Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial

TLDR

The study evaluated whether graduated extinction and bedtime fading improve infant sleep patterns, reduce parent and infant stress, and affect child emotional/behavioral outcomes and attachment. Infants were randomized to graduated extinction, bedtime fading, or sleep education control; sleep was tracked with parent diaries and actigraphy, while infant stress was assessed by salivary cortisol and maternal mood/stress questionnaires, with 12‑month follow‑up evaluations of child behavior and attachment. Both interventions markedly reduced infant sleep latency and awakenings, lowered cortisol and maternal stress modestly, but did not alter child emotional/behavioral problems or attachment at 12 months, indicating sleep benefits without adverse long‑term effects.

Abstract

To evaluate the effects of behavioral interventions on the sleep/wakefulness of infants, parent and infant stress, and later child emotional/behavioral problems, and parent-child attachment.A total of 43 infants (6-16 months, 63% girls) were randomized to receive either graduated extinction (n = 14), bedtime fading (n = 15), or sleep education control (n = 14). Sleep measures included parent-reported sleep diaries and infant actigraphy. Infant stress was measured via morning and afternoon salivary cortisol sampling, and mothers' self-reported mood and stress. Twelve months after intervention, mothers completed assessments of children's emotional and behavioral problems, and mother-child dyads underwent the strange situation procedure to evaluate parent-child attachment.Significant interactions were found for sleep latency (P < .05), number of awakenings (P < .0001), and wake after sleep onset (P = .01), with large decreases in sleep latency for graduated extinction and bedtime fading groups, and large decreases in number of awakenings and wake after sleep onset for the graduated extinction group. Salivary cortisol showed small-to-moderate declines in graduated extinction and bedtime fading groups compared with controls. Mothers' stress showed small-to-moderate decreases for the graduated extinction and bedtime fading conditions over the first month, yet no differences in mood were detected. At the 12-month follow-up, no significant differences were found in emotional and behavioral problems, and no significant differences in secure-insecure attachment styles between groups.Both graduated extinction and bedtime fading provide significant sleep benefits above control, yet convey no adverse stress responses or long-term effects on parent-child attachment or child emotions and behavior.