Tools for Practice Outils pour la pratique


#196 Infant Sleep Training—Rest Easy?


CLINICAL QUESTION
QUESTION CLINIQUE
What is the evidence for infant sleep training?


BOTTOM LINE
RÉSULTAT FINAL
Sleep training improves infant sleep problems, with about 1 in 4 to 1 in 10 benefitting over no sleep training, with no adverse effects reported after five yearsMaternal mood scales also significantly improve, with patients having worse baseline depression scores benefitting most.   



CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session



EVIDENCE
DONNÉES PROBANTES
  • Sleep training, or “controlled crying,” is where parents respond to their infant’s cry at increasing time intervals to allow independent settling. 
  • Six week Randomized Controlled Trial (RCT) of 235 infants, mean age seven months, with 2 awakenings/night on ≥5 nights/week:1  
    • Sleep training versus safety educationStatistically significant reductions in: 
      • Parental report severe infant sleep problems: 4% versus 14%, Number Needed to Treat (NNT)=10. 
      • Number of infants with 2 diary-recorded awakenings per night: 31% versus 60%, NNT=4. 
      • And improved parent fatigue, sleep quality, and mood scales. 
  • Cluster RCT, 328 families reporting infant sleep problem, mean infant age seven monthsTailored sleep intervention including sleep training versus usual care.2   Intervention group: 
    • At 10 months: 
      • Significant reduction in maternal report of infant sleep problems: 56% versus 68%, NNT=9. 
      • Non-significant reduction in mothers with depression (Edinburgh Postnatal Depression Scale >9): 28% versus 35%.  
        • Those with baseline score >9 had significant numerical improvement in depression scale (subgroup analysis). 
    • At two years:  
      • Reduced reporting depression symptoms:3 15% versus 26%, NNT=9 
    • At five years: No difference in any of 20 outcomes including:4 
      • Child behaviour, relationships, and maternal mental health.  
  • Recent smaller studies5,6 and systematic reviews7,8 support sleep training interventions for sleep and improved parent depressive symptoms.7  
Context: 
  • Infants sleep problems are associated with parental depression,9,10 psychological distress,11 and poor general health.11 
  • Increased infant sleep is associated with easy temperament, adaptability, and low distractibility.12 
  • Complete extinction (allowing baby to “cry it out”) has been demonstrated to be similarly effective, although parents tend to find this method more stressful.7 
  • Sleep training is simple and can be introduced at six months. Examples include leaving the room and not returning for 2-5 minutes before responding to crying, then lengthening that interval.


Latest Tools for Practice
Derniers outils pour la pratique

#359 Topical corticosteroids for atopic dermatitis - More than skin deep

What are the benefits/harms of topical corticosteroids for atopic dermatitis in adults/children?
Read Lire 0.25 credits available Crédits disponibles

#358: Any berry good solutions to preventing UTIs: Cranberries?

Do cranberry products prevent recurrent urinary tract infections (UTIs)?
Read Lire 0.25 credits available Crédits disponibles

#357: Overcoming Resistance: Antipsychotics for difficult to treat depression

In patients with treatment-resistant depression, is adding an atypical antipsychotic to current therapy safe and effective?
Read Lire 0.25 credits available Crédits disponibles

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session


Author(s)
Auteur(s)
  • Christina Korownyk MD CCFP
  • Adrienne J Lindblad BSP ACPR PharmD

1. Hall WA, Hutton E, Brant RF, et al. BMC Pediatr. 2015 Nov 13; 15:181.

2. Hiscock H, Bayer J, Gold L, et al. Arch Dis Child. 2007 Nov; 92(11):952-8.

3. Hiscock H, Bayer JK, Hampton A, et al. Pediatrics. 2008; 122(3):e621-7.

4. Price AMH, Wake M, Obioha C, et al. Pediatrics. 2012; 130:643-51.

5. Gradisar M, Jackson K, Spurrier NJ, et al. Pediatrics. 2016 Jun; 137(6). pii: e20151486.

6. Symon BG, Marley JE, Martin AJ, et al. Med J Aust. 2005; 182:215-8.

7. Mindell JA, Kuhn B, Lewin DS, et al. Sleep. 2006; 29(10):1263-76.

8. Ramchandani P, Wiggs L, Webb V, et al. BMJ. 2000; 320(7229):209-13.

9. Hiscock H, Wake M. Pediatrics. 2001; 107:1317-22.

10. Cook F, Giallo R, Petrovic Z, et al. J Paediatr Child Health. 2017 Feb; 53(2):131-5.

11. Martin J, Hiscock H, Hardy P, et al. Pediatrics. 2007; 119:947-55.

12. Spruyt K, Aitken RJ, So K, et al. Early Hum Dev. 2007; 84:289-96.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.