Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial

Pediatrics. 2012 Oct;130(4):643-51. doi: 10.1542/peds.2011-3467. Epub 2012 Sep 10.

Abstract

Background and objectives: Randomized trials have demonstrated the short- to medium-term effectiveness of behavioral infant sleep interventions. However, concerns persist that they may harm children's emotional development and subsequent mental health. This study aimed to determine long-term harms and/or benefits of an infant behavioral sleep program at age 6 years on (1) child, (2) child-parent, and (3) maternal outcomes.

Methods: Three hundred twenty-six children (173 intervention) with parent-reported sleep problems at age 7 months were selected from a population sample of 692 infants recruited from well-child centers. The study was a 5-year follow-up of a population-based cluster-randomized trial. Allocation was concealed and researchers (but not parents) were blinded to group allocation. Behavioral techniques were delivered over 1 to 3 individual nurse consultations at infant age 8 to 10 months, versus usual care. The main outcomes measured were (1) child mental health, sleep, psychosocial functioning, stress regulation; (2) child-parent relationship; and (3) maternal mental health and parenting styles.

Results: Two hundred twenty-five families (69%) participated. There was no evidence of differences between intervention and control families for any outcome, including (1) children's emotional (P = .8) and conduct behavior scores (P = .6), sleep problems (9% vs 7%, P = .2), sleep habits score (P = .4), parent- (P = .7) and child-reported (P = .8) psychosocial functioning, chronic stress (29% vs 22%, P = .4); (2) child-parent closeness (P = .1) and conflict (P = .4), global relationship (P = .9), disinhibited attachment (P = .3); and (3) parent depression, anxiety, and stress scores (P = .9) or authoritative parenting (63% vs 59%, P = .5).

Conclusions: Behavioral sleep techniques have no marked long-lasting effects (positive or negative). Parents and health professionals can confidently use these techniques to reduce the short- to medium-term burden of infant sleep problems and maternal depression.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Behavior Therapy / methods*
  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant Care / methods*
  • Infant Care / psychology
  • Linear Models
  • Logistic Models
  • Male
  • Mental Health
  • Mothers / psychology
  • Parent-Child Relations
  • Parenting / psychology
  • Psychology, Child
  • Single-Blind Method
  • Sleep Wake Disorders / psychology
  • Sleep Wake Disorders / therapy*
  • Stress, Psychological
  • Surveys and Questionnaires
  • Treatment Outcome

Associated data

  • ISRCTN/ISRCTN48752250