Infant sleep problems and emotional health: a review of two behavioural approaches

Abstract

Background: Infant sleep problems (ISP) are among the most common reasons for which parents seek advice from health professionals. A substantial literature supports the efficacy and effectiveness of behavioural approaches, based on the principal of extinction, in treating ISP. Questions have been raised, however, about the potential negative effects of temporarily withholding responding to infant crying during sleep‐time to infant mental health. Critics of this strategy have advocated an alternative approach where parents are immediately responsive to signs of infant distress. Aims: To evaluate critically the evidence for and against these approaches in infants aged 6–24 months, with particular reference to issues of clinical effectiveness and infant mental health. Discussion is included of clinical implications and cultural and attachment factors impacting on parents’ preferences for settling methods. Results: The weight of clinical effectiveness empirical support is with extinction‐based interventions. Moreover, the core arguments against this approach regarding disruption to the infant’s mental health do not have empirical support, with available studies indicating either no change or modest improvements to the infant’s mental health. At this stage the onus is on proponents of the immediate‐responding approach to undertake effectiveness research. Well‐designed comparative studies would also help to advance this debate.

Keywords:

• infancy
• sleep
• intervention
• psychosocial factors
• attachment

Notes

1. Note that a small proportion of ISP have a medical aetiology, commonly respiratory in nature (e.g. obstructive sleep apnoea); however, ISP may also be caused by a range of non‐respiratory medical conditions (Moore, Allison, & Rosen, 2006; Thiedke, 2001). Such medically based sleep problems and their treatment will not be considered in this paper.