Though its difficult learning how to get your baby to fall asleep on its own, a new study demonstrates that there is little harm in your child crying him/herself to sleep.

'Crying' to Sleep Safe for Babies

By Crystal Phend, Senior Staff Writer, MedPage Today

Published: September 10, 2012

 

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

 

Behavioral techniques for getting babies to sleep by themselves, such as camping out in the child's room initially, can be effective without any long-term downside for parents or children, clinical trial follow-up showed.

 

Sleep problems at age 6 weren't significantly more common among kids trained to go to bed with such methods as infants (9% versus 7% among controls, P=0.2), reported Anna M.H. Price, PhD, of the Royal Children's Hospital in Parkville, Australia, and colleagues.

The training didn't leave kids more distant from their parents or emotionally damaged, the group stated in the October issue of Pediatrics.

"Parents and health professionals can confidently use these techniques," they suggested.

The trial originally showed that "camping out" to get kids to fall asleep and "controlled comforting" to teach them to settle down on their own by gradually lengthening intervals at which parents respond to crying did improve infants' sleep and cut maternal depression by 60%.

Because of worries about long-term harm if parents don't consistently respond to their child -- as noted by the distress caused by an older technique that called for parents to let children "cry it out" without responding at all -- the researchers followed children into the school years.

Of the 328 families randomized to behavioral training or usual care for infant sleep problems reported at well-child visits by parents when the child was 7-months-old, 225 participated in the study for assessment around the child's sixth birthday.

For the primary outcomes, the intervention group didn't show poorer scores on children's emotional or conduct behavior (P=0.8 and P=0.6, respectively).

Likewise, the population-based study showed no differences between groups at age 6 for the following outcomes:

• Sleep habits (P=0.4)
• Parent-reported psychosocial functioning (P=0.7)
• Child-reported psychosocial functioning (P=0.8)
• Chronic stress as measured by saliva cortisol levels on a non-school day (29% versus 22%, P=0.4)
• Child-parent closeness (P=0.1)
• Conflict between parent and child (P=0.4)
• Overall quality of the relationship between parent and child (P=0.9)
• Disinhibited attachment (P=0.3)
• Depression, anxiety, and stress scores in the mother (P=0.9)
• Authoritative parenting, viewed as the optimal parenting style with warmth and control (63% versus 59%, P=0.5)

Although there weren't lasting benefits, the lack of harm suggested the techniques are safe, the researchers concluded.

They cautioned that loss to follow-up of about a third of families meant the study couldn't rule out small harms or benefits long term.

"Nonetheless, the precision of the confidence intervals make clinically meaningful group differences unlikely," they wrote.

The inclusion of only English speakers in largely more advantaged families might limit generalizability to other settings, they noted.

"Along with trials like ours demonstrating that sleep problems can be effectively treated in older infants, recent efficacy trials for children younger than 6 months suggest that parent education programs that teach parents about normal infant sleep and the use of positive bedtime routines could effectively prevent later sleep problems," they wrote.

The Infant Sleep Study was funded by the Australian National Health & Medical Research Council Project and the Pratt Foundation. The follow-up Kids Sleep Study was funded by the Foundation for Children and the Victorian Government's Operational Infrastructure Support Program.
The researchers all reported financial support from the Foundation for Children.

Primary source: Pediatrics
Source reference:
Price AMH, et al "Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial" Pediatrics 2012; 130: DOI: 10.1542/peds.2011-3467.