Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children: An American Academy of Sleep Medicine report

Mayo Sleep Disorders Center, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Sleep (Impact Factor: 4.59). 11/2006; 29(10):1277-81.
Source: PubMed


Bedtime problems and frequent night wakings are highly prevalent in infants, toddlers, and preschoolers. Evidence suggests that sleep disruption and/or insufficient sleep have potential deleterious effects on children's cognitive development, regulation of affect, attention, health outcomes, and overall quality of life, as well as secondary effects on parental and family functioning. Furthermore, longitudinal studies have demonstrated that sleep problems first presenting in infancy may become chronic, persisting into the preschool and school-aged years. A solid body of literature now exists supporting the use of empirically-based behavioral management strategies to treat bedtime problems and night wakings in infants, toddlers, and preschoolers. The following practice parameters present recommendations for the use of behavioral (i.e., non-pharmacological) treatments of bedtime problems and night wakings in young children (aged 0 - 4. years 11 months). A companion review paper on which the recommendations are based was prepared by a taskforce appointed by the Standards of Practice Committee (SPC) of the American Academy of Sleep Medicine (AASM), and summarizes the peer-reviewed scientific literature on this topic. The authors of the review paper evaluated the evidence presented by the reviewed studies according to modified Sackett criteria. Using this information and a grading system described by Eddy (i.e., standard, guideline or option), the Standards of Practice Committee and Board of Directors of the American Academy of Sleep Medicine determined levels of treatment recommendation presented in the practice parameters below. These practice parameters provide 3 types of recommendations. First, recommendations are provided indicating that behavioral interventions are effective in the treatment of bedtime problems and night wakings in young children, producing reliable and significant clinical improvement in sleep parameters. Second, recommendations are made regarding specific behavioral therapies, including: (1) unmodified extinction, extinction with parental presence, and preventive parent education are all rated as individually effective therapies in the treatment of bedtime problems and night wakings (Standards), and (2) graduated extinction, bedtime fading/positive routines and scheduled awakenings are rated as individually effective therapies in the treatment of bedtime problems and night wakings but with less certainty (Guidelines). There was insufficient evidence to recommend standardized bedtime routines and positive reinforcement as single therapies. In addition, although behavioral therapies for bedtime problems and night wakings are often combined, there was insufficient evidence available to recommend one individual therapy over another or to recommend an individual therapy over a combination of therapies. Finally, recommendations are provided regarding the beneficial effects of behavioral treatments on secondary outcomes, including daytime functioning (child) and parental well-being.

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    • "A large (N = 8,950), longitudinal study indicated that overactivity, anger, aggression, impulsivity, tantrums, and annoying behaviors predicted shorter sleep duration (Scharf, Demmer, Silver, & Stein, 2013). Bedtime resistance problems (verbal and behavioral resistance to entering and staying in bed) are common among young children, ranging in prevalence from 20% to 30% and have been linked to childhood obesity (Lozoff, Wolf, & Davis, 1985; Morgenthaler et al., 2006). Longitudinal evidence during early childhood showed that without intervention, bedtime problems often persist from infancy through early preschool ages (Byars, Yolton, Rausch, Lanphear, & Beebe, 2012). "
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    ABSTRACT: This study evaluated the influence of child and family functioning on child sleep behaviors in low-income minority families who are at risk for obesity. A cross-sectional study was utilized to measure child and family functioning from 2013 to 2014. Participants were recruited from Head Start classrooms while data were collected during home visits. A convenience sample of 72 low-income Hispanic (65%) and African American (32%) families of preschool-aged children were recruited for this study. We assessed the association of child and family functioning with child sleep behaviors using a multivariate multiple linear regression model. Bootstrap mediation analyses examined the effects of family chaos between child functioning and child sleep problems. Poorer child emotional and behavioral functioning related to total sleep behavior problems. Chaos associated with bedtime resistance significantly mediated the relationship between Behavioral and Emotional Screening System (BESS) and Bedtime Resistance. Families at high risk for obesity showed children with poorer emotional and behavioral functioning were at higher risk for problematic sleep behaviors, although we found no link between obesity and child sleep. Family chaos appears to play a significant role in understanding part of these relationships. Future longitudinal studies are necessary to establish causal relationships between child and family functioning and sleep problems to further guide obesity interventions aimed at improving child sleep routines and increasing sleep duration.
    No preview · Article · Jan 2016 · Behavioral Sleep Medicine
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    • "In regard to infant nighttime care, the lack of consensus regarding what constitutes best care practice approaches can create a challenge for parents (Sobralske & Gruber, 2009; Morgenthaler et al., 2006). NPs can help parents understand what normative sleep patterns are like, to make decisions about nighttime care and to feel comfortable about their choices. "
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    ABSTRACT: PurposeReview infant sleep research with a focus on understanding the elements related to infant safety and infant and maternal well-being during nighttime care.Data sourcesThis review summarizes current research and addresses the controversies and conflicting outcomes reported in infant nighttime care. This review addresses current literature on infant sleep patterns, as well as factors that influence infant sleep and are consequences of different care routines. Conversation points are provided to help nurse practitioners (NPs) address safety and practice concerns.Conclusions Shared information can help parents provide a safe and healthy environment for infants and help to facilitate communication ties between the healthcare providers and the families.Implications for practiceNPs need to help parents understand infant sleep patterns norms, what is current knowledge about infant nightwakings and parental presence, as well as about approaches to altering infant sleep patterns. Integrating this knowledge with parent preferences that are influenced by cultural practices and individual differences is crucial in helping parents develop a strong sense of competence and comfort with their choices and behaviors.
    Full-text · Article · Jul 2014 · Journal of the American Association of Nurse Practitioners
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    • "The impact of successful treatment often goes beyond improvements in child sleep, extending to better overall child and family functioning. This paper provides an overview of conceptualisation, assessment, and treatment options, focusing on findings published since the 2006 American Academy of Sleep Medicine Review and Standards Practice Parameters papers [4] [5]. "
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    ABSTRACT: Night wakings and bedtime problems in infants and young children are prevalent, persistent, and associated with a variety of impairments in youth and their families. Assessment strategies include clinical interview, sleep diaries, actigraphy, and subjective measures. A number of treatment approaches with varying degrees of empirical support are available, and several novel strategies have been evaluated in recent years. Appropriate sleep scheduling and a bedtime routine are important components of any treatment program.
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