Infant sleep training or first wave behavioural approaches remain the dominant health system approach to infant sleep

In Australia and in many countries today, parents continue to be advised that sleep training or first wave behavioural (FWB) approaches are necessary for optimal developmental outcomes and good sleep habits.

Infant sleep training emerged in the 1950s and 1960s when the first wave of the school of behaviorism (FWB) in psychology was applied to infantcare. Yet high level evidence fails to reliably demonstrate decreased night waking as a result of FWB interventions, and studies show no improvement in developmental outcomes from application of FWB approaches to infant sleep.1-8

The NDC neurobiological approach to infant sleep (the Possums Sleep Program) contests the benefits of sleep training

The NDC or Possums neurobiological approach unsettled infant behaviour proposes that application of FWB approaches to infant sleep in very early life impacts negatively on neurodevelopmental outcomes in susceptible infants, because FWB approaches decrease environmental stimulation in four ways:

1. Parents are advised to teach the infant ‘good sleep habits’ by having the infant sleep in a cot or on an immobile surface, often in a quiet dim room with deliberately minimised visual stimulation, iteratively throughout the day. This regular recourse to a low sensory interior environment impoverishes sensory-motor experience, both social and non-social, and fails to offer susceptible infants adequate task demands for optimal development of skills in interpretation of sensory information, adaptation of movements in response to external stimuli, and organisation of postural control.

2. Stimulation is problematized. Parents are advised to avoid social and non-social ‘overstimulation’.

3. Inadequate sensory-motor stimulation results in SNS-HPA arousal (crying and fussing), which parents are advised to interpret as ‘tired signs’ or ‘overstimulation’, triggering more attempts to put the baby to sleep.

4. Patterns of inadequate environmental enrichment may result in chronic infant SNS-HPA hyperarousal.9-11

The NDC neurobiological approach to infant sleep proposes that sleep training disrupts parent-infant neurobehavioural synchrony

In response to emerging neuroscience and psychological attachment research, FWB approaches have adopted a discourse which emphasises the importance of cued care for secure attachment and optimal mental health outcomes. Yet paradoxically, FWB sleep advice continues to actively disrupt cued care and biobehavioral synchrony, by advising parents to behave towards their baby in directive and non-contingent ways, iteratively, day and night.

More extreme FWB strategies, such as minimising eye contact and interaction at sleep-time throughout the days and nights, present a ‘still face’ to the infant, which is known to result in greater efforts by the infant to engage at first, before he or she withdraws from cueing.12 Standard FWB approaches advise parents to not respond to SNS-HPA arousal, or to delay responses, or to respond but not as they believe the baby intends. Parents are advised to iteratively override the powerful biological cues of sleepiness after feeds by applying behaviors such as burping, holding upright, or wrapping, at the same time as they are instructed to achieve prescribed nap frequencies and durations.

FWB approaches may exacerbate parental anxiety, which predisposes to poor sleep efficiency and postnatal depression.13, 14 The parent trying to enforce sleep because she believes it necessary for her baby’s healthy development is likely to feel anxious and distressed when the baby ‘resists sleep’ multiple times a day; the infant ‘resisting sleep’ (that is, whose sleep pressure is not yet high enough for easy sleep) is repeatedly subject to the biological stress of a low sensory environment, resulting in chronic SNS-HPA hyperarousal and increased allostatic load. This cycle may place behaviorally hypo-aroused infants at particular risk.

The link between sleep problems in very early life and behavioral and sleep problems in later childhood may be, paradoxically, mediated by the widespread sociocultural and clinical application of sleep training or FWB strategies, resulting in cascades of both parent and infant chronic SNS-HPA hyperarousal.11, 15, 16 FWB approaches also disrupt the dyadic synchrony of the circadian clock, by promoting long blocks of sleep during the day.17

References

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