Behavioral interventions for pediatric insomnia: one treatment may not fit all

Abstract Study Objectives Behavioral interventions for pediatric insomnia are cost-effective and benefit most families, but there is no evidence indicating which treatments are most suitable for specific patient populations. This randomized controlled trial evaluated the moderating role of infant se...

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Bibliographic Details
Published in:Sleep (New York, N.Y.) N.Y.), 2020-04, Vol.43 (4), p.1
Main Authors: Kahn, Michal, Juda-Hanael, Michal, Livne-Karp, Efrat, Tikotzky, Liat, Anders, Thomas F, Sadeh, Avi
Format: Article
Language:English
Subjects:
Actigraphy
Adolescent
Anxiety
Babies
Behavior modification
Behavior Therapy
Camping
Care and treatment
Child
Evidence-based medicine
Humans
Infant
Infants
Insomnia
Male
Parenting
Pediatrics
Sleep
Sleep Initiation and Maintenance Disorders - therapy
Treatment Outcome
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Summary:Abstract Study Objectives Behavioral interventions for pediatric insomnia are cost-effective and benefit most families, but there is no evidence indicating which treatments are most suitable for specific patient populations. This randomized controlled trial evaluated the moderating role of infant separation anxiety in two brief interventions for infant sleep problems. Methods Ninety-one infants aged 9–18 months (61% boys) with pediatric insomnia were randomized to either Checking-in, a Graduated extinction protocol which involves gradual separation from parents, or to the Camping-out intervention, in which parental presence is maintained. Sleep was measured using actigraphy and parent reports. Infant separation anxiety was observed in the laboratory. Assessments were completed at baseline, post-treatment and 6-month follow-up. Results Improvement in sleep was demonstrated following both interventions and maintained at follow-up. Separation anxiety did not change significantly following treatment. Infant separation anxiety moderated treatment efficacy, with greater benefit for infants with high separation anxiety in the Camping-out compared to the Checking-in intervention. Conclusions This study provides support for considering infant separation anxiety in the effort to personalize treatment for pediatric insomnia. Pediatricians should incorporate evaluation of infant separation anxiety to assessment processes, and favor more gentle treatment approaches, such as Camping-out, over Graduated extinction for highly anxious infants. Clinical Trial Registration NCT01489215.
ISSN:0161-8105
1550-9109
DOI:10.1093/sleep/zsz268