Table 4 Development and evaluation of sleep related interventions. (Presented in publication year order)

12.

Douglas et al. (2013) [53]

Australia

Investigates if behavioral sleep interventions in families with infants less than 6 months may improve child and maternal outcomes.

Systematic review.

638 studies were detected, and 43 studies selected for review.

The authors argue that behavioral sleep interventions are inefficient for infants younger than 6 months. Main critiques are presented as 3 methodical limitations related to:1) lack of focus on associations with feeding difficulties, 2) to little differentiation between the first and second part of infants first year and 3) that some studies interpret associations as causal relations.

Focus on the high variability in neurodevelopmental stages and sleep maturation the first six months. Unsettled infant behavior in this period is a complex phenomenon. They argue for a holistic approach in attempts to support and empower parents including individualized approaches, cue-based care, and healthy daytime biopsychological rhythms.

13.

Kempler et al. (2016) [54]

Australia

May a psychosocial sleep-focused interventions improve infant sleep or maternal mood in the first year?

Systematic review and meta-analysis of RCT’s.

7 of 9 included studies reports on children less than six months

(N = 2023 mother-infant dyads).

The designed interventions had a small positive effect on total night-time sleep for infants (TNTS), p < 0.001, Hedge’s g = 0.204, but only a weak, non-significant effect on infant night waking.

It is a great heterogeneity between the programs included in this study. Thus, they can’t conclude what types of interventions that is best. Efficacy depends on infants’ maturation and age.

Results from this study differs compared to Douglas et al. (2013) [53] but are in line with previous Cochrane review [57].

14.

Cricton & Symon (2016)

[55]

Australia

Exam the effects of behavioral sleep techniques on infant aged six month or less.

Non-systematic review.

11 studies, covering 2663 infants included

The studies provide evidence that active preventive intervention improves infant sleep in the earliest month of life (no statistics).

No results indicating harmful effects of delayed responses were found.

Key information given to parents included: infant sleep physiology, patterns and cycles, sleep onset associations, routines, use of diaries: focal feed, self-settling, settling techniques, minimized interactions on night, differentiate night and day.

Provision of parental education differed between individual and group settings.

15.

Paul et al. (2016) [56]

USA

Investigates if a responsive parenting intervention (RPI) might improve sleep outcomes in a sample of families with newborn infants compared to a control group.

N = 279 infants.

RCT that recruited families right after childbirth and conducted follow-up assessments at 2, 8, 52 weeks after birth with parental reports.

Compared with controls the RPI- group were less likely to have prolonged bedtime routines at one year of age, earlier bedtimes at 16 weeks, they were more seldom fed to sleep and had longer nocturnal sleep duration at 8, 16 and 40 weeks.

RPI is a multicomponent program including advice about bedtime routines, sleep location and parental soothing behavior and behavior in relation to night waking.

16.

Mihelic et al. (2017) [29]

Australia

Evaluation of the efficacy of parental interventions. Only results on infants sleeping problems are included here (13 studies).

A meta-analytic review of publications from 5 databases, all published before February 2016.

Participation in the intervention groups were associated with significantly better sleep outcomes among children, Cohen’s d = 0.24, p < 0.001 compared to control groups. Interventions assessing infant crying did not show significant intervention effects.

The findings concur with Cochrane review in 2013 [57].

Parental competence or confidence was only assessed in five studies and the authors mention this as these factors are known to have impact on sleep outcomes.

17.

Galland et al. (2017) [58]

New Zealand

Evaluates the preventive effects of a sleep intervention given antenatally and three weeks post-partum.

N = 802 families

RCT with four groups: 1) usual care, 2) sleep intervention, 3) activity and feeding intervention and 4) combination of 2) and 3). Data based on parental self-report and actigraphy.

Analysis with linear mixed models did not detect any significant benefits of the sleep education at 6 months. The frequency of problematic sleep reported by all mothers were 16.1% at 4 months and 19.9% at 6 months. Parental practices related to infant safe sleep were not affected by the intervention.

The authors questions if antenatal education to parents may be to early.

They acknowledge that infant awaking and disrupted sleep the first 6 month should be viewed as normal, due to the ongoing neurodevelopmental maturation and infants’ adaptation to the extrauterine world.

18.

Middlemiss et al. (2017) [59]

USA

Investigating changes in infants total sleep time (TST) in a prospective, clinical study. Families were enrolled in a sleep intervention program.

N = 34 mother-infant dyads.

A response-based sleep intervention with four timepoints when children were from 4 to 11 months old.

Data was collected from sleep logs, questionnaires and salvia-samples.

Analyses of infant sleep, from before admission to the program until finish detected a significant increase in childrens total sleep time (TST) (t(59) = 8.96, p < 0.001). The mean increase in TST was 5.8-hour pr 24 hours.

Teaching parents to understand and respond to infant cues, through the day and at the transition to sleep was associated with an increase in mothers’ ability to overview their infants sleep schedules.

These effects were possible without engaging in behavioral extinction strategies. Interestingly, maternal registrations of infant sleep were associated with higher degrees of maternal anxiety or depression, possibly associated with changes in response patterns.

19.

Martins et al. (2018) [27]

Portugal

An evaluation of a postnatal education program distributed to 159 new mothers (IG) before discharge from the maternity ward in comparison with a control group (CG). Total N = 314.

An experimental, longitudinal study with implementation of a 15- minutes educational session. Data was collected from self-report on questionnaires at childrens age of 1,2,4 and six months.

Infants in the IG group slept more often in their own bed at their age of one month (OR adj = 4.51; 95% CI,1.69–12) and were more often able to fall asleep alone (OR adj = 4.11; 95% CI, 2.3–7.4). IG-infants were less often feed to sleep than controls (OR adj = 1.49; 95% CI, 0.9–2.4). At 6 months IG-infants still were reported as more able to fall in sleep alone and needed less feeding to sleep.

The intervention consisted of one individual session with a specially trained sleep-consultant (pediatrician), supplemented with a leaflet. The information included knowledge about normal sleep cycles, the importance of sleep for healthy development, sleep hygiene including routines, infant solitary sleeping, sleep promotive environments and how to support infants self-soothing capacities.

20.

Ball et al. (2020) [28]

United Kingdom

A description of the development of a new approach to support parental wellbeing and responsive infant caregiving in UK.

Responses were given by 164 health practitioners and 535 new parents.

An action research study that adapts an existing Australian program to a new UK-intervention “Sleep, Baby & You” (SBY). Data were collected on stakeholder meetings. Field-testing of the SBY were done among health practitioners and new parents.

Practitioners were positive about the concepts and suggestions contained within the SBY-materiel. SBY is described as a non-prescriptive approach that search to normalize the life with a newborn infant and the challenges it brings.

12 parents gave anonymous response on the program. They emphasize the importance of getting knowledge about normal sleep development and that spoken and written materiel support each other.

Feedback given across this developmental process confirms that parents want knowledge about normal infant sleep both antenatally and in infancy, adapted to the needs of each family.

This paper does not mention the importance of infant safe sleep; thus, we don’t know if it’s incorporated in the program.

21.

Sweeney et al. (2020) [26]

New Zealand

A pilot testing of a perinatally delivered behavioral-educational sleep intervention (PIPIS).

20 mothers formed a control-group (CG) and 20 a sleep intervention-group (SIG).

N = 40.

A pilot of a controlled trial.

Data collection used self-reported sleep quality and actigraphic measures

from mothers and infants.

Total sleep time per 24 hours (TST) among mothers were similar in the groups, but total nocturnal TST became significantly different. SIG-mothers had an increase of 47 minutes in nocturnal sleep, but not for CG-mothers from 6 to 12 weeks postpartum [t(36.55) = − 4.30, P < 0.001.

Infants sleep outcomes were similar across groups. By 12 weeks, compared with 6-week reports, maternal perception of infant sleep problems was improved for SIG-mothers but not for CG-mothers.

SIG-mothers reported greater confidence in managing their infants sleep even the relation was not tested.

Infant sleep development follows individual tracks the first six month of life. Results from this study may indicate that the intervention strengthened mothers’ capacity to handle these challenges.