Behavioural sleep interventions in infants: Plan B – Combining models of responsiveness to increase parental choice

Abstract

In families with infants between the ages of 6 and 18 months, sleep disruption can be significant, often putting parents at risk of a range of negative psychological and psychosocial consequences. Commonly prescribed sleep interventions typically involve 'extinction' methods, which require parents to completely or periodically ignore their infant's overnight cries. These methods can be effective in many, but not all cases. For over 40 years 30-40% of parents have consistently reported difficulty ignoring their child. For this group, ignoring their child is behaviourally and/or ideologically difficult with attrition often leading to a perceived sense of failure. For these parents the treatment may be worse than the problem. On the other hand, there is emerging evidence to support the use of more responsive methods for those who find extinction approaches behaviourally or ideologically challenging. In this paper we propose an integrated, less polarised approach to infant behavioural sleep interventions that better caters to those who have difficulty with extinction methodsour so-called 'Plan B'. This approach potentially resolves the often opposing ideological and theoretical perspectives of extinction versus responsiveness into a practical, complementary and pragmatic treatment framework. Recommendations on how best to implement Plan B are also presented. In our view, Plan B could provide practitioners with a logically integrated well-targeted suite of clinical interventions that could potentially improve compliance, reduce attrition and ultimately benefit the sleep and well-being of all infants and their parents, especially those who struggle with traditional extinction methodologies.

Breastfeeding and Maternal Perceptions of Infant Sleep, Settle and Cry Patterns in the First 9 Months

“…It is important to consider parenting confidence and mental health status when examining perceptions of infant sleep, and greater support should be provided to these parents. Traditional infant sleep education programs are not consistently effective and are unacceptable to some parents [ 34 ]. An alternative approach is a responsive sleep intervention, with emerging evidence of effectiveness in consolidating infant sleep and reducing night waking while promoting maternal adjustment and reducing rates of perceived problematic infant sleep [ 34 , 35 , 36 ].…”

An overview of reviews for preventing and treating sleep problems in infants

“…For example, families who struggle with behavioural interventions could benefit from a more tailored approach, thus preventing a sense of failure 32 . Meanwhile, proponents of infant behaviour management must acknowledge that some families need alternative interventions, despite a current lack of research on these 33,34 …”

“…32 Meanwhile, proponents of infant behaviour management must acknowledge that some families need alternative interventions, despite a current lack of research on these. 33,34…”

Increasing Sleep Health Awareness in Pediatric Settings: Creating Opportunities for Generating a More Sleep-literate Health Care Workforce

“…For these parents the treatment may be worse than the problem. On the other hand, there is emerging evidence to support the use of more responsive methods for those who find extinction approaches behaviorally or ideologically challenging (16). Behavioral sleep treatments that do not necessitate unattended crying are emerging and are often termed "responsive" methods because they do not ignore an infant's cries and may offer a less stressful option to parents attempting to improve their infant's sleep (16,17).…”

“…from extinction to responsive methods if required), that could cater for all parenting styles. Offering choice would potentially improve compliance, reduce attrition and ultimately benefit the sleep and wellbeing of all infants and their parents, especially those who struggle with traditional extinction methodologies (16).…”