Some of the main critiques of the current research on CIO by APers which shows no adverse effects is that the infant populations studied contain relatively few children under the age of a year, the studies themselves are rather small, and there is a relatively short follow-up period. Some APers suggest that this lack of absolute evidence is sufficient to recommend against using behavioral methods, and CIO in particular, in children under a year old. I disagree with this position, as I find there is no evidence whatsoever that suggests CIO might be harmful in the first place (despite some rather blatant scare tactics by APers who compare the practice to child abuse/neglect), and that assuming a priori that the practice may be harmful merely because it’s unpleasant for the parents is not a logical approach. A new study on the subject is in last month’s Pediatrics which addresses these issues and – not surprisingly to me, at least – helps confirm this.
Long-term Mother and Child Mental Health Effects of a Population-Based Infant Sleep Intervention: Cluster-Randomized, Controlled Trial by Hiscock et al studied sleep-troubled infants who were randomized to be given information about a sleep-training method of their choice by a nurse (intervention, 174 families of which 100 took the nurses up on their offer) or to regular well-baby care (control, 154 families). Of the 100 families who accepted the sleep intervention from the nurse, 53 chose graduated extinction (akin to the Ferber Method), and an additional 7 chose “adult fading” – where an adult stays by the child until he falls asleep, and gradually moves away from his room over a period of weeks (this often also involves crying, as usually the child is not to be cuddled or picked up).
Mothers handed in questionnaires assessing the existence of sleep problems, the degree/existence of maternal postpartum depression, their parenting practices, and indicators of the infants’ mental health when the babies were 10, 12 and 24 months old.
This study has several strong points in that: 1) the study population is randomized, 2) all the infants studied were between 6-12 months old, 3) it’s a relatively large study for this topic, 4) infant mental health was assessed, and 5) there’s a year+ period of follow-up. The study’s main flaw, IMO, is that a rather large proportion of infants in the intervention group (43%) did not actually receive an intervention, and of those that did, the intervention wasn’t the same for all families.
The intervention group’s mothers displayed a significant decrease in maternal depressive symptoms, and 55 of the mothers who used interventions strongly endorsed their use and reported them as having a positive effect on their relationship to their child. Most importantly, no long-term differences either in parenting practices or effects on the children’s mental health (positive or negative) were seen.
Like in all other matters, I would like to see this research replicated, perhaps with all the mothers in the intervention arm receiving the same sleep-related advice, and with follow-up on if the advice was implemented and how well it went. But this is, overall, good and very welcome news on the infant sleep front for parents using CIO or similar methods.
Filed under: Infant sleep