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Lecuelle F, Leslie W, Gustin MP, Franco P, Putois B. Treatment for behavioral insomnia in young children with neurotypical development under 6 years of age: A systematic review. Sleep Med Rev 2024; 74:101909. [PMID: 38394890 DOI: 10.1016/j.smrv.2024.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
This literature review examines all treatments for behavioral insomnia in children under 6 years of age to determine which treatments have empirically demonstrated efficacy. Following PRISMA guidelines, three databases were investigated (Pubmed, Cochrane and Psychinfo) to select randomized controlled trials (RCTs) which assess treatments for behavioral insomnia in children under 6 years of age, all with neurotypical development. A total of 908 articles met the search criteria. 21 articles were selected and analyzed in their entirety for a total of 2363 children (ranging from 2 months to 6 years of age). Based on these studies, treatment of behavioral insomnia in young children under 6 years of age is primarily based on behavioral therapy. There is no evidence that pharmacological treatments are effective in the long term for neurotypical children. This review highlights the lack of RCTs in this field: new RCTs should be carried out among young children to refine and optimize the therapeutic approach and to address the risk of therapeutic abuse through the use of non-scientifically validated methods.
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Affiliation(s)
- Florian Lecuelle
- Pediatric Sleep Unit, Hospital for Women Mothers & Children, Lyon 1 University, France; Swiss Distance Learning University, Faculty of Psychology, Brig, Switzerland; Research Laboratory on the Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, Lyon, France.
| | | | - Marie-Paule Gustin
- Institute of Pharmaceutic and Biological Sciences, University Claude Bernard Lyon 1, Villeurbanne, France; Emerging Pathogens Laboratory-Fondation Merieux, International Center for Infectiology Research (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, Lyon, France
| | - Patricia Franco
- Pediatric Sleep Unit, Hospital for Women Mothers & Children, Lyon 1 University, France; Research Laboratory on the Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, Lyon, France
| | - Benjamin Putois
- Swiss Distance Learning University, Faculty of Psychology, Brig, Switzerland; Research Laboratory on the Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, Lyon, France
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Tran T, Stanzel K, Nguyen H, Thean P, French D, Popplestone S, Fisher J. Effects of a residential psychoeducational parenting program on maternal anxiety and fatigue symptoms. J Reprod Infant Psychol 2024:1-17. [PMID: 38198123 DOI: 10.1080/02646838.2024.2303468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024]
Abstract
AIMS To evaluate the effects of a 5-day residential psychoeducational program on maternal anxiety and fatigue symptoms among women admitted with their unsettled infants and determine the psychological, social and demographic characteristics which are associated with the effect sizes. METHODS This is a secondary analysis of routinely collected data from mothers with children aged up to 24 months who were admitted to and completed the residential early parenting psychoeducational program at Masada Private Hospital Early Parenting Centre in Melbourne. Maternal anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale Three-item Anxiety subscale and maternal fatigue symptoms were the Modified Fatigue Assessment Scale at preadmission, predischarge and follow-up 6-weeks post discharge. RESULTS Overall, 1220 admissions were included in analyses. Cohen's d for reductions in the anxiety symptoms during the program was 0.64 (95% CI 0.59 to 0.70) and from pre-discharge to post-discharge was 0.14 (95% CI 0.09 to 01.9), and for fatigue was 1.21 (95% CI 1.11 to 1.32). Higher borderline personality disorder symptoms and experiencing more stressful life events were associated with lower mean reductions in anxiety and fatigue symptoms. Women with a history of mental health problems had lower anxiety symptom reductions. Women who were older or had younger babies had lower fatigue score reductions. CONCLUSION This study confirms the effectiveness of a 5-day residential early parenting psychoeducational program provided by a private sector facility in reducing postnatal anxiety and fatigue rapidly, with effects maintained to at least 6-weeks post-discharge.
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Affiliation(s)
- Thach Tran
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karin Stanzel
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hau Nguyen
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Patsy Thean
- Early Parenting Centre, Ramsay Health Care - Masada Private Hospital, Melbourne, Australia
| | | | - Sally Popplestone
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane Fisher
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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D'Souza L, Cassels T. Contextual considerations in infant sleep: Offering alternative interventions to families. Sleep Health 2023; 9:618-625. [PMID: 35768320 DOI: 10.1016/j.sleh.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 05/03/2022] [Accepted: 05/19/2022] [Indexed: 10/17/2022]
Abstract
Infant sleep problems are one of the commonly reported reasons parents seek professional help, yet what constitutes a "sleep problem" depends on the models used to explain the development of infant sleep. The current models are based on research conducted in the western context where infant solitary sleeping is the norm. Parent-child co-sleeping is the norm in many cultures around the world. We argue that the primary focus of current research on parent-child interactions as the mediating context for the development of infant sleep problems has inherently made these models and ensuing interventions less sensitive and applicable to infant sleep problems in the context of co-sleeping families. When families present for help with infant sleep difficulties, extinction based behavioral interventions or interventions focused on reducing parental presence at bedtime are commonly recommended. These recommendations may not always align with cultural values and parenting practices of all families, therefore precluding these families from getting necessary help. In attempting to provide families with choices that depart from behavioral based interventions, this paper draws on research and adapts current models to propose an alternative to conceptualize perceptions of infant sleep problems that may be sensitive to and applied across various cultural and personal contexts. We attempt to provide a rationale for interventions that are inclusive and sensitive to families where reduced parental nighttime responsiveness may not be a preferred choice.
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Affiliation(s)
- Levita D'Souza
- Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, Victoria, 3800, Australia.
| | - Tracy Cassels
- Evolutionary Parenting, 116 County Rd, 16 Milford, ON, K0K 2P0, Canada
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Landsem IP, Cheetham NB. Infant sleep as a topic in healthcare guidance of parents, prenatally and the first 6 months after birth: a scoping review. BMC Health Serv Res 2022; 22:1135. [PMID: 36076290 PMCID: PMC9454198 DOI: 10.1186/s12913-022-08484-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 08/23/2022] [Indexed: 11/26/2022] Open
Abstract
Background This scoping review focuses on infant sleep-related factors and themes that are relevant when health practitioners provide preventive health services to expectant and new parents. Methods A systematic literature search in CINAHL, PubMed, and PsycINFO, published in 2010 or later, identified 1661 records. The search was further narrowed to focus on sleep in healthy term-born infants until the second half of the first year of life. A blinded review by both authors covered 136 papers, of which 43 papers were reviewed in the full text. Finally, 38 articles were included in the data extraction. Results The analysis process showed that the selected studies formed three main information categories: 11 studies thematised safe infant sleep issues, 10 studies described design and findings from sleep-related intervention studies, and 17 studies focused on different parent-child interactive aspects that may influence the quality and duration of infant sleep in the first six months of life. The main finding is that knowledge about early infant sleep is very complex, and includes both child, parent, and environmental factors. Several studies have shown that the concepts and factors related to safe infant sleep also influence the development of healthy infant sleep patterns. Thus, these aspects are interwoven with each other and should be addressed together in communication with parents. Conclusions Health practitioners with different professional backgrounds need to search for an agreement on when and how different aspects of sleep-related knowledge should be communicated to new and expectant parents to enable the design of national follow-up programs. Parents want coherent and personalized services regarding infant sleep issues that may allow them to choose sleeping arrangements, routines, and behaviors that fit in with their sociocultural attitudes and traditions. Many different sources and formats may be used to empower parents regarding infant sleep issues. Studies have described the use of group or individual meetings, videos, and written materials. The key issue is the importance of consistent and seamless knowledge-based services.
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Affiliation(s)
- Inger Pauline Landsem
- The Arctic University of Norway, The Health Research Faculty, Institute of Health and Caring Science, Hansine Hansens veg 18, 9019, Tromsø, Norway. .,Child and Adolescent Department, University Hospital of North Norway, Sykehusvegen 38, 9019, Tromsø, Norway.
| | - Nina Bøhle Cheetham
- The Arctic University of Norway, The Health Research Faculty, Institute of Health and Caring Science, Hansine Hansens veg 18, 9019, Tromsø, Norway
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Blunden S, Osborne J, King Y. Do responsive sleep interventions impact mental health in mother/infant dyads compared to extinction interventions? A pilot study. Arch Womens Ment Health 2022; 25:621-631. [PMID: 35380237 PMCID: PMC9072263 DOI: 10.1007/s00737-022-01224-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Sarah Blunden
- Appleton Institute, Central Queensland University, 44 Greenhill Rd, South Australia, Wayville, 5034, Australia.
| | - Joanne Osborne
- Appleton Institute, Central Queensland University, 44 Greenhill Rd, South Australia Wayville, 5034 Australia
| | - Yaroslava King
- Appleton Institute, Central Queensland University, 44 Greenhill Rd, South Australia Wayville, 5034 Australia
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Sweeney BM, Signal TL, Babbage DR. Effect of a behavioral-educational sleep intervention for first-time mothers and their infants: pilot of a controlled trial. J Clin Sleep Med 2021; 16:1265-1274. [PMID: 32807294 DOI: 10.5664/jcsm.8484] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This study tested the acceptability and efficacy of a perinatally delivered behavioral-educational sleep intervention. METHODS Participants were 40 primiparous women assigned in late pregnancy to either an intervention (n = 20) or control (n = 20) group. The sleep intervention group (SIG) received prenatal anticipatory education and guidance regarding their own and their infant's sleep during the first 3 months postpartum. This was reinforced during phone calls within the first 6 weeks postpartum. The control group (CG) received brief sleep hygiene information at a prenatal session, followed by 2 phone calls during the same period. Mother-infant pairs wore actigraphs for 48 hours at 6 and 12 weeks postpartum, and mothers kept sleep diaries. Questionnaires completed in late pregnancy and 6 and 12 weeks postpartum related to sleep, newborn care, and mood. The main outcome measures included maternal sleep quantity, efficiency, and self-reported quality and infant sleep duration and consolidation. RESULTS Mothers reported high acceptability of the study processes. Sleep duration and quality increased for mothers and infants across time in both groups, with a significantly greater increase in nocturnal sleep duration for mothers in the SIG. CONCLUSIONS Prenatal sleep guidance and postnatal follow-up seems to enhance nocturnal sleep of mothers, change their perceptions of their own sleep, and increase confidence in managing their infant's sleep. Follow-up at later intervals and replication with larger, more diverse samples may reveal further differences.
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Affiliation(s)
- Bronwyn M Sweeney
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - T Leigh Signal
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Duncan R Babbage
- Centre for Person Centered Research, Auckland University of Technology, Auckland, New Zealand.,Centre for eHealth, Auckland University of Technology, Auckland, New Zealand
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Öztürk M, Boran P, Ersu R, Peker Y. Possums-based parental education for infant sleep: cued care resulting in sustained breastfeeding. Eur J Pediatr 2021; 180:1769-1776. [PMID: 33507387 DOI: 10.1007/s00431-021-03942-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/01/2021] [Accepted: 01/11/2021] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Merve Öztürk
- Division of Social Pediatrics, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey
| | - Perran Boran
- Division of Social Pediatrics, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey.
| | - Refika Ersu
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkey.,Division of Pediatric Pulmonology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Yüksel Peker
- Department of Pulmonary Medicine, School of Medicine, Koc University, Istanbul, Turkey.,Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
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Blunden S, Dawson D. Behavioural sleep interventions in infants: Plan B - Combining models of responsiveness to increase parental choice. J Paediatr Child Health 2020; 56:675-679. [PMID: 32073200 DOI: 10.1111/jpc.14818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/20/2020] [Accepted: 02/02/2020] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Sarah Blunden
- Appleton Institute of Behavioural Science, Central Queensland University, Adelaide, South Australia, Australia
| | - Drew Dawson
- Appleton Institute of Behavioural Science, Central Queensland University, Adelaide, South Australia, Australia
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Ball HL, Douglas PS, Kulasinghe K, Whittingham K, Hill P. The Possums Infant Sleep Program: parents' perspectives on a novel parent-infant sleep intervention in Australia. Sleep Health 2018; 4:519-526. [PMID: 30442320 DOI: 10.1016/j.sleh.2018.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/06/2018] [Accepted: 08/16/2018] [Indexed: 01/06/2023]
Abstract
AIM To evaluate parental perspectives on the acceptability and usefulness of a 'cued-care' approach to infant sleep implemented in an Australian primary care setting. The Possums Infant Sleep Program aims to empower parents to better understand their infant's sleep and their responses to it, and optimize healthy function of the infant's biological sleep regulators to protect against excessive night-waking. METHODS The evaluation was undertaken by an independent infant sleep researcher, with no previous involvement in the Possums program. Parents' experiences of the sleep intervention were captured using a mixed methods approach involving (a) group discussions of sleep issues between parents and clinic staff, (b) discussions with parents who volunteered to provide face-to-face feedback, and (c) an online survey designed in light of the information gained from a and b. A one-year audit of clinic registrations provided contextual data. RESULTS Sixty-four clinic clients fully (45) or partially (19) provided answers to survey questions. Respondents were primarily mothers, mean age 34, with a postgraduate qualification and high family income. Their term infants were predominantly breastfed and attended the clinic for feeding and/or sleeping difficulties across the first year of life. Almost all embraced the Possums approach, describing it as challenging and life changing. Audit data confirmed the survey sample reflected the general clinic population. CONCLUSIONS The Possums Infant Sleep Program was acceptable to parents, and highly valued. Recipients reported reduced stress, less concern about perceived sleep problems (frequent night-waking, short-day-time naps, delayed sleep onset), and better quality of life.
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Affiliation(s)
- Helen L Ball
- Durham University, Infancy & Sleep Centre, Department of Anthropology, Dawson Building, Lower Mountjoy, Durham DH1 3LE, United Kingdom.
| | - Pamela S Douglas
- Possums Education, PO Box 5139 West End, Queensland 4101, Australia; Discipline of General Practice, The University of Queensland, Brisbane, Australia; Maternity, Newborn and Families Research Collaborative, MHIQ, Griffith University, Brisbane, Australia
| | | | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), UQ Child Health Research Centre, The University of Queensland, Centre for Children's Health Research, Brisbane, Australia
| | - Peter Hill
- School of Public Health, The University of Queensland, Brisbane, Australia
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Bindt C. Exzessives Säuglingsschreien, persistierende Unruhe und Bindungsentwicklung: Plädoyer für einen erweiterten Blick. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Supporting lower-income working women to initiate breastfeeding: Learning who is breastfeeding and what helps. J Am Assoc Nurse Pract 2018; 30:519-528. [DOI: 10.1097/jxx.0000000000000077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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