Personalized Approach Best for Infants with Sleep Problems

Michal Kahn, PhD

There may not be a standard approach to treating infants with separation anxiety, meaning a more personalized approach may work best.

A team, led by Michal Kahn, PhD, School of Psychological Sciences, Tel Aviv University, evaluated the moderating role of infant separation anxiety in a pair of brief interventions for infant sleep problems.

Behavioral interventions for pediatric insomnia are often cost-effective and beneficial to most families. However, there is no evidence indicating which treatments are most suitable for specific patient populations.

The randomized controlled trial included 91 infants between 9-18 months with pediatric insomnia. The study population was 61% male.

The investigators randomized the individuals to either Checking-in, a Graduated extinction protocol which involves gradual separation from parents or to a Camping-out intervention group, where parental presence is maintained.

The team measured sleep using actigraphy and parental reports, while infant separation anxiety was observed in the laboratory. The investigators completed assessments on each individual participant at baseline, post-treatment, and during a 6-month follow-up.

Overall, improvement in sleep was demonstrated after both interventions and was maintained at the follow-up.

They did not find that separation anxiety changes significantly following treatment. They also found infant separation anxiety moderated treatment efficacy with greater benefits to the infants with high separation anxiety in the Camping-out group compared to the Checking-in intervention group.

“This study provides support for considering infant separation anxiety in the effort to personalize treatment for pediatric insomnia.,” the authors said. “Pediatricians should incorporate evaluation of infant separation anxiety to assessment processes, and favor more gentle treatment approaches, such as Camping-out, over Graduated extinction for highly anxious infants.”

Recently, a team, led by Fallon Cook, PhD, Department of Pediatrics at the University of Melbourne, determined whether infants with severe persistent sleep problems are at an increased risk of meeting the diagnostic criteria for a psychiatric disorder at age 10 or have elevated symptoms of mental health difficulties at ages 4 and 10.

In the prospective longitudinal community cohort study, dubbed the Maternal Health Study, mothers completed questionnaires and interviews at 15 weeks’ gestation, 3,6,9, and 12 months postpartum, as well as when their child turned 4 and 10 years old.

There was a total of 1460 mother-infant pairings from 6 public hospitals in Melbourne, Australia, beginning in April 2003. Participants were eligible if they were at least 18 years old, at 10-20 weeks’ gestation, and had sufficient English to complete the questionnaire and phone interviews.

Some of the measured included a parental report of the infant’s night waking and sleep problems and child mental health assessment completed through the Strengths and Difficulties Questionnaire, Spence Children’s Anxiety Scale and a development and well-being Assessment.

In the study, 283 infants (19.4%) infants had persistent severe sleep problems, 817 infants (56.0%) had moderate/fluctuating sleep problems, and 360 infants (24.7%) were settled.

Infants with persistent severe sleep problems are more likely to report an emotional disorder at age 10 (adjusted OR, 2.37; 95% CI, 1.05-5.36; P = 0.04).

These infants also had elevated symptoms of separation anxiety (AOR, 2.44; 95% CI, 1.35-4.41; P <0.01), fear of physical injury (AOR, 2.14; 95% CI, 1.09-4.18; P = 0.03), and overall elevated anxiety (AOR, 2.20; 95% CI, 1.13-4.29; P = 0.02) at age 10.

The study, “Behavioral interventions for pediatric insomnia: one treatment may not fit all,” was published online in Sleep.