships with sleep outcomes in a large sample of children ages birth to 36months in multiple countries/regions.
Parents of 29,287 infants and toddlers (48% boys; Australia, Canada, China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, New Zealand, Philippines, Singapore, Taiwan, Thailand, United Kingdom, United States, and Vietnam) completed an internet-based expanded version of the Brief Infant Sleep Questionnaire.
Overall, there is a high level of parental involvement in sleep onset and sleep maintenance for young children, with significant differences in parenting behaviors across cultural groups. For predominantly-Caucasian, the most common behavior occurring at bedtime is falling asleep independently in own crib/bed (57%), compared to just 4% of those children living in predominantly-Asian regions. Parental behaviors and sleep ecology, including parental presence at sleep onset, bedtime, and bedtime routine, significantly explain a portion of the variance in sleep patterns. Overall, parental behaviors are more highly predictive of nighttime sleep outcomes in predominantly-Caucasian regions. Finally, parental involvement in sleep onset mediates the relationship between cosleeping and sleep outcomes.
Overall, the best predictors of nighttime sleep are related to parental behaviors at bedtime and during the night. Furthermore, sleep disruption and decreased total sleep associated with bed sharing and room sharing are mediated by parental presence at bedtime. These findings provide additional support for addressing parental behaviors in behavioral interventions for infant and toddler sleep problems.
To characterize cross-cultural sleep patterns and sleep problems in a large sample of children ages birth to 36 months in multiple predominantly-Asian (P-A) and predominantly-Caucasian (P-C) countries.
Parents of 29,287 infants and toddlers (predominantly-Asian countries/regions: China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, Philippines, Singapore, Taiwan, Thailand, Vietnam; predominantly-Caucasian countries: Australia, Canada, New Zealand, United Kingdom, United States) completed an internet-based expanded version of the Brief Infant Sleep Questionnaire.
Overall, children from P-A countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to both bed-share and room-share than children from P-C countries, p<.001. Bedtimes ranged from 19:27 (New Zealand) to 22:17 (Hong Kong) and total sleep time from 11.6 (Japan) to 13.3 (New Zealand) hours, p<.0001. There were limited differences in daytime sleep. Bed-sharing with parents ranged from 5.8% in New Zealand to 83.2% in Vietnam. There was also a wide range in the percentage of parents who perceived that their child had a sleep problem (11% in Thailand to 76% in China).
Overall, children from predominantly-Asian countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to room-share than children from predominantly-Caucasian countries/regions. These results indicate substantial differences in sleep patterns in young children across culturally diverse countries/regions. Further studies are needed to understand the basis for and impact of these interesting differences.
This study examines the association between nighttime sleep characteristics and cortisol levels and how these variables relate to aspects of children's temperament and behavior. Twenty-seven healthy children, aged 12-36 months, attending group childcare settings, participated in the study. Each child's sleep was measured at home with actigraphy over three nights. Saliva samples were collected by the mothers at bedtime and within 30 min of awakening. In addition, both the mother and the daycare teacher rated the child's behavioral difficulties and negative emotionality. It was found that children with more fragmented sleep displayed higher awakening cortisol levels compared to children with more efficient sleep. Moreover, elevated awakening cortisol levels were correlated with teachers' ratings of internalizing behavior and negative emotionality. These preliminary findings suggest that awakening cortisol may serve as a useful index of adrenocortical reactivity in young children, signaling a disturbance in physiological regulation, and underscore the need for more research pertaining to the dynamic associations between sleep and HPA-axis across the 24-hr period.
Previous laboratory studies have found a relationship between experimentally manipulated emotion regulation strategies such as suppression and reappraisal and cardiovascular reactivity. However, these studies have not examined trait forms of these strategies and cortisol responses. The aim of the present study is to investigate the relationship between trait suppression, reappraisal, and cortisol reactivity to a social-evaluative speech task.
Participants completed the Emotion Regulation Questionnaire [ERQ; Gross, J.J., John, O.P., 2003. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J. Pers. Soc. Psychol. 85, 348-362] to assess trait suppression and reappraisal and were asked to complete a speech task in front of an evaluative audience. They provided five saliva samples throughout the duration of the session to assess cortisol response patterns.
Consistent with hypotheses, trait suppression predicted exaggerated cortisol responses to the speech task, with those scoring higher on suppression exhibiting greater cortisol reactivity. High levels of trait reappraisal also predicted exaggerated cortisol reactivity to the speech task.
Findings suggest that certain emotion regulation strategies such as suppression and reappraisal predict heightened cortisol reactivity to an acute stressor. Future studies should examine the psychological mechanisms through which these emotion regulation strategies affect cortisol response patterns.
Sleep disorders are highly prevalent among otherwise healthy young children and can be extremely disruptive to family life. Treatment was initiated in a multiple baseline fashion for the chronic night waking and nighttime disturbance exhibited by a 14-month-old girl. We found that "graduated extinction" (gradually increasing the time before attending to the child's crying) resulted in rapid reductions in these sleep disorders. Additionally, data on parental depression and marital satisfaction showed general improvement as a function of improved child sleep patterns. These results are discussed as they relate to the treatment of common childhood behavior disorders and their role in family satisfaction.
A series of studies were conducted to investigate pediatricians' training, knowledge, and practices regarding sleep and sleep disorders in children and adolescents.
Study 1, a national survey of 156 pediatric residency programs, found that pediatricians receive a mean of 4.8 hours of instruction on sleep and sleep disorders, although the mode and median hours of instruction is 0 hours. In study 2, 88 pediatricians completing a questionnaire concerning general knowledge about sleep disorders in children and adolescents received a mean score of 71.8% (range, 40% to 93%). Pediatricians appear to know the most about developmental issues and sleep hygiene and the least about specific disorders such as narcolepsy and parasomnias. In the third study, 183 pediatricians were surveyed about their actual beliefs and practices regarding young children's sleep problems. Together, those surveyed reported that approximately 25% of their patients experience some type of sleep problem. Most pediatricians recommend behavioral interventions, although 14.8% of pediatricians report prescribing pharmacological treatments, and 48.9% inform parents that their child is likely to outgrow the problem.
The results of these studies support the need for more education in sleep and sleep disorders in children and adolescents within medical schools, pediatric residency programs, and the practicing pediatric community.
To describe infant sleep patterns and investigate relationships between infant sleep problems and maternal well-being in the community setting.
Cross-sectional community survey. Setting. Maternal and Child Health Centers in 3 middle-class local government areas in Melbourne, Australia.
Mothers of infants 6 to 12 months of age.
Maternal well-being (Edinburgh Postnatal Depression Scale) and infant sleep problems (standardized maternal questionnaire).
The survey was completed by 738 mothers (94% response rate), of whom 46% reported their infant's sleep as a problem. In the univariate analyses, sleep patterns characterizing a sleep problem included the infant sleeping in the parent's bed, being nursed to sleep, taking longer to fall asleep, waking more often and for longer periods overnight, and taking shorter naps. The same sleep patterns were associated with high depression scores and tended to increase as depression scores increased. Because of positive skew, the Edinburgh Postnatal Depression Score was analyzed in 3 categories (<10, 10-12, and >12) using validated cutoff scores from community and clinical studies. Fifteen percent of mothers scored above 12 on the depression scale, indicating probable clinical depression, and 18% scored between 10 and 12, indicating possible clinical depression. After adjusting for potential confounders and factors significant in the univariate analyses, maternal report of an infant sleep problem remained a significant predictor of a depression score >12 (odds ratio: 2.13; 95% confidence interval: 1.27,3.56) and >10 (odds ratio: 2.88; 95% confidence interval: 1.93,4.31). However, mothers reporting good sleep quality, despite an infant sleep problem, were not more likely to suffer depression.
Maternal report of infant sleep problems and depression symptoms are common in middle-class Australian communities. There is a strong association between the 2, even when known depression risk factors are taken into account. Maternal report of good sleep quality attenuates this relationship. Appropriate anticipatory guidance addressing infant sleep could potentially decrease maternal report of depressive symptoms.
These studies assessed adults' latencies to signal that they would respond to infant crying as functions of (1) the degree of infant distress they perceived in the cry, and (2) contextual information relevant to caregiving. In the first study (N = 34), listeners waited longer to respond to cries that they had earlier rated as sounding less distressed than when they heard cries of higher distress. Further, those who had been told that the infant needed sleep waited longer to respond than those without this information. This effect of context information, however, was limited to the latencies; in another study (N = 50), listeners' ratings of distress were not affected. Several acoustic features of the cries correlated with distress ratings and with latencies to signal a caregiving response. Taken together, the results suggest that adults' responses to crying are influenced both by acoustic gradations in the cry itself and by the caregiving context. Ratings of degree of distress manifest in the cry, in other words, may be highly predictive of caregiving behavior but not wholly so. Finally, although certain acoustic variations related to greater perceived distress and speed of response, differences were apparent between infants in the magnitude of these variations. The implication that the general process of cry perception may be calibrated, or fine tuned, to the range of acoustic variation provided by individual infants is discussed.
Research on both animals and humans is providing more and more evidence that prenatal factors can have long-term effects on development. Most human studies have examined the effects of prenatal stress on birth outcome (i.e. shorter pregnancies, smaller infants). The few studies that have looked at the infants' later development have found prenatal stress to be related to more difficult temperament, behavioral/emotional problems and poorer motor/cognitive development. In this paper, we have examined links between late pregnancy cortisol levels and infant behavior during the first 5 months of life.
Seventeen mothers and their healthy, full-term infants participated in this prospective, longitudinal study. The mothers' cortisol was determined in late pregnancy. The infants' behavior was videotaped during a series of bath sessions at the home: at 1, 3, 5, 7, 18 and 20 weeks of age. The mothers filled in temperament questionnaires (ICQ) in postnatal weeks 7 and 18.
The infants were divided into two groups based on their mothers' late pregnancy cortisol values: high and low prenatal cortisol groups. A trend was found for the high cortisol infants to be delivered earlier than the low cortisol group. Furthermore, the behavioral observations showed the higher prenatal cortisol group to display more crying, fussing and negative facial expressions. Supporting these findings, maternal reports on temperament also showed these infants to have more difficult behavior: they had higher scores on emotion and activity. The differences between the infants were strongest at the youngest ages (weeks 1-7).
This article provides a selective review and integration of the behavioral literature on Pavlovian extinction. The first part reviews evidence that extinction does not destroy the original learning, but instead generates new learning that is especially context-dependent. The second part examines insights provided by research on several related behavioral phenomena (the interference paradigms, conditioned inhibition, and inhibition despite reinforcement). The final part examines four potential causes of extinction: the discrimination of a new reinforcement rate, generalization decrement, response inhibition, and violation of a reinforcer expectation. The data are consistent with behavioral models that emphasize the role of generalization decrement and expectation violation, but would be more so if those models were expanded to better accommodate the finding that extinction involves a context-modulated form of inhibitory learning.