Parents deserve a Government-funded alternative to sleep training

Parents deserve a Government-funded alternative to sleep training

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Andrea Fallon started this petition to NSW Government and

To the Hon Bronnie Taylor, Minister for Mental Health, Regional Youth and Women, NSW,

As an Australian parent and member of the community concerned about the well-being of parents and their babies, I welcome your public acknowledgement reported on 24 April 2020 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.

I know from both personal experience and the research, that parents dealing with sleep, breastfeeding, and unsettled infant behaviour are at increased risk of mental health problems.

I know that the mental health of parents caring for babies is even more urgently challenged in the context of COVID-19.

I am 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 ‘sleep training’ or modified extinction methods, an approach to infant sleep developed in the 1950s and 1960s.

Because infant sleep training remains, sixty years later both in Australia and internationally, the dominant Government-funded approach to the care of new babies, it has been well investigated.

Four systematic reviews of sleep training studies (adapted for a range of programs), including a systematic review of randomised controlled trials, conclude on careful analysis 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

Single studies used to promote sleep training as evidence-based are methodologically flawed and demonstrate interpretation bias. 5-7

The sleep training advice in the SleepWellBaby app risks disruption to breastfeeding physiology. It also encourages prescribed or delayed responses to baby cues, conflicting with the neuroscience demonstrating the importance of sensitive or responsive care. 8, 9

As a parent, when I hear that a program has been endorsed (allocating funding implies endorsement) by the government, I trust that it is the most evidence-based, appropriate and beneficial approach.

However, many parents have found that sleep training strategies worsen distress and anxiety, disrupt breastfeeding, and worsen night waking in time, due to disruption to their baby's circadian clock (these concerns are supported by research. 10-13).

This experience then causes overwhelming mental distress (both parent and baby) for many who take on and persevere with the sleep training approach because alternative approaches are not being endorsed in the same way and therefore much harder to find.

An example of an alternative science-based approach to parent-infant sleep, which has been developed here in Australia from a paradigm quite different to sleep training, is known as The Possums Sleep Program.

This approach works gently with baby’s biology and supports a parent’s own enjoyment, instead of aiming to entrain sleep and feed biology into routines.

It also repairs excessive night-waking by repairing disruptions to the baby’s circadian clock. 14-18  

The Possums Sleep Program is one part of a holistic evidence-based approach to infant sleep, feeds and unsettled behaviour known as Neuroprotective Developmental Care (NDC) or The Possums Programs.

I respectfully request that the Government invest in resources for new parents, including during the stressors of the COVID-19 pandemic, which allow parents to have a choice.


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.            Gradisar M, Jackson K, Supurrier N, Gibson J, Whitham J, Williams AS, et al. Behavioral interventions for infant sleep problems: a randomised controlled trial. Pediatrics. 2016;137:e20151486.

6.            Hiscock H, Cook F, Bayer JK, Le HN, Mensah FK, Cann W, et al. Preventing early infant sleep and crying problems and postnatal depression: a randomized trial. Pediatrics. 2014;133(2):e346-354.

7.            Symon B, Marley JE, Martin JA, Norman ER. Effect of a consultation teaching behaviour modification on sleep performance in infants:  a randomised controlled trial. Med J Aust. 2005;182(5):215-218.

8.            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.

9.            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).

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

11.          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.

12.          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.

13.          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.

14.          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.

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

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

17.          Whittingham K, Palmer C, Douglas PS, Creedy DK, Sheffield J. Evaluating the 'Possums' health professional training in parent-infant sleep. Infant Mental Health Journal. 2020; In press.

18.          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.

 

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