Part Two – Research that Supports Teaching the Skill of Sleep
Many parents are frightened by the headlines regarding crying and sleep. A great deal of the information available to parents perpetuates the myth that crying involved in learning the skill of sleep causes harm to children. Because of this, many parents allow their families to live in a state of exhaustion. Unfortunately, the sleep deprivation which results can be detrimental to the health and well-being of children, mothers and families.
Inadequate sleep has a damaging effect on a child’s overall health. Negative health associations include impaired cognitive development, difficulties regulating mood, attention and behaviour, weakened immune function and an increased risk for accidental injuries.1,2 Children who do not get enough sleep are also at risk for decreased physical activity and obesity.3
Infant sleep problems can also impact the health of the mother and the father. According to a study published in the journal Pediatrics, a strong association was found between infant sleep problems and maternal depression.4 Infants who experienced frequent night wakings at 6 months were more likely to have mothers who were depressed and fathers who were more likely to have health issues.5
Various studies have been completed to better understand the impact of behavioural sleep interventions on the overall health of the child, mother and family:
In 2006, a systematic review was completed of 52 studies involving behavioural interventions for sleep problems in children.2 More than 2500 infants and toddlers participated in the 52 studies and the following are the results from this review:
- 49 of the 52 studies reported that the use of behavioural sleep interventions significantly reduced bedtime resistance and night wakings.
- The studies determined that sleep interventions such as extinction and gradual extinction were effective in decreasing night wakings.
- Parents reported fewer symptoms of depression and an improvement in their overall mental health status.
- Adverse effects, including negative infant-parent attachment relationships were not identified in any of the studies reviewed. In contrast, infants and children that received behavioural sleep interventions were found to be more secure, predictable, and less irritable.
In 2010, a review of the current literature (between 1990 and 2009) on infant sleep identified6:
- Infants who required significant parental involvement (nursing, rocking, etc.) to fall asleep were more likely to wake in the night.
- The use of behavioural interventions for sleep improved child behaviour and parent well-being and the use of these interventions was not found to compromise infant-parent attachment relationships.
In a 5 year follow-up study of 225 children randomly assigned to an intervention group (received some form of behavioural sleep intervention) or a control group (did not receive a behavioural sleep intervention), the long term findings indicated7:
- No significant difference between the 2 groups (intervention group or control group) for factors such as emotional and behavioural scores, sleep problems, psychosocial functioning, child-parent closeness, and parent depression.
- No long lasting harmful effects with the use of behavioural sleep interventions indicating that the use of behavioural sleep interventions are safe in the long term.
The literature that supports the use of behavioral sleep interventions is based on a large sample of children. These studies were often completed in nonthreatening environments such as the child’s home rather than in a lab or hospital setting. The children in these studies were allowed to be close to their parents and their parents provided the sleep interventions. The studies also looked at the effects that sleep deprivation can have on the physical and mental health of children, mothers, and families and the long-term health benefits that behavioral sleep interventions can have on the entire family.
Parents must make informed decisions regarding the health of their families. A review of the research on crying and sleep reveals the truth: The crying involved in teaching the skill of sleep poses no harm to children, however, long-term sleep deprivation is related to various health risks for children, mothers and families. Behavioural interventions are effective in teaching children how to sleep and promote positive health outcomes for all members of a family.
Because the information available regarding children and sleep does not always accurately represent solid research, parents need to navigate this terrain with a critical eye. Making informed decisions about children and sleep becomes even more difficult under the emotional cloud of sleep deprivation. The Certified Child Sleep Consultants at SleepWell Baby guide parents through this journey. We know that when a child learns a new skill there is almost always some degree of crying involved. Crying is an infant’s only way to communicate frustration, discomfort and uncertainty. While teaching the skill of sleep will usually involve some crying, there are various methods that are effective and parents can choose the approach that best suits their family. At SleepWell Baby we empower our clients with the science of sleep, a customized approach and all the support and education that is essential to help the whole family rest easy.
- Gruber, R. (2013). Making room for sleep: The relevance of sleep to psychology and the rationale for development of preventative sleep education programs for children and adolescents in the community. Canadian Psychology, 54(1), 62-71.
- Mindell, J.A., Kuhn, B., Lewin, D.S., Meltzer, L.J., & Sadeh, A. (2006). Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 29(10), 1263-1276
- Magee, C.A., Gordon, R. & Caputi, P. (2014). Distinct developmental trends in sleep durationduring early childhood. Pediatrics, 133(6), e1561-1567.
- Hiscock, H. & Wake, M. (2001). Infant sleep problems and postnatal depression: A community-based study. Pediatrics, 107(6), 1317-1322.
- Weinraub, M., Friedman, S.L., Knoke, B., Houts, R., Bender, R.H., Susman, E.J., Bradley, R., & Williams, J. (2012). Patterns of developmental change in infants’ nighttime sleep awakenings from 6 through 36 months of age. Developmental Psychology, 48 (6), 1511-1528.
- Sadeh, A., Tikotzky, L., & Scher, A. (2010). Parenting and infant sleep. Sleep Medicine Reviews, 14, 89-96.
- Price, A.M.H., Wake, M., Ukoumunne, O.C., & Hiscock, H. (2012). Five-year follow-up of harms and benefits of behavioural infant sleep intervention: Randomized trial. Pediatrics, 130(4), 643-651.