Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep Intervention: Randomized Trial

BACKGROUND AND OBJECTIVES: Randomized trials have demonstrated the short-to medium-term effectiveness of behavioral infant sleep interventions. However, concerns persist that they may harm children's emotional development and subsequent mental health. This study aimed to determine long-term harms and/or benefits of an infant behavioral sleep program at age 6 years on (1) child, (2) child-parent, and (3) maternal outcomes. METHODS: Three hundred twenty-six children (173 intervention) with parent-reported sleep problems at age 7 months were selected from a population sample of 692 infants recruited from well-child centers. The study was a 5-year follow-up of a population-based cluster-randomized trial. Allocation was concealed and researchers (but not parents) were blinded to group allocation. Behavioral techniques were delivered over 1 to 3 individual nurse consultations at infant age 8 to 10 months, versus usual care. The main outcomes measured were (1) child mental health, sleep, psychosocial functioning, stress regulation; (2) child-parent relationship; and (3) maternal mental health and parenting styles. RESULTS: Two hundred twenty-five families (69%) participated. There was no evidence of differences between intervention and control families for any outcome, including (1) children's emotional (P=.8) and conduct behavior scores (P=.6), sleep problems (9% vs 7%, P=.2), sleep habits score (P=.4), parent-(P=.7) and child-reported (P=.8) psychosocial functioning, chronic stress (29% vs 22%, P=.4); (2) child-parent closeness (P=.1) and conflict (P=.4), global relationship (P=.9), disinhibited attachment (P=.3); and (3) parent depression, anxiety, and stress scores (P=.9) or authoritative parenting (63% vs 59%, P=.5). CONCLUSIONS: Behavioral sleep techniques have no marked long-lasting effects (positive or negative). Parents and health professionals can confidently use these techniques to reduce the short-to medium-term burden of infant sleep problems and maternal depression. Pediatrics 2012; 130: 643-651