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Cited by 849Sleep and related disordersInfant Health and DevelopmentBehavioral and Psychological Studies

Behavioral treatment of bedtime problems and night wakings in infants and young children

An American Academy of Sleep Medicine Review, Jodi A. A. Mindell, Brett R. Kuhn, D Lewin, Lisa J. Meltzer, Avi Sadeh·2006·Sleep
DOI 10.1093/sleep/29.10.1263
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Abstract

This paper reviews the evidence regarding the efficacy of behavioral treatments for bedtime problems and night wakings in young children. It is based on a review of 52 treatment studies by a task force appointed by the American Academy of Sleep Medicine to develop practice parameters on behavioral treatments for the clinical management of bedtime problems and night wakings in young children. The findings indicate that behavioral therapies produce reliable and durable changes. Across all studies, 94% report that behavioral interventions were efficacious, with over 80% of children treated demonstrating clinically significant improvement that was maintained for 3 to 6 months. In particular, empirical evidence from controlled group studies utilizing Sackett criteria for evidence-based treatment provides strong support for unmodified extinction and preventive parent education. In addition, support is provided for graduated extinction, bedtime fading/positive routines, and scheduled awakenings. Additional research is needed to examine delivery methods of treatment, longer-term efficacy, and the role of pharmacological agents. Furthermore, pediatric sleep researchers are strongly encouraged to develop standardized diagnostic criteria and more objective measures, and to come to a consensus on critical outcome variables.

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  • Caregiver presence and related activities at sleep onset, rather than before lights out, can create problematic sleep onset associations that negatively affect sleep.

    “Caregiver presence and related activities at child sleep onset, as opposed to prior to lights out, can create problematic sleep onset associations that negatively impact sleep [19,24].”

    From Benefits of a bedtime routine in young children: Sleep, development, and beyond. (2018) · cites this paper as [24]

    The diagnostic criteria for sleep-onset association insomnia say that special conditions at sleep onset can delay or disrupt sleep when absent, and that nighttime awakenings may require caregiver intervention. The Parent Education/Prevention section recommends putting babies to bed “drowsy but awake.” The paper does not explicitly make the claimed contrast between caregiver activities at sleep onset and activities before lights out. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Broader behavioral sleep interventions that include a bedtime routine have generally improved child sleep outcomes, such as less bedtime resistance, shorter sleep onset latency, fewer night awakenings, and longer nighttime sleep.

    “broader behavioral sleep interventions that include a bedtime routine have largely resulted in improved child sleep outcomes, including diminished bedtime resistance, decreased sleep onset latency and nighttime awakenings, and longer nighttime sleep duration”

    From Benefits of a bedtime routine in young children: Sleep, development, and beyond. (2018) · cites this paper as [24]

    The General conclusions (section 7.1; page unavailable) report that behavioral interventions generally improved bedtime problems and night wakings, and that many studies included a consistent bedtime routine. The copy also discusses quicker sleep initiation and increased total sleep time, but it does not establish that routine-containing interventions generally shortened sleep-onset latency or lengthened nighttime sleep specifically. It does not evaluate a bedtime routine as a stand-alone treatment. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • From a behavioral perspective, consistently following a predictable set of pre-sleep behaviors can increase compliance with a set bedtime, reduce pre-bedtime arousal, and create positive sleep onset associations, which together increase total sleep time, sleep consolidation, and sleep quality.

    “following a predictive set of behaviors consistently before sleep onset can lead to increased compliance with a set bedtime, decreased arousal prior to bedtime, and positive sleep onset associations, all of which contribute to increased total sleep time, greater sleep consolidation, and better quality sleep”

    From Benefits of a bedtime routine in young children: Sleep, development, and beyond. (2018) · cites this paper as [24]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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Authors
An American Academy of Sleep Medicine Review, Mindell, J. A. A., Kuhn, B. R., Lewin, D., Meltzer, L. J., & Sadeh, A.
Affiliations
  • Saint Joseph's University (US)
  • University of Nebraska Medical Center (US)
  • Children's National (US)
  • Tel Aviv University (IL)
ORCID
Venue
Sleep
Publisher
Oxford University Press (OUP)
Published
2006-10-01
Volume
29
Issue
10
Pages
1263-76
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.1093/sleep/29.10.1263
OpenAlex
W2113082425
Cited by
849
References
5
Citations by year
2026: 5 · 2025: 25 · 2024: 38 · 2023: 55 · 2022: 33 · 2021: 51 · 2020: 63 · 2019: 69 · 2018: 58 · 2017: 52 · 2016: 67 · 2015: 44 · 2014: 59 · 2013: 40 · 2012: 35
FWCI
29.01
Type
journal article
Language
en
Open access
closed
Locations
  • SLEEP (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Health Professions › Pharmacy › Infant Health and Development
  • Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
Keywords
bedtime problems, nocturnal awakenings, behavioral sleep interventions, extinction, young children, treatment efficacy, practice parameters, pediatric sleep disorders
MeSH terms
Behavior Therapy, Child, Child, Preschool, Humans, Infant, Sleep Initiation and Maintenance Disorders, Parents, Trimeprazine, Wakefulness, Prevalence, Sleep Disorders, Circadian Rhythm, Histamine H1 Antagonists, Non-Sedating

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