'Cued care' approach helps new babies, parents to sleep

A new program in Australia is helping new parents to understand their infant’s sleep patterns - and get better sleep themselves, too, researchers say.

Following the Possums Infant Sleep Program, parents reported less stress, less concern about sleep problems such as night-waking and day-time naps, and better quality of life, the study authors report in the journal Sleep Health.

“Most of us struggle with sleep disruption when our babies’ sleep patterns aren’t aligned with our own, and parents can become quite anxious and have a low mood,” said lead study author Helen Ball of Durham University’s Parent-Infant Sleep Lab in the United Kingdom.

The Possums Infant Sleep Program educates parents about expectations around normal infant sleep and encourages them to experiment with strategies. In particular, the program explains sleep regulators such as the circadian clock and sleep pressure and encourages parents to respond to babies’ “cues” for eating and sleeping.

“Little possum” is an Australian term of endearment for babies. As part of the Possums Clinic in Brisbane, Australia, new moms can sign up for infant sleep consultations during their postnatal appointments. Ball and colleagues surveyed moms who participated in group discussions and one-on-one meetings about the program and its effects.

Among the 64 respondents who filled out an online survey, most reported having had concerns about frequent night waking, too little day sleep, an inability to put the baby down, and maternal stress regarding infant sleep. They mentioned their levels of stress, exhaustion, anxiety, depression, lack of self-care and feelings of being unable to cope. For many, this was the first behavioral approach they had tried with a professional sleep consultant.

The mothers appreciated that the program encouraged flexibility in their parenting, respected their choices, and helped them to relate better to their baby. In addition, they enjoyed learning about normalizing infant sleep, understanding how sleep works, and attending to their baby’s circadian clock and sensory needs. They also felt better about their self-efficacy as parents, adjusted their expectations about sleep and reduced anxiety, and said the program transformed their parenting journey.

“What stuck out to me was how awful parents felt when they were struggling to implement strategies that were not working for them and their baby,” Ball said by email. “It was initially difficult for them to put aside all the guidance they had received before and start again thinking about their baby’s sleep from a fresh perspective, but when they did, they reported a dramatic change in their enjoyment of their baby and their parenting experience.”

Ball is implementing the Possums approach in the UK - called Sleep, Baby and You - and is developing a visual discussion tool for parents and doctors to talk about infant sleep, especially in low socioeconomic areas with low literacy levels.

“Many of the current strategies for aiding infant sleep do not necessarily fit with the ‘lived realities’ of families, and messages promoting good infant sleep do not always fit from a cultural or economic perspective,” said Barbara Galland of the University of Otago Dunedin School of Medicine in Dunedin, New Zealand.

Galland, who wasn’t involved with this study, researches how different cultures perceive the traditional approaches to promoting good sleep in infants. For example, traditional approaches suggest quiet, dark places for infants to sleep, but that’s difficult for some families. More family-tailored approaches need to be considered, she said.

“This is a movement toward understanding that infants are communicating and that responding to infants’ cues/communication is a central and critical part of any healthy caretaking routine,” said Wendy Middlemiss, who studies infant sleep at the University of North Texas in Denton but wasn’t involved with this study.

“This development of their regulatory systems impacts later ability to maintain attention, control stress response, and establish sleep patterns and other developmental outcomes that contribute to academic and social ability,” Middlemiss told Reuters Health by email.

“Sleep is important for the health and quality of life of everyone in the house, so it should certainly be a priority,” said Liora Kempler of the Woolcock Institute of Medical Research in Sydney, Australia.

Kempler, who wasn’t involved with this study, said by email, “Expectant parents should find those programs offering evidence-based information (amongst the many which do not) and prepare for the parenting experience as much as possible so they can have realistic expectations and better ways of managing theirs and their babies’ sleep.”