Citation of the paper in APA style : Field, T. (2017). Infant sleep problems and interventions: a review. Infant behavior and development, 47, 40-53.
“Infant sleep problems have been the focus of a growing literature over the last few years”.
For this reason, Field, in 2017, wrote a literature review about some experiments done on infant sleep problems. This literature review relies on various studies to put forward the infant sleep and its impact on their future development. It includes risk and protective factors found in various studies, and then discusses possible interventions. A lot of studies are mentioned and the results are put into perspective by the author, who points out numerous methodological biases. It is important to consider her comments, because of the professional background of this child development specialist. In fact, as a professor in the Departments of Pediatrics, Psychology, and Psychiatry at the University of Miami School of Medicine and Director of the Touch Research Institute, Field received awards for her contribution to the psychology development and for her research. We can thus believe in her expertise, while keeping a critical mind on the work we will describe below.
To start with, the author defines the sleep time per night of infants (between 10.5 hours to 12.8 hours long). Thus, sleep problems are defined as the time spent sleeping per night being at least 1 standard deviation below this average. Concretely, we can also talk about sleep problems when the infant takes a long time to fall asleep, sleeps little at night and wakes up frequently at night. Sleep problems are thought to have negatives effects on the cognitive, physical and socio-emotional development of children.
In the first place, Field emphasizes the relationship between infant sleep patterns and later weight problems. Studies find a link between sleep time and infant weight problems. She points out that, there is also a relationship between the number of night-time awakenings, their duration reported by the mother and the child’s weight (at 6 years old). However, as these studies do not allow for a meta-analysis, the conclusions can’t be considered definitive. She reports a link between sleep disorders and socio-emotional problems as well. Indeed, studies show a link between poor sleep and higher internalizing scores, including inhibition, separation distress, anxiety and depression. But the author warns about the reliability of the results given the non-objectivity of the measures.
Then, Field talks about the different risk and protective factors for infant sleeping problems. Most of the risk factors relates to parental management of bedtime routines but also to more general elements of parental lifestyle : the presence of television in the same room, bedtimes feedings, close contact at bedtime, etc… Some protective factors found were maternal emotional availability, less arousing bedtime activities, or parent tolerance to infant crying for example. Once again, Field notes many problems with the sample and with the studie’s methodology.
Finally, the author highlights different types of interventions for sleep disorders. Most of them are educational or behavioral interventions. She resumes recent studies on them, particularly on bedtime routines given to parents of newborns. These strategies include for example : a minimum of stimulation before bedtime, feeding twenty minutes before bedtime, avoidance of reactive co-sleeping, etc… : these interventions would also show benefits for parents, notably on their state of fatigue, stress, and others. But again the author points out limitations to these intervention programs, such as sampling problems or poor choices in data analysis.
Field concludes this literature review suggesting that developmental effects of infant sleep problems are being identified, that risk factors for the development of sleep problems are being explored as early as the newborn stage and that interventions are being developed. Finally, she gives hope for the possibility of helping parents who find themselves in need when faced with the sleep difficulties of their newborns.
As for us, this article has given us a lot of information about infant sleep problems and the different factors that can influence them. So, it gives us some keys to deepen our knowledge on this subject.
Another good point is that this article has discussed the reasons for being cautious with study results in general. In fact, the author criticizes each of the studies, since according to her, none of them has really significant results. Indeed, despite satisfactory results for some studies, Field notes a sampling problem that would bias the study. We therefore have the impression that not many studies are really satisfactory meaning that we cannot really conclude to one or the other of the different hypotheses stated. So, on the one hand it is an interesting article to take a step back on all the results of this study. But, on the other hand, this article does not bring anything more than the studies that have already been published. We think that it is the main weakness of this article. Further research with better sampling on the various issues would provide additional insight. Moreover, the author exposes a lot of results and it is sometimes difficult to focus on important information. It would have been clearer if the researcher had been more synthetical.
Finally, even if the author writes about a lot of studies, we felt that we could not benefit from any of them because there was always a problem with the methodology, which gave us the impression that in the end, none of the results could be fully taken into account. But we can notice that the author mentions this limit in her literature review and it is an important quality for a researcher to have self-criticism. Moreover, the reading of this article enables us to make more specific research about this subject and we have found a more recent systematic review. Indeed, Knappe & al. (2020) has published an article on parental cognitions about sleep problems in infants. Results imply that a large part of problematic cognitions in child sleep pertains to parental difficulties with limiting their involvement at nighttime. Problematic cognitions include troubles setting limits as well as concerns that infants might experience distress upon awakening at night, inferring that parents should directly help and sooth their infant. They however suggest including parental cognitions for interventions on offspring sleep, for example by targeting limit setting in TCC-based interventions including psychoeducation and cognitive techniques. So parental cognitions appear to play a pivotal role for the development and maintenance of sleep problems in young children, arguing that parents’ attitudes and beliefs regarding child sleep inadvertently prompt parental behavior toward adverse sleep. Nevertheless, additional parental factors such as mental health or self-efficiency, as well as additional toddlers factors including temperamental dispositions and regulatory abilities, requires consideration in further studies. Thus, it offers other avenues of exploration for this thesis.
Key terms :
- Sleep problems – problèmes de sommeil
- Nightwaking – réveil nocturne
- Risk and protective factors – facteurs de risque et de protection
- Infant – nourrisson
- Parenthood – parentalité
Words we have learned :
- Toddlerhood – petite enfance
- Delays – retard
- Sub-samples – sous-échantillon
- The extent – le degré
- Videotaped – filmé