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Nurse-Led Intervention Helps Improve Infant Sleep.

I sleep during infancy is known to have negative effects on both infants and families. In a study to determine the effect on infant sleep-related issues of a “responsive parenting” intervention—called INSIGHT (Intervention Nurses Start Infants Growing on Healthy Trajectories)—visiting nurses were trained to help firsttime mothers establish consistent bedtime routines for their new babies, encourage self-soothing and early bedtimes, and learn strategies to deal with waking during the night. The mothers in the intervention were compared with a “home safety” control group of mothers who were educated on crib safety and prevention of sudden infant death syndrome via a mailing two weeks and a home visit three to four weeks after the babies were born. A total of 291 mother–infant pairs were randomized to either the intervention or the control group within two weeks of childbirth, and 279 completed the first study visit. The nurses administered the interventions at home visits conducted when the infants were three to four, 16, 28, and 40 weeks old; in addition, a research clinic visit occurred at one year. The responsive parenting intervention included developmentally appropriate guidance on bedtime routines, the best locations for sleeping, and how to respond to night waking; the information was provided in writing and via video as supplements to the one-on-one home visits. A validated questionnaire was used to assess the sleep factors. Differences between the two groups began to emerge at eight weeks. Compared with infants in the control group, those in the responsive parenting group had earlier bedtimes and shorter bedtime routines, were less likely to need to be fed immediately before bedtime or to have to be held to fall asleep, and were more likely to be able to self-soothe to fall asleep. In addition, at weeks 8, 16, and 40, nocturnal sleep duration was longer by 35, 25, and 22 minutes, respectively, in the responsive parenting group. At one year, the durations of both daytime and nighttime sleeping were similar in the two groups, although infants in the intervention group were marginally more likely to sleep the recommended 12 to 14 hours per day. The authors conclude that sleeprelated behaviors can be modified during infancy and that parents can be taught simple strategies associated with significantly longer and noninterrupted sleep at night.