Effect of Parental Counseling on Infants’ Healthy Sleep Habits in Brazil

Abstract

IMPORTANCE Poor sleep during early childhood is associated with adverse outcomes, including obesity, cognitive impairment, and mental and behavioral disorders. OBJECTIVE To assess the efficacy of an educational intervention in the promotion of nighttime sleep duration. DESIGN, SETTING, AND PARTICIPANTS This single-blind, intent-to-treat randomized clinical trial included participants in Pelotas, Brazil, aged 3 months who were followed up until age 24 months. Eligibility criteria included healthy infants aged approximately 3 months who slept less than 15 hours per 24 hours. Infants were randomized to the intervention group or control group. INTERVENTIONS Information on sleep characteristics, improvements in the environment, establishment of a nighttime sleep routine, and waiting before attending nocturnal awakenings was delivered to mothers in the intervention group by trained home-visitors at baseline. The intervention group received a telephone call on the first and second day after the intervention and a home visit on the third day after the intervention. The intervention's content was reinforced at health care visits for ages 6 months and 12 months. Mothers allocated to the control group were counseled on the benefits of breastfeeding for the mother's and child's health and given written material with content on breastfeeding. MAIN OUTCOMES AND MEASURES Nighttime sleep duration was measured by interview and actigraphy at baseline and ages 6, 12, and 24 months and diaries at baseline and age 6 months. At ages 3 and 6 months, nighttime sleep self-regulation was calculated by subtracting nighttime sleep duration recorded by actigraphy from nighttime sleep duration recorded in the diaries and at ages 12 and 24 months by subtracting nighttime sleep duration recorded by actigraphy from nighttime sleep duration obtained by interview. RESULTS Among 1812 mother-infant dyads invited to participate, 798 met the inclusion criteria and 586 agreed to participate. The intervention group included 298 infants (154 [52.9%] boys), and the control group included 288 infants (164 [58.2%] boys). At age 6 months, mean (SD) nighttime sleep duration recorded in diaries was 9.80 (1.85) hours in the intervention group and 9.49 (2.07) hours in the control group, a difference of 19 minutes longer for the intervention group. At age 12 months, mean (SD) nighttime sleep duration based on the Brief Infant Sleep Questionnaire was 8.43 (1.35) hours in the intervention group and 8.52 (1.35) hours in the control group, a difference of 5 minutes shorter for the intervention group. At age 24 months, compared with information from the interview, actigraphy records showed that children in the intervention group stayed awake at night without signalizing for a mean (SD) of 0.52 (2.52) hours, whereas children in the control group stayed awake (continued) Key Points Question Can an educational intervention improve infants' nighttime sleep duration and sleep habits? Results In this randomized clinical trial with 586 children assessed at ages 3 (baseline),...

Maternal perinatal depression and infant sleep problems at 1 year of age: Subjective and actigraphy data from a population‐based birth cohort study

“…Another potential limitation was the exclusion of children who slept fewer than 15 hr a day at 3 months, who were participating in the nested Sleep Trial. However, at baseline, mean EPDS scores of mothers in the intervention group were similar to those in the control group (5.8 and 5.2, respectively) (Santos et al, 2019). Additionally, in our sample, 81.5% of mothers who were depressed in the perinatal period were still depressed at 12 months after delivery ( n = 212 of 260 perinatally depressed mothers whose 12‐month depression rates were available).…”

Development and evaluation of ‘Sleep, Baby & You’—An approach to supporting parental well-being and responsive infant caregiving

“…[22,38,39]. Although several trials have tested the effectiveness of educational interventions (based on sleep hygiene, self-settling, and the use of routines) alone or in combination with other psychological approaches [13,[23][24][25] they have at best produced mixed results, and most have been found to be ineffective [14,[40][41][42]. 'Limit-setting' educational approaches designed to support the development of 'settled infant night-time behaviour' have been examined as preventative interventions [7,24,26] but have been unsuccessful in achieving their primary outcome of increasing the duration of infant night-time sleep, although researchers do not agree on the strength of evidence for these approaches and better research is needed.…”

“…by eliminating infant 'sleep problems' [22][23][24]. Treatment-oriented interventions often involve extinction techniques applied to infants who are causing parental sleep disruption [22,23,[25][26][27].…”

“…Likewise some interventions for IRSD have been anticipatory and universal with a general focus on establishing bed-time routines, self-settling, and sleep schedules [ 7 , 17 ], with more elaborate approaches for older infants and toddlers combining the latter with guidance on feeding, bathing, and bed-time stories [ 18 – 21 ]. In contrast the traditional intervention strategy for ISD has been targeted and treatment-oriented, aiming to improve disrupted parental sleep by eliminating infant ‘sleep problems’ [ 22 – 24 ]. Treatment-oriented interventions often involve extinction techniques applied to infants who are causing parental sleep disruption [ 22 , 23 , 25 – 27 ].…”

Increased risk for excessive weight gain in infants who sleep less than 12 hours per 24 hoursCommentary on Yu J, Jin H, Wen L, et al. Insufficient sleep during infancy is correlated with excessive weight gain in childhood: a longitudinal twin cohort study. J Clin Sleep Med . 2021;17(11):2147–2154. doi:10.5664/jcsm.9350

“…24 Several prospective studies are encouraging parents to help infants acquire healthier sleep habits, move more, and spend less time in the car seat; avoid using food as reward or punishment (response feeding); breastfeed rather than use formula; and avoid electronic screen exposure before age 18 months. [25][26][27][28][29] Particularly intriguing is the Snuggle Bug/Acurrucadito study investigating the influence of sleep/wake patterns on gut microbiome development and rapid weight gain in infancy. 29 Increases in the abundance of Bifidobacteria species at age 3 months and Staph aureus at ages 6 and 12 months are associated with being overweight at age 10 years.…”