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

Abstract

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.

Exploring Maternal Perceptions of Infant Sleep and Feeding Method Among Mothers in the United Kingdom: A Qualitative Focus Group Study

“…The predominant view is that formula feeding promotes infant sleep while breastfed infants are too demanding, feed too frequently, and do not allow their mothers sufficient sleep through the night (Ball, Hooker, & Kelly, 1999;Brown & Harries, 2015). In both the UK and the US, many parents give night-waking as the reason they switched to formula (Douglas & Hill, 2013) and the idea that feeding the infant formula before bed will help the whole family to sleep better is widely accepted (Rosen, 2008). Mothers are advised by peers and family to introduce formula or solid foods to the infant diet in order to promote longer periods of nocturnal sleep (Clayton, Li, Perrine, & Scanlon, 2013;Crocetti, Dudas, & Krugman, 2004).…”

“…Some studies suggest that breastfed babies sleep less, wake more or wake for longer than formula fed infants (Quillin & Glenn, 2004). In the last decade, an increasing number of studies have found that breastfeeding mothers and infants experience as much or more sleep than formula-feeding pairs, that breastfeeding mothers return to sleep more rapidly after overnight awakenings, and that hormonal mechanisms associated with breastfeeding may result in higher quality sleep (Doan, Gardiner, Gay, & Lee, 2007;Douglas & Hill, 2013;Montgomery-Downs, Clawges, & Santy, 2010).…”

“…We found among the formula-feeding participants that personal behavioural choices were guided by authoritative cultural norms (Chianese, Ploof, Trovato, & Chang, 2009). Currently, most interventions for infant sleep emphasize the negative effects that altered sleep patterns may have on parents and infants and focus on increasing sleep duration (Douglas & Hill, 2013). The language used, focused as it is on sleep disruption and deprivation, creates a negative association between infancy and parental sleep (Rosen, 2008).…”

High level evidence does not support first wave behavioural approaches to parent-infant sleep

“…ignoring the cue of sleepiness at the end of feeds and implementing feed-play-sleep cycles). 2,[4][5][6] In summary, Kempler et al's study confirms that high level evidence does not support the application of FWB approaches to parent-infant sleep, particularly in the first six months of life. Douglas and Hill's findings suggest that FWB approaches may even be detrimental to some families.…”

“…Our metanarrative review also concludes (p499): 'Application of behavioural methods from the first weeks of life increases self-regulated sleep periods and increases total 24-hour duration of time spent in the cot without signalling by 29 minutes.' 2 We then go on to argue that 'decreased episodes of night-waking or longer infant sleep durations do not inevitably improve outcomes for mothers and their infants, as is often assumed. '…”