BEHAVIORAL AND MASSAGE TREATMENTS FOR INFANT SLEEP PROBLEMS

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

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Infant massage may also benefit the person who gives the massage. Parents, other infant caregivers, and adult volunteers have all reported decreased anxiety and a heightened sense of well being after administering infant massage. In addition, previous research suggests that infant massage may significantly improve parent-child bonding and the quality of parent-child interactions.17,20

Although the calming properties of massage are widely recognized, its effects on pediatric sleep have not been well studied. Existing research in this area is somewhat limited in scope and methodological design. However, recent studies have shown that massage in the newborn period may have a long-term effect on melatonin synthesis and the development of normal circadian rhythms.21 Only a few studies have looked at massage as an intervention for pediatric sleep problems, all of which report shortened sleep onset latency, fewer nighttime awakenings, and improved daytime alertness/behavior following regular bedtime massage. Prior infant massage studies have typically measured infant sleep only by subjective measures, including parent report measures such as child behavior rating scales and sleep diaries.2123 Although some studies included brief periods of video monitoring to document sleep-wake patterns around the time of intervention, the effects of massage on infant sleep problems have yec to be measured with validated, objective measures of sleep (i.e. actigraphy, polysomnography).

PREVENTION AND PARENT EDUCATION

Research suggests that parent education and prevention are among the most cost-effective and efficient approaches to behavioral sleep problems in infancy.12, 24-25 Parents who receive preventive education are able to support their infant's early sleep skills while avoiding the inadvertent reinforcement of negative night time behaviors. In addition, early education is an effective way to impact large populations of infants who may be at risk. The high prevalence and chronicity of infant sleep problems support the need for widespread, early preventive education in pediatric practice.

PRACTICAL CONSIDERATIONS FOR CLINICAL PRACTICE

Most infants with sleep problems will respond to behavioral treatment. However, little research has been done to describe the efficacy of different sleep training methods relative to each other. Many of the existing studies involve at least two interventions, such as an extinction program paired with a consistent bedtime routine. It is therefore impossible to choose a behavioral treatment for infant sleep problems based on empirical evidence alone. Instead, the choice of a behavioral program for infant sleep problems is based largely on the characteristics of each case.

In order for infant sleep training to be successful, the pediatric provider must consider the best way to deliver information and provide support to parents. As with choosing a treatment method, the means of information delivery and parental support can vary widely and should be tailored to the needs of each family. Infant sleep training may therefore require a certain level of commitment from the provider as well as the infant's parents. Again, early prevention may be more time and cost effective than the treatment of established sleep problems, and many pediatrie organizations recommend a routine sleep assessment during every well child visit.