Effect of a consultation teaching behaviour modification on sleep performance in infants: a randomised controlled trial

Brian G Symon, John E Marley, A James Martin and Emily R Norman
Med J Aust 2005; 182 (5): 215-218.


Objective: To evaluate the effect of a behaviour modification program, taught to parents in a single visit to a trained nurse, in improving sleep performance in newborn infants.

Design: Randomised controlled trial.

Setting and participants: 268 families with normal newborn infants in the community, recruited between October 1996 and March 1997 from birth notices published in a South Australian daily newspaper.

Intervention: A 45-minute consultation with a nurse 2–3 weeks after the birth, including a tutorial discussion on normal sleep patterns in newborn infants, supported by retained written material and, for infants with weight gain < 30 g daily, referral to their usual postnatal care provider.

Main outcome measures: Hours of daytime sleep (0600–1800), night sleep (1800–0600) and total sleep per 24 h; and number of daily records with total sleep ≥ 15 h per 24 h, assessed by 7-day sleep diary at ages 6 and 12 weeks.

Results: 268 families returned at least one sleep diary (137/171 intervention, 131/175 control), recording 3273 days. Two intervention infants were referred for low weight gain. Total sleep time was 15 h or more per 24 h on 62% of recorded days in the intervention group, compared with 36% in the control group (P < 0.001). At 6 weeks of age, intervention infants slept a mean 1.3 h per day more than control infants (95% CI, 0.95–1.65), comprising a mean 0.5 h more night sleep (95% CI, 0.32–0.69) and 0.8 h more daytime sleep (95% CI, 0.56–1.07). At 12 weeks, intervention infants slept a mean 1.2 h per day more (95% CI, 0.94–2.14), comprising 0.64 h more night sleep (95% CI, 0.19–0.89) and 0.58 h more daytime sleep (95% CI, 0.39–1.03). There was no significant difference in crying time between the groups.

Conclusions: A single consultation supported by written material in the first 3 weeks of a child’s life improves sleep performance at 6 weeks of age. This improvement is maintained at 3 months.

Please login with your free MJA account to view this article in full

  • Brian G Symon1
  • John E Marley2
  • A James Martin3
  • Emily R Norman4

  • 1 Adelaide, SA.
  • 2 The University of Newcastle, Newcastle, NSW.
  • 3 Adelaide Women's and Children's Hospital, Adelaide, SA



This research was supported by a grant from the Adelaide Women’s and Children’s Hospital Research Foundation. The follow-up study was supported by a Primary Health Care Research, Evaluation and Development Research Bursary from the Department of General Practice, Adelaide University. The authors wish to thank Louise Taylor, Fiona Martin, Heather McElroy, Dr Phil Ryan, Ben Symon, Nicole Pratt and Emmae Ramsay (University of Adelaide, SA).

Competing interests:

Dr Brian Symon is the author of the books Your baby, which was given to parents in the intervention group, and Silent nights, which discusses sleep in a manner similar to that presented in the intervention.

  • 1. Ferber R. Sleep, sleeplessness, and sleep disruptions in infants and young children. Ann Clin Res 1985; 17: 227-234.
  • 2. Armstrong KL, Quinn RA, Dadds MR. The sleep patterns of normal children. Med J Aust 1994; 161: 202-206.
  • 3. Kerr SM, Jowett SA. Sleep problems in pre-school children: a review of the literature. Child Care Health Dev 1994; 20: 379-391.
  • 4. Ramchandani P, Wiggs L, Webb V, Stores G. A systematic review of treatments for settling problems and night waking in young children. BMJ 2000; 320: 209-213.
  • 5. Hiscock H, Wake M. Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. BMJ 2002; 324: 1062.
  • 6. Boyce P, Stubbs J. The importance of postnatal depression. Med J Aust 1994; 161: 471-472.
  • 7. Zuckerman B, Stevenson J, Bailey V. Sleep problems in early childhood: continuities, predictive factors, and behavioural correlates. Pediatrics 1987; 80: 664-671.
  • 8. Ferber R. Solve your child’s sleep problems. New York: Simon & Schuster; 1985.
  • 9. Richman W. A community survey of characteristics of 1–2 year olds with sleep disruptions. Am Acad Child Psychiatry 1981; 20: 281-291.
  • 10. Johnson MC. Infant and toddler sleep. A telephone survey of parents in one community. Dev Behav Pediatrics 1991; 12: 108-114.
  • 11. St James-Roberts I, Sleep J, Morris S, et al. Use of a behavioural programme in the first 3 months to prevent infant crying and sleeping problems. J Paediatr Child Health 2001; 37: 289-297.
  • 12. Wolfson A, Lacks P, Futterman A. Effects of parent training on infant sleeping patterns, parents’ stress, and perceived parental competence. J Consult Clin Psychol 1992; 60: 41-48.
  • 13. Rickert VI, Johnson CM. Reducing nocturnal awakenings and crying episodes in infants and young children. A comparison between scheduled awakenings and systematic ignoring. Pediatrics 1988; 81: 203-211.
  • 14. Pocock S. Clinical trials — a practical approach. Bath: Pittman Press, 1983.
  • 15. Symon B. Your baby. Adelaide: University of Adelaide, 1997.
  • 16. Centers for Disease Control and Prevention. Epi Info, version 6.04a [computer program]. Atlanta, Ga: Centers for Disease Control and Prevention, 1996.
  • 17. Liang KY, Zeger SL. Longitudinal data analysis using generalised linear models. Biometrica 1986; 73: 13-22.
  • 18. SAS Institute. The gennod procedure, SAS-STAT software, changes and enhancements through release 6.12. Cary, NC: SAS Institute, 1997.
  • 19. Australian Bureau of Statistics. Information paper: 1991 census — socio-economic indexes for areas. Canberra: ABS, 1993.
  • 20. Kerr SM, Jowett SA, Smith LN. Preventing sleep problems in infants: a randomised controlled trial. J Advanced Nursing 1996; 24: 928-942.
  • 21. Barr R, Kramer M, Boisjoly C, et al. Parental diary of infant cry and fuss behaviour. Arch Dis Child 1988; 63:380-387.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.