Behavioral Sleep Interventions in the First Six Months of Life Do not Improve Outcomes for Mothers or Infants: A Systematic Review

Douglas, Pamela S.; Hill, Peter S.

doi:10.1097/dbp.0b013e31829cafa6

Cited by 129Infant Health and DevelopmentSleep and related disordersPediatric Pain Management Techniques

Behavioral Sleep Interventions in the First Six Months of Life Do not Improve Outcomes for Mothers or Infants: A Systematic Review

Douglas, Pamela S., Hill, Peter S.·2013·Journal of Developmental & Behavioral Pediatrics

DOI 10.1097/dbp.0b013e31829cafa6

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Abstract

OBJECTIVE: The United Kingdom's National Institute for Health Research has recently invited proposals for the design of a multicomponent primary care package of behavioral interventions to reduce parental distress caused by excessive infant crying in the first 6 months of life. A systematic review was performed to determine whether behavioral interventions for sleep, when applied by parents to infants younger than 6 months, improve maternal and infant outcomes. METHODS: Searches of PubMed, CINAHL, and Cochrane Database of Systematic Reviews were conducted to identify systematic reviews, meta-analyses, clinical trials, and cohort studies investigating the effects of behavioral sleep interventions in infants younger than 6 months (January 1993-March 2013). The evidence is critically analyzed, according to PRISMA guidelines. RESULTS: Cry-fuss, feeding, and sleep problems emerge out of multiple dynamically interacting and co-evolving variables in early life and are for this reason generically referred to as regulatory problems. Studies that link behavioral interventions for sleep in the first 6 months with positive effects on maternal and infant health demonstrate 3 methodological constraints. They fail to identify and control for feeding difficulties, fail to distinguish between the neurodevelopmentally different first and second halves of the first year of life, and apply reductive analyses to evaluations of complex interventions. Despite substantial investment in recent years in implementation and evaluation of behavioral interventions for infant sleep in the first 6 months, these strategies have not been shown to decrease infant crying, prevent sleep and behavioral problems in later childhood, or protect against postnatal depression. In addition, behavioral interventions for infant sleep, applied as a population strategy of prevention from the first weeks and months, risk unintended outcomes, including increased amounts of problem crying, premature cessation of breastfeeding, worsened maternal anxiety, and, if the infant is required to sleep either day or night in a room separate from the caregiver, an increased risk of SIDS. CONCLUSION: The belief that behavioral intervention for sleep in the first 6 months of life improves outcomes for mothers and babies is historically constructed, overlooks feeding problems, and biases interpretation of data.

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Trials of educational interventions have at best produced mixed results, and most have been found to be ineffective.
“they have at best produced mixed results, and most have been found to be ineffective [14,40–42].”
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How to treat: the crying baby
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The links between sleep duration, obesity and type 2 diabetes mellitus
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Rapid review to update evidence for Healthy Child Programme 0-5
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Development and evaluation of ‘Sleep, Baby & You’—An approach to supporting parental well-being and responsive infant caregiving
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Diet and nutrients in the modulation of infant sleep: a review of the literature
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Maternal perinatal depression and infant sleep problems at 1 year of age: Subjective and actigraphy data from a population‐based birth cohort study
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Effect of a behavioral-educational sleep intervention for first-time mothers and their infants: pilot of a controlled trial
Sweeney, B., Signal, T. L., & Babbage, D. R. (2020) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.8484 · Cited by 27 · see citing works
Effectiveness of behavioral sleep interventions on children’s and mothers’ sleep quality and maternal depression: a systematic review and meta-analysis
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Chronic insomnia of early childhood: Phenotypes and pathophysiology
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ABM Clinical Protocol #37: Physiological Infant Care—Managing Nighttime Breastfeeding in Young Infants
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Perinatal maternal depression, antidepressant use and infant sleep outcomes: Exploring cross-lagged associations in a pregnancy cohort study
Galbally, M., Watson, S., Teti, D. M., & Lewis, A. J. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.05.025 · Cited by 23 · see citing works
Pre-emptive Intervention for Autism Spectrum Disorder: Theoretical Foundations and Clinical Translation
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Infant sleep as a topic in healthcare guidance of parents, prenatally and the first 6 months after birth: a scoping review
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An overview of reviews of breastfeeding barriers and facilitators: Analyzing global research trends and hotspots
Miranda, A. R., Barral, P. E., Scotta, A. V., Cortez, M. V., & Soria, E. A. (2025) · Global Epidemiology · doi:10.1016/j.gloepi.2025.100192 · Cited by 28 · see citing works
Sleep Consolidation, Sleep Problems, and Co-Sleeping: Rethinking Normal Infant Sleep as Species-Typical
Barry, E. S. (2021) · The Journal of Genetic Psychology · doi:10.1080/00221325.2021.1905599 · Cited by 20 · see citing works
Preventing postpartum insomnia: findings from a three-arm randomized-controlled trial of cognitive behavioral therapy for insomnia, a responsive bassinet, and sleep hygiene
Quin, N., Tikotzky, L., Astbury, L., Spina, M.-A., Fisher, J., Stafford, L., Wiley, J. F., & Bei, B. (2024) · SLEEP · doi:10.1093/sleep/zsae106 · Cited by 20 · see citing works
IGNORING CHILDREN'S BEDTIME CRYING: THE POWER OF WESTERN‐ORIENTED BELIEFS
Maute, M., & Perren, S. (2018) · Infant Mental Health Journal · doi:10.1002/imhj.21700 · Cited by 20 · see citing works
The effects of infant behavioural sleep interventions on maternal sleep and mood, and infant sleep: A randomised controlled trial
Rouzafzoon, M., Farnam, F., & Khakbazan, Z. (2021) · Journal of Sleep Research · doi:10.1111/jsr.13344 · Cited by 20 · see citing works
Video evidence that parenting methods predict which infants develop long night-time sleep periods by three months of age
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Possums-based parental education for infant sleep: cued care resulting in sustained breastfeeding
Öztürk, M., Boran, P., Ersu, R. H., & Peker, Y. (2021) · European Journal of Pediatrics · doi:10.1007/s00431-021-03942-2 · Cited by 19 · see citing works
The role of sleep protection in preventing and treating postpartum depression
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New perspectives on responsive infant care: A qualitative study of the ways in which Neuroprotective Developmental Care (NDC) shapes mother-infant co-occupations
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Descriptive figures for differences in parenting and infant night-time distress in the first three months of age
James‐Roberts, I. S., Roberts, M., Hovish, K., & Owen, C. (2016) · Primary Health Care Research & Development · doi:10.1017/s1463423616000293 · Cited by 17 · see citing works
The association between baby care books that promote strict care routines and infant feeding, night‐time care, and maternal–infant interactions
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An overview of reviews for preventing and treating sleep problems in infants
Drozd, F., Leksbø, T. S., Størksen, H. T., Wilhelmsen, C. E. W., & Slinning, K. (2022) · Acta Paediatrica · doi:10.1111/apa.16475 · Cited by 17 · see citing works
Postpartum fatigue, daytime sleepiness, and psychomotor vigilance are modifiable through a brief residential early parenting program
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Prescribing Sleep: An Overlooked Treatment for Postpartum Depression
Leistikow, N., Baller, E. B., Bradshaw, P. J., Riddle, J. N., Ross, D. A., & Osborne, L. M. (2022) · Biological Psychiatry · doi:10.1016/j.biopsych.2022.03.006 · Cited by 16 · see citing works
Controversies in Behavioral Treatment of Sleep Problems in Young Children
Thomas, J. H., Moore, M. E., & Mindell, J. A. A. (2014) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2014.02.004 · Cited by 16 · see citing works
Behavioural sleep interventions in infants: Plan B – Combining models of responsiveness to increase parental choice
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Association between delayed bedtime and sleep-related problems among community-dwelling 2-year-old children in Japan
Kitamura, S., Enomoto, M., Yuichi, K., Inada, N., Moriwaki, A., Kamio, Y., & Mishima, K. (2015) · Journal of PHYSIOLOGICAL ANTHROPOLOGY · doi:10.1186/s40101-015-0050-x · Cited by 15 · see citing works
Relationships between postpartum depression, sleep, and infant feeding in the early postpartum: An exploratory analysis
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Infant sleep interventions – Methodological and conceptual issues
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Longitudinal changes in wellbeing amongst breastfeeding women in Australia and New Zealand during the COVID-19 pandemic
Sakalidis, V. S., Rea, A., Perrella, S. L., McEachran, J. L., Collis, G., Miraudo, J., Prosser, S. A., Gibson, L. Y., Silva, D. T., & Geddes, D. T. (2022) · European Journal of Pediatrics · doi:10.1007/s00431-022-04580-y · Cited by 13 · see citing works
Interventions Supporting Mental Health and Positive Behavior in Children Ages Birth–5 Yr: A Systematic Review
Kingsley, K. L., Sagester, G., & Weaver, L. L. (2020) · American Journal of Occupational Therapy · doi:10.5014/ajot.2020.039768 · Cited by 13 · see citing works
Perinatal depression prevention through the mother-infant dyad: The role of maternal childhood maltreatment
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The Sleeping Elephant in the Room: Practices and Policies regarding Sleep/Rest Time in early Childhood Education and Care
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Authors: Douglas, P. S., & Hill, P. S.
Affiliations: The University of Queensland (AU)
ORCID: Douglas, Pamela S.
Hill, Peter S.
Venue: Journal of Developmental & Behavioral Pediatrics
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2013-09
Volume: 34
Issue: 7
Pages: 497-507
ISSN: 0196-206X (ISSN-L)
DOI: 10.1097/dbp.0b013e31829cafa6
OpenAlex: W1987631506
Cited by: 129
References: 117
Citations by year: 2026: 6 · 2025: 7 · 2024: 8 · 2023: 8 · 2022: 10 · 2021: 18 · 2020: 14 · 2019: 10 · 2018: 12 · 2017: 8 · 2016: 9 · 2015: 13 · 2014: 5 · 2013: 1
FWCI: 2.28
Type: journal article
Language: en
Open access: closed
Locations: Journal of Developmental & Behavioral Pediatrics (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › Pharmacy › Infant Health and Development
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords: infant sleep, behavioral sleep interventions, infant crying, parental distress, maternal outcomes, infant outcomes, feeding difficulties, postpartum depression, breastfeeding, sudden infant death syndrome, infant sleep environment, primary care intervention
MeSH terms: Crying, Female, Humans, Infant, Infant, Newborn, Mothers, Sleep, Sleep Deprivation, Treatment Outcome, Infant Behavior

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Behavioral Sleep Interventions in the First Six Months of Life Do not Improve Outcomes for Mothers or Infants: A Systematic Review

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