Getting an Infant to Sleep: Graduated Extinction and Sleep Fading Are Effective

Clinical Question

Which method of getting an infant to sleep causes less stress in infants and parents?

Bottom Line

This study found that graduated extinction (increasing intervals between comforting the infant) and sleep fading (putting the child to bed progressively later until the parent finds the sweet spot) are both effective at decreasing sleep latency and the number of awakenings and decreasing maternal and infant stress. Neither approach affected the likelihood of secure child-parent attachment. (Level of Evidence = 1b−)

Synopsis

This study included 43 infants six to 16 months of age (63% girls) and their parents who were initially assigned to one of three methods to get the infant to sleep. After a one-week observation period to collect baseline data, the families were then randomized, using concealed allocation, into one of three groups: (1) graduated extinction, in which the parent puts the child in bed while still awake and waits before checking on the child, initially for two minutes, then four minutes, and then six minutes (in the same night); (2) sleep fading, in which the children were put to bed 15 minutes later than normal; if still awake 15 minutes later, they were put to bed 30 minutes later the following night; and (3) control, in which parents received only general information about infant sleep. Both interventions, compared with the control group, resulted in decreased time to sleep and number of awakenings. Maternal stress, measured by a survey questionnaire, moderately decreased over the first month of the intervention. Infant stress, measured by salivary cortisol levels, was slightly lower in the infants in the treatment groups. The security of child-parent attachment was not different among the treatment groups.

Study design: Randomized controlled trial (single-blinded)

Funding source: Foundation

Allocation: Concealed

Setting: Outpatient (primary care)

Reference: Gradisar M, Jackson K, Spurrier NJ, et al. Behavioral interventions for infant sleep problems: a randomized controlled trial. Pediatrics. 2016;137(6):e20151486.