This is a partial list of research supporting the KinderSleep key sleep concepts for newborns and infants which are:

• Don't worry about sleep - it can make it worse
• Find the enjoyment in your baby day and night - you will feel less moody and  cope better
• Make your OWN sleep a priority
• Don't worry about creating so called "bad habits"
• Sleep can be improved at any age so you are in no hurry.
• Nurse/Feed and comfort your baby to sleep and back to sleep as long as it works
• If you are struggling with your infant, it may help to keep him/her from getting overtired
• If you are still struggling, we can help with some gentle strategies - Book a free consult
• Total day sleep is insignificant - don't worry about the charts!
• If you have a sleep problem later, we can help with gentle, responsive & supportive methods

Research Supporting No Sleep Interventions before 4 and 6 Months

Please note that there are many different types of research informing sleep including:

Sleep medicine, attachment and bonding, behavioural science, nutrition, safe sleep, safe co-sleeping research, treatment research, perinatal mood research, child development, infant mental health and even anthropology.

While no single study is conclusive there is a great deal of compelling evidence and large reviews that can help us inform decisions. The research sited below if primarily hard core sleep science research. We strive to promote evidence based practice in supporting families, which involves considering various research, our own knowledge, experience and desire to be gentle and the individual family/child dynamic. There are times when we work with families under 6 months of age who are having a sleep emergency. In this case we strive to offer support, reassurance and gentle strategies to improve sleep for the whole family. When necessary the earliest we would do sleep coaching is 4.5 months of age, however we may start working earlier with gentle strategies. In general, we encourage all families who are managing well to continue doing what works for then and not worry about sleep coaching until at least 6 months of age or wait until they have a sleep problem. There is no hurry for this, we work with children right up to age 6 as well as adults and we believe that sleep can be improved at any age. This list is in no way comprehensive. If you have a suggested study please feel free to add in into the comments.

Behavioral sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic review. Douglas PS¹, Hill PS.

CONCLUSION:  “The belief that behavioral intervention for sleep in the first 6 months of life improves outcomes for mothers and babies is historically constructed, overlooks feeding problems, and biases interpretation of data”

Abstract:  http://www.ncbi.nlm.nih.gov/pubmed/24042081

Type of study:   Systematic review of research
Parameters/size ages:   Children under 6 months
Date of study:  2013

Key findings:

• Parents of infants in the first 3 months are more concerned with crying than sleep. Sleep interventions in the first 3 months may improve sleep but have no effect on crying.
• “crying, feeding and sleep problems interact and co-evolve, particularly in the first neurodevelopmentally sensitive 4 months”
• First 3-4 months are neurodevelopmentally sensitive

No sleep interventions before 6 months

1. Due to complications with feeding issues
   • Feeding and sleeping problems interact and may go unidentified and untreated
   • “Latch, positional instability problems, anatomic abnormalities, functional lactose overlowd, scheduled or spaced feeds may cause poor satiety, crying and frequent wakings both day and nights in the first weeks and months” as well as premature breastfeeding cessation
   • Feeding problems can occur with both breastfeeding and bottle feeding babies
   • Feeding issues increase maternal anxiety and disrupt Mother-Baby relationship
2. Brain Development differences between 0-6 month olds and 6-12 month olds are vast. Studies show positive findings for babies over 6 months of age should not be applied to babies under 6 months of age

• Excessive crying in early months linked to increased risk of behavioural and feeding problems later in childhood
• Waking to breastfeed does not create long-term sleep problems
• Sleep interventions in the early months do not show decrease in PPD
• Rigid schedules at 3 months = 3x more likely to have a behavioural problem at 6 months
• Sleep interventions (even those considered sleep shaping (see other below) are associated with premature cessation of breastfeeding and increased crying
• Teaching parents to focus on sleep lengths, frequency, night wakings and potential negative effects of lack of sleep, have shown to cause sleep anxiety, sleep efficiency and increase feelings of sleep deprivation in parents.

Sleep interventions before 6 months:

• do not decrease crying or prevent sleep problems later or prevent PPD
• Can cause potential problems
  • Increased crying
  • Early breastfeeding ceasation
  • Increased maternal anxiety
  • Increased risk of SIDS if in separate room

Other:

• Eat-play-sleep cycles (or EASY) may undermine parents ability to read babies signs may mask feeding issues. Feeding to sleep has strong biological factors
• Feed-spacing is associated with breastfeeding problems
• Paced bottle-feeding is recommended to avoid overfeeding for bottle fed babies
• Sleep algorithms (average sleep lengths and wakeful windows) day and night and teaching parents to watch for sleepy signs and promoting behaviours as overtired may not be helpful – 22 studies show variability in sleep. At 3 and 6 months normal sleep amounts vary by over 8 hours.
• Dark quiet room in the day for naps may inhibit nighttime sleep consolidation and increase risk of SIDS

 

Sleep of 4-month-old infants: bedtime, night waking and sleep problems. Hayama J¹, Adachi Y, Nishino N, Ohryoji F.

Where:  Japan
Parameters/size ages:  194 Mothers and babies 4 months
Date of study:  2007

Conclusion:  Possibility that night waking are due to delayed development of circadian rhythms.

 

Sleep and Settling Development in Infants. Community Pædiatric Review

Full text:  http://www.rch.org.au/uploadedFiles/Main/Content/ccch/CPRVol15No3.pdf

Type:  Article
Date:  2006

Key Insights:

• Parents may have unrealistic expectations
• Development of sleep does not support sleep interventions before 3 months of age
• 3-6 months of age parents can try interactions such as
  • Dreamfeed
  • Dark room at night
  • Reduce interaction at night
  • Trying to put baby down DBA (with maximum of 10 minutes of grizzling/crying)
• 3-6 months, if behavioural modification is used parents should first consult with a professional to assess if technique should be used.
• Extinction should not be used before 6-8 months
• Controlled crying should only be used if parents have access to timely coaching
• With either method parents should listen to and monitor baby

 

Preventing and Managing Infant Sleep Problems  Author: Ian St. James-Roberts, PhD, FBPsS

 

Full text:  http://www.purplecrying.info/sub-pages/sleeping/preventing-or-managing-infant-sleeping.php

Type:  Article
Date:  2013

Key Findings:

• Realistic expectations influence parents feelings about their sleep situation
• There is nothing wrong with babies that wake in the night and most show normal long-term development
• No benefit to gentle sleep shaping before 6 weeks of age
• Core night stretching can start as early as 6 weeks.

Moore, T. and Ucko, C. (1957). "Night waking in early infancy." Archives of Disease in Childhood 32: 333-342.

NIGHT WAKING IN EARLY INFANCY: PART I

Full text:  http://adc.bmj.com/content/32/164/333

Where:  University of London Institutes of Education and Child Health

Insights:     Babies rely on Mother’s contact in the early weeks and months. Night waking associated with Breathing episodes and regulation, deficiency of nursing time and other factors.

 

Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. James J. McKenna* and Thomas McDade PAEDIATRIC RESPIRATORY REVIEWS (2005) 6, 134–152

Full text:  http://cosleeping.nd.edu/assets/31970/mckenna_why_babies_should_n.pdf

Conclusion:  Sleeping in proximity has protective factors for infants

Insights:  Sleeping baby in a separate room increases risks of SIDS

 

Nighttime parenting strategies and sleep-related risks to infants Soc Sci Med. 2013 Feb;79:92-100. doi: 10.1016/j.socscimed.2012.05.043. Epub 2012 Jul 7.  Volpe. I, E et al

Full text:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505270/

Where:  Overnight Mother Baby Behavioral Lab, University of Notre Dame, USA
Parameters/size ages: 45 Mother/baby pairs; 4 month olds
Date of study:  2002-2004

Conclusion:

Potential safety risks for sleep interventions

Strategies to minimize a Mother’s sleep disruptions may put the infant at risk.

 

Co-Sleeping, Breastfeeding and Sudden Infant Death Syndrome, by James J. McKenna and Lee T. Gettler, Encyclopedia on Early Childhood Development [online] 2010.

 

Full text:  http://cosleeping.nd.edu/assets/33678/mckenna_gettlerangxp.pdf

Where:  University of Nortre Dam, Northwestern University, USA
Type of study:  Article/review of research
Date of study:  2010

Key Findings

Reduced risk of SIDS with:

• Breastfeeding
• Sleeping in proximity/safe bedsharing

Other research / Articles supporting being gentle with infants:

Ferber, S.G. and Makhoul, I.R. (2004). "The Effect of Skin-to-Skin Contact (Kangaroo Care) Shortly After Birth on the Neurobehavioural Responses of the Term Newborn: A randomized, controlled trial " Pediatrics 113(4): 858-865.

• Suggests that separating Mother and baby to sleep may have short and long-term negative effects

Small, M.F. (1998). Our babies ourselves-how biology and culture shape the way we parent. New York, NY: Doubleday Dell Publishing Group.

• Babies rely on proximity of mothers to support regulation of breathing, temperature and heart rate

Middlemiss, W., Granger, D.A., Goldberg, W.A. and Nathans, L. (2012). "Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following extinction of infant crying responses induced during the transition to sleep." Early Human Development 88: 227-232.

• Extinction with 4-10 month olds. Where improvements were seen after 3 nights the cortisol levels remained just as high as the third night.
• Mothers cortisol levels when down by the 3^rd

Fleming, P., Blair, P., Bacon, C., Berry, P. (2000). Sudden unexplained deaths in infancy. The CESDI SUDI studies 1993-1996. London:  the stationary office 2000

• Room sharing at night for at least 6 months

Mitchell, E.A., Thompson, JMD. Co-sleeping increases the risk of KIDS, but sleeping in the parent’s bedroom lowers it. IN:  Rognum TO, editor. Sudden infant death syndrome:  new trends in the nineties. Oslo:  Scandinavian University Press;  1995.p.266-9

Cassidy, J. (1994). Emotion regulation: Influences of attachment relationships. Monographs of the Society for Research in Child Development, 59, 228-283.

Davidov, M. & Grusec, J.E. (2006). Untangling the links of parental responsiveness to distress and warmth to child outcomes. Child Development, 77, 44-58.

Davidov, M. & Grusec, J.E. (2006). Untangling the links of parental responsiveness to distress and warmth to child outcomes. Child Development, 77, 44-58.

Stifter, C.A,, & Spinrad, T.L. (2002. The effect of excessive crying on the development of emotion regulation. Infancy, 3, 133-152.

Cassidy, J. (1994). Emotion regulation: Influences of attachment relationships. Monographs of the Society for Research in Child Development, 59, 228-283. Child Dev. 1991 Dec;62(6):1525-37.

Conditions of continuity and discontinuity in infant negative emotionality: newborn to five months. Fish M¹, Stifter CA, Belsky J.

 

"Designed for Relationship: Infants' Brain Structures and Chemicals Respond to Nurture and Stress"
by Nancy Williams, MA, MFT, CCE, IBCLC (2006)

Scheduling Feeds 2008 Diane Wiessinger, IBCLC   www.normalfed.com

‘Babywise’ advice linked to dehydration, failure to thrive by Matthew Aney, M.D. AAP News  http://www.ezzo.info/resources/timeline/81-timeline/107-babywise-advice-linked-to-dehydration-failure-to-thrive

 Epigenetics and the biological definition of gene x environment interactions.

Meaney MJ.

 

Parmelee, A., Wenner, W.H. and Schultz, H.R. (1964). "Infant sleep patterns: from birth to 16 weeks of age." Pediatrics 65(4): 576-582.

Newborn Behavior, Parent–Infant Interaction, and Developmental Change Processes: Research Roots of Developmental, Relational, and Systems-Theory-Based Practice Sparrow J.

Sensitive time-windows for susceptibility in neurodevelopmental disorders

Blunden, S.L., Thompson, K.R. and Dawson, D. (2011). "Behavioural sleep treatments and night time crying in infants: Challenging the status quo." Sleep Medicine Reviews 15(5): 327-334.

The consolidation of infants' nocturnal sleep across the first year of life. Henderson JM¹, France KG, Blampied NM.   Sleep Med Rev. 2011 Aug;15(4):211-20. doi: 10.1016/j.smrv.2010.08.003. Epub 2010 Nov 3.

 

Cassidy, J. (1994). Emotion regulation: Influences of attachment relationships. Monographs of  the Society for Research in Child Development, 59, 228-283.