Sleep counseling program for parents increases children’s sleep hours at six months

Iná da Silva dos Santos

Federal University of Pelotas (UFPEL)
Project: Counseling for healthy sleep habits during childhood: a randomized controlled trial

Those who have a baby or children under the age of two at home know the drama at bedtime well. To make the little ones fall asleep, each parent adopts a different strategy. For some, total silence works best. Others prefer to follow rituals to relax their child, such as bathing, offering soothing foods or reading a book. Even so, sometimes all of these strategies fail, crying begins and the only solution seems to be to give in to the child’s demands and bring it to the middle of the parents’ bed.

The problem is that insufficient, irregular, non-routine, or low-quality sleep can impair child development. Research shows that it is essential for ensuring growth, and good motor and cognitive performance in the first 1,000 days.

To advise parents on this difficult task every night, and assess the impacts of these recommendations, the physician and researcher Iná da Silva dos Santos, from the Federal University of Pelotas (UFPEL) and a specialist in evaluating maternal and child health programs and services, proposed an innovative project in Brazil. “This is still a very underexplored topic and rarely present in consultations with pediatricians, but it is necessary to provide instruction to parents as soon as possible,” says Iná. “The topic is so new that this project led to the creation of a line of research in postgraduate studies on sleep.”

Iná and her team devised a program aimed at parents to improve infant sleep quality through visits from trained technicians at home. To assess the impacts of the initiative on children’s sleep, they conducted a so-called randomized controlled trial, one of the most reliable scientific methods. 586 mothers of three-month-old babies were recruited. Of this total, 298 were selected at random to receive visits and another 288 were part of the control group and did not receive the team’s guidance.

During the visits, the team provided information to the mothers of the babies in the intervention group about sleep characteristics in the first year of life and the ideal conditions to make the child “go to sleep.” These included corrections to the environment to generate restful sleep: low noise, no sound from TVs and low light. In addition, they taught women how to establish a routine prior to bedtime: feeding, bathing and lying down to avoid stimulating or shaking the child before going to sleep. Other lessons included techniques for putting the child to sleep when it was drowsy and how to deal with waking up in the middle of the night.

A nurse visits mother and baby participating in the sleep counseling program for parents

When their children were three and six months, the mothers of both groups filled out a diary about the child’s sleep. The researchers also used a questionnaire to evaluate the children at three, six, 12 and 24 months old. All mothers, from both groups, were interviewed when their children turn six, 12 and 24 months.

The evaluations showed that the intervention had an effect at six months, with a longer duration of nighttime sleep, and at two years, the age when children woke up less and slept better. Although at 6 months, the children in the intervention group slept 19 minutes longer than those in the control group, according to the mothers’ diary, this difference was not statistically significant, according to the researchers.

At one year old, children whose parents received counseling performed better on the psychomotor development test than those in the control group. With respect to growth, there were no differences in the two groups for children between the ages of one and two years old. “Our results show that sleep needs to be on the agenda and a concern during early childhood,” says Iná.