Health professionals want evidence-based approach for infant sleep and maternal wellbeing

Health professionals want evidence-based approach for infant sleep and maternal wellbeing

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Andrea Fallon started this petition to NSW Government and

Hon Bronnie Taylor,

Minister for Mental Health, Regional Youth and Women

The Government of New South Wales

2 May 2020

 

As Australian health professionals who care for parents with babies, we welcome your public acknowledgement reported on 24 April 2020. We wholeheartedly agree that parents caring for babies in social isolation during the COVID-19 pandemic are under heightened stress and at increased risk of mental health problems.

We are dismayed, however, that you have granted $1.44 million, intended to address this serious problem, into funding free access to the SleepWellBaby app. SleepWellBaby educates parents in the strategies that comprise modified extinction methods, more commonly termed ‘sleep training’.

Four systematic reviews of sleep training studies (adapted for a range of programs), including a systematic review of randomised controlled trials, conclude that sleep training does not decrease night-waking; nor is there reliable evidence that sleep training improves maternal mood relative to any other caring therapeutic encounter. 1-4

Sleep training as offered in SleepWellBaby app incorporates advice which disrupts breastfeeding physiology, and encourages prescriptive or delayed responses to infant cues, disrupting parent-infant synchrony. 5, 6

In our experience as clinicians from multiple disciplines around Australia, sleep training advice regularly worsens parental anxiety, disrupts breastfeeding, and worsens night waking due to disruption to the infant’s circadian clock. Our concerns are supported by emerging research. 7-10

Despite the evidence against it, sleep training persists as the dominant strategy offered to parents through Government-funded early childhood services.

When a dominant and mainstreamed idea (such as sleep training) fails to withstand examination by the research community, proponents typically continue to call for more research and financial investment, when in fact, innovation is urgently required. 11

The Possums Sleep Program has been developed from rigorous theoretical frames and is one part of a holistic evidence-based approach to infant sleep, feeding and unsettled behaviour collectively known as Neuroprotective Developmental Care (NDC).

The program has been delivered clinically in Australia since 2011, adapted by the Durham University Infancy and Sleep Centre in the UK12, and underpinned a recent RACGP educational module for GPs. Preliminary evaluations are positive. 13-16

We request that Government offer parents choice when investing in resources which aim to support their mental health, including during the stressors of the COVID-19 pandemic.

 

 

1.            Douglas P, Hill PS. Behavioural sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic review. J Dev Behav Pediatr. 2013;34:497–507.

2.            Bryanton J, Beck C, Montelpare W. Postnatal parental education for optimizing infant general health and parent-infant relationships. Cochrane Database Syst Rev. 2013(11):CD004068. DOI: 004010.001002/14651858.CD14004068.pub14651854.

3.            Kempler L, Sharpe L, Miller CB, Bartlett DJ. Do psychosocial sleep interventions improve infant sleep or maternal mood in the postnatal period? A systematic review and meta-analysis of randomised controlled trials. Sleep Medicine Reviews. 2016;29:15-22.

4.            NHMRC. Report on the evidence: promoting social and emotional development and wellbeing of infants in pregnancy and the first year of life. http://www.nhmrc.gov.au: Australian Government, 2017.

5.            Harries V, Brown A. The association between baby care books that promote strict care routines and infant feeding, night time care, and maternal-infant interactions. Maternal and Child Nutrition. 2019:e12858.

6.            Feldman R. Parent-infant synchrony and the construction of shared timing: physiological precursors, developmental outcomes, and risk conditions. Journal of Child Psychology and Psychiatry. 2007;48(3).

7.            Brown A, Arnott B. Breastfeeding duration and early parenting behaviour: the importance of an infant-led, responsive style. PLoS One. 2014;9:e83893.

8.            Etherton H, Blunden S, Hauck Y. Discussion of extinction-based behavioral sleep interventions for young children and reasons why parents may find them difficult. Journal of Clinical Sleep Medicine. 2016;12(11):1535-1543.

9.            Blunden S, Dawson D. Behavioural sleep interventions in infants: Plan B - combining models of responsiveness to increase parental choice. Journal of Paediatrics and Child Health. 2020:doi:10.1111/jpc.14818.

10.          Morales-Munoz I, Partonen T, Saarenpaa-Heikkila O, Kylliainen A, Polkki P, Porkka-Heiskanen T, et al. The role of parental circadian preference in the onset of sleep difficulties in early childhood. Sleep Medicine. 2018;54:223-230.

11.          Joyner MJ, Paneth N, Ioannidis JPA. What happens when underperforming big ideas in research become entrenched? JAMA. 2016;316(13):Volume 316, Number 313.

12.          19.          Ball H, Taylor CE, Thomas V, Douglas PS, Sleep Baby and You Working Group. Development and evaluation of Sleep, Baby and You - an intervention to support parental well-being and responsive caregiving. Under review. 2020.

13. Whittingham K, Douglas PS. Optimising parent-infant sleep from birth to 6 months: a new paradigm. Infant Mental Health Journal. 2014;35:614-623.

14.          Douglas PS. The Possums Sleep Program: supporting easy, healthy parent-infant sleep. International Journal of Birth and Parent Education. 2018;6(1):13-16.

15.          Ball H, Douglas PS, Whittingham K, Kulasinghe K, Hill PS. The Possums Infant Sleep Program: parents' perspectives on a novel parent-infant sleep intervention in Australia. Sleep Health. 2018;4(6):519-526.

16.          Whittingham K, Palmer C, Douglas PS, Creedy DK, Sheffield J. Evaluating the 'Possums' Health Professional training in parent-infant sleep. Under review. 2020.

 

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