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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

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

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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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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 › Medicine › Pediatrics, Perinatology and Child Health › 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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