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Published on: January 26, 2019
Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial
Anna M H Price1, Melissa Wake, Obioha C Ukoumunne
1Centre for Community Child Health, The Royal Children's Hospital, Flemington Rd, Parkville VIC 3052, Australia. anna.price@mcri.edu.au
Insights
Behavioral infant sleep interventions show no long-term negative effects on child mental health or development. Parents can confidently use these techniques to address infant sleep problems without lasting harm.
Area of Science:
- Child Psychology
- Developmental Pediatrics
- Behavioral Science
Background:
- Behavioral infant sleep interventions are effective short-term but raise concerns about long-term child emotional development.
- Previous studies demonstrated short- to medium-term benefits of these sleep programs.
Purpose of the Study:
- To assess the long-term (6-year) harms and benefits of infant behavioral sleep programs.
- To evaluate effects on child mental health, psychosocial functioning, and stress regulation.
- To examine child-parent relationship dynamics and maternal mental health outcomes.
Main Methods:
- A 5-year follow-up of a population-based cluster-randomized trial involving 326 infants.
- Intervention group received 1-3 nurse consultations for behavioral sleep techniques; control group received usual care.
- Outcomes included child mental health, sleep, psychosocial functioning, stress regulation, child-parent relationship, and maternal mental health.
Main Results:
- No significant differences were found between intervention and control groups at age 6 years.
- Child outcomes (emotional, conduct, sleep, psychosocial functioning, stress) showed no group differences.
- Child-parent relationship (closeness, conflict, attachment) and maternal mental health (depression, anxiety, parenting style) were also similar between groups.
Conclusions:
- Behavioral infant sleep techniques do not have significant long-lasting negative or positive effects.
- These interventions can be confidently used to alleviate short- to medium-term infant sleep problems and maternal depression.
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.
