Parents’ own best efforts at treating sleep problems in infants and toddlers

Lynn Loutzenhiser, Ph.D. R.D. PsychChild and Family Research GroupUniversity of ReginaRegina, Saskatchewan, Canada

Background• Parents are concerned about

infant/toddler sleep behaviours (e.g., Ferber, 2006; Thiedke, 2001; Thome & Skuladottir, 2005).

• Parents seek out and receive an abundance of advice about infant/toddler sleep.

Background• “there’s so much literature and

information out there for parents to solve your child’s sleep problem that it makes you feel like there’s things that you can do and there’s a right way and there’s a wrong way to have your child be a good sleeper.” (mother of 1)

Background

“you start to look at some of these books and you know they’re basically telling you methods like that you need to let that baby cry it out and all this, and I just didn’t feel comfortable with that, I really basically stopped reading the literature because I thought well this isn’t really helping me.” (mother of 2)

Background• “And we never, we never found any advice.

We ended up paying for, I don’t know, I guess she must have been a nurse practitioner. … And, so we thought, you know, it’s worth $200 if they come in, if they can look at what we’re doing because you can’t always see what you’re doing wrong. So we decided to try it, and most of what she suggested we’d already read about, and weren’t things that were going to work with him… So, I, I’ve probably read every website on sleep, every book that’s available on sleep, and never came to a good solution.” (mother of 2).

Background

• Parents report feeling conflicted about what to do and “judged” by others regardless of their choices.

• “ I think that’s a common misconception that people have, that when they are not doing kind of what the books all say you should do, or what everybody at the baby group already does, that you don’t talk about it, because it’s kind of a taboo subject.” (mother of 1)

Background• “I guess part of the thing that I found

frustrating was the range that seemed, this sort of Ferber cry it out and the really all the way attachment parenting which has said “just respond to them regardless and eventually like when they’re older, preschoolers probably it will get better”. I found that a really kind of wide range to figure out what a middle ground was.” (mother of 1)

Background

• Few empirical studies have examined parents’ use of sleep interventions for infants and toddlers in non-clinical populations.

• “Night-waking in Infants and Toddlers Study”

Research Objectives

To identify parents’ use of strategies to help infants and toddlers sleep through the night.

To assess parents’ use of controlled crying strategies.

To assess parents’ perceptions of the effectiveness of controlled crying strategies and identify factors associated with perceived effectiveness.

Participants (N=926)

11.9%

.2% .3%

12.5%16.6%

3.6% 46.4%2.1%

1.5%2.7%

1.4%.8%

Procedures

• Data was collected for this study in March and April, 2009

• Participants were recruited through a pop-up screen on the Today’s Parent Website (a popular Canadian parenting magazine), as well as through media interviews and mother networking sites

• Participants completed the survey on-line

MeasuresInfant Variables:

• Age• Temperament• Physical health • Behaviour upon night-waking

Parent Variables:• Age, Education, Family income, Number of children, • Use of techniques to help infant/toddler sleep through

night,• Specific questions about controlled crying techniques• Cognitions regarding infant/toddler sleep

Results

Parental Use of Techniques

0102030405060708090

100

in parent'sbed

in ownbed/crib

to bed awake

before 6 months after 6 months

Results

Parental Use of Techniques

0102030405060708090

100

positiveroutine

scheduledawake

structuredday

before 6 months after 6 months

Results

child age first tried controlled crying

before 6 mon6-12 mon13-19 monover 19 mon

Just over ½ of all participants (N=490) have used a controlled crying technique

55%

36%

ResultsReasons for not using controlled crying(N=436)

Strongly agree or agree

Parents can’t control infant/toddler sleep 45%

Child is a good sleeper 46%

Night-wakings are not a problem 59%

Stressful for infant/toddlers 77%

Stressful for parents 79%

ResultsPerceived effectiveness of

controlled crying at reducing night-wakings

eliminatedreduced sig'fsomewhata littlenot at all

37%

10

17%

10

26%

Results: Infant Variables

Parents who perceived controlled crying to be effective:

• had infants who were significantly less distressed upon waking, t(294)=-3.72, p<.01.

• had infants who were in better physical health, t(488)=-1.88, p=.06.

• Age of infant, and temperament were not significantly different between the groups

Results: Parent Variables

Parents who perceived controlled crying to be effective:

• Reported significantly higher incomes, t(488)=3.57, p<.01.

• Indicated significantly higher agreement with the statements that parents can control infant sleep patterns, t(488)=-6.75, p<.01, and that parents should be able to easily put their children to sleep, t(488)=-3.19, p<.01.

• Scored significantly lower on the limit-setting scale, which indicates fewer difficulties with setting limits, t(463)=-12.77, p<.01.

• Parent age, education level and number of children were not significantly different between the groups.

Results Technique Variables

Parents who perceived controlled crying to be effective:

• Indicated significantly lower agreement with the statement that controlled crying is stressful for the parent and child, t(488)=-8.29, p<.01

• Indicated significantly higher agreement with the statement that others close to you support this technique, t (488)=-6.24, p<.01

• Duration of use of the technique and the number of times it had been started were not significantly different between the groups.

Results

Logistic regression used to predict effectiveness of controlled crying techniques (N=490).

The overall model was statistically significant and accounted for 44% of the variance in effectiveness scores.

Significant predictors of effectiveness were:• Parental limit-setting • Parental beliefs about the controllability of infant sleep• Parents’ perceptions of the support of close others while using

this technique • Parents’ perceptions of stress for themselves and their child

Discussion & Implications

• We need to know more about how expert advice is understood by parents, how it is applied, and how it is related to parental beliefs about infant/toddler sleep behaviours and the role of expert advice.

Discussion & Implications• How does lack of success with sleep training

techniques impact parents and their views on sleep advice? What might work for them?

• Effectiveness of controlled crying is related to parental cognitions about infant sleep and infant behaviours (limit-setting). These variables need to be taken into account in clinical practice and public education efforts.

• Infant behaviour upon night-waking is a understudied variable in sleep research yet may be an important factor for the success of some sleep training techniques.

Limitations & Future Directions

• Study based on parent self-report and retrospective data

• Direction of the relationship between variables is not clear

• Really need longitudinal studies of nonclinical parents

Acknowledgements

• John Hoffman, Contributing Editor, Today’s Parent Magazine

• Today’s Parent Magazine • Graduate Students at the Child and Family

Research Group at the University of Regina – Phillip Sevingy, M.A.– Angela Bathgate, B.A.– Kathy Chan, B.A.– Maureen Thompson, B.A.

• University of Regina, Dean’s Research Award