Sleepeducation.com Research Summary
Associated Professional Sleep Societies
Sleep | 10/01/2006
Study Title
Practice Parameters for Behavioral Treatment of Bedtime Problems and Night Waking's in Infants and Young Children
Publication
The October 1, 2006, issue of the journal Sleep
Goal
To review the current scientific research and give doctors recommendations that should meet the needs of most patients
Importance
Bedtime problems and night waking's are common in young children. They occur in about 20 percent to 30 percent of infants, toddlers and preschool kids. Bedtime problems include:
- Stalling
- Verbal protests
- Crying
- Clinging
- Refusing to go to bed
- Getting out of bed
- Attention-getting behaviors.
- Asking for food, drinks or stories
Night waking's are one of the most common sleep problems in infants and toddlers. Twenty-five percent to 50 percent of children over six months of age continue to awaken during the night.
Sleep problems that first appear in infancy may persist as the child grows older. Sleep problems can affect a child's learning, mood, attention, behavior and health. A child's sleep problems also can cause stress for the parent.
Results
Ninety-four percent of the studies (49 of 52) support the use of behavioral treatments for bedtime problems and night waking's. These treatments produce positive and lasting changes.
About 82 percent of children benefit from treatment. The majority of these children maintain the positive results for three to six months.
Behavioral treatment has positive effects on how the child acts during the day. The well-being of the parent also improves.
The research supports using these methods for infants and children up to the age of four years and 11 months:
Unmodified extinction and extinction of undesired behavior with parental presence
Twenty-one of 23 studies concluded that this method is effective. The parent puts the child to bed at a regular bedtime. The parent then ignores the child's protests and crying until morning. Extinction with parental presence allows the parent to remain in the child's room during the process.
Graduated extinction of undesired behavior
Parents ignore bedtime crying for a set period of time. The parent then returns to the room and briefly checks on the child. The parent leaves the room and repeats the process.
Delayed bedtime with removal from bed
The parent delays the child€™s bedtime until the time when the child normally falls asleep. The parent gradually moves the bedtime earlier as the child gets used to falling asleep quickly. The parent also removes the child from bed for a set period of time if the child is unable to fall asleep.
Scheduled awakenings
The parent keeps track of when the child normally wakes up during the night. Then the parent begins to wake the child prior to those times. The parent provides the usual response, such as feeding or rocking. Then the parent returns the child to bed. Over time the parent gradually stops the scheduled awakenings.
Parent education and prevention
The parent learns how to help his or her child develop positive sleep habits. This method includes information on bedtime routines and sleep schedules. It may occur by meeting with a therapist, by attending group sessions or by reading education booklets.
Positive bedtime routines
The parent develops a regular routine to get the child ready for bed each night. This routine involves quiet activities that please and soothe the child. This method usually is combined with another treatment. Studies have not yet shown if it is effective when it is the only treatment involved.
What it Means to You
You can take steps to improve the sleep of a child who has bedtime problems or night waking's. You should discuss your child's sleep problems with your child's doctor. He or she can help you decide which treatment method will work best for your child.
Participants
The study group consisted of more than 2,500 children up to four years and 11 months of age. They had no known medical or mental problem that would explain their sleep problems.
Study Design
A task force of experts reviewed scientific studies that were published between 1970 and 2005. A total of 52 studies were included in the review.
Study Methods
Each study was evaluated to determine the quality of its evidence.
Limits of the Study
- There is currently not enough evidence to recommend the use of one treatment over another. Few studies have conducted head-to-head comparisons.
- Most of the studies that were reviewed had a follow-up period of six months or less. They do not show if these treatments are effective for longer periods of time.
- Most behavioral studies of children rely heavily on parental reports of the problem.
- There is little research that compares behavioral methods with drug therapy in treating bedtime problems and night waking's in children.
Lead Author
Timothy I. Morgenthaler, MD, of the Mayo Clinic in Rochester, Minnesota
Conflicts of Interest
This was not an industry-supported study.
View the study abstract online.
