8 evidence-based infant sleep strategies

in this post:

• what does evidence based even mean?

• are there evidence based ways to improve sleep?

• the eight Interventions for improving sleep

If you’ve been looking for baby sleep info, you’ve probably seen the term “evidence-based” to describe certain strategies, approaches or programs. What is this “evidence” anyway? And what does it mean for a sleep philosophy or tool to be “evidence-based?”

What does “evidence based” even mean?

Typically used in fields of medicine and academia, evidence-based denotes an approach that emphasizes the practical application of the findings of the best available current research.

Evidence Based Practice (EBP) is a process of “integrating the best available research evidence with clinical expertise and the patient’s unique values and circumstances” (Straus, Glasziou, Richardson, & Haynes, 2011).

are there evidence-based ways to improve infant sleep?

There are! While we don’t have mountains of research papers on infant sleep, and many studies are imperfect, we do have lots of practices that are evidence based and widely accepted.

Keeping in mind that “evidence-based” is meant to use best research available PAIRED WITH clinical expertise and the patient’s (or parent’s!) particular values, preferences and circumstances, there are plenty of strategies you can use with your infant that will or WILL NOT feel right to YOU, and that’s okay! Just because something is “evidence-based” does not mean it’s required.

Here are eight evidence-based sleep interventions for babies and children:

1. Establishing a Positive Bedtime Routine: Consistency and connection are the keys when it comes to bedtime routines. Engage in calming activities such as a warm bath, gentle massage, putting on a soothing playlist, or reading a bedtime story to signal to your baby that it’s time to wind down. Establishing consistent and positive bedtime routines including these activities can signal to children that it’s time to wind down and prepare for sleep. For older children, routines are important as well and can reduce things like power struggles and anxiety around bedtime.

2. Responsive Feeding: Responsive feeding in a mother-baby dyad involves feeding a baby when they show hunger cues and when you want to feed them. Remember that you don’t need to adhere to strict clock-based schedules, but just knowing your baby’s hunger cues and responding to them quickly can help them (and you!) get back to sleep more quickly after waking at night. Studies show exclusively breastfeeding mothers actually get more sleep than their mixed- or formula-feeding counterparts. Always speak with your healthcare team/ an IBCLC if you have concerns with your child’s feeding. If your child is over 12 months, you’re still completely fine to feed during the night, contrary to lots of fear mongering out there!

3. Creating a Sleep-Inducing Environment: Keep the sleep environment conducive to rest by maintaining a comfortable room temperature (around 68-72°F) when possible, minimizing noise and light disturbances, and using calming noise like humming, music etc. to soothe your baby to sleep. You also want to be sure your baby is dressed in breathable fabrics so that they don’t overheat, and that their sleep space is clear of hazards so they are safe.

4. Bedtime Fading: This approach involves gradually delaying bedtime to match the child’s natural sleep onset, thereby reducing bedtime resistance and improving sleep duration. [2] This technique is typically most effective with toddlers and older children, and I describe how to implement this approach in this blog post.

5. Scheduled Awakenings: This technique involves intentionally waking the child during periods of lighter sleep to prevent the occurrence of night terrors or sleepwalking episodes. [3] I often call this trick “wake to sleep” and it can be done to help with short naps, early morning wakings, etc. as well. It’s a great little hack!

6. Mindfulness-Based Interventions: Mindfulness practices, such as meditation and relaxation techniques, have shown promise in improving sleep quality and reducing sleep disturbances in both children and adolescents. One mindfulness strategy that works for young children is mindfulness-infused stories like the ones inside the Goldminds App.

7. Light Therapy: Natural light exposure, particularly in the morning, can help regulate the circadian rhythm and improve sleep quality, especially for children with circadian rhythm disorders or delayed sleep phase syndrome. Getting outside with your baby, particularly in the morning, can be a great start to the day and lead to better sleep at night. Win win! Similarly, avoiding artificial light close to bedtime and overnight can help sleep improve as well.

8. Sleep Hygiene Education: Providing children and their parents with education on sleep hygiene practices, such as limiting screen time before bed, maintaining a consistent sleep schedule, and creating a comfortable sleep environment, can promote healthy sleep habits.

These interventions, supported by research evidence, offer additional options for parents and caregivers seeking to address sleep challenges in babies and children with gentle and responsive methods.

References:

1. Mindell, J. A., Kuhn, B., Lewin, D. S., Meltzer, L. J., & Sadeh, A. (2006). Behavioral Treatment of Bedtime Problems and Night Wakings in Infants and Young Children. https://pediatrics.aappublications.org/content/117/5/e924.short

2. Gradisar, M., & Wolfson, A. R. (2012). Treatment of sleep problems in families with young children: Effects of treatment on family well-being. https://pubmed.ncbi.nlm.nih.gov/21892993/

Paul IM, Savage JS, Anzman-Frasca S, Marini ME, Mindell JA, Birch LL. INSIGHT Responsive Parenting Intervention and Infant Sleep. Pediatrics. 2016 Jul;138(1):e20160762. doi: 10.1542/peds.2016-0762. PMID: 27354460; PMCID: PMC4925087.

Kendall-Tackett, K., Cong, Z. and Hale, T.W., 2011. The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation, 2(2), pp.22-26.

3. Kohyama, J. (2011). Sleep terrors in children. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312397/

4. Bei, B., Byrne, M. L., Ivens, C., Waloszek, J., Woods, M. J., Dudgeon, P., … & Allen, N. B. (2013). Pilot study of a mindfulness‐based, multi‐component, in‐school group sleep intervention in adolescent girls. https://onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.12052

5. Reid, K. J., & Zee, P. C. (2009). Circadian rhythm disorders. https://pubmed.ncbi.nlm.nih.gov/19343004/

6. Mindell, J. A., & Williamson, A. A. (2018). Benefits of a bedtime routine in young children: Sleep, development, and beyond. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958164/

7. Gruber, R., Cassoff, J., Frenette, S., Wiebe, S., & Carrier, J. (2012). Impact of sleep extension and restriction on children’s emotional lability and impulsivity. https://pubmed.ncbi.nlm.nih.gov/22238410/

Kok EY, Kaur S, Mohd Shukri NH, Abdul Razak N, Takahashi M, Teoh SC, Tay JEF, Shibata S. The role of light exposure in infant circadian rhythm establishment: A scoping review perspective. Eur J Pediatr. 2024 Dec 30;184(1):112. doi: 10.1007/s00431-024-05951-3. PMID: 39738921; PMCID: PMC11685245.

8.Gradisar, M., & Wolfson, A. R. (2012). Treatment of sleep problems in families with young children: Effects of treatment on family well-being. https://pubmed.ncbi.nlm.nih.gov/21892993/