The Evidence Base for Infant Sleep Coaching

This article was written by:

La Terra Jackson | NCS, CLC, CIMT, BA Psychology and Human Development and

Laura Shiff | Copywriter

Published October 1, 2018


 

When trying to filter through the research, there continues to be so much conflicting advice for new parents on the best ways to handle infant sleep behaviors and problems:

  • Well meaning-advice emphasizes the benefits of breastfeeding which results in mothers nursing their babies longer, often on-demand throughout the night, in order to maintain their milk supply. While this is positive in many aspects, it can quickly exhaust the mother, leading to some of the disorders already mentioned.
  • The American Academy of Pediatrics’ 2016 guidelines that babies should sleep in the same room as their parents for the first 6 to 12 months of life is also intended to be positive, but can too make sleeping harder for all.

 

With all of the options available, it is vital that parents use evidence-based approaches to understand what the right choice is for them and their mental health. Sleep coaches help to cut through the confusion about what sleep-training methods are best, including how to help babies sleep through the night while the mother continues to successfully breastfeed.

 

Sleep Consulting for Newborns

Many people, especially new parents, question the evidence-base and safety of sleep consulting for newborns. However, this lack of understanding only further hurts everyone involved, particularly mothers, who are especially vulnerable.

Mothers often reach the end of their maternity leave feeling wrung out, disconnected from their baby, and alone. These same moms are typically expected to return to their pre-baby level of functioning as though the pregnancy, birth, and postpartum period were just a thing they did rather than a life-changing experience that altered their entire being to the very core.

 

But it’s not just mothers who are affected; fathers are negatively impacted, as well. Although fathers are spending more time than ever with their children, the expectations for them at work remain the same, with less sympathy than mothers for sleepless nights and nighttime parenting duties.

 

Maternal and Infant Health Outcomes

With many parents feeling ashamed for seeking assistance and less asking for help when it comes to infant sleep, there is a huge ripple effect, with research showing major impacts on overall maternal health concerns. This increased anxiety and exhaustion can quickly escalate to depression, having a negative contribution to child and maternal health outcomes like cognitive and learning factors. This leads to the question, will treating infant sleep problems also contribute to the reduction of maternal depression?

 

Infant Sleep Coaching as a Solution

For tired parents that are contemplating help from an infant sleep coach, there are many questions that typically arise:

  • Won’t the baby outgrow whatever you teach them in a couple months anyway?
  • What about when the parents have to do it on their own?
  • Why are parents looking for help with just nighttime sleep?

While the internet is a goldmine of limitless discussion boards and blog posts on the topic, these often contradictory opinions only lead to confusion, frustration, and ultimately, no results. However, there have been countless research studies conducted over the years regarding infant sleep problems as well as how they can be treated and prevented.

 

A Universal Parenting Program

Some of the strongest evidence that supports the positive impact of infant sleep coaching comes from research conducted through randomized control trials whose goal was to prevent early infant sleep and cry problems and associated parental depression.

 

In the first controlled study, first-time parents were provided with information via booklet and home visits that educated them about normal infant sleep/wake patterns as well as the importance of establishing an appropriate sleep routine that promoted self-settling in the infant. Compared with parents in the control group, the intervention group infants had significantly fewer night awakenings (23% in the intervention group woke up two or three times per night vs. 46% in the control group) and had significantly fewer settling difficulties (21% in the intervention vs. 39% in the control) by the time they were 12 weeks of age.

 

In a different controlled study, families with infants aged 8 to 14 days old were split into three groups: those who received a structured behavioral program, those who received an education-oriented group, and those who received the usual care provided by their health services. Parents in the behavioral group were taught how to allow their infant to self-settle back to sleep independently and to only respond to the infant when they were generally crying (as opposed to fussing or squirming). They were also taught how to reduce stimulation in the evenings and the proper way to gradually increase time between night feeds once the infant turned three months.

 

By 12 weeks of age, there was a significant number of infants in the behavioral group compared to the other two groups who were sleeping through the night (considered uninterrupted sleep from 12am-5am). Parents also needed less access to health services for their infant’s sleep in the following six months. In summary, responding to an infant on-demand may reduce overall crying in the first few weeks of life, but switching to a more predictable and structured style of care after the first few weeks results in less night waking at 12 weeks of age.

 

There is also clear evidence that utilizing sleep interventions for infants is directly associated with significant improvement in maternal mental health and mood. Given the strong correlation between infant sleep problems and diagnosed postnatal depression, it is likely that there are substantial numbers of mothers who are diagnosed with postnatal depression that are suffering the effects of chronic sleep deprivation.

 

Why This is Important

This research is so important as it shows that sleep coaching helps to provide a predictable environment in the first few months of life, potentially preventing both infant sleep and cry problems. While sleep coaching does not mean babies won’t cry, it certainly minimizes the crying during the times of day when parents are the most exhausted. By properly managing infant sleep behaviors, mothers have a better chance of seeing positive outcomes in their own mood disorders, leading to reduced health service use and increased mother-child attachment and bonding.

 

Infant Sleep Interventions

Another controlled trial of sleep interventions for infants pointed out what we already know about sleep disorders: mothers who regarded their infants’ sleep as a problem were more likely to have depression and depression scores that increased with sleep-problem severity. This research also found that mothers of children with sleep problems struggled significantly more with sleep anger, the feelings of rage and anger associated with sleep-deprivation along with irritability, lack of good judgement, and irrational behavior.

 

Why This is Important

Behavioral interventions are intended to coach parents in understanding self-soothing capabilities in infants as well as ways to help them become more independent sleepers. In fact, when parents don’t fully understand infant sleep behaviors, they can interfere with their child’s self-soothing and further extend the duration of the infant’s night waking, unintentionally making the problem worse. By teaching parents about the correct ways to respond, infants are seen to have less night wakings and less crying by 12 weeks of age.

 

Conclusion

In looking at this research, there are multiple conclusions that can be reached about the results of various infant sleep intervention programs:

  • Parents who were provided with information and visits regarding normal infant sleep/wake patterns as well as how to establish a sleep routine saw 50% less night wakings in their infants by the time they reached 12 weeks of age
  • When included in a structured behavioral program that taught parents how to teach sleep independence and promote self-settling skills, infants displayed less night waking by 12 weeks of age
  • By teaching parents about the correct ways to respond, infants are seen to have less night wakings and less crying by the time they are 12 weeks old

 

Based on the research, when choosing among competing sleep coaching methods, parents and providers should emphasize strategies that allow for self-soothing and helping parents discern infant cues in order to achieve the best sleep for their infants.

 

Making the First Step

My approaches are grounded in research on best practices and I have years of experience providing positive outcomes for infants and families. I have a proven track record of helping babies sleep through the night and I am confident my clients’ successes are possible because of the approach I use. If you are interested in learning more information about infant sleep coaching, please feel free to reach out to me at info@darlinbabyco.com


 

Resources

 

Armstrong KL, Van Haeringen AR, Dadds MR, Cash R. Sleep deprivation or postnatal depression in later infancy: separating the chicken from the egg. J Paediatr Child Health. 1998;34:260–262. doi: 10.1046/j.1440-1754.1998.00213.x

 

Bailey WT. A longitudinal study of fathers’ involvement with young children: infancy to age 5 years. J Genet Psychol. 1994;155:331–339. doi: 10.1080/00221325.1994.9914783

 

Bayer JK, Hiscock H, Hampton A, Wake M. Sleep problems in young infants and maternal mental and physical health. J Paed Child Health. 2007;43:66–73. doi: 10.1111/j.1440-1754.2007.01005.x

 

Cook, F., Bayer, J., Le, H. N., Mensah, F., Cann, W., & Hiscock, H. (2012). Baby Business: a randomized controlled trial of a universal parenting program that aims to prevent early infant sleep and cry problems and associated parental depression. BMC Pediatrics, 12(1). doi:10.1186/1471-2431-12-13

 

Hall, W. A., Hutton, E., Brant, R. F., Collet, J. P., Gregg, K., Saunders, R., … Wooldridge, J. (2015). A randomized controlled trial of an intervention for infants’ behavioral sleep problems. BMC Pediatrics, 15(1). doi:10.1186/s12887-015-0492-7

 

Hiscock H, Bayer J, Gold L, Hampton A, Ukoumunne OC, Wake M. Improving infant sleep and maternal mental health: a cluster randomised trial. Arc Dis Child. 2007;92:952–958. doi: 10.1136/adc.2006.099812

 

Insana, S. P., & Montgomery-Downs, H. E. (2013). Sleep and Sleepiness among First-Time Postpartum Parents: A Field- and Laboratory-Based Multimethod Assessment. Developmental Psychobiology, 55(4), 361–372. http://doi.org/10.1002/dev.21040

 

St James-Roberts I, Sleep J, Morris S, Owen C, Gillham P. 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. doi: 10.1046/j.1440-1754.2001.00699.x

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