Infant Sleep Training Methods Compared

The longstanding debate over sleep training methods, in particular those that include some aspect of  “crying it out,” picked up a new chapter recently after a new study was published in the journal Pediatrics.  What was more unique about this study was its head to head comparison of two methods, one using graduated extinction (the technical term for parents delaying their giving comfort to infants for designated periods of time) to what might be described as a more gentle method that does not involve extinction.  These alternative methods have increasingly cropped up due to lingering concerns that extinction-based methods might be experienced as traumatic and disrupt

photo from freedigitalphotos.net

photo from freedigitalphotos.net

parent-child despite there being no direct evidence of this.

In this Australian study,  a total of 43 infants around 10 months of age, all of whom were experiencing sleep problems, were recruited and randomized to one of three groups. One was taught a graduated extinction approach in which parents returned to the crib at progressively longer intervals over the course of a week. Another group used an approach called “bedtime fading” in which the infant’s bedtime was moved forward or backwards until the child sleep latency time was consistently less than 15 minutes. After that, parents were told to do what they normally do for nighttime awakenings. There was also a control group that received sleep educational materials. Sleep was assessed using both questionnaires and more objectively using ankle monitors, and saliva cortisol levels were also ascertained at follow-up as a measure of physiological stress. Attachment status was also assessed with the Strange Situation procedure.

At 3 month follow-up, significant improvements were found for both treatment conditions relative to controls with regard to length of sleep latency time and time to waking after sleep onset. The graduated extinction technique showed improvements relative both to the control and bedtime fading condition for reducing the number of nighttime awakenings, while total sleep time increased for the graduated extinction and control conditions. In terms of markers of stress, afternoon infant cortisol levels and levels of maternal stress were found to decrease for the two behavioral treatment groups relative to controls.  When the sample was assessed again at 12 month follow-up, no group differences were found related to attachment or levels of behavioral problems.

The authors concluded that their data support the effectiveness of brief behavioral sleep interventions without causing long-term stress or behavioral problems.

Will this study end the debate on sleep training?  For sure it will not, but the study does add some additional evidence that such techniques can work and do not represent traumatic experiences for children that result in harm.  At the same time, what might be more novel to some parents and primary care physicians alike is the realization that there are other evidence-based methods out there that have been shown to be effective and may be more palatable to parents than techniques that involve some aspect of crying it out.

Reference

GradisarM, et al.  Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial.  Pediatrics 2016; 137(6): epub ahead of print

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