Responsive Parenting intervention linked to improved infant bedtime routines

1. Infants placed in the Responsive Parenting (RP) group were more likely to have earlier bedtimes at 16 and 40 weeks and less likely to have prolonged bedtime routines (greater than 45 minutes).

2. RP group infants were also more likely to self-soothe to sleep and less likely to be fed immediately before bed.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: Inadequate sleep during infancy has been associated with many adverse socioemotional, cognitive, psychomotor, and developmental outcomes. Bedtime routines vary greatly by parenting practice and are often a known stressor to families, affecting their emotional wellbeing. This study sought to investigate the potential for infant sleep behavior improvement through a parenting intervention, originally designed for obesity prevention. Researchers found that RP infants, when compared to control groups, were more likely to have earlier bedtimes at 16 and 40 weeks and less likely to have prolonged bedtime routines (greater than 45 minutes). They were also more likely self-soothe and less likely to be fed immediately before bed. RP group sleep duration was longer at several check points throughout the intervention. This study was limited by maternal self-report and the potential lack of generalizability given that the study cohort was comprised of a fairly homogeneous population. These findings indicate that most sleep-related behaviors can be modified in infancy, potentially influencing a child’s sleep behaviors into toddlerhood. Pediatricians and other providers can counsel parents on the importance of simple interventions including earlier and consistent bedtimes in order to help with parents and their infants with successful sleep.

Click to read the study, published today in Pediatrics

Relevant Reading: Getting rhythm: how do babies do it?

In-Depth [randomized controlled trial]: Mothers and newborns were recruited as part of the INSIGHT study (Intervention Nurses Start Infants Growing on Healthy Trajectories) from Pennsylvania State Hershey Medical Center. A total of 279 mother-infant dyads were enrolled in this study and randomized into RP or control groups, stratified on birth weight for gestational age and intended feeding mode. Nurses delivered RP and control interventions at home visits given at infant age 3-4, 16, 28, and 40 weeks, concluding with a visit to the research center at age 1 year. The RP intervention focused on consolidating sleep, extending night sleep duration, providing sleep-related parenting behaviors, establishing consistent bedtime routines, encouraging self-soothing and early bedtimes, as well as strategies for night-time waking. RP infants were significantly more likely to have shorter bed time routines at 16 weeks (51% vs. 37%, p = 0.03) and 40 weeks (57% vs. 44%, p = 0.04). RP infants had earlier bed time routines at 16 weeks, 46% of RP infants were in bed by 8:00pm as compared to 24% of controls (p < 0.001). At 40 weeks, 66% of RP infants were in bed by 8:00pm as opposed to 47% of controls (p = 0.002). RP mothers were less likely to report feeding their infant back to sleep in response to nighttime awakenings at 16 weeks (54% vs. 72%, p = 0.002) and at 40 weeks (24% vs. 41%, p = 0.005).

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