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Statistical analysis, conclusions, acknowledgment, prevalence and factors associated with safe infant sleep practices.

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Ashley H. Hirai , Katherine Kortsmit , Lorena Kaplan , Erin Reiney , Lee Warner , Sharyn E. Parks , Maureen Perkins , Marion Koso-Thomas , Denise V. D’Angelo , Carrie K. Shapiro-Mendoza; Prevalence and Factors Associated With Safe Infant Sleep Practices. Pediatrics November 2019; 144 (5): e20191286. 10.1542/peds.2019-1286

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Video Abstract

To examine prevalence of safe infant sleep practices and variation by sociodemographic, behavioral, and health care characteristics, including provider advice.

Using 2016 Pregnancy Risk Assessment Monitoring System data from 29 states, we examined maternal report of 4 safe sleep practices indicating how their infant usually slept: (1) back sleep position, (2) separate approved sleep surface, (3) room-sharing without bed-sharing, and (4) no soft objects or loose bedding as well as receipt of health care provider advice corresponding to each sleep practice.

Most mothers reported usually placing their infants to sleep on their backs (78.0%), followed by room-sharing without bed-sharing (57.1%). Fewer reported avoiding soft bedding (42.4%) and using a separate approved sleep surface (31.8%). Reported receipt of provider advice ranged from 48.8% (room-sharing without bed-sharing) to 92.6% (back sleep position). Differences by sociodemographic, behavioral, and health care characteristics were larger for safe sleep practices (∼10–20 percentage points) than receipt of advice (∼5–10 percentage points). Receipt of provider advice was associated with increased use of safe sleep practices, ranging from 12% for room-sharing without bed-sharing (adjusted prevalence ratio: 1.12; 95% confidence interval: 1.09–1.16) to 28% for back sleep position (adjusted prevalence ratio: 1.28; 95% confidence interval: 1.21–1.35). State-level differences in safe sleep practices spanned 20 to 25 percentage points and did not change substantially after adjustment for available characteristics.

Safe infant sleep practices, especially those other than back sleep position, are suboptimal, with demographic and state-level differences indicating improvement opportunities. Receipt of provider advice is an important modifiable factor to improve infant sleep practices.

Approximately 3500 infants die annually in the United States from sleep-related sudden unexpected causes. Previous studies have indicated suboptimal adherence to safe infant sleep recommendations and highlighted various sociodemographic disparities and connections with provider advice.

We update previous estimates of safe infant sleep and include a new composite measure assessing the use of separate approved sleep surfaces. We also explore state variation and examine associations between provider advice and each of 4 corresponding sleep-related practices.

Approximately 3500 infants die annually in the United States from sudden unexpected infant deaths (SUIDs), including sudden infant death syndrome (SIDS), undetermined causes, and accidental suffocation and strangulation in bed. 1 – 4   SUID rates declined 45% from 1990 to 1998, 4   coinciding with the 1992 American Academy of Pediatrics (AAP) recommendation that infants be placed on their backs to sleep 5 , 6   and the accompanying Back to Sleep (now Safe to Sleep) campaign led by the National Institutes of Health. 7   Since 1998, however, the SUID rate has declined <10%, 4   whereas the prevalence of back sleep position has plateaued. 8 – 10   To further reduce SUID, the AAP expanded safe sleep recommendations to include using a firm sleep surface (eg, crib or bassinet), room-sharing without bed-sharing, and avoiding soft objects and loose bedding. 3 , 11 – 13   Data from the National Infant Sleep Position (NISP) study, conducted among nighttime caregivers, show that bed-sharing doubled from 1993 to 2010 (from 6.5%→13.5%), 14   whereas soft bedding declined by over a third (from 85.9% to 54.7%). 15  

Ongoing national surveillance of adherence to the AAP safe sleep recommendations has been limited since the NISP ended in 2010. Through the Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based survey of mothers with recent live births, information on sleep position has been collected in participating states since 1996 and on bed-sharing and use of soft bedding in select states since 2009. PRAMS data from 2015 showed that unsafe sleep practices were common and indicated demographic and state-level variation. 9   However, analyses beyond sleep position were limited to <15 states. With funding from the Health Resources and Services Administration (HRSA), new PRAMS questions capturing expanded sleep-related recommendations were added for all participating states in 2016 as part of a new national performance measure for the Title V Maternal and Child Health Services State Block Grant Program. 16   Given that provider advice influences sleep practices, 8 , 10 , 14 , 17   questions assessing the reported receipt of advice for sleep-related practices were also included. We analyzed 2016 PRAMS data to describe safe sleep practices aligned with the AAP recommendations and HRSA Title V national performance measure as well as associations with receipt of provider advice and other factors to identify improvement opportunities.

PRAMS data collection methodology has been previously described. 18   Briefly, mothers are randomly sampled from birth certificate records and complete the PRAMS survey (mail or telephone) within 2 to 9 months postpartum. Twenty-nine of 39 participating states met the Centers for Disease Control and Prevention’s (CDC’s) response rate threshold (55%) for analysis. The weighted overall mean response rate was 61% (range: 55%–73%). Data were weighted to account for selection probability, differential nonresponse by demographic characteristics, and noncoverage, representing all births in 29 states (51% of all 2016 US births). Analysis was restricted to infants living with their mothers at survey completion (98.7%). The weighted mean infant age was 4.1 months with 97.4% ≤6 months. The CDC and each state’s institutional review board approved the PRAMS protocol.

Safe Sleep Practices

We examined maternal report of 4 infant sleep practices: (1) back sleep position, (2) separate approved sleep surface, (3) room-sharing without bed-sharing, and (4) no soft objects or loose bedding (“soft bedding”). “Back sleep position” was assessed by a single item regarding the position mothers most often placed their infant to sleep (ie, back versus side, stomach, or combination). “Separate approved sleep surface” was assessed with a 5-item composite indicating how the infant usually slept in the past 2 weeks: (1) separate was defined as an infant sleeping alone in their own crib or bed (always or often versus sometimes, rarely, or never) and (2) an approved sleep surface was defined as the infant usually sleeping in a crib, bassinet, or pack and play but not in a twin or larger bed, couch or armchair, or infant car seat or swing (no versus yes). “Room-sharing without bed-sharing” was assessed as a 2-item composite indicating whether the infant usually slept in the past 2 weeks: (1) alone in their own crib or bed (always or often versus sometimes, rarely, or never) and (2) in the same room as their mothers (yes versus no). Operationalization of these 2 measures offers a consistent assessment of usual practice across items, which aligns with previous national studies. 6 , 8 , 14 , 15 , 19   We also examined report of the infant “always” versus “often, sometimes, rarely, or never” sleeping in their own crib or bed for “separate approved sleep surface” and “room-sharing without bed-sharing” to more closely reflect adherence to the AAP recommendation of separate sleep surfaces for infants. “No soft bedding” was assessed with a 3-item (no versus yes) composite indicating that the infant usually slept in the past 2 weeks without blankets, toys, cushions, or pillows and crib bumper pads.

Safe Sleep Advice

We examined reported receipt of advice from a doctor, nurse, or other health care worker corresponding to the 4 safe sleep practices. Mothers reported whether they were told by a provider to (1) place their infant on their back to sleep; (2) place their infant to sleep in a crib, bassinet, or pack and play; (3) place infant’s crib or bed in the mother’s room; and (4) what items should and should not be in the infant sleep environment.

Consistent with previous literature, 3 , 8 – 10 , 14 , 15 , 19 – 22   we examined characteristics that may be associated with sleep practices and receipt of advice. Sociodemographic characteristics obtained from the birth certificate included maternal age, race and ethnicity, education, marital status, and state of residence as well as infant gestational age. Behavioral characteristics from the PRAMS survey included breastfeeding and smoking at time of survey. Health care characteristics obtained from the birth certificate that may influence the delivery of provider advice and sleep practices included prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); timing of prenatal care initiation; and insurance coverage at delivery.

Bivariate associations between main outcomes and covariates were examined with χ 2 tests of significance. We used multivariable logistic regression models, with each safe sleep practice as the dependent variable, to examine adjusted associations with maternal and infant characteristics, behaviors, health care characteristics, and receipt of corresponding provider advice as well as state of residence. To improve interpretation and translation, we converted estimated odds to marginal probabilities and adjusted prevalence ratios. 23   Unadjusted and model-adjusted state-level prevalence estimates were compared to assess the contribution of covariates in explaining state variation. Statistical significance was defined as a P value <.05 with only practically meaningful differences of at least 5 percentage points highlighted within the text. Missing data ranged from 2% to 6% across outcomes. Approximately 9% of observations were missing covariate data and were excluded from regression analysis. Analyses accounted for the complex sampling design of PRAMS by using SAS-callable SUDAAN 11.0.0.

Overall, most (78.0%) mothers reported placing their infants to sleep on their backs ( Table 1 ). Although most (74.4%) usually (“always or often”) used a separate sleep surface, slightly more than half (57.1%) also reported room-sharing. A smaller proportion (41.1%) reported room-sharing and “always” using a separate sleep surface. Less than one-third of infants (31.8%) “always or often” slept separately on an approved sleep surface; a smaller proportion (26.3%) “always” slept separately on an approved sleep surface. Most mothers reported that their infants usually slept in a crib, bassinet, or pack and play (87.8%), but these were the sole usual sleep surfaces for only 34.9%. Infant car seat or swing (50.7%), twin or larger bed (30.9%), and couch or armchair (9.0%) were less frequently reported as the usual sleep surface. Less than half of mothers (42.4%) reported using no soft bedding for infant sleep. Blankets were most commonly reported (50.5%), followed by crib bumper pads (17.6%) and toys, cushions, or pillows (8.9%).

Infant Sleep Practices, 29 States, PRAMS, 2016

Data are from Alaska, Arkansas, Colorado, Connecticut, Delaware, Illinois, Iowa, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Nebraska, New Hampshire, New Jersey, New Mexico, New York, Oklahoma, Pennsylvania, Rhode Island, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. CI, confidence interval.

Defined as most often placing their infant to sleep on the back versus side, stomach, or combination.

Defined as a composite of 5 items indicating how the infant usually slept in the past 2 wk: (1) alone in their own crib or bed (always or often versus sometimes, rarely, or never); (2) in a crib, bassinet, or pack and play; (3) not in a standard bed; (4) not on a couch or armchair; and (5) not in a car seat or swing (yes versus no).

Defined as a composite of 5 items indicating how the infant usually slept in the past 2 wk: (1) alone in their own crib or bed (always versus often, sometimes, rarely, or never); (2) in a crib, bassinet, or pack and play; (3) not in a standard bed; (4) not on a couch or armchair; and (5) not in a car seat or swing (yes versus no).

Defined as a composite of 2 items indicating that the infant usually slept in the past 2 wk: (1) alone in their own crib or bed (always or often versus sometimes, rarely, or never) and (2) in the same room as their mothers (yes versus no).

Defined as a composite of 2 items indicating that the infant usually slept in the past 2 wk: (1) alone in their own crib or bed (always versus often, sometimes, rarely, or never) and (2) in the same room as their mothers (yes versus no).

Defined as a composite of 3 items indicating that the infant usually slept in the past 2 wk without (1) blankets; (2) toys, cushions, or pillows; and (3) crib bumper pads (yes versus no).

Mothers who were older, non-Hispanic white, more educated, and married were more likely to report the following usual safe sleep practices: back sleep position, separate approved sleep surface, and no soft bedding ( Table 2 ). In contrast, younger, Hispanic, less-educated, and unmarried mothers had a higher prevalence of usually room-sharing without bed-sharing. Racial and ethnic differences existed across all safe sleep practices. Non-Hispanic black mothers had the lowest prevalence of using the back sleep position (62.3%), Non-Hispanic Asian or Pacific Islander mothers had the lowest prevalence of using separate approved sleep surfaces (20.6%), and non-Hispanic American Indian or Alaska Native mothers had the lowest prevalence of room-sharing without bed-sharing (50.5%) and avoiding soft bedding (25.6%). There was also an age gradient for soft bedding use, with teenaged mothers having the lowest prevalence of following recommendations to avoid soft bedding (25.0%) compared with approximately half of mothers ≥30 years.

Usual Safe Infant Sleep Practices by Sociodemographic, Behavioral, and Health Care Characteristics, 29 States, PRAMS, 2016

Data are from Alaska, Arkansas, Colorado, Connecticut, Delaware, Illinois, Iowa, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Nebraska, New Hampshire, New Jersey, New Mexico, New York, Oklahoma, Pennsylvania, Rhode Island, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. CI, confidence interval; GED, general equivalency diploma; —, not applicable.

Defined as a composite of 5 items indicating how the infant usually slept in the past 2 wk: (1) alone in their own crib or bed (always or often versus sometimes, rarely, or never); (2) in a crib, bassinet, or pack and play; (3) not in a standard bed; (4) not in a couch or armchair; and (5) not in car seat or swing (yes versus no).

Mothers who reported currently breastfeeding had a higher prevalence of using the back sleep position (80.5% vs 75.2%) and no soft bedding (46.8% vs 37.5%) than mothers not breastfeeding. However, breastfeeding mothers had a lower prevalence of room-sharing without bed-sharing (53.3% vs 61.3%). Mothers currently smoking had a lower prevalence of using separate approved sleep surfaces (25.6% vs 32.5%) and no soft bedding (31.2% vs 43.8%) than nonsmokers. Mothers who participated in WIC, received late or no prenatal care, and were Medicaid insured or uninsured generally had lower rates of safe sleep practices. However, room-sharing without bed-sharing was more common among WIC participants than nonparticipants (62.8% vs 53.5%) and among Medicaid-insured than privately insured mothers (63.2% vs 52.5%). Types of sleep surfaces and soft bedding showed similar patterns to overall indicators, with the exception of sleeping in a car seat or swing, which lacked substantial or consistent patterning ( Supplemental Table 5 ). Infants of non-Hispanic American Indian or Alaska Native mothers had notably higher rates of sleeping on a couch or armchair (18.2% vs 9.0% overall) and with a blanket (70.3% vs 50.5% overall).

Most mothers reported receiving provider advice on placing their infant to sleep on their back (92.6%); in a crib, bassinet, or pack and play (83.5%); and about what items are appropriate in the sleep environment (85.0%) ( Table 3 ). Only half (48.8%) reported receiving advice to room share without bed-sharing. Differences by sociodemographic, behavioral, and health care characteristics with regard to provider advice were generally smaller than for safe sleep practices (mostly within 5–10 percentage points). Receiving room-sharing without bed-sharing advice was more common among mothers who were younger, less educated, WIC participants, either Medicaid insured or uninsured, and whose race or ethnicity was not non-Hispanic white or multiple race.

Receipt of Health Care Provider Advice by Sociodemographic, Behavioral, and Health Care Characteristics, 29 States, PRAMS, 2016

After adjustment, most characteristics remained significantly related to one or more safe sleep practice, with the exception of WIC participation ( Table 4 ). Using a separate approved sleep surface and avoiding soft bedding had some of the largest sociodemographic differences. In particular, teenage mothers were 34% less likely than 25- to 29-year-olds to avoid soft bedding, whereas non-Hispanic Asian or Pacific Islander mothers were ∼40% less likely than non-Hispanic white mothers to use separate approved sleep surfaces and avoid soft bedding. Currently breastfeeding mothers were 22% less likely than mothers not breastfeeding to use separate approved sleep surfaces, whereas mothers who were smoking were 23% less likely than nonsmokers to use separate approved sleep surfaces and 13% less likely to avoid soft bedding. Report of receiving health care provider advice was associated with an increased prevalence of safe sleep practices, ranging from 12% (room-sharing without bed-sharing) to 28% (back sleep position) higher, with absolute prevalence differences ranging from 6.0 to 17.3 percentage points.

Adjusted Associations With Usual Safe Infant Sleep Practices, 29 States, PRAMS, 2016

All models are adjusted for PRAMS state. Data are from Alaska, Arkansas, Colorado, Connecticut, Delaware, Illinois, Iowa, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Nebraska, New Hampshire, New Jersey, New Mexico, New York, Oklahoma, Pennsylvania, Rhode Island, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. aPR, adjusted prevalence ratio; CI, confidence interval; GED, general equivalency diploma; —, not applicable.

Defined as a composite of 5 items indicating how the infant usually slept in the past 2 wk: (1) alone in their own crib or bed (always or often versus sometimes, rarely, or never); (2) in a crib, bassinet, or pack and play; (3) not in a standard bed; (4) not on a couch or armchair; and (5) not in car seat or swing (yes versus no).

The prevalence of each safe sleep practice varied significantly by state, ranging ∼20 to 25 percentage points across outcomes ( Supplemental Table 6 ). Back sleep position ranged from 67.4% in Louisiana to 87.7% in Iowa. Separate approved sleep surface ranged from 20.1% in New Mexico to 40.0% in West Virginia, whereas room-sharing without bed-sharing ranged from 46.8% in Alaska to 65.5% in Delaware. No soft bedding ranged from 24.7% in New Mexico to 51.8% in Michigan. States with prevalence estimates significantly higher (green) or lower (orange) than overall rates by at least 5 percentage points are highlighted in Fig 1 . After adjustment for covariates, state estimates changed by <1 percentage point across outcomes on average.

Usual safe infant sleep practice prevalence by state, PRAMS, 2016. A, Back sleep position. B, Separate approved sleep surface. C, Room-sharing without bed-sharing. D, No soft objects or loose bedding.

The findings from this 29-state PRAMS analysis indicate that most mothers place their infants to sleep on their back (78.0%), whereas fewer room share without bed-sharing (57.1%), and less than half report using separate approved sleep surfaces (31.8%) and avoiding soft bedding (42.4%). Common use of soft bedding, including blankets, has been previously documented 9 , 15   and is frequently reported among SIDS and accidental suffocation and strangulation in bed cases. 24 , 25   Although only 9% of mothers reported their infant usually slept on a couch or armchair, consistent with previous estimates, 19   this practice is associated with a highly elevated risk of SIDS and suffocation (eg, wedging, entrapment, and overlay), especially when surface sharing with another person. 20 , 25 , 26  

Although the Safe Infant Sleep Study of Attitudes and Factors Effecting Infant Care Practices (SAFE), the most recent national study, assessed both bed-sharing and usual sleep surface (eg, crib, bassinet, adult bed, car seat, sofa), 19   we developed a composite measure to assess usual use of a separate approved (crib, bassinet, or pack and play) sleep surface. Our estimate from the component of usual (“always or often”) sleep on a separate sleep surface (74.4%; “always”: 55.7%, “often”: 18.7%) was comparable to the not usually bed-sharing estimate from SAFE (79.3%). Although nearly 90% of mothers reported their infant usually slept in a crib, bassinet, or pack and play, only about one-third reported it as a sole usual sleep surface, which may represent an underacknowledged risk. Our estimates for usual back sleep position (78.0%) and room-sharing without bed-sharing (57.1%) were comparable to SAFE estimates (77.3% 10   and 65.5%, 19   respectively).

Both NISP 6 , 8 , 14 , 15   and SAFE 10 , 19   lacked sufficient sample size to examine all major racial and ethnic groups. We found that non-Hispanic black mothers were least likely to report back sleep position and also had lower prevalence of using separate approved sleep surfaces and avoiding soft bedding compared with non-Hispanic white mothers. Non-Hispanic American Indian or Alaska Native mothers were least likely to avoid soft bedding, had lower use of separate approved sleep surfaces, and had doubled prevalence of couch or arm chair sleeping compared with non-Hispanic white mothers. Both racial and ethnic groups have SUID rates twice as high as non-Hispanic white mothers. 27   However, non-Hispanic Asian or Pacific Islander mothers had the lowest prevalence of using separate approved sleep surfaces and were less likely to report back sleep position and avoiding soft bedding yet have SUID rates less than half of non-Hispanic white mothers. 27   This paradox may arise from differences in other risk and protective factors, 28   such as lower smoking 22 , 29   and higher breastfeeding 30 , 31   rates. Although adjustment mitigated many racial and ethnic disparities, crude prevalence may be more informative in identifying a need for culturally appropriate and focused programmatic efforts.

Although breastfeeding reduces SIDS risk, 20 , 32   breastfeeding was associated with lower rates of room-sharing without bed-sharing and using separate approved sleep surfaces, consistent with other literature. 9 , 19 – 21   The AAP recognizes women may fall asleep when breastfeeding 20   and recommends that if mothers fall asleep while feeding on the same surface, they should return the infant to a separate sleep surface as soon as they awaken. Smith et al 19   found that receiving advice from multiple sources, such as family members and health care providers, improved room-sharing without bed-sharing without negatively affecting breastfeeding rates. By contrast, smoking is a SIDS risk factor, and risk is particularly pronounced when combined with bed-sharing. 20 , 33 , 34   Current smoking was associated with lower rates of using separate approved sleep surfaces and avoiding soft bedding even after adjustment for demographic characteristics, suggesting a need for enhanced counseling among women with smoking histories.

Reported receipt of provider advice was associated with increased prevalence of each corresponding safe sleep practice. Yet, 15% of mothers reported not receiving advice to use a separate sleep surface and avoid soft bedding, whereas over half reported not receiving advice to room share without bed-sharing. Before 2005, the AAP recommended room-sharing only as an alternative to bed-sharing, which may explain lower rates of provider advice. However, previous studies have reported lower estimates of provider advice for other safe sleep practices, 8 , 10 , 14 , 17 , 35   indicating a general need to improve messaging beyond room-sharing without bed-sharing. A previous national survey of pediatricians and family physicians also corroborates improvement opportunities in provider knowledge and practice regarding safe sleep recommendations. 36   Several HRSA-funded initiatives 37 , 38   and the National Institutes of Health–funded Safe to Sleep campaign 7   include provider training modules that integrate effective behavior change methods, such as motivational interviewing. New mobile health message interventions, 39   clinical decision support tools, 40 – 42   and quality improvement initiatives, 43 – 46   including CDC-funded perinatal quality collaborative initiatives, 47   also show promise to improve safe sleep practices.

State-level differences in safe sleep practices spanned ∼20 to 25 percentage points and did not substantially change after adjustment to promote comparability across demographic, behavioral, and health care characteristics. The average change across outcomes, before and after adjustment, was <1 percentage point. This suggests state-level differences in sleep practices are not heavily influenced by sociodemographic characteristics and reflect state or regional norms as well as the impact of programmatic efforts, such as the Collaborative Innovation and Improvement Network to reduce infant mortality. 48 , 49   In future analyses, researchers could explore the range of risk and protective factors that may explain state-level SUID variation.

Although this analysis offers a recent, population-based assessment of safe sleep practices and provider advice, the analysis was limited to 29 states and lacks representation from southeastern states, which have some of the highest SUID rates in the nation. 4 , 50   Thus, our 29-state range in safe sleep practices may be narrower than the total US state range. Additionally, our estimates of usual practice do not represent consistent adherence to AAP recommendations. Although we compared “always” versus “always or often” sleeping separately, it is unclear whether “often” responses reflected bed-sharing with a sleeping parent versus incidental infant sleep while feeding or bonding with an awake adult. Bed-sharing was not specifically assessed either in the measurement of the outcome or provider advice. Similarly, our measure of separate approved sleep surface did not distinguish between intentional versus incidental sleep in a car seat or swing. For example, infants may fall asleep during usual commuting without being intentionally placed to sleep in a car seat. Our estimate of separate approved sleep surface increases from 31.8% to 56.2% if usual sleep in a car seat or swing is excluded. Further, cribs, bassinets, and pack and plays were presumed “approved” but may not meet safety standards.

The safest place for infants to sleep is on their backs, on separate, firm sleep surfaces without any soft bedding and in the same room as caregivers. 3   Safe sleep practices, especially those other than back sleep position, are suboptimal, with demographic and state-level differences indicating improvement opportunities. Provider advice is an important, modifiable factor to improve safe sleep practice. Expanded efforts to reach population groups with multiple overlapping SUID risks, such as smoking, soft bedding, and shared sleep surfaces, are needed. Ongoing collection and analysis of PRAMS and other data are essential to inform and evaluate both national and state-specific efforts.

We thank the PRAMS Working Group for coordinating collection of the data used in this analysis.

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Health Resources and Services Administration, Centers for Disease Control and Prevention, or National Institutes of Health.

Dr Hirai conceptualized and designed the study, supervised the analysis, drafted the initial manuscript, and reviewed and revised the manuscript; Dr Kortsmit contributed to the study design, conducted the analysis, assisted with data interpretation, and reviewed and revised the manuscript; Ms Kaplan and Drs Warner and Parks contributed to the study design and interpretation of data and reviewed and revised the manuscript; Ms Reiney was instrumental to data acquisition, contributed to the study design, and reviewed and revised the manuscript; Ms Perkins, Dr Koso-Thomas, and Ms D’Angelo contributed to the study design and reviewed and revised the manuscript; Dr Shapiro-Mendoza contributed to the study design, analysis, and interpretation and critically revised the manuscript for important intellectual content; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

FUNDING: No external funding.

COMPANION PAPER: A companion to the article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2019-2310 .

American Academy of Pediatrics

Centers for Disease Control and Prevention

Health Resources and Services Administration

National Infant Sleep Position

Pregnancy Risk Assessment Monitoring System

Safe Infant Sleep Study of Attitudes and Factors Effecting Infant Care Practices

sudden infant death syndrome

sudden unexpected infantdeath

Special Supplemental Nutrition Program for Women, Infants, and Children

Competing Interests

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• Open access
• Published: 04 May 2024

Early sleep intervention for improving infant sleep quality: a randomized controlled trial, preliminary result

• Auraya Sinthong 1 &
• Dussadee Ngernlangtawee 1  

BMC Pediatrics volume  24 , Article number:  306 ( 2024 ) Cite this article

314 Accesses

Metrics details

Healthy sleep issues should provide to family within first 6 months of infant’s life. This study aimed to evaluate the effect of early sleep intervention on nighttime sleep quality.

Eligible infants aged 4 months ± 2 weeks were randomized to receive early sleep intervention or usual care. Data on sleep variables were obtained via parental interview at baseline and 6 months of age. Using logistic regression to analyze the efficacy of early sleep intervention.

At baseline, 335 eligible infants were enrolled and randomized. In total, 306 participants were final analyzed: early sleep intervention group ( n  = 148) and the usual care group ( n  = 158). The early sleep intervention group had a significantly longer nighttime sleep duration and a shorter night waking duration than the usual care group (585.20 ± 80.38 min vs. 496.14 ± 87.78 min, p  < .001 and 61.01 ± 36.38 min vs. 89.72 ± 45.54 min, p  < .001). At 6 months of age, the early sleep intervention group had a longer night sleep duration (≥ 4 h/time) than the usual care group (adjusted odds ratio: 2.39, 95% confidence interval: 1.34–4.28).

Conclusions

Early sleep intervention should be recommended to infants at 4 months of age as a part of well childcare to improve infant sleep quality.

Trial Registration

Thai Clinical Trials Registry (thaiclinicaltrial.org). Retrospective registered TCTR20230117001 (17/01/2023).

Peer Review reports

Introduction

Night waking and a short sleep duration are common issues during the infancy period. According to the normal sleep development, infants aged 3–6 months can consolidate their sleep throughout the night without feeding [ 1 , 2 ]. A longer duration of nighttime sleep is correlated with older age [ 3 , 4 ]. Within the first 6 months of life, an infant’s sleep is significantly changing. Infants have the longest sleep period increase rate at 7.2–39 min per month, and have a decreased number of night waking rate at 0.33 wakes per month [ 5 , 6 , 7 ]. At 6 months of age, 56% of healthy full-term infants developed sleep regulation, and they could consolidate their sleep up to 8.5 h per night [ 8 ]. Nonmaintenance of sleep or a short sleep duration is significantly associated with later sleep issues at 12, 24, and 36 months of age (odd ratio: 6.7, 3.1, and 3.3, respectively) [ 9 ] or other issues such as childhood overweight [ 10 ], emotional challenges [ 11 ], and maternal psychological problems [ 12 , 13 , 14 ].

Review studies have shown that good sleep in the early stage of life has several benefits. That is, it can result in a longer night sleep duration and decreased sleep issues, which are associated with positive effects on memory, language, executive function, and cognitive outcomes from toddlerhood to adolescence [ 15 ]. Infant sleep intervention reduced the number of night waking, increased daytime and nighttime sleep duration, and promoted independence in going back to sleep after night waking [ 5 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. IP Landsem and NB Cheetham [ 23 ] evaluated sleep studies on infants aged < 6 months. In particular, 9 of 17 studies focused on infant sleep interventions such as responsive parent intervention, parental cry tolerance, and behavioral–educational sleep intervention. This review showed that interventions focusing on parental education about normal sleep development, bedtime routine consistency, and methods used to develop infant sleep consolidation should be discussed with families within the first 3–6 months of an infant’s life. One important points, the authors suggested that parental education should fit with sociocultural attitude and consistent with routine service, via any types of educational materials.

JA Mindell, A Sadeh, B Wiegand, TH How and DY Goh [ 24 ] revealed that race or ethnicity is a factor influencing sleep outcomes. There are only a few studies on early infant sleep intervention among Asians who differ in terms of sleep culture and trajectory. Asian infants had a significantly later bedtime and a shorter total sleep duration than Caucasian infants. Male sex (odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.3–1.8) and breastfeeding during sleep (OR: 1.3, 95% CI: 1.1–1.5) [ 25 , 26 ] were associated with a shorter sleeping period or a greater number of night waking.

Even pediatricians and child health personnels are knowledgeable about the importance of promoting good sleep health. However, in real-world settings, several issues should be discussed with the parents within a limited time. As our reviewed, we decided to use a 15-min educational clip to empower parental knowledge about early infant sleep in well-childcare clinic. Further, the efficacy of early sleep intervention before the age of 6 months in Thai infants has been questioned. Hence, the current study aimed to explore the positive effects of a 15-min educational clip about early sleep intervention on sleep outcomes in infants at the age of 6 months.

Study design

This was a randomized controlled trial. Eligible participants were randomized into two groups by a computer-generated block of four. One of the authors allocated participants to assign groups and another author provided sleep educational media to intervention group without discussion. The early sleep intervention and usual care groups were appointed at the Vajira hospital well-childcare clinic on different dates. Data were collected by the blinded-research assistant at 4 months of age (before group randomization) and at 6 months via direct or telephone interview. This study followed the criteria of the Consolidated Standards of Reporting Trial (CONSORT) statement for reporting parallel group randomized trial.

Recruitment of participants

This study was approved by the institutional review board of the faculty of Medicine Vajira hospital (COA 184/64) and retrospectively registered at Thai Clinical Trial Registry (thaiclinicaltrail.org; TCTR20230117001). The time of trial registration was January 16, 2023, research ethical approval was September 26, 2021, and first participant inclusion was November 1, 2021. There was misunderstanding between the first and corresponding authors about trial registration, we immediately registered after recognizing the pitfall. Research teams invited and registered the parents at well-childcare clinic to study. In accordance with the declaration of Helsinki, parents or legal guardians provided a written inform consent. Parents and infants aged 4 months ± 2 weeks who experienced night waking (≥ 3 times/night) were enrolled in this research. Infants with syndrome or genetic diseases, major neurodevelopmental issues (such as brain anomaly, cerebral palsy, and global developmental delay), history of allergy (cow’s milk protein allergy) or colic, a current history of anticonvulsant or sedative use, and a previous history of severe birth asphyxia or low birthweight or birth before 37 weeks of gestational age and twin participants were not included in the analysis. Moreover, parents who had a Center for Epidemiologic Studies-Depression scale (CES-D) score of ≥ 22, those who cannot communicate in Thai language, those whose who did not sleep with an infant, and those who cannot be followed-up were excluded from the study.

Sample size

Sample size estimates were based on intervention effect on sleep outcome measure, the number of night waking [ 25 ] and duration of nighttime sleep [ 17 ]. Based on previous study, a sample of 157 participants is required to detect a 30-minute mean difference in sleep duration and 97 participants to detect 20%-reduction of night waking at significant level of 0.05 and 80% power. Considering a 10% possible drop-out, a total of 173 participants per group will be recruited.

• Sleep intervention

A 15-min recorded-media about early sleep intervention was developed by research authors. This media included knowledge about normal sleep development, effects of poor sleep hygiene, safe sleep environment, and methods that can improve infant sleep hygiene.

At baseline (4-month checkup), one of authors provided a 15-min recorded-media to parents of the early sleep intervention group in a group (≤ 10 persons per group) before the well-childcare visit. The of the usual care group had or had not received sleep information at the well-childcare clinic.

Data assessment

Sleep quality was evaluated based on the number of night waking and duration of nighttime sleep. The nighttime period was from 6:01 pm to 6 am and the daytime period from 6:01 am to 6 pm. We collected data on the demographic characteristics of the participants, sleep environment, and infant and parent sleeping data. Information on infant sleep was collected via parental interview at baseline and 2 months after the intervention. A sleep questionnaire designed for this study was used. The content validity of the questionnaire was reviewed and examined by 2 developmental and behavioral pediatrics and 1 pediatric pulmonology. Each item must have the item-objective congruence (IOC) greater than 0.5 before using. The blinded-research assistant was trained to interview about sleep data within the last 7 days, which included sleep–wake time, number of wakening during nighttime, time and duration of each sleep–wake cycles, number of persons per bedroom, bedsharing, and methods used to fall asleep at onset and during nighttime (parental involvement: breastfeeding/bottle-feeding/use of pacifier/holding/padding or touching the baby and self-soothing: thumb sucking/swinging/use of a blanket/no intervention). In intervention group, one of parents who received media, was interviewed. We interviewed the same parents at follow-up visit in both groups.

Maternal depression was assessed using CES-D, Thai version [ 27 ]. CES-D is a self-reported questionnaire with 20 items. The item scores were as follows: 0, 1, 2, and 3, with a total score of 0–60. A score of ≥ 22 was associated with depression. The reliability Cronbach’s alpha coefficient is 0.86.

Statistical analysis

Statistical analyses were performed using the Statistical Package for the Social Sciences software version 25 (IBM SPSS Statistics for windows, version 25.0. Armonk, NY: IBM Corp). Continuous variables were expressed as means and standard deviation or median and interquartile range (IQR) if the data had a non-normal distribution. Categorical variables were presented as count and percentages. The baseline characteristics and sleep outcomes of both groups were compared using the chi-square test, independent t -test, and Mann–Whitney U test. A P value of < 0.05 was considered statistically significant. Variables such as age, sex, breast feeding, family income, parental education, and daytime sleep in the sleep outcome analysis were controlled and presented as adjusted odds ratio (AOR) with 95% confidence interval (95% CI). Incomplete or missing follow-up data were excluded. All analyses were per protocol.

In total, 357 infant–mother dyads were recruited, and 22 participants were excluded from the study. Among the remaining 335 participants, 167 were included in the early sleep intervention group and 168 in the usual care group. During the follow-up study, 18 participants were lost to follow-up ( n  = 8 in the early sleep intervention group, n  = 10 in the usual care group), and 11 participants in the early sleep intervention group refused to be followed-up and visited other well-childcare clinics. Finally, 306 participants were evaluated ( n  = 148 in the early sleep intervention group, n  = 158 in the usual care group) (Fig.  1 ).

Flowchart of participant selection

Table  1 shows the baseline characteristics of infants and parents. Results showed no significant difference in terms of infant sex, nighttime breast feeding, self-soothing ability, mother as the caregiver, caregiver’s age and education, house’s sound environment, and parental depression score. Table  2 presents the baseline characteristics of infant sleep. There was no significant difference in terms of total sleep duration ( P  = .186), total nighttime sleep duration ( P  = .871), and night wake time duration ( P  = .707). The early sleep intervention group had a significantly higher frequency of night waking than the usual care group ( P  < .001).

As shown in Table  3 , in terms of the 6-month outcome, the early sleep intervention group had a longer duration of total nighttime sleep (585.20 ± 80.38 vs. 496.14 ± 87.78 min, P  < .001) and night sleep period (213.11 ± 64.54 vs. 170.20 ± 56.98 min, P  < .001), shorter duration of night waking time (61.01 ± 36.38 vs. 89.72 ± 45.54 min, P  < .001), and lower number of night waking (1.93 ± 0.69 vs. 2.10 ± 0.67, P  = .025) than the usual care group. After adjusting for covariates, the early sleep intervention group had a longer nighttime sleep duration (sleep ≥ 4 h/time) than the usual care group (2.39 times; AOR 2.39, 95% CI: 1.34–4.28) (Table  4 ).

Infant sleep quality

This study found that early sleep intervention at the age of 4 months significantly improved sleep quality at the age of 6 months in infants. Providing a 15-min sleep education media to parents resulted in a longer total nighttime sleep duration (approximately 89 min) and a lower number of night waking in the intervention group compared with the usual care group. The early sleep intervention group had a higher proportion of infants who had prolonged night sleep (> 4 h per time) than the usual care group (28.4% vs. 13.9%). The effect of sleep intervention significantly differed after adjusting for covariate factors (AOR: 2.39, 95% CI: 1.34–4.28). Our results supported the study of IP Landsem and NB Cheetham [ 23 ], which showed the importance of providing encouragement to parents with infants who experienced sleep issues before the age of 6 months.

Comparison with previous studies

The nighttime sleep duration of infants in this study was similar to that in the randomized controlled study by IM Paul, JS Savage, S Anzman-Frasca, ME Marini, JA Mindell and LL Birch [ 17 ]. That is, the early sleep intervention group had a longer total nighttime sleep duration than the control group. However, other studies (BC Galland, RM Sayers, SL Cameron, AR Gray, AM Heath, JA Lawrence, A Newlands, BJ Taylor and RW Taylor [ 28 ], IS Santos, B Del-Ponte, L Tovo-Rodrigues, CS Halal, A Matijasevich, S Cruz, L Anselmi, MF Silveira, PRC Hallal and DG Bassani [ 29 ]) found that early sleep intervention did not significantly enhance sleep outcomes between two groups based on maternal reports. The early sleep intervention and usually care groups in this study had a higher percentage of breastfeeding during nighttime (75.4–79.2%) than those in previous studies on Thai/Asian infants (34.9–56.9%) [ 25 , 26 ]. Breastfeeding was associated with a greater number of night waking. This finding was in contrast to that of previously published studies [ 17 , 28 , 29 ], which showed that early sleep intervention had no significant effect on the number of night waking. Moreover, the current study found that the early sleep intervention group had a significantly lower night waking frequency (1.93 ± 0.69 vs. 2.10 ± 0.67, P  = .025) than the usual care group. Based on previous randomized controlled studies, 4–6% of the Asian populations may have ethnic or sleep cultural differences.

The early sleep intervention and usual care groups had a low proportion of 6-month-old infants who slept > 4 h/period (28.4 vs. 13.9). Further, only one infant from the early sleep intervention group slept for > 6 h/period (data not shown). The development of sleep consolidation in most infants was slower than expected. This result may be associated with parental sleep duration, late onset of parental sleep, or family socioeconomic status. Hence, this notion should be further explored.

Limitations

Our intervention was a simplified method and could be provided in all well-child clinics. We used a 15-min educational video clip regarding the benefits of good sleep, normal infant sleeping duration, and methods that can be used to increase nighttime sleeping hours and facilitate a safe sleep to educate parents of 4-month-old infants. One research assistant who was blinded to the participant’s group was trained to perform interviews. Each group was appointed separately to decrease contamination.

The current study had some limitations. Similar studies on infant sleep, number of night waking, and sleep duration were based on parental report. The current analysis method is feasible. However, recall bias might have existed, and inaccurate information on sleep outcomes could have been obtained with this method compared with the gold-standard method. M Camerota, KP Tully, M Grimes, N Gueron-Sela and CB Propper [ 30 ] suggested sleep questionnaire using beware underestimated 1.38 time of night waking and overestimated 32 min of infant sleep duration when compared with videosomnography. However, according to subjective parental reports, infant sleep duration and number of night waking were correlated with actigraphy results particularly in breast-fed infants [ 31 , 32 ]. One of limitations was natural exposure of sleep knowledge from social media or others, we did not explore or control about this. This may enhance the effect of intervention. The long-term efficacy of intervention is another limitation. Finally, considering statistics, we excluded missing outcome data from analysis, even though the result showed no difference in baseline characteristics, but interpretation of final outcomes should be aware of type I error.

Early sleep intervention had positive effects. The intervention focused on parental education about normal infant sleeping patterns and the promotion of healthy sleep. Further, information on early sleep intervention should be provided to families before the age of 6 months of infants. Nevertheless, further studies must be performed to evaluate self-soothing abilities or abilities to develop any behaviors that infant use to regulate themselves to sleep without parental involvement after early sleep intervention or the long-term outcomes of the intervention in Asian populations.

Data availability

The datasets used and/or analysed during the current study available from corresponding author on reasonable request.

Paruthi S, Brooks LJ, D’Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, et al. Recommended amount of Sleep for Pediatric populations: a Consensus Statement of the American Academy of Sleep Medicine. J Clin Sleep Med. 2016;12(6):785–6.

Article   PubMed   PubMed Central   Google Scholar  

Owen JA. JWSG, Blum NJ, Shah SS, Tasker RC, Wilson KM. Philadephia: Elsevier : Sleep medicine. In: Nelson textbook of pediatrics 21 edn. Edited by Kliegman RM, III 2020: 172–184.

Sadeh A, Mindell JA, Luedtke K, Wiegand B. Sleep and sleep ecology in the first 3 years: a web-based study. J Sleep Res. 2009;18(1):60–73.

Article   PubMed   Google Scholar  

Miano S. Normal sleep from Infancy to Adolescence. J Pediatr Biochem 2017.

Galland BC, Taylor BJ, Elder DE, Herbison P. Normal sleep patterns in infants and children: a systematic review of observational studies. Sleep Med Rev. 2012;16(3):213–22.

Bruni O, Baumgartner E, Sette S, Ancona M, Caso G, Di Cosimo ME, Mannini A, Ometto M, Pasquini A, Ulliana A, Ferri R. Longitudinal study of sleep behavior in normal infants during the first year of life. J Clin Sleep Med. 2014;10(10):1119–27.

Goh SKY, Tham EKH, Goh DYT, Teoh OH, Saw SM, Yap F, Chong YS, Qiu A, Broekman BFP. Infant night sleep trajectory from age 3–24 months: evidence from the Singapore GUSTO study. Sleep Med. 2017;33:82–4.

Henderson JMT, Blampied NM, France KG. Longitudinal study of infant Sleep Development: early predictors of Sleep Regulation across the First Year. Nat Sci Sleep. 2020;12:949–57.

Byars KC, Yolton K, Rausch J, Lanphear B, Beebe DW. Prevalence, patterns, and persistence of sleep problems in the first 3 years of life. Pediatrics. 2012;129(2):e276–284.

Halal CS, Matijasevich A, Howe LD, Santos IS, Barros FC, Nunes ML. Short sleep duration in the First years of life and Obesity/Overweight at age 4 years: a birth cohort study. J Pediatr. 2016;168:99–e103103.

Mindell JA, Leichman ES, DuMond C, Sadeh A. Sleep and Social-Emotional Development in infants and toddlers. J Clin Child Adolesc Psychol. 2017;46(2):236–46.

Bayer JK, Hiscock H, Hampton A, Wake M. Sleep problems in young infants and maternal mental and physical health. J Paediatr Child Health. 2007;43(1–2):66–73.

Škodová Z, Kelčíková S, Maskálová E, Mazúchová L. Infant sleep and temperament characteristics in association with maternal postpartum depression. Midwifery 2022, 103232(105).

Karraker KH, Young M. Night Waking in 6-Month-Old infants and maternal depressive symptoms. J Appl Dev Psychol. 2007;28(5–6):493–8.

Tham EK, Schneider N, Broekman BF. Infant sleep and its relation with cognition and growth: a narrative review. Nat Sci Sleep. 2017;9:135–49.

Hall WA, Hutton E, Brant RF, Collet JP, Gregg K, Saunders R, Ipsiroglu O, Gafni A, Triolet K, Tse L, et al. A randomized controlled trial of an intervention for infants’ behavioral sleep problems. BMC Pediatr. 2015;15:181.

Paul IM, Savage JS, Anzman-Frasca S, Marini ME, Mindell JA, Birch LL. INSIGHT responsive parenting intervention and infant sleep. Pediatrics 2016, 138(1).

Martins RMA, Oliveira JRA, Salgado CCG, Marques BLS, Oliveira LCF, Oliveira GR, Rodrigues TS, Ferreira RT. Sleep habits in infants: the role of maternal education. Sleep Med. 2018;52:138–44.

Kahn M, Livne-Karp E, Juda-Hanael M, Omer H, Tikotzky L, Anders TF, Sadeh A. Behavioral interventions for infant sleep problems: the role of parental cry tolerance and sleep-related cognitions. J Clin Sleep Med. 2020;16(8):1275–83.

Fiese BH, Cai T, Sutter C, Bost KK. Bedtimes, bedtime routines, and children’s sleep across the first 2 years of life. Sleep 2021, 44(8).

Fangupo LJ, Haszard JJ, Reynolds AN, Lucas AW, McIntosh DR, Richards R, Camp J, Galland BC, Smith C, Taylor RW. Do sleep interventions change sleep duration in children aged 0–5 years? A systematic review and meta-analysis of randomised controlled trials. Sleep Med Rev 2021, 59.

Drozd F, Leksbo TS, Storksen HT, Wilhelmsen CEW, Slinning K. An overview of reviews for preventing and treating sleep problems in infants. Acta Paediatr. 2022;111(11):2071–6.

Landsem IP, Cheetham NB. Infant sleep as a topic in healthcare guidance of parents, prenatally and the first 6 months after birth: a scoping review. BMC Health Serv Res. 2022;22(1):1135.

Mindell JA, Sadeh A, Wiegand B, How TH, Goh DY. Cross-cultural differences in infant and toddler sleep. Sleep Med. 2010;11(3):274–80.

Anuntaseree W, Mo-suwan L, Vasiknanonte P, Kuasirikul S, Ma-a-lee A, Choprapawan C. Night waking in Thai infants at 3 months of age: association between parental practices and infant sleep. Sleep Med. 2008;9(5):564–71.

Ramamurthy MB, Sekartini R, Ruangdaraganon N, Huynh DH, Sadeh A, Mindell JA. Effect of current breastfeeding on sleep patterns in infants from Asia-Pacific region. J Paediatr Child Health. 2012;48(8):669–74.

Trangkasombut U, Labboonsarp V, Havanont P. CES-D in adolescents. J Psychiatry Association Thail. 1997;42(1):2–13.

Google Scholar  

Galland BC, Sayers RM, Cameron SL, Gray AR, Heath AM, Lawrence JA, Newlands A, Taylor BJ, Taylor RW. Anticipatory guidance to prevent infant sleep problems within a randomised controlled trial: infant, maternal and partner outcomes at 6 months of age. BMJ Open. 2017;7(5):e014908.

Santos IS, Del-Ponte B, Tovo-Rodrigues L, Halal CS, Matijasevich A, Cruz S, Anselmi L, Silveira MF, Hallal PRC, Bassani DG. Effect of parental counseling on infants’ healthy sleep habits in Brazil: a Randomized Clinical Trial. JAMA Netw Open. 2019;2(12):e1918062.

Camerota M, Tully KP, Grimes M, Gueron-Sela N, Propper CB. Assessment of infant sleep: how well do multiple methods compare? Sleep 2018, 41(10).

Rudzik AEF, Robinson-Smith L, Ball HL. Discrepancies in maternal reports of infant sleep vs. actigraphy by mode of feeding. Sleep Med. 2018;49:90–8.

Rudzik AEF, Ball HL. Biologically normal sleep in the mother-infant dyad. Am J Hum Biol. 2021;33(5):e23589.

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Acknowledgements

The authors thank the parents who participated in the study and thank all staff of Vajira well-childcare clinic. Special thanks to Thapakorn Konthongkum for statistical support. This protocol was presented as oral presentation at 88th Thai Pediatric Annual conference.

This work was funded by Navamindradhiraj University Research Fund (grant no. 115/2564).

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D.N. conceived and designed the study, interpreted results and drafted the manuscript. A.S. co-designed the study, coordinated the study and data collection, interpreted the results and drafted manuscript. All authors reviewed the final manuscript and gave their consent.

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Correspondence to Dussadee Ngernlangtawee .

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Sinthong, A., Ngernlangtawee, D. Early sleep intervention for improving infant sleep quality: a randomized controlled trial, preliminary result. BMC Pediatr 24 , 306 (2024). https://doi.org/10.1186/s12887-024-04771-6

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How mother and infant sleep patterns interact during the first two years of life

New mothers can expect sleep deprivation in the first few years of baby's life. But too little sleep can take a toll on the health of both mother and child. A new study from the University of Illinois Urbana-Champaign looks at maternal and infant sleep patterns, identifying predictors and providing recommendations for instilling healthy habits.

"The first two years is a really critical period where a lot of development is going on, and sleep is important for health. We wanted to look at the association of mother and infant sleep and whether it changes over time," said Tianying Cai, now a postdoctoral researcher at Northwestern University. She worked on the research as a doctoral student in the Department of Human Development and Family Studies (HDFS), part of the College of Agricultural, Consumer and Environmental Sciences (ACES) at the U. of I.

"We identified two distinct groups, a low maternal sleep group where the mothers get 5 to 6 hours of sleep per night, and an average maternal sleep group, which meets the national recommended sleep guidelines with 7 to 8 hours per night. Children in the low maternal sleep group also slept less, although the difference wasn't as large as for the mothers," Cai stated.

The research team followed parents of 464 infants in the first two years of life. Mothers completed surveys about bedtime routines, their child's sleep duration, nighttime waking, and sleep problems at 3, 12, 18, and 24 months of age.

The families were part of STRONG Kids 2, a program at the U. of I. that promotes nutrition and healthy habits in families with young children. STRONG Kids 2 co-directors Barbara Fiese, professor emerita of HDFS, and Sharon Donovan, professor of food science and human nutrition, also contributed to the study.

Mothers who fit the low maternal sleep profile got an average of 5.74 hours of sleep per night at 3 months and 5.9 hours at 12 to 24 months, while their children got 9.6 and 10.52 hours, respectively. In the average sleep profile, mothers got 7.31 hours at 3 months and 7.28 hours at 12 to 24 months, while child sleep averaged 9.99 hours at 3 months and 11 hours at 12 to 24 months.

The research team also identified factors that influence the amount of sleep a mother gets. Not surprisingly, one of the strongest predictors is infant-signaled nighttime waking, which means the infant is more likely to alert the parent at night. This could be either because these infants woke more frequently, or because the mothers were more likely to wake up when infants stirred, Cai noted.

Mothers who had longer employment hours were more likely to be in the low sleep group at 3 months, although that was no longer a factor by 12 months. Furthermore, those who breastfed their infant at 12 months were more likely to be in the average sleep group.

Over time, many families transitioned from the low to the average sleep group as infant sleep patterns consolidated. At 3 months, 60% were in the low maternal sleep group and 40% were in the average group, while at 12 months the numbers were reversed. Most of those who were in the average sleep group at 3 months continued to be so throughout the study period.

The researchers found that an earlier bedtime and consistent routines were associated with better sleep patterns, corroborating a previous study from Fiese and Cai.

"If parents can establish early bedtime routines at three months, it improves sleep duration and reduces sleep problems," Fiese said. "Parents may feel overwhelmed and don't realize that they have this in their toolkit. Something as simple as setting a regular bedtime early on and having routines, like reading a story to your child before they go to bed. You may not think they're understanding, but the rhythm of your voice establishes predictability, and you can expand this bedtime routine over the first few years of life."

The researchers noted they did not observe any significant differences due to demographic characteristics in the sample.

"Maternal education, income, or ethnicity did not predict sleep group memberships across 3 to 24 months; all parents were facing similar challenges. I think having a baby is a great equalizer for a lot of things, although moms who have to go back to work or work longer hours may have more pressures," Donovan said.

Even so, there are steps everyone can take to improve bedtime habits and sleep patterns.

"Getting kids to bed earlier and trying to meet the American Academy of Pediatrics guidelines is really important because studies have shown that sleep is associated with a lot of neurocognitive outcomes and health in kids. The parents can be quite proactive even early in life to get their kids off on the right foot," she concluded.

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• Tianying Cai, Carolyn Sutter, Sharon M. Donovan, Barbara H. Fiese. The Relationship Between Maternal and Infant Sleep Duration Across the First Two Years . Journal of Developmental & Behavioral Pediatrics , 2023; Publish Ahead of Print DOI: 10.1097/DBP.0000000000001195

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Infant Sleep

What are an infant's sleep needs.

Sleep needs for babies vary depending on their age. Newborns do sleep much of the time. But their sleep is in very short segments. As a baby grows, the total amount of sleep slowly decreases. But the length of nighttime sleep increases.

Generally, newborns sleep about 8 to 9 hours in the daytime and about 8 hours at night. But they may not sleep more than 1 to 2 hours at a time. Most babies don't start sleeping through the night (6 to 8 hours) without waking until they are about 3 months old, or until they weigh 12 to 13 pounds. About two-thirds of babies are able to sleep through the night on a regular basis by age 6 months.

Babies also have different sleep cycles than adults. Babies spend much less time in rapid eye movement (REM) sleep (which is dream time sleep). And the cycles are shorter. The following are the usual nighttime and daytime sleep needs for newborns through 2 years old:

What are the signs of infant sleep problems?

Once a baby begins to regularly sleep through the night, parents are often unhappy when the baby starts to wake up at night again. This often happens at about 6 months old. This is often a normal part of development called separation anxiety. This is when a baby does not understand that separations are short-term (temporary). Babies may also start to have trouble going to sleep because of separation anxiety. Or because they are overstimulated or overtired.

Common responses of babies having these night awakenings or trouble going to sleep may include the following:

Waking and crying one or more times in the night after sleeping through the night

Crying when you leave the room

Refusing to go to sleep without a parent nearby

Clinging to the parent at separation

Sleep problems may also happen with illness. Talk with your baby's healthcare provider if your baby begins having trouble going to sleep or staying asleep, especially if this is a new pattern.

Signs of sleep readiness

You can help your baby sleep by recognizing signs of sleep readiness, teaching him or her to fall asleep on his own, and comforting him or her with awakenings. Your baby may show signs of being ready for sleep by:

Rubbing eyes

Looking away

Helping your baby fall asleep

Babies may not be able to create their own sleeping and waking patterns. Surprisingly, not all babies know how to put themselves to sleep. And not all babies can go back to sleep if they are awakened in the night. When it is time for bed, many parents want to rock or breastfeed a baby to help him or her fall asleep. Creating a bedtime routine is a good idea. But don't let your baby fall asleep in your arms. This may become a pattern. And your baby may begin to expect to be in your arms in order to fall asleep. When your baby briefly wakes up during a sleep cycle, they may not be able to go back to sleep on their own.

Babies who feel secure are better able to handle separations, especially at night. Cuddling and comforting your baby during the day can help him or her feel more secure. Other ways to help your baby learn to sleep include:

Allowing time for naps each day as needed for your baby's age.

Not having any stimulation or activity close to bedtime.

Creating a bedtime routine, such as bath, reading books, and rocking.

Playing soft music while your baby is getting sleepy.

Offering a transitional object that your baby can take to bed. This may be a small blanket or a soft toy. But don't do this before your baby is old enough. Your baby should be able to roll and sit. This will prevent the risk of suffocation.

Tucking your baby into bed when he or she is drowsy, but before going to sleep.

Comforting and reassuring your baby when he or she is afraid.

For night awakenings, comfort and reassure your baby by patting and soothing. Don't take your baby out of bed.

If your baby cries, wait a few minutes, then return and reassure with patting and soothing. Then say goodnight and leave. Repeat as needed.

Being consistent with the routine and your responses.

Reducing the risk for sudden infant death syndrome (SIDS) and other sleep-related infant deaths

Here are recommendations from the American Academy of Pediatrics (AAP) on how to reduce the risk for SIDS and sleep-related deaths from birth to 1 year old:

Have your baby immunized. An infant who is fully immunized may reduce his or her risk for SIDS.

Breastfeed your baby. The AAP recommends breastmilk only for at least 6 months.

Place your baby on their back for all sleep and naps until they are 1 year old. This can reduce the risk for SIDS, breathing in food or a foreign object (aspiration), and choking. Never place your baby on their side or stomach for sleep or naps. If your baby is awake, give your child time on their tummy as long as you are watching. This can reduce the chance that your child will develop a flat head.

Always talk with your baby's healthcare provider before raising the head of the crib if your baby has been diagnosed with gastroesophageal reflux.

Offer your baby a pacifier for sleeping or naps. If your baby is breastfeeding, don't use a pacifier until breastfeeding has been fully established.

Use a firm mattress that is covered by a tightly fitted sheet. This can prevent gaps between the mattress and the sides of a crib, a play yard, or a bassinet. That can reduce the risk of the baby getting stuck between the mattress and the sides (entrapment). It can also reduce the risk of suffocation and SIDS.

Share your room instead of your bed with your baby. Putting your baby in bed with you raises the risk for strangulation, suffocation, entrapment, and SIDS. Bed sharing is not recommended for twins or other multiples. The AAP recommends that infants sleep in the same room as their parents, close to their parents' bed. But babies should be in a separate bed or crib appropriate for infants. This sleeping arrangement is recommended ideally for the baby's first year. But it should at least be maintained for the first 6 months.

Don't use infant seats, car seats, strollers, infant carriers, and infant swings for routine sleep and daily naps. These may lead to blockage of an infant's airway or suffocation.

Don't put infants on a couch or armchair for sleep. Sleeping on a couch or armchair puts the baby at a much higher risk of death, including SIDS.

Don't use illegal drugs and alcohol, and don't smoke during pregnancy or after birth. Keep your baby away from others who are smoking and places where others smoke.

Don't overbundle, overdress, or cover your baby's face or head. This will prevent them from getting overheated, reducing the risk for SIDS.

Don't use loose bedding or soft objects (bumper pads, pillows, comforters, blankets) in your baby's crib or bassinet. This can help prevent suffocation, strangulation, entrapment, or SIDS.

Don't use home cardiorespiratory monitors and commercial devices (wedges, positioners, and special mattresses) to help reduce the risk for SIDS and sleep-related infant deaths. These devices have never been shown to reduce the risk of SIDS. In rare cases, they have caused infant deaths.

Always place cribs, bassinets, and play yards in places with no dangling cords, wires, or window coverings. This can reduce the risk for strangulation.

Related Links

• Johnson Center for Pregnancy and Newborn Services
• Pediatric Sleep Disorders
• Tips for Better Rest
• The Neonatal Intensive Care Unit (NICU)
• Behavior Changes
• Newborn Sleep Patterns

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More results...

Pediatric Sleep Research

• AAP leaders call decision to pull harmful weighted sleep products a ‘strong first step’

Unsafe weighted infant sleep products pulled by retailers.

• 2022 American Academy of Pediatrics (AAP) safe sleep recommendations

Read the 2022 American Academy of Pediatrics (AAP) recommendations for safe infant sleep.

• Sleep training could benefit some babies — and their parents

There are many ways to go about sleep training – helping your child learn to fall asleep on her own at bedtime and sleep for longer stretches overnight. Read Erin Chan Ding’s Washington Post article about types and the benefits of sleep training for children and the family.  

• Here’s How To Get Your Baby To Sleep In A Crib, Experts Say

Get tips to help your baby learn to sleep in a crib.

For better sleep, borrow the bedtime routine of a toddler

Learn more about how you can change your own sleep habits using steps often in a toddler’s bedtime routine.

Is ‘Momsomnia’ Keeping You Up at Night?

Parents can certainly have difficulty falling and staying asleep even after their young children are sleeping well overnight. Read more about what you can do about those sleepless nights in Jessica Grose’s article and interview with Dr. Shelby Harris at The New York Times.

Secrets of baby sleep: how snoozing helps your baby’s development

What’s going on while your baby is sleeping? How does it help development? Find out from the BBC and our expert, Dr. Alice Gregory.

Infant Sleep Experts Weigh in on 7 Common Myths

Seven sleep myths – put to bed or still up for debate

Is Your Toddler Ready for a ‘Big Kid Bed’?

Wondering if your toddler is ready to transition to a bed? The New York Times gives some guidance along with Dr. Jodi Mindell.

Q&A: Clinicians can use social media to help parents find expert health advice

Social media has a lot of information about sleep aids for children, but very little of it is written by health care professionals.

How Children’s Sleep Habits Have Changed in the Pandemic

Read more about how children’s sleep habits have changed during the pandemic.

How to sleep through a global pandemic

Dr. Alice Gregory talks to Sarah Cox from Goldsmiths University of London about how the pandemic may be affecting sleep health for adults and children, including some tips to help ease the strain.

Family and Environmental Risk Factors are Linked to Poor Sleep in Young Children

Environment and family risk factors impact sleep.

Encouraging good sleep habits

Read more about healthy sleep habits such as getting enough sleep, healthy bedtime habits, and some tips and tricks for an easy bedtime routine on Indian Link by Dr. Vishal Saddi.  

Insomnia: How to Help Children Get a Good Night’s Sleep

Read more about childhood insomnia and how to help, with some great information from Dr. Michael Gradisar.

Sleep Training Truths: What Science Can (And Can’t) Tell Us About Crying It Out

Listen to experts talk about sleep training myths and truths on NPR.

Go to bed! Brain researchers warn that lack of sleep is a public health crisis.

Societal lack of sleep can be considered a public health crisis. Read this Washington Post article to find out more about the importance of sleep across the lifespan .

Toddlers may sleep better in cribs until age 3

The crib-to-bed transition: but when?!

When Your Baby Is Your Roommate

Learn more information that may help your family make decisions about room-sharing in this New York Times article.

To Help Children Sleep, Go Dark

Did you know that children’s eyes let in more light than adults’ eyes do? Read more here about the importance of a dark evening environment.

Sleep vs. Exercise?

Moms and dads: to sleep or to exercise? Find out here.

How parents tackle bedtime around the world

Bedtimes, bedtime routines, and sleep spaces vary widely by nation and culture.

Parents find older babies sleep better in their own room

Older infants who sleep in their own room tend to sleep better than infants who share a room with their parents.

Mom’s Insomnia Linked to Children’s Sleep Quality, No Link Found to Dad’s Sleep

Child sleep quality is associated with mom’s sleep problems but not necessarily dad’s sleep problems, study finds.

Changing childcare settings can affect sleep

Study suggests that inconsistent childcare arrangements can affect toddlers’ sleep.

Most moms aren’t putting babies to sleep safely, study says

Sleep safety – put babies on their backs to sleep.

Babies Sleep Better In Their Own Rooms After 4 Months, Study Finds

Room-sharing and sleep outcomes in infancy – read this NPR article to learn more.

Sleep intervention training could prevent babies from becoming obese toddlers

Sleep interventions may prevent being overweight in early childhood.

Racial And Ethnic Disparities Persist In Sudden Infant Deaths

Read about continued racial and ethnic disparities in sudden unexpected infant death in this NPR article.

New Study Suggests Putting Kids To Bed Earlier Is Better For Mom’s Mental Health

Early bedtimes are good for kids and moms!

Penn State study: Helpful dads can mean less colicky babies

Having social support relates to fewer reports of colicky, fussy babies.

Kids Who Use Touchscreen Devices Sleep Less at Night

Babies and toddlers tend to get less sleep and have a harder time falling asleep the more touchscreen time they have – but more research is needed to find out why.

When Baby Sleeps Near Mom, Guess Who Doesn’t Sleep Well?

Israeli researchers are reporting that even sleeping in the same room can have negative consequences: not for the child, but for the mother.

How science can make your baby sleep better

Read Drs. Alice Gregory and Erin Leichman take on combining science and family preferences to help your little one sleep on The Conversation’s website.

Improving the sleep of socioeconomically disadvantaged children

Read about how a brochure outlining three simple stories helped families support better sleep hygiene.

Advertisers depict unsafe sleeping environments for infants, study shows

Despite safe sleep recommendations, retailers continue to depict babies in unsafe sleeping environments through retail images.

Volunteer for Sleep Research – REST Study!

Are you pregnant and not sleeping well? Check out a new research study working to help expecting moms sleep better. Participants will receive an online, evidence-based program to improve sleep and up to $60 in gift cards.

Dr. Catherine Hill is on BBC Radio!

Listen to Dr. Catherine Hill on a BBC Radio Ask the Expert segment talk about some exciting pediatric sleep topics!

Sleep Experts Issue Recommendations for Children and Adolescent Sleep

More news about the American Academy of Sleep Medicine’s sleep range recommendations for children as well as their mental and physical health.

Self-reported time in bed and sleep quality in association with internalizing and externalizing symptoms in school-age youth

Sonia L. Rubens Elementary school students report of the amount of time they spend in bed. Sleep quality is associated with internalizing (for example, anxiety, depression) and externalizing (for example, reactive aggression) symptoms.

Development of infant and toddler sleep patterns: Real-world data from a mobile application

Jodi Mindell Information on newborn, infant, and toddler (0 to 36 months) sleep patterns was collected via a smartphone app. Sleep patterns developed at about 5-6 months old, later bedtimes predicted less sleep, and morning waketimes were generally consistent across children. Unique images from the data collected were created, representing sleep consolidation (sleeping for longer stretches) over a three-year period for both daytime and nighttime sleep.

Evaluating behavioral interventions for infant sleep problems

Michael Gradisar Two types of sleep training improve falling asleep and overnight sleep, do not relate to adverse stress responses in infants or mothers, and have no long term negative effects on attachment, emotion, or behavior.

Sleep problems in childhood psychiatric disorders

Alice M. Gregory Learn more about the role of sleep and interventions in childhood psychiatric problems in the context of development.

Sleep problems in children

K. Hannan Sleep problems are common in childhood, but home-based behavioral sleep interventions implemented by caregivers can help. These interventions can be implemented by caregivers with community health practitioners playing a key role in describing strategies to families.

Pacifier use, finger sucking, and infant sleep

R. Butler Babies who sucked their fingers, but not necessarily babies who used a pacifier, tended to sleep better overnight (fewer night wakings and longer stretches of sleep), a recent study showed.

The development of a screening questionnaire for obstructive sleep apnea in children with Down syndrome

Emma Sanders Many children with Down syndrome also suffer from obstructive sleep apnea (OSA). Development of a screening tool for OSA specifically for children with Down syndrome is described.

Melatonin treatment in children with developmental disabilities

A.J. Swichtenberg For children with developmental disabilities, melatonin is generally associated with taking less time to fall asleep at bedtime in addition to uncommon and mild side effects.

Sleep and health related quality of life in parents of ventilator-assisted children

Lisa Meltzer Caregivers (mothers and fathers) of children who require ventilator assistance to breathe have poor sleep as compared to caregivers of healthy children. Poor sleep for these families was associated with health related quality of life.

Sleep in pediatric primary care

Sarah Honaker Learn more about how the primary care setting (your doctor’s office) is a great place to screen for and manage your child’s sleep difficulties. Also, learn more about the barriers to effectively addressing sleep in those settings, as although sleep problems are frequent actual screening and management rates are low.

Longitudinal study of sleep behavior in normal infants during the first year of life

Oliviero Bruni Study on sleep in the first year of life suggests that sleep shows the most stability between 6 and 12 months and prevention efforts should focus on the first 3 to 6 months. Approximately 10% of babies in the study were considered to have problematic sleep.

Controversies in behavioral treatment of sleep problems in young children

Jocelyn Thomas Learn about potential controversies related to treating sleep problems in young children such as which strategies have the most empirical support, the best age to begin to use these strategies, and any possible negative consequences of using these strategies.

Childhood restless legs syndrome

Jose Carlos Pereira, Jr. Learn more about restless legs syndrome in this review from experts in the field.

Parental concerns about infant and toddler sleep assessed by a mobile app

Jodi Mindell The research team analyzed more than 1,000 sleep-related questions that were submitted to an Ask the Expert section of a publicly available smart phone app for sleep in young children. Caregivers asked questions primarily about night wakings, sleep schedules, and bedtime problems.

Bed sharing, room sharing, and solitary sleeping

Robyn Stremler According to this study, the choice to room or bed share varies by family and changes over time for families of newborns from 6 weeks to 12 weeks after birth. Bed sharing at any frequency was quite common (41 to 51% depending on baby age), and was associated with more sleep disruption for moms.

Sleep in new mothers and fathers

Hawley E. Read up on moms’ and dads’ sleep right after they have a little one.

An update on bedtime problems and night wakings in young children

Sarah Honaker Read a review of information about evidence-based treatments for bedtime problems and night wakings in young children.

Prevalence of habitual snoring and its correlates in young children across the Asia Pacific

Li A.M. Prevalence of habitual snoring shows racial differences among countries across Asia Pacific, based on a study of over 23,000 infants.

Behavioral sleep problems and development of executive function

Kathryn Turnbull Read a review about the developmental context of sleep as it relates to self-regulation and executive functioning in childhood.

Evaluation of a behavioral treatment package to reduce sleep problems in children with Angelman Syndrome

Keith D. Allen A set of behavioral strategies to reduce chronic sleep problems in five children with Angelman Syndrome was evaluated. Parents were highly satisfied with the treatment and improvements in disruptive bedtime behaviors as well as falling asleep were noted.

Evaluating sleep and sleep disorders in the pediatric primary care setting

Debra Babcock Parents and caregivers should be asked about their children’s sleep at every routine physical examination. Educating families about the importance of sleep is an important intervention that can be delivered in a pediatric primary care setting.

Helping preschool-age children get to sleep and stay asleep

Graham Reid See Dr. Reid talk about strategies to help your preschooler get to sleep and stay asleep more easily.

Bedtime problems and night wakings: Treatment of behavioral insomnia of childhood

Melisa Moore Read a case study and treatment options for bedtime problems and night wakings.

Cross-cultural differences in infant and toddler sleep

Jodi Mindell Sleep patterns of over 29,000 infants and toddlers in several countries in predominantly Asian countries and predominantly Caucasian countries were analyzed. Overall, children from predominantly Asian countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to room-share than children from predominantly Caucasian countries/regions.

Relationships between sleep and behavioral problems in toddlers

Graham Reid Sleep problems in toddlers, including night wakings and bedtime resistance, are predictors of internalizing (for example, anxiety) and externalizing (for example, hyperactivity, aggression) behavioral problems.

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Newborn Sleep Patterns

What are the sleep patterns of a newborn.

The average newborn sleeps much of the day and night, waking only for feedings every few hours. It's often hard for new parents to know how long and how often a newborn should sleep. Unfortunately, there is no set schedule at first, and many newborns have their days and nights confused. They think they are supposed to be awake at night and sleep during the day.

Generally, newborns sleep a total of about 16 to 17 hours per day. But because they have a small stomach, they must wake every few hours to eat. Most babies don’t start sleeping through the night (6 to 8 hours) until at least 3 months of age. But this can vary a lot. Some babies don’t sleep through the night until closer to 1 year. In most cases, your baby will wake up and be ready to eat at least every 3 hours. How often your baby will eat depends on what they are being fed and their age. Make sure you talk with your healthcare provider to figure out if you need to wake your baby for feedings.

Watch for changes in your baby's sleep pattern. If your baby has been sleeping consistently, and suddenly is waking more often, there may be a problem. Or your baby may be going through a growth spurt and need to eat more often. Some sleep disturbances are simply due to changes in development or because of overstimulation.

What are the different alert phases of a newborn?

Babies are also different in how alert they are during the time they are awake.

Quiet alert phase

When a newborn wakes up at the end of the sleep cycle, there is typically a quiet alert phase. This is a time when the baby is very still, but awake and taking in the environment. During the quiet alert time, babies may look or stare at objects, and respond to sounds and motion. This phase usually progresses to the active alert phase. This is when the baby is attentive to sounds and sights, and moves actively.

Crying phase

After the quiet alert phase is a crying phase. The baby's body moves erratically, and they may cry loudly. Babies can easily be overstimulated during the crying phase. It's often best to find a way of calming the baby and the environment. Holding your baby close or wrapping your baby snugly in a blanket (swaddling) may help calm a crying baby.

It's often best to feed babies before they reach the crying phase. During the crying phase, they can be so upset that they may refuse the breast or bottle. In newborns, crying is a late sign of hunger.

Caution on swaddling

Swaddling means wrapping newborn babies snugly in a blanket to keep their arms and legs from flailing. This can make a baby feel safe and help them fall asleep. You can buy a special swaddling blanket designed to make swaddling easier.

But don’t use swaddling if your baby is 2 months or older, or if your baby can roll over on their own. Swaddling may raise the risk for SIDS (sudden infant death syndrome) if the swaddled baby rolls onto their stomach.

When you swaddle, give your baby enough room to move their hips and legs. The legs should be able to bend up and out at the hips. Don’t place your baby’s legs so that they are held together and straight down. This raises the risk that the hip joints won’t grow and develop correctly. This can cause a problem called hip dysplasia and dislocation.

Also be careful of swaddling your baby if the weather is warm or hot. Using a thick blanket in warm weather can make your baby overheat. Instead use a lighter blanket or sheet to swaddle the baby.

Helping your baby sleep

Babies may not be able to form their own sleeping and waking patterns, especially in going to sleep. You can help your baby sleep by knowing the signs of sleep readiness, teaching them to fall asleep on their own, and providing the right environment for comfortable and safe sleep.

What are the signs of sleep readiness?

Your baby may show signs of being ready for sleep when you see the following signs:

Rubbing eyes

Looking away

How can you help your baby fall asleep?

Not all babies know how to put themselves to sleep. When it's time for bed, many parents want to rock their baby to sleep. Newborns and younger infants will fall asleep while breastfeeding. Having a routine at bedtime is a good idea. But if an older baby falls asleep while eating or in your arms, this may become a pattern. Your baby may then start to expect to be in your arms to fall asleep. When your baby briefly wakes up during a sleep cycle, they may not be able to go back to sleep on their own.

After the newborn period, most experts advise allowing your baby to become sleepy in your arms, then placing them in the bed while still awake. This way your baby learns how to go to sleep on their own. Playing soft music while your baby is getting sleepy is also a good way to help create a bedtime routine.

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SIDS: The Latest Research on How Sleeping With Your Baby is Safe

Research on sids, sids and co-sleeping facts.

There has been a lot of media claiming that sleeping with your baby in an adult bed is unsafe and can result in accidental smothering of an infant. One popular research study came out in 1999 from the U.S. Consumer Product Safety Commission that showed 515 cases of accidental infant deaths occurred in an adult bed over an 8-year period between 1990 and 1997. That’s about 65 deaths per year. These deaths were not classified as Sudden Infant Death Syndrome (SIDS), where the cause of death is undetermined. There were actual causes that were verified upon review of the scene and autopsy. Such causes included accidental smothering by an adult, getting trapped between the mattress and headboard or other furniture, and suffocation on a soft waterbed mattress.

The conclusion that the researchers drew from this study of research on SIDS was that sleeping with an infant in an adult bed is dangerous and should never be done. This sounds like a reasonable conclusion, until you consider the epidemic of SIDS as a whole. During the 8-year period of this study, about 34,000 total cases of SIDS occurred in the U.S. (around 4250 per year). If 65 cases of non-SIDS accidental death occurred each year in a bed, and about 4250 cases of actual SIDS occurred overall each year, then the number of accidental deaths in an adult bed is only 1.5% of the total cases of SIDS.

Related Articles

• Safe Babywearing
• Quiet Around Sleeping Baby
• The Latest Research on Safe Co-Sleeping

There are two pieces of critical data that are missing that would allow us to determine the risk of SIDS or any cause of death in a bed versus a crib.

• How many cases of actual SIDS occur in an adult bed versus in a crib?
• How many babies sleep with their parents in the U.S., and how many sleep in cribs?

The data on the first question is available, but has anyone examined it? In fact, one independent researcher examined the CPSC’s data and came to the opposite conclusion than did the CPSC – this data supports the conclusion that sleeping with your baby is actually SAFER than not sleeping with your baby (see Mothering Magazine Sept/Oct 2002). As for the second question, many people may think that very few babies sleep with their parents, but we shouldn’t be too quick to assume this. The number of parents that bring their babies into their bed at 4 am is probably quite high. Some studies have shown that over half of parents bring their baby into bed with them at least part of the night. And the number that sleep with their infants the whole night is probably considerable as well. In fact, in most countries around the world sleeping with your baby is the norm, not the exception. And what is the incidence of SIDS in these countries? During the 1990s, in Japan the rate was only one tenth of the U.S. rate, and in Hong Kong, it was only 3% of the U.S. rate. These are just two examples. Some countries do have a higher rate of SIDS, depending on how SIDS is defined.

Until a legitimate survey is done to determine how many babies sleep with their parents, and this is factored into the rate of SIDS in a bed versus a crib, it is unwarranted to state that sleeping in a crib is safer than a bed.

If the incidence of SIDS is dramatically higher in crib versus a parent’s bed, and because the cases of accidental smothering and entrapment are only 1.5% of the total SIDS cases, then sleeping with a baby in your bed would be far safer than putting baby in a crib.

The answer is not to tell parents they shouldn’t sleep with their baby, but rather to educate them on how to sleep with their infants safely.

Now the U.S. Consumer Product Safety Commission and the Juvenile Products Manufacturer’s Association are launching a campaign based on research on SIDS from 1999, 2000, and 2001. During these three years, there have been 180 cases of non-SIDS accidental deaths occurring in an adult bed. Again, that’s around 60 per year, similar to statistics from 1990 to 1997. How many total cases of SIDS have occurred during these 3 years? Around 2600 per year. This decline from the previous decade is thought to be due to the “back to sleep” campaign – educating parents to place their babies on their back to sleep. So looking at the past three years, the number of non-SIDS accidental deaths is only 2% of the total cases of SIDS.

A conflict of interest?

Who is behind this new national campaign to warn parents not to sleep with their babies? In addition to the USCPSC, the Juvenile Products Manufacturers Association (JPMA) is co-sponsoring this campaign. The JPMA? An association of crib manufacturers. This is a huge conflict of interest. Actually, this campaign is exactly in the interest of the JPMA.

What does the research say?

The September/October 2002 issue of Mothering Magazine presents research done throughout the whole world on the issue of safe sleep. Numerous studies are presented by experts of excellent reputation. And what is the magazine’s conclusion based on all this research? That not only is sleeping with your baby safe, but it is actually much safer than having your baby sleep in a crib. Research shows that infants who sleep in a crib are twice as likely to suffer a sleep related fatality (including SIDS) than infants who sleep in bed with their parents.

Education on safe sleep.

I do support the USCPSC’s efforts to research sleep safety and to decrease the incidence of SIDS, but I feel they should go about it differently. Instead of launching a national campaign to discourage parents from sleeping with their infants, the U.S. Consumer Product Safety Commission should educate parents on how to sleep safely with their infants if they choose to do so.

Here are some ways to educate parents on how to sleep safely with their baby:

• Use an Arm’s Reach® Co-Sleeper® Bassinet. An alternative to sleeping with baby in your bed is the Arm’s Reach® Co-Sleeper®. This crib-like bed fits safely and snuggly adjacent to parent’s bed. The co-sleeper® arrangement gives parents and baby their own separate sleeping spaces yet, keeps baby within arm’s reach for easy nighttime care. To learn more about the Arm’s Reach® Co-Sleeper® Bassinet visit www.armsreach.com .
• Take precautions to prevent baby from rolling out of bed, even though it is unlikely when baby is sleeping next to mother. Like heat-seeking missiles, babies automatically gravitate toward a warm body. Yet, to be safe, place baby between mother and a guardrail or push the mattress flush against the wall and position baby between mother and the wall. Guardrails enclosed with plastic mesh are safer than those with slats, which can entrap baby’s limbs or head. Be sure the guardrail is flush against the mattress so there is no crevice that baby could sink into.
• Place baby adjacent to mother, rather than between mother and father. Mothers we have interviewed on the subject of sharing sleep feel they are so physically and mentally aware of their baby’s presence even while sleeping, that it’s extremely unlikely they would roll over onto their baby. Some fathers, on the other hand, may not enjoy the same sensitivity of baby’s presence while asleep; so it is possible they might roll over on or throw out an arm onto baby. After a few months of sleep-sharing, most dads seem to develop a keen awareness of their baby’s presence.
• Place baby to sleep on his back.
• Use a large bed, preferably a queen-size or king-size. A king-size bed may wind up being your most useful piece of “baby furniture.” If you only have a cozy double bed, use the money that you would ordinarily spend on a fancy crib and other less necessary baby furniture and treat yourselves to a safe and comfortable king-size bed.
• Some parents and babies sleep better if baby is still in touching and hearing distance, but not in the same bed. For them, a bedside co-sleeper is a safe option.

Here are some things to avoid:

• You are under the influence of any drug (such as alcohol or tranquilizing medications) that diminishes your sensitivity to your baby’s presence. If you are drunk or drugged, these chemicals lessen your arousability from sleep.
• You are extremely obese. Obesity itself may cause sleep apnea in the mother, in addition to the smothering danger of pendulous breasts and large fat rolls.
• You are exhausted from sleep deprivation. This lessens your awareness of your baby and your arousability from sleep.
• You are breastfeeding a baby on a cushiony surface, such as a waterbed or couch. An exhausted mother could fall asleep breastfeeding and roll over on the baby.
• You are the child’s baby-sitter. A baby-sitter’s awareness and arousability is unlikely to be as acute as a mother’s.
• Don’t allow older siblings to sleep with a baby under nine months. Sleeping children do not have the same awareness of tiny babies as do parents, and too small or too crowded a bed space is an unsafe sleeping arrangement for a tiny baby.
• Don’t fall asleep with baby on a couch. Baby may get wedged between the back of the couch and the larger person’s body, or baby’s head may become buried in cushion crevices or soft cushions.
• Do not sleep with baby on a free-floating, wavy waterbed or similar “sinky” surface in which baby could suffocate.
• Don’t overheat or overbundle baby. Be particularly aware of overbundling if baby is sleeping with a parent. Other warm bodies are an added heat source.
• Don’t wear lingerie with string ties longer than eight inches. Ditto for dangling jewelry. Baby may get caught in these entrapment’s.
• Avoid pungent hair sprays, deodorants, and perfumes. Not only will these camouflage the natural maternal smells that baby is used to and attracted to, but foreign odors may irritate and clog baby’s tiny nasal passages. Reserve these enticements for sleeping alone with your spouse.

Parents should use common sense when sharing sleep. Anything that could cause you to sleep more soundly than usual or that alters your sleep patterns can affect your baby’s safety. Nearly all the highly suspected (but seldom proven) cases of fatal “overlying” I could find in the literature could have been avoided if parents had observed common sense sleeping practices.

The bottom line is that many parents share sleep with their babies. It can be done safely if the proper precautions are observed. The question shouldn’t be “is it safe to sleep with my baby?”, but rather “how can I sleep with my baby safely.” The data on the incidence of SIDS in a bed versus a crib must be examined before the medical community can make a judgment on sleep safety in a bed.

Read more about SIDS in our SIDS Facts article.

Holding Your Crying Baby isn't Spoiling Them, You're Just Meeting the Child's Needs

M any new parents are given conflicting advice. The baby should sleep on their stomach… wait no, the back or… the side? The baby should sleep with the mother, no, in their own crib, no, in their own room. Sometimes the advice comes from a trusted place, like a doctor or a family member. Most of the time it's unsolicited from well-meaning people, who often chirp things like, "Enjoy this age while it lasts!" "Catch up on sleep when the baby sleeps," and the cherry on top, "Stop holding the baby so much - you’re going to spoil them."

Parents struggle when it comes to comforting a crying baby. Their instinct is to rush over and hold their child, but with advice like, "don't spoil him," they might hesitate the next time they hear the cry.

The good news is there is no reason to hesitate when cuddling with your crying baby. Here's the truth: it's impossible to spoil them.

The Purpose of a Baby's Cry

Notre Dame psychologist Darcia Narvaez led a research team that found children become healthier and happier adults when they have parents who treated them with affection, sensitivity, and playfulness since birth.

"Sometimes, we have parents that say, you are going to spoil the baby if you pick them up when they are feeling distressed. No, you can't spoil a baby," said Professor Narvaez.

There are many possible reasons to explain why a baby is crying and Professor Narvaez reassures parents that it's never wrong for wanting to give the child comfort.

"Part of it is following your instincts because we as parents want to hold our children," she says. "We want to keep that child close, follow that instinct. We want to keep the child quiet and happy because the cry is so distressing." [1]  

The Research

Professor Narvaez worked with two colleagues, Lijuan Wang and Ying Cheng, to conduct this research and their findings will be published in an upcoming article in the journal Applied Developmental Science .

The three professors surveyed over 600 adults about their childhoods. They examined things like how much affectionate touch was given in their household, how much free play they were allowed as a child, and how much positive family time they experienced. The researchers found that adults with less anxiety and overall better mental wellbeing had positive childhoods.

"These things independently, but also added up together, predicted the adults' mental health, so they were less depressed, less anxious, and their social capacities - they were more able to take other people's perspective," said Professor Narvaez. "They were better at getting along with others and being open-hearted."

J. Kevin Nugent, director of the Brazelton Institute at Children’s Hospital in Boston and a child psychologist, said that a newborn baby learns from his interactions with his parents that the world is reliable, and can trust that his needs will be met.

Responding to baby’s cries “isn’t a matter of spoiling,” he said. “It’s a matter of meeting the child’s needs.” [2]

Open Letter to Parents

Professor Narvaez encourages parents to respond to their baby's cries, whether it means holding them, touching them, or rocking them; it's all good. [3]

“What parents do in those early months and years are really affecting the way the brain is going to grow the rest of their lives,” explains Narvaez, “so lots of holding, touching and rocking, that is what babies expect. They grow better that way. And keep them calm, because all sorts of systems are establishing the way they are going to work. 

"If you let them cry a lot, those systems are going to be easily triggered into stress. We can see that in adulthood - that people that are not cared for well, tend to be more stress reactive and they have a hard time self-calming.”

The researchers found that free play in and out of doors is vital for child development, as well as growing up in a positive, warm home environment. 

Narvaez believed that humans need these important things from the time they are born. Therefore, she recommends parents follow their instincts.

"Sometimes, we have parents that say, you are going to spoil the baby if you pick them up when they are feeling distressed. No, you can’t spoil a baby. You are actually ruining the baby if you don’t pick them up. You are ruining their development,” says Narvaez. "…So follow the instinct to hold, play, interact, that is what you want to do.”

After all, a baby's cry is heart-breaking for a reason.

It Takes a Village

While a parent might feel relieved that they can pick up their baby every time he cries, this quickly becomes exhausting, especially if there's only one parent at home while the other works most of the day. The at-home parent might struggle to eat, sleep, and do basic chores when they attend to the baby's every cry.

"We need to, as a community support families so they can give children what they need," Professor Narvaez says, who recommends involving grandparents, aunts, uncles, cousins, and friends in the baby's life.

"We really didn't evolve to parent alone. Our history is to have a community of caregivers to help - the village, so that when mom or dad needs a break, there is someone there who is ready to step in." [4]

Keep Reading: 12 Signs That Can Help You Understand Your Baby Better

• ‘Psychologists Find Parent Interaction Vital to Child’s Well-being as Adult’   Notre Dame News  January 18, 2016
• ‘Know When to Hold ‘Em’   Web MD
• ‘Can You Spoil Your Baby?’   Psychology Today Meri Wallace LCSW. Published July 5, 2012
• ‘Cuddling your kids may make them healthier adults’  Notre Dame Research Kristin Bien. Published February 1, 2016.

The post Holding Your Crying Baby isn't Spoiling Them, You're Just Meeting the Child’s Needs appeared first on Secret Life Of Mom .

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Helping women get better sleep by calming the relentless 'to-do lists' in their heads

Yuki Noguchi

Katie Krimitsos is among the majority of American women who have trouble getting healthy sleep, according to a new Gallup survey. Krimitsos launched a podcast called Sleep Meditation for Women to offer some help. Natalie Champa Jennings/Natalie Jennings, courtesy of Katie Krimitsos hide caption

Katie Krimitsos is among the majority of American women who have trouble getting healthy sleep, according to a new Gallup survey. Krimitsos launched a podcast called Sleep Meditation for Women to offer some help.

When Katie Krimitsos lies awake watching sleepless hours tick by, it's almost always because her mind is wrestling with a mental checklist of things she has to do. In high school, that was made up of homework, tests or a big upcoming sports game.

"I would be wide awake, just my brain completely spinning in chaos until two in the morning," says Krimitsos.

There were periods in adulthood, too, when sleep wouldn't come easily, like when she started a podcasting company in Tampa, or nursed her first daughter eight years ago. "I was already very used to the grainy eyes," she says.

Now 43, Krimitsos says in recent years she found that mounting worries brought those sleepless spells more often. Her mind would spin through "a million, gazillion" details of running a company and a family: paying the electric bill, making dinner and dentist appointments, monitoring the pets' food supply or her parents' health checkups. This checklist never, ever shrank, despite her best efforts, and perpetually chased away her sleep.

"So we feel like there are these enormous boulders that we are carrying on our shoulders that we walk into the bedroom with," she says. "And that's what we're laying down with."

By "we," Krimitsos means herself and the many other women she talks to or works with who complain of fatigue.

Women are one of the most sleep-troubled demographics, according to a recent Gallup survey that found sleep patterns of Americans deteriorating rapidly over the past decade.

"When you look in particular at adult women under the age of 50, that's the group where we're seeing the most steep movement in terms of their rate of sleeping less or feeling less satisfied with their sleep and also their rate of stress," says Gallup senior researcher Sarah Fioroni.

Overall, Americans' sleep is at an all time low, in terms of both quantity and quality.

A majority – 57% – now say they could use more sleep, which is a big jump from a decade ago. It's an acceleration of an ongoing trend, according to the survey. In 1942, 59% of Americans said that they slept 8 hours or more; today, that applies to only 26% of Americans. One in five people, also an all-time high, now sleep fewer than 5 hours a day.

Popular myths about sleep, debunked

"If you have poor sleep, then it's all things bad," says Gina Marie Mathew, a post-doctoral sleep researcher at Stony Brook Medicine in New York. The Gallup survey did not cite reasons for the rapid decline, but Mathew says her research shows that smartphones keep us — and especially teenagers — up later.

She says sleep, as well as diet and exercise, is considered one of the three pillars of health. Yet American culture devalues rest.

"In terms of structural and policy change, we need to recognize that a lot of these systems that are in place are not conducive to women in particular getting enough sleep or getting the sleep that they need," she says, arguing things like paid family leave and flexible work hours might help women sleep more, and better.

No one person can change a culture that discourages sleep. But when faced with her own sleeplessness, Tampa mom Katie Krimitsos started a podcast called Sleep Meditation for Women , a soothing series of episodes in which she acknowledges and tries to calm the stresses typical of many women.

Shots - Health News

Many grouchy, error-prone workers just need more sleep.

That podcast alone averages about a million unique listeners a month, and is one of 20 podcasts produced by Krimitsos's firm, Women's Meditation Network.

"Seven of those 20 podcasts are dedicated to sleep in some way, and they make up for 50% of my listenership," Krimitsos notes. "So yeah, it's the biggest pain point."

Krimitsos says she thinks women bear the burdens of a pace of life that keeps accelerating. "Our interpretation of how fast life should be and what we should 'accomplish' or have or do has exponentially increased," she says.

She only started sleeping better, she says, when she deliberately cut back on activities and commitments, both for herself and her two kids. "I feel more satisfied at the end of the day. I feel more fulfilled and I feel more willing to allow things that are not complete to let go."

Are weighted sleep products safe for babies? Lawmaker questions companies, stores pull sales

Sen. richard blumenthal of connecticut says two companies have refused to address 'broad, unverified safety claims about their products in the face of strong opposition from child safety experts'.

A U.S. senator is calling on the Federal Trade Commission to investigate the "seemingly deceptive advertising practices" of two makers of weighted sleep products for infants, while major companies like Amazon and Target have stopped sales of some of the items.

In a Thursday letter to commission Chair Lina Khan, Democratic Sen. Richard Blumenthal of Connecticut specifically called out Dreamland Baby and Nested Bean , saying the companies have refused to address their "broad, unverified safety claims about their products in the face of strong opposition from child safety experts," according to a news release from the lawmaker's office.

“I ask that the commission investigate these companies to determine whether any unlawful, unfair, or deceptive advertising practices are taking place and potentially harming millions of families,” Blumenthal wrote in the letter. "The stakes are simply too high to allow weighted infant sleep products to be advertised as ‘safe,’ especially without a clear disclaimer explaining the lack of an agreed-upon standard for determining safety."

What do the companies say?

Nested Bean founder and CEO Manasi Gangan told USA TODAY on Tuesday that retailers' decision to pull the products "stemmed from an unsupported and unilateral warning from a single CPSC (Consumer Product Safety Commission) commissioner that was based on inaccurate and incomplete data."

Gangan continued to say that "there have been no recalls of any Nested Bean products for infants and toddlers."

"And in the 13 years since the launch of our company, we have amassed an impeccable safety record while attracting over 2.5 million deeply loyal and satisfied customers," she said of the company, based in Hudson, Massachusetts.

Dreamland Baby, based in Danville, California, didn't respond to a request for comment from USA TODAY.

Amazon, Target, Babylist discontinue sales

Amazon has not specified which products it will pull, but it did publish a notice Wednesday that it will prohibit the sale of certain weighted sleep products for infants.

According to Amazon, listings for weighted infant sleep products will be removed if they:

• Refer to an infant, or use terms such as "baby," "newborn," "very young child," or “young child” in product detail page titles, descriptions, bullet points, or images
• Include images of an infant with the product
• Describes the use of weight in their use to aid in better infant sleep or use terms such as "self-soothing," "fall asleep fast," "deeper sleep" or "sleep longer" in product detail page titles, descriptions, bullet points, or images

“In the interest of safety, we informed selling partners on April 9, 2024, that Amazon will no longer allow the sale of weighted infant sleep products in the Amazon store,” an Amazon spokesperson told USA TODAY on Friday.

Target and Babylist follow Amazon's decision

A Target spokesperson said the retailer is "in the process of working with vendors and manufacturers of the products" and will remove the items from stores and online by the end of the week.

“Out of an abundance of caution, we have decided to voluntarily stop selling weighted baby sleep products as the industry continues to learn more," the retailer said.

Likewise, Babylist confirmed with USA TODAY Friday that it "no longer sells weighted infant sleep products."

"We are constantly reevaluating the merchandise we sell based on available industry guidance and made the decision to remove these from our offerings," a company spokesperson said.

Are weighted sleep sacks safe?

The American Academy of Pediatrics put out a report on evidence-based safe sleep recommendations in 2022 asking that "weighted blankets, weighted sleepers, weighted swaddles, or other weighted objects not be placed on or near the sleeping infant.”

Though Nested Bean's weighted sleeper is advertised to calm "like a hand on your baby's chest" and Dreamland Baby's weighted sleepwear is described as feeling "like a hug," there is concern from pediatricians, consumers and consumer safety advocates that such products could affect an infant's or heart rate.

Rachel Moon, a doctor and chair of the academy's task force on sudden infant death syndrome, outlined the following risks to Consumer Reports:

• Babies' rib cages aren't rigid, so it doesn't take a lot of pressure to create obstruction
• If a baby ends up in an unsafe sleeping position, the pressure of the weighted sacks makes it harder to get out of
• Weighted sleep products could cause suffocation if shifted out of position to cover a baby's mouth or nose
• Weighted sleep products make it tougher for babies to wake up and feed

“In terms of babies who die of SIDS, what we think is happening is that they can’t wake up," she told Consumer Reports. "There’s a problem with their arousal ... We want babies to wake up at night. That is actually protective."

The U.S. Centers for Disease Control and Prevention has a thorough list of safety tips for infant sleep that you can read here .