Preventing Early Infant Sleep and Crying Problems and Postnatal Depression: A Randomized Trial

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Infant sleep and crying problems are common and associated with postnatal depression. No programs aiming to prevent all 3 issues have been rigorously evaluated. WHAT THIS STUDY ADDS:A prevention program targeting these issues improves caregiver mental health, behaviors, and cognitions around infant sleep. Implementation at a population level may be best restricted to infants who are frequent feeders because they experience fewer crying and daytime sleep problems. abstract OBJECTIVE: To evaluate a prevention program for infant sleep and cry problems and postnatal depression. METHODS:Randomized controlled trial with 781 infants born at 32 weeks or later in 42 well-child centers, Melbourne, Australia. Follow-up occurred at infant age 4 and 6 months. The intervention including supplying information about normal infant sleep and cry patterns, settling techniques, medical causes of crying and parent self-care, delivered via booklet and DVD (at infant age 4 weeks), telephone consultation (8 weeks), and parent group (13 weeks) versus well-child care. Outcomes included caregiver-reported infant night sleep problem (primary outcome), infant daytime sleep, cry and feeding problems, crying and sleep duration, caregiver depression symptoms, attendance at night wakings, and formula changes. RESULTS:Infant outcomes were similar between groups. Relative to control caregivers, intervention caregivers at 6 months were less likely to score .9 on the Edinburgh Postnatal Depression Scale (7.9%, vs 12.9%, adjusted odds ratio [OR] 0.57, 95% confidence interval [CI] 0.34 to 0.94), spend .20 minutes attending infant wakings (41% vs 51%, adjusted OR 0.66, 95% CI 0.46 to 0.95), or change formula (13% vs 23%, P , .05). Infant frequent feeders (.11 feeds/24 hours) in the intervention group were less likely to have daytime sleep (OR 0.13, 95% CI 0.03 to 0.54) or cry problems (OR 0.27, 95% CI 0.08 to 0.86) at 4 months.CONCLUSIONS: An education program reduces postnatal depression symptoms, as well as sleep and cry problems in infants who are frequent feeders. The program may be best targeted to frequent feeders.

PREPP: postpartum depression prevention through the mother–infant dyad

“…There also is an association between infant sleeping problems and PPD, which may be mediated via disruption in women’s sleep (Armstrong et al 1998; Bayer et al 2007; Dennis and Ross 2005; Hiscock and Wake 2001). To date, including the treatment of infant behaviors in PPD interventions is only beginning (Hiscock and Wake 2002; Hiscock et al 2014). …”

“…In the first of its kind, Hiscock et al (2014) provided 781 mother-infant dyads with written materials and an educational DVD that presented information about infant sleep cycles and crying patterns, strategies to promote independent settling (e.g., swaddling), and information about self–care for parents. Mothers in the intervention group were significantly less likely to meet criteria for possible depression (>9 on the Edinburgh Postnatal Depression Scale) when their infant was 6 months old, though there were no differences between the intervention and control groups at 4 months postpartum.…”

Improving Psychosocial Health, Coping, and Self-Efficacy in Parents of Sleep-Disturbed Young Children

“…First, data suggest that disturbed sleep in newborns and infants is associated with a new onset of depressive symptoms in mothers [11,15], and maternal depression scores are not identified as predictors of later child sleep problems in long-term studies [6]. Second, findings indicate that the treatment of the child´s sleep problem can simultaneously improve maternal depression scores [16][17][18][19][20] and maternal stress or marital satisfaction [21]. Research including data on both parents is quite rare.…”

“…Various studies demonstrate the efficacy of behavioral interventions in reducing pediatric sleep disturbances [21,35] and in improving parental strain [16][17][18][19][20]. Personal support (face-to-face or telephone support) seems to increase improvements in parental psychosocial health [36,37].…”

Management of perinatal depression with non-drug interventions

“…Most controlled trials of educational sleep interventions for postnatal dyads have focused on the quality of infants’ sleep, and on balance these trials have not shown major benefits 81. Among the minority of trials that examined maternal depressive symptoms as an outcome, most studies reported positive results 828384. One notable pilot RCT of 30 postpartum women found that women who received a sleep counseling intervention averaged more night-time sleep than controls (57 (95% confidence interval 6 to 106) min; P=0.03) 85.…”