Behavioral sleep interventions really work, parents say

Michael G Burke, MD

Most parents in a Facebook peer support group for parents using behavioral sleep interventions (BSIs) reported in an online survey that their infant cried significantly less by the end of 1 week of BSI implementation and that they achieved complete success within 2 weeks, regardless of which type of BSI they used.

Investigators defined 4 specific approaches to BSI: unmodified extinction (leaving the room and not returning); modified extinction (leaving the room but returning at intervals to check or reassure the infant); parental presence (staying continuously in the room without providing additional support); and parental presence with support (patting, picking up the infant).

Of the 652 participants, about half used modified extinction and a third unmodified extinction, with far fewer using the other 2 approaches. On average, parents started BSI at age 5.6 months, with most reporting that their infant cried most the first night (an average of 43 minutes) but significantly less after 1 week (an average of 8 minutes).

More than 75% of families reported that BSI was successful within the first 2 weeks, and only 14% needed to use it for more than 4 weeks. About a quarter of parents started with one BSI approach and switched to another; 83% reported successful implementation of BSI on the first attempt. Whatever BSI type they used, parents indicated that after intervention their infants had less difficulty falling asleep and fewer night awakenings, and were more likely to sleep in their room or in their own crib (Honaker SM, et al. J Pediatr. 2018;199:106.e2-111.e2).

Thoughts from Dr. Burke

I am not sure how results of this survey were affected by recruiting participants from an online support group of parents who use BSI. Are these parents who went online for help with particularly bad baby bedtimes or have they successfully tried these techniques and joined the group to share their endorsements? Either way, I suspect these results resonate and that you or some parents in your practice have had similar success with behavioral management at bedtime. You can use the evidence to promote this approach with dubious parents.