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Evid Based Nurs 12:9 doi:10.1136/ebn.12.1.9
  • Treatment

Mothers were less likely to be depressed after a structured behavioural intervention for infant sleep problems

H Hiscock

Dr H Hiscock, Royal Children’s Hospital, Parkville, Victoria, Australia; harriet.hiscock{at}rch.org.au

QUESTION

Is a structured behavioural intervention (SBI) for infant sleep problems effective for maternal depression, parenting style, and child mental health and sleep outcomes at 2 years?

METHODS

Design:

cluster randomised controlled trial (RCT).

Allocation:

concealed.

Blinding:

blinded {families, nurses, data collectors, and data analysts}.*

Follow-up period:

{17 months}.*

Setting:

49 maternal and child health centres in 6 government areas in Melbourne, Victoria, Australia.

Patients:

328 mothers (mean age 33 y) who reported infant sleep problems (mean infant age 7.4 mo, 54% boys). Infants born at < 32 weeks’ gestation and mothers who did not know sufficient English to complete questionnaires were excluded.

Intervention:

25 centres (n = 174) were allocated to SBIs to improve infant sleep, and 24 centres (n = 154) were allocated to usual well-child care. In the SBI group, 100 families accepted the offer of help from nurses and were given sleep management plans based on adult fading (mother sits with infant until infant falls asleep and slowly removes her presence over 2–3 wks) (n = 7) or graduated extinction (mother responds to infant’s cry at increasing time intervals) (n = 53) or were taught simple strategies (positive bedtime routine or management of pacifiers) (n = 20). Nurses did not record the choice of SBI in 20 families.

Outcomes:

maternal depression (Edinburgh Postnatal Depression Scale score >9 or ⩾13), parenting practices, child mental health, and child sleep problems (as reported by mother).

Patient follow-up:

outcome data were available for 100% of centres and 83% of families at child age 2 years (intention-to-treat analysis).

MAIN RESULTS

Fewer mothers in the SBI group had depression compared with the usual care group (table). Groups did not differ for parenting practices, child sleep problems (table), or child mental health.

A structured behavioural intervention v usual well-child care for maternal and infant outcomes*

CONCLUSION

A behavioural intervention for infant sleep problems improved maternal depression but did not differ from usual well-child care for child sleep problems or mental health at child age 2 years.

*Information provided by author.

A modified version of this abstract appears in Evidence-Based Medicine.

ABSTRACTED FROM

Hiscock H, Bayer JK, Hampton A, et al. Long-term mother and child mental health effects of a population-based infant sleep intervention: cluster-randomized, controlled trial. Pediatrics 2008;122:e621–7.

Clinical impact ratings: Family/general practice 6/7; Paediatrics 6/7; Psychiatry 6/7

Footnotes

  • Source of funding: Pratt Foundation.

Commentary

Sleep problems affect up to 50% of infants,1 and about 20% do not grow out of night waking. The RCT by Hiscock et al showed persistent decreases in maternal depression up to 2 years of age after intervention for infant sleep problems. Reducing depression is important for mothers because of the short-term and long-term effects on mother–infant attachment and child behaviour.2 Difficulty with persistent child sleep problems is important to mothers, whether or not it is associated with depression. Only 11% of mothers in the SBI group reported infant sleep problems at all assessment points compared with 22% in the usual care group (adjusted odds ratio 0.51, 95% CI 0.25 to 1.03). However, groups did not differ for maternal report of infant sleep problems at 2 years, despite significant differences at 10 and 12 months. 22% of mothers in the usual care group received help from nurses who were not involved in the RCT. Using outside resources may have reduced group differences at 2 years. Moreover, mothers in the SBI group were not exposed to 1 specific intervention. They were offered a choice between adult fading and graduated extinction; 20 mothers received simple interventions that were not described in detail, and interventions chosen by 20 families were not recorded. Further comparative study could examine whether particular interventions can maintain effects over 2 years. Because settling difficulties are more common than night waking in preschool children,3 it is possible that effective interventions during infancy may not suffice at later developmental stages.

Mothers reported positive effects of interventions on their relationships with their children. SBIs delivered by nurses can reduce rates of depression in mothers of 2-year-old children, even though sleep problems can persist.

References

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