The prevention of infant sleep disturbance: a universal approach
Creators: name: Watts, Steven
Publisher: name: RMIT University
Year: 2024
Subjects: classificationCode: 520304
subject: Health psychology

description: Childhood sleep problems continue to pervade modern societies at alarming rates with substantial costs to individuals, families, and communities. Despite good evidence that parent preventive education may be the most acceptable, effective, time-efficient, economical, and ethical approach to behaviourally-based paediatric sleep disturbance, the availability of prevention programs remains limited. This thesis reports on a prevention strategy designed to enhance knowledge of normal sleep development, and promote adaptive sleep-related practices among parents of young children. The primary aim was to investigate the role of written anticipatory guidance in the prevention of problematic sleep. In addition, the pathways to infant sleep disturbance, including chronic sleeping difficulties within the first year of life are examined. <br><br>Three hundred and fifty-four first-time mothers of healthy, normally developing infants were recruited from infant health centres throughout Victoria, Australia. All participants completed a 4-day infant sleep diary and parent questionnaire at 6 and 12 months, post-birth. Three studies are presented. The first investigates the use of a six-page parent tip sheet designed for universal distribution to parents of newborn infants. To examine its efficacy, two groups were formed—half of the participants received the written advice and the remainder served as a control group. The second study examines many of the proximal risk and protective factors thought to be associated with infant sleep regulation and consolidation. The final report considers the factors relating to persistently problematic and enduring healthy infant sleep using two extreme subgroups of 40 participants. <br><br>Results revealed that the written anticipatory guidance was successful in influencing parent cognitions and behaviours and by extension, infant sleep outcomes. Parents privy to the parent tip sheet were significantly more likely to report adaptive cognitions about infant sleep and less likely to engage in maladaptive night-time parenting behaviours at 6 and 12 months. Importantly, the infants of intervention mothers exhibited healthier sleep patterns on both the retrospective parent questionnaire and the prospective infant sleep diary, at each time of measurement. Remarkably, the sleep patterns of intervention infants at 6 months were comparable to those of control infants at 12 months. <br><br>Additional key findings were revealed in the second and third studies. Overall, infants sleeping in their own bedroom were significantly more likely to exhibit healthy sleep patterns, while infants sleeping within the parental bedroom from birth were at increased risk of persistent sleep problems. There was general support for widely held view that night-time parenting strategies involving active physical comforting provide the most immediate and direct path to infant sleep disturbance. This research also substantiates the influential role of maternal cognitions involving limit-setting, anger, doubt, and feeding in infant sleep regulation and consolidation. Stimulatory parenting behaviours and unhelpful maternal cognitions were additionally associated with chronic sleeping difficulties over the first 12 months of life. A multitude of other factors, including infant temperament, the co-parenting alliance, and maternal depression, anxiety, and stress were found to have weaker and/or more complex relationships with infant sleep pattern development. Methodological issues and implications for prevention theory, research, and practice are also considered.