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Step-by-step guide for settling and waking problems: what is the evidence?
Baby crying in cot credit iStockphoto.com/Oleksii Zabusik
 

The strategies recommended in our Guide for solving sleep problems are based on scientific evidence of what works in solving infant sleeping and settling problems. In addition, the strategies presented in the guide have been specifically evaluated in Australian research. Here we describe this research and its findings.

Sleep problems and maternal depression

Sleep problems in infants and postnatal depression in mothers are common experiences in Australian families. Recent research reveals that 31% of parents believe that their 3 month old has a sleep problem, and approximately 13% of women experience postnatal depression in the 12 months following the birth of their baby.

Both problems can have serious consequences for families and adversely affect child development. There also appears to be a link between infant sleep problems and depression in mothers, but research is yet to work out what is causing what. Does maternal depression affect how babies sleep? Does disrupted sleep cause depression in mothers? Or is it simply that depressed mothers notice or report more sleep problems than non-depressed mothers? Research has yet to look at the issue of depression in fathers and sleep problems in infants.

Could a simple sleep plan help babies and mothers?

If infant sleep problems and maternal depression are associated, it’s possible that helping parents resolve sleep problems might also have a positive effect on a mother’s mood and wellbeing.

Dr Harriet Hiscock and Dr Jordana Bayer, researchers from the Centre for Community Child Health (Royal Children’s Hospital, Melbourne) decided to research this question. They wanted to find out whether simple behavioural strategies – controlled comforting and camping out – would be effective in reducing both sleep problems in infants and symptoms of depression in mothers.

The study

A total of 328 mothers participated in the research. All mothers were reporting significant sleep problems with their infants at seven months of age. 

Some of these mothers were randomly allocated to a program (treatment group) where they received consultations from a maternal and child health nurse. The nurse helped the mothers develop an individualised sleep management plan. The plan involved positive bedtime routines, controlled comforting or camping out, and strategies for phasing out night-time feeds and dependence on dummies.

The other mothers (control group) didn’t receive the program – instead, they received an information sheet on normal childhood sleep.

Sleep diaries kept by the mothers and a postnatal depression questionnaire were used to assess the effects of the program.

What did they find?

When infants were 10, 12 and 24 months old, all mothers were asked about their child’s sleep and their own mood. Here is a summary of what the researchers found:

  • The program was effective in helping parents resolve infant sleep problems. Sleep problems were resolved for more participants in the treatment group than in the control group and those sleep problems that remained in the treatment group were less severe. These findings were maintained at two years.
  • The intervention was also effective in reducing depression symptoms overall. These results were maintained at two years, with mothers in the treatment group less likely to report high levels of depression compared to mothers in the control group.
  • However, the results were best for mothers who entered the study with higher levels of depression. They reported greater improvements in their baby’s sleep problems and greater reductions in their depression symptoms than mothers in the control group.
  • In other findings, the program was found to be acceptable to mothers and reduced the need for other help from professionals.

What can we conclude?

This research is consistent with previous research that has found simple behavioural strategies to be effective in addressing sleeping problems in young children. The results also suggest there may be real benefits in the health and wellbeing of mothers when infant sleep problems are effectively addressed.

Postscript

The researchers decided to find out how the families who completed the program were going when their children were 3-4 years old. Most sleeping problems had been resolved (including those in the control group). However, nearly one in five problems had returned. The researchers speculated that parents may have been reporting sleeping difficulties caused by other reasons now that the children were older. The good news was that regardless of whether there were sleep difficulties, all families were functioning well.

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  • Last Updated 15-11-2012
  • Last Reviewed 24-03-2013
  • Hiscock, H., Bayer, J., Gold, L., Hampton, A., Ukoumunne, O., & Wake, M. (2007). Improvising infant sleep and maternal mental health: a cluster randomised trial.  Archives of Disease in Childhood, 92, 952-958.

    Hiscock, H., Bayer, J., Hampton, A., Ukoumunne, O., & Wake, M. (2008). Long-term mother and child mental health effects of a population-based infant sleep intervention: Cluster-randomized, controlled trial. Pediatrics, 122, 621-627.

    Hiscock, H., & Wake, M. (2001). Infant sleep problems in postnatal depression: A community-based study. Pediatrics, 107, 1317-1322.

    Hiscock, H., & Wake, M. (2002). Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. British Medical Journal 324 (7345) p.1062

    Lam, P., Hiscock, H. & Wake, M. (2003). Outcomes of Infant Sleep Problems: A Longitudinal Study of Sleep, Behavior, and Maternal Well-Being, Pediatrics 111, 203-207.

    Milgrom, J., Mendelsohn, J., & Gemmill, A. W. (2011). Does postnatal depression screening work? Throwing out the bathwater, keeping the baby. Journal of Affective Disorders, 132(3), 301-310.

    National Health and Medical Research Council (2006). Postnatal depression, not just the baby blues. Retrieved December 3, 2010, from http://www.nhmrc.gov.au/PUBLICATIONS/synopses/wh29syn.htm

    Teng, A., Bartle, A., Sadeh, A., & Mindell, J. (2012). Infant and toddler sleep in Australia and New Zealand. Journal of Pediatrics and Child Health, 48(3), 268-273.

    Wake, M., Morton-Allen, E., Poulakis, Z., Hiscock, H., Gallagher, S., & Oberklaid, F. Prevalence, stability, and outcomes of cry-fuss and sleep problems in the first 2 years of life: Prospective community-based study. Pediatrics, 117(3), 836-842.