Behavioral Treatment of Bedtime Problems and Night Wakings in Infants and Young Children

TLDR

The paper reviews evidence on behavioral treatments for bedtime problems and night wakings in young children, and calls for further research on delivery methods, long‑term efficacy, pharmacological adjuncts, and standardized diagnostic and outcome measures. The authors conducted a systematic review of 52 treatment studies compiled by an American Academy of Sleep Medicine task force to develop practice parameters for behavioral management of bedtime problems and night wakings in young children. The review shows that behavioral therapies are reliably effective, with 94 % of studies reporting efficacy and over 80 % of children achieving clinically significant improvement sustained for 3–6 months, particularly through unmodified extinction, preventive parent education, graduated extinction, bedtime fading/positive routines, and scheduled awakenings.

Abstract

This paper reviews the evidence regarding the efficacy of behavioral treatments for bedtime problems and night wakings in young children. It is based on a review of 52 treatment studies by a task force appointed by the American Academy of Sleep Medicine to develop practice parameters on behavioral treatments for the clinical management of bedtime problems and night wakings in young children. The findings indicate that behavioral therapies produce reliable and durable changes. Across all studies, 94% report that behavioral interventions were efficacious, with over 80% of children treated demonstrating clinically significant improvement that was maintained for 3 to 6 months. In particular, empirical evidence from controlled group studies utilizing Sackett criteria for evidence-based treatment provides strong support for unmodifi ed extinction and preventive parent education. In addition, support is provided for graduated extinction, bedtime fading/positive routines, and scheduled awakenings. Additional research is needed to examine delivery methods of treatment, longer-term efficacy, and the role of pharmacological agents. Furthermore, pediatric sleep researchers are strongly encouraged to develop standardized diagnostic criteria and more objective measures, and to come to a consensus on critical outcome variables.