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#196 Infant Sleep Training—Rest Easy?


CLINICAL QUESTION
What is the evidence for infant sleep training?

BOTTOM LINE
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 years. Maternal mood scales also significantly improve, with patients having worse baseline depression scores benefitting most.   


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EVIDENCE
  • 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 education. Statistically 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 months. Tailored 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.

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Author(s):

  • Adrienne J Lindblad BSP ACPR PharmD
  • Christina Korownyk MD CCFP

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.