The informed choice model of care: Offering caregivers choices for infant behavioural sleep intervention

Sleep in infants aged 6-18 months can be disrupted and may cause impairment in some families. Caregivers often seek assistance to improve their infant's sleep through behavioural sleep interventions (BSI). BSI approaches can vary considerably ranging from leaving a child to cry alone to reactive co-sleeping. The majority of available literature on BSI focusses on less responsive approaches (such as controlled crying or cry-it-out) and so understandably these are the most commonly recommended and prescribed by health professionals. However, these may not be the preferred option for some caregivers. Many factors influence caregiver choice of a preferred intervention for their infant, including their beliefs about controlled crying, caregiver cry-tolerance, infant age and temperament, and cultural norms. Yet many caregivers seeking help from healthcare providers for infant sleep report being presented with only one or two BSI options, denying them the opportunity to make an informed decision about a preferred choice. We propose here the notion of an Informed Choice Model of Care (ICMoC) in which those caregivers who are seeking help for perceived sleep problems in their infants, are informed about a broad range of BSIs and select an approach that best fits their needs and preferences in collaboration with their child's healthcare provider. We suggest that the use of the ICMoC may increase caregiver agency and empowerment, facilitate successful completion of BSI protocols, and thus reduce the negative impacts of poor sleep for infants and their families.