BEHAVIORAL AND MASSAGE TREATMENTS FOR INFANT SLEEP PROBLEMS

Medicine and Health Rhode Island,  Mar 2006  by Forbes, Elizabeth A

• E-mail
• Print
• Link

POSITIVE ROUTINES/FADED BEDTIME WITH RESPONSE COST

Positive bedtime routines are designed to "cue" the infant for sleep by providing him/her with a predictable sequence of calm, enjoyable activities at bedtime. The infant's bedtime is delayed to encourage rapid sleep onset, and appropriate cues for sleep are paired with positive parent-child interactions. Once the infant's behavior is well established and he/she is falling asleep quickly, the bedtime is gradually advanced to the desired time.

Faded bedtime with response cost involves removing the infant from the crib for specified periods of time when sleep onset is delayed. This strategy is similar to positive bedtime routines. Both methods take advantage of the infant's decreased arousal at his/her natural sleep onset time to enforce appropriate bedtime behaviors, in contrast to extinction programs, which aim instead to decrease inappropriate bedtime behaviors (i.e. prolonged crying).

There is some evidence to suggest that positive bedtime routines and faded bedtime with response cost may be rapid and effective treatments for infant sleep problems.1215 Although these strategies have not been widely studied, they offer a promising alternative to families who are unable to tolerate any of the extinction methods of infant sleep training.

INFANT MASSAGE

The importance of parental consistency in the behavioral treatment of infant sleep problems has been discussed. However, many parents have difficulty adhering to these methods due to the perceived emotional and/or environmental consequences of letting their baby cry unattended. Even when successful, sleep training is work intensive for parents and health care providers alike. These difficulties have promoted an ongoing interest in alternative methods to treat infant sleep problems and improve parental adherence with behavioral treatments. Infant massage may be a safe, simple, and effective way to meet both of these goals.

Infant massage is commonly used in many areas of the world, especially Africa, India, and Asia. Its use has been steadily increasing in the West, and many hospitals now offer massage programs that apply specific techniques to infants and children. Research over the past 10-15 years has shown massage to be a beneficial adjunct to the medical treatment of many pediatric problems, including: prematurity, burns/trauma, mental health and behavioral issues, disordered and/or incompetent immune systems, respiratory illnesses, and chronic pain syndromes.16-17 In infants, massage has been associated with improved alertness, temperament, consolability, and growth. Positive effects on learning, development, and sleep have also been reported.17-18

It has been postulated that the direct benefits of infant massage are due to a variety of behavioral and physiological factors. Physiologically, massage may decrease stress hormones such as cortisol, epinephrine, and norepinephrine, and increase relaxation hormones such as serotonin. Massage has been associated with increased vagal tone, which may increase alertness, improve growth, and promote a greater sense of well being.17 Massage in adolescents and adults has also been associated with EEG findings that reflect a heightened sense of alertness, such as decreased alpha and beta wave amplitudes.17,19