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.
- 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.
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