“Controlled crying” may help infants sleep and improve maternal mood
Many parents around the world, particularly mothers, lament the relentless nighttime crying of their babies. Many of these same mothers suffer from symptoms of depression that may be related to lack of sleep and frustration with their baby’s crying. Recent research published in BMJ (formerly the British Medical Journal ) suggests that learning how to manage their infants’ crying can help mothers improve their infants’ sleep problems and relieve their own symptoms of depression.
About the study
Researchers at Royal Children’s Hospital in Melbourne, Australia, enrolled 156 mothers of infants 7 to 9 months old, who were attending free health screenings between May 1998 and April 1999. The mothers completed a survey about their infants’ sleep patterns and a questionnaire about their own well-being, called the Edinburgh postnatal depression scale.
Women were included in the study if their infants met any of the following criteria:
- Awakened more than five nights per week
- Awakened more than 3 times per night
- Took more than 30 minutes to fall asleep
- Required parental presence to fall asleep
Women were excluded from the study if they were receiving treatment for postnatal depression, reported thoughts of self-harm, or if their infants had medical conditions likely to cause their sleep problems.
Seventy-eight women were assigned to attend three private sessions (each two weeks apart) with a maternal and child health specialist. During these sessions they were given sleep management plans for their infants and information about normal and problem infant sleep patterns. In particular, they learned to respond to their baby’s crying at increasing time intervals (a technique called controlled crying) and to gradually reduce the time they spent on night feedings. The other 78 women were assigned to a control group who received only a mailed pamphlet on normal infant sleep patterns without any advice as to how best to manage infant sleep problems.
After two months and four months, infant sleep problems and mothers’ well-being were assessed with mailed questionnaires, which again included the Edinburgh depression scale. Researchers compared mothers’ assessments of their infants’ sleep problems and mothers’ scores on the depression scale among women who received the controlled crying and sleep management plans and those who did not.
At two months, 53 women in the controlled crying/sleep management group reported that their infants’ sleep problems had resolved, compared with only 36 women in the control group. Also at the two-month evaluation, depression scores of women in both groups fell, but scores for the controlled crying/sleep management group fell slightly more than for the control group.
By four months, changes in sleep problems and depression scores were similar for both groups. This overall improvement in both groups may be attributable to the natural tendency for infant sleep patterns to improve with time.
Although these results are interesting, there are some limitations to this study. It’s unknown whether this intervention would be successful in women with severe postnatal depression because they were excluded from this study. In addition, the women knew which group of the two interventions they had been assigned to. This introduces the possibility of the placebo effect. That is, maybe the women who received the controlled crying intervention believed that their infants’ sleep—and their own well being—had improved, when in fact it had not.
How does this affect you?
Is there help out there for mothers of babies who keep them up all night with their crying? It sure sounds like it. This study confirms the findings of other smaller studies that mothers can learn effective coping strategies and techniques for reducing infant crying and nighttime waking. And it makes sense that reducing their child’s sleep problems can reduce moms’ symptoms of mild depression.
The authors of this study recommend that their techniques be tested with a larger group of mothers who receive the training from primary health care providers.
It only took three sessions to teach mothers the controlled crying and other sleep management techniques that were effective in this study. If you think your infant has problems sleeping, ask your health care provider for advice on controlled crying techniques. And remember, this study confirmed what many mothers already know: The all-night crying will end! You just may need some help getting through the tough months until it subsides.
Hiscock H and Wake M. Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. BMJ . May 4, 2002;324:1062-1065.
Last reviewed May 3, 2002 by ]]>Richard Glickman-Simon, MD]]>
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