Infant sleep problems and interventions: A review

doi:10.1016/j.infbeh.2017.02.002

Infant Behavior and Development

Volume 47, May 2017, Pages 40-53

https://doi.org/10.1016/j.infbeh.2017.02.002 Get rights and content

Highlights

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This is a review on infant sleep research published during the last two years.
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Infant sleep issues lead to later developmental problems.
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Risk factors include feeding, close contact and arousing activities at bedtime.
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Maternal depression and infant temperament are mediating factors of infant sleep problems.
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Interventions include teaching on extinction and bedtime fading and massages by mothers.

Abstract

Infant sleep problems have been the focus of a growing literature over the last few years. The current review is based on literature searches of Pubmed and PsycInfo for studies published over the last few years including randomized controlled trials, systematic reviews and meta-analyses on infant sleep problems and resulting developmental effected, risk factors and interventions. Several risk/protective factors for sleep problems have been identified including health literacy, TV in the room, feeding, close contact and arousing activities at bedtime, intolerance for infant crying, co-sleeping, maternal depression and infant temperament. Cross-cultural differences have been noted both for infant sleep problems and parents’ perceived distress by those problems. A number of interventions have been tried to ameliorate infant sleep problems including consultations, teaching sessions on extinction and bedtime fading, internet-based interventions and nighttime massages by parents. Some of these studies have shown improvements and others have suggested only short-term or negligible effects. Significant methodological problems exist with this literature including the almost sole use of parent report as well as the mixed age samples and the potential confounding variables.

Section snippets

Effects on later development

Very few norms have been reported for normal/typical infant sleep and for atypical infant sleep or sleep problems. In a very extensive study on 841 children from birth to 3 years, Mindell and her colleagues very recently reported that sleep sessions during the first few months lasted approximately 3.5 h, and between 3 and 7 months nighttime sleep lasted about 10.5 h (Mindell, Leichman, Composto et al., 2016). Another research group noted that on average across infancy, nighttime sleep lasted

Risk and protective factors for infant sleep problems

Several risk and protective factors for infant sleep problems have been researched over the last few years including health literacy, television in the same room, bedtime feedings, close contact at bedtime, arousing activities at bedtime, emotional availability, bedtime routine, parent regulation, intervention delays, co-sleeping (bed-sharing), maternal depression and infant temperament (see Table 2 for a list of risk and protective factors for infant sleep problems). Although most of these

Interventions for infant sleep problems

Most of the recent intervention studies for infant sleep problems have involved educational/behavioral interventions including consultation on sleep physiology and strategies to improve infant sleep, group teaching along with support calls, graduated extinction and bedtime fading (see Table 3 for a list of interventions for infant sleep problems). Included here are randomized controlled trials, systematic reviews and a meta-analysis that are briefly reviewed along with an internet-based

Limitations and future directions

The limitations and directions suggested for future studies fall under the categories of sampling, variables, interventions and data analyses. With regard to sampling, one of the methodological problems of the reviewed studies is the grouping of several different age infants when it is known that normative data show significant changes not only between ages but also stability within individuals. And the normative data appear to differ by culture. For example, in one of the youngest samples

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Construction of the Views oN Infant Sleep (VNIS) Questionnaire
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Parents' beliefs about infant sleep behaviour vary over time and across cultures. No validated instrument exists to understand parents' pre- and postnatal views on infant sleep behaviours, which may influence their caregiving decisions. The Views oN Infant Sleep Questionnaire (VNIS) will be a tool to assess parents' beliefs in order to facilitate tailored perinatal care, increase the reliability of postnatal self-report measures, allow for cross-cultural comparisons, and provide a baseline for researchers to use in longitudinal studies. We recruited an online sample of 971 female participants who were resident in the United Kingdom, at least 28 weeks pregnant, and at least 18 years of age. The initial questionnaire consisted of 31 questions about infant independence, night-waking, infant feeding, touch, and safety, and items were rated on a 5-point Likert scale. The item pool was reduced to 12 using principal component analysis and a structure was found for the three components “Closeness”, “Independence”, and “Night-waking”. Overall, these results suggest that the VNIS can provide a brief scale to measure different aspects of individuals' beliefs about infant sleep. In further research the VNIS needs to be validated with a confirmatory factor analysis in another sample, and to be tested as a cross-cultural instrument.
Sleep characteristics, early spontaneous movements, and developmental functioning in preterm infants in the early postnatal period
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This study aimed to investigate the following: (i) sleep characteristics in preterm infants at 9–20 weeks of corrected age, and (ii) differences in early spontaneous movements and developmental functioning results between the groups based on some sleep characteristics.
Seventy-four preterm infants (36 female) were included. Sleep characteristics were assessed according to the Brief Infant Sleep Questionnaire (BISQ). The infants were divided into two groups based on total sleep duration: less than 12 h (38 infants), and 12 h and more (36 infants). Video recordings were made for the General Movements Assessment (GMA) and evaluated using the Motor Optimality Score for 3- to 5-Month-Old-Infants-Revised (MOS). Cognitive, language, and motor development were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III).
The total sleep duration of all preterm infants (mean ± SD) was 11.8 ± 3.3 h. Infants who had absent fidgety movements slept less than 12 h, and fidgety movements differed between the groups (p = 0.012). Infants who slept 12 h or more had significantly higher MOS (p = 0.041), cognitive (p = 0.002), language (p < 0.001), and motor (p = 0.002) development results. Infants who snored had lower MOS (p = 0.001), cognitive (p = 0.004), language (p = 0.002), and motor (p = 0.001) development results. Infants with fewer than three nocturnal awakenings had significantly higher Bayley-III cognitive (p = 0.007), language (p = 0.032), and motor (p = 0.005) domain results. Prone and supine sleeping positions showed higher motor domain results than lateral positions (p = 0.001).
Sleep in preterm infants might be a key factor in early developmental functioning processes and nervous system integrity. Even in the first months of life, there are substantial differences in cognitive, language, and motor development in association with sleep characteristics.
The Integration of the Maternal Care with Sleep During the Postpartum Period
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Effects of psychosocial sleep interventions on improving infant sleep and maternal sleep and mood: A systematic review and meta-analysis
2023, Sleep Health
Infant sleep problems are prevalent and have a negative impact on infant growth and development, maternal sleep, and maternal mood. The effects of psychosocial sleep interventions on infant sleep and maternal sleep and mood are unclear. This study aimed to systematically evaluate the effects of psychosocial sleep interventions on improving infant sleep, including nocturnal total sleep time, daytime total sleep, total sleep time, night wakings, and maternal sleep and mood problems (ie, depression and fatigue). We searched PubMed, Web of Science, Cochrane Library, Embase, EBSCO, OpenGrey, DeepBlue, China National Knowledge Infrastructure, and Wanfang databases. We focused on randomized controlled trials examining the effectiveness of psychosocial sleep interventions on infant sleep. The study was preregistered at the International Prospective Register of Systematic Reviews (CRD42022301654). Thirteen studies from 5889 articles were included in the review, which found that psychosocial sleep interventions improved infant nocturnal total sleep time (0.28 [0.04-0.52], p < 0.05, I² = 83.9%) and maternal depression (−0.10 [−0.28 to −0.08], p < 0.05, I² = 8.7%). To test and explore heterogeneity, we used the I² statistic, influence analysis, subgroup analyses, and subgroup meta-analyses. Funnel plots and Egger's tests revealed no evidence of publication bias. Psychosocial sleep interventions improved infant nocturnal total sleep time and maternal depression. Future research should include more randomized controlled trials examining the effect of psychosocial sleep interventions on the improvement of maternal sleep and fatigue.
Possible contribution of better maternal psychological well-being to the acquisition of sleeping through the night in infants during the early postpartum period
2023, Infant Behavior and Development
The objective of this study was to elucidate whether better maternal psychological well-being contributes to the acquisition of “sleeping through the night” (STN) in infants during the early postpartum period. Fifty-two primiparous mothers completed the General Health Questionnaire-28 (GHQ-28) in the third trimester (prenatal) and when the conceptional ages of their babies reached 8–9 weeks (hereafter, 2 months), 12–13 weeks (3 months), and 16–17 weeks (4 months). They also recorded babies’ nocturnal sleep patterns in a timetable for 5 consecutive days each month postpartum. “Regular STN” was defined when the mean of longest nocturnal sleep duration for 5 consecutive days was > 8 h or between 6 and 8 h with < 1.0 nocturnal awakenings. According to these criteria, a total of 14 infants (27 %) acquired regular STN at 4 months (referred to as “STN infants”), with STN infants showing a marked increase in longest nocturnal sleep duration and a decrease in nocturnal awakenings from 2 to 3 months of age. The mothers of STN infants demonstrated steady reductions in postnatal GHQ-28 scores and had significantly lower prenatal GHQ-28 scores compared with the mothers of non-STN infants (3.7 ± 3.0 vs. 6.4 ± 4.1, p = 0.027). In random forest models for binomial classification, both prenatal and postnatal (at 4 months) GHQ-28 scores were identified as significant covariates for distinguishing STN infants, and other important covariates, including weeks of delivery, stepfamily, birth weight of the infant, and maternal co-sleeping at bedtime, were selected. Among these covariates, maternal co-sleeping at bedtime had relatively stronger correlations with both STN infants (r = − 0.440) and prenatal maternal GHQ-28 scores (r = 0.377). In conclusion, because prenatal maternal psychological well-being was thought to predict the acquisition of STN in infants, infants born from mothers with better psychological well-being appear to have some advantages in acquiring STN. These cross-lagged correlations suggest that the pathway from mothers to infants may be mediated by certain parenting behaviors, such as maternal co-sleeping at bedtime.
Can cry tolerance be increased in mothers of infants with sleep problems, and why does it matter? A quasi-experimental study
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Infant sleep problems are one of the most common complaints of new parents. Research to date has demonstrated a relationship between low parental cry tolerance and infant sleep problems. The aim of this study was to explore whether three emotion regulation strategies could increase parental cry tolerance.
This study utilised a quasi-experimental design. We recruited 83 females (Mage= 32, SD= 5.26) comprising 3 groups: mothers of good sleeping infants aged 6–24 months, mothers of poor sleeping infants aged 6–24 months, and good sleeping women aged 23–40 years without children. Participants were instructed to listen to crying audio segments and indicate when they felt the child needed to be tended to (measured in seconds). This crying audio was paired with one of three emotion-regulation strategies (i.e., music, gaming, reappraisal). Each participant completed all 4 cry conditions which were counterbalanced to control for order effects.
We found that all three strategies yielded significantly longer reaction times (indicating higher cry tolerance) compared to the control condition (p <.001). We also found that mothers of poor sleepers and good sleeping women benefitted from all three emotion regulation strategies compared to control (p <.001 and p= <.05, respectively). The cry tolerance of mothers of good sleepers, on the other hand, did not differ between the control condition and any of the strategies (all ps >.05).
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View all citing articles on Scopus

View full text

Infant sleep problems and interventions: A review

Highlights

Abstract

Section snippets

Effects on later development

Risk and protective factors for infant sleep problems

Interventions for infant sleep problems

Limitations and future directions

Preventive Medicine Reports

Sleep Medecine Review

Academic Pediatrics

Early Human Development

Infant Behavior and Development

Infant Behavior and Development

Infant Behavior and Development

Sleep Medicine Reviews

Sleep Medicine Reviews

Infant Behavior and Development

Sleep Medicine

Infant Behavior and Development

Sleep Medicine Reviews

Academic Pediatrics

Infant Behavior and Development

Sleep Medicine

Sleep patterns among South Korean infants and toddlers: Global comparison

Journal of Korean Medical Science

Shortened nighttime sleep duration in early life and subsequent childhood obesity

Archives of Pediatrics and Adolescent Medicine

Pacifier use, finger sucking and infant sleep

Behavioral Sleep Medicine

Behavioral management of sleep problems in infants under 6 months—What works?

Journal of Developmental and Behavioral Pediatrics

Reactivity and sleep in infants: A longitudinal objective assessment

Monographs of the Society for Research in Child Development

Behavioral sleep interventions in the first six months of life do not improve outcomes for mothers or infants: A systematic review

Journal of Developmental and Behavioral Pediatrics

Massage therapy by mothers enhances the adjustment of circadian rhythms to the nocturnal period in full-term infants

Journal of Developmental and Behavioral Pediatrics

Sleep disturbances in depressed pregnant women and their newborns

Infant Behavior and Development

Moderate pressure is essential for massage therapy effects

International Journal of Neuroscience

Prenatal depression effects on the fetus and newborn

Infant Behavior and Development

Behavioral interventions for infant sleep problems: A randomized controlled trial

Pediatrics

Nighttime sleep durationand sleep behaviors among toddlers from low-income families: Associations with obesogenic behaviors and obesity and the role of parenting

Childhood Obesity

A randomized controlled trial of an intervention for infants’ behavioral sleep problems

BMC Pediatrics

A comparison of actigraphy and sleep diaries for infants sleep behavior

Front Psychiatry