A Behavioral Model of Infant Sleep Disturbance

Abstract

Chronic sleep disturbance, such as bed refusal, sleep-onset delay, and night waking with crying, affects 15% to 35% of preschool children. Biological factors, particularly arousals associated with recurrent episodes of rapid-eye-movement sleep, render infants vulnerable to repeated awakenings. Parental failure to establish appropriate stimulus control of sleep-related behaviors and parentmediated contingencies of reinforcement for sleep-incompatible behaviors may shape and maintain infant sleep disturbance. Treatment and prevention strategies are discussed, and research needs are identified.

Treating sleep disturbance in infants: What generalizes?

“…Most infants are able to sleep through the night without regular parental care by approximately 6 months of age (Henderson, 2001;Moore & Ucko, 1957) but some experience infant sleep disturbance (ISD; Blampied & France, 1993;France, Henderson, & Hudson, 1996;France & Hudson, 1990), a subset of pediatric sleep disturbance (France & Blampied, 2004;Kuhn & Elliot, 2003). ISD involves long delays in initial sleep onset, with crying and oppositional behavior while settling to sleep when first put to bed (initial sleep-onset delay), and chronic repeated waking and difficulty in settling to sleep again without parental attention (night waking).…”

“…Research demonstrates that parental attention functions as positive reinforcement for the infant's sleep disturbances (see Blampied & France, 1993;, France, Blampied, & Henderson, 2003Williams, 1959) and that withdrawal of attention constitutes an extinction procedure. While complete and immediate withdrawal of parental attention (planned ignoring) has been shown to be effective for both sleep-onset delay and night waking (e.g., France & Hudson, 1990;Lawton, Blampied, & France, 1995;Reid, Walter, & O'Leary, 1999;Seymour, Bayfield, Brock, & During, 1983) some parents find it difficult to comply with the therapy because it requires them to tolerate their child's crying (Adams & Rickert, 1989;Reid et al, 1999) which may be intensified above normal levels by a post-extinction response burst (Lawton, France, & Blampied, 1991;Lerman & Iwata, 1995).…”

Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial

“…[1][2][3] Night wakings allow infants to signal parents' provision of sustenance and comfort. 1,3,4 At 2 months of age, sleep homeostatic pressure develops, potentially compressing nighttime awakenings.…”

“…[1][2][3] Night wakings allow infants to signal parents' provision of sustenance and comfort. 1,3,4 At 2 months of age, sleep homeostatic pressure develops, potentially compressing nighttime awakenings. 2 Large declines in nocturnal wakefulness occur (on average) over the first 6 months of age, and plateau thereafter, 2,5 occurring after 24-hour circadian rhythm stabilization at ∼3 to 6 months of age.…”

“…8,9 Sleep problems may be due to reduced sleep homeostatic pressure 2 and/or a "coercive behavior trap, " whereby parents' nocturnal responses are more reinforcing than sleep. 1 Aside from an array of known daytime impairments that follow from sleep restriction in adults, 10 serious consequences have been reported for families who have an infant with a sleep problem. Mothers of infants with a sleep problem are more likely to use physical punishment, 11,12 and are at an increased risk of developing depression (eg, >2.0 odds ratio).…”