Brief behavioural intervention for infant sleep problems reduces depression in mothers.

ED FROM Hiscock H, Bayer JK, Hampton A, et al. Long-term mother and child mental health effects of a population-based infant sleep intervention: Cluster-randomized, controlled trial. Pediatrics 2008;122:E621–7. Correspondence to: Dr Harriet Hiscock, Royal Children’s Hospital, Centre for Community Child Health, Flemington Road, Parkville, Victoria 3052, Australia; [email protected] Source of funding: NHMRC and the Pratt Foundation, Australia. c A reference list and a table are published online only at http://ebmh.bmj.com/ content/vol12/issue2 C O M M EN TA R Y E motional distress in mothers of infants constitutes a significant public health problem internationally but few epidemiological investigations have considered the contribution of infant behaviour to maternal mood. Education about strategies to optimise infant sleep and establish sustainable routines of daily care is not widespread and remains controversial. Persistent crying, resistance to soothing, frequent overnight waking and short daytime sleeps in infants are common reasons for help seeking. While these poorly understood infant behaviours are often attributed to hunger or gastrointestinal pain, they might rather be attributable to infant fatigue in a sociocultural context which emphasises early stimulation. Behaviour management, including regulating feeds, reducing stimulation, recognising tired cues and applying consistent, sustainable soothing and settling strategies, is effective in promoting sleep and reducing crying in infants, and in improving maternal mood and confidence. However, opponents suggest that this approach undermines infant trust and the mother–infant relationship and compromises development. Hiscock and colleagues have already made seminal contributions to evidence, demonstrating that straightforward strategies to promote infant sleep can be taught in primary care and reduce problematic infant sleep and maternal distress. This study makes a further vital contribution through demonstrating that neither infant development nor the mother–infant relationship is compromised by sleep behaviour management and that improvements to maternal mental health are sustained. It also demonstrates that primary health care professionals can incorporate this non-stigmatising intervention readily into routine practice. Postnatal depression is a widely used but broadly defined construct. Occupational fatigue caused by prolonged work hours, shiftwork and insufficient or interrupted sleep is well researched but not yet applied to the work of mothering a newborn. Like depression, it is characterised by irritability and reduced mood, concentration and functional efficiency. The investigators speculate on the links between poor infant sleep and maternal mood. Their data support the notion that occupational fatigue might underpin maternal depression and that improvements in the domestic working environment, by improving infant sleep, are central to the development of a competent, confident maternal identity. Jane R W Fisher, BSc, PhD, MAPS Key Centre for Women’s Health in Society, WHO Collaborating Centre for Women’s Health, Melbourne School of Population Health, University of Melbourne 3010, Australia Competing interests: None. Therapeutics 46 EBMH May 2009 Vol 12 No 2 group.bmj.com on November 4, 2016 Published by http://ebmh.bmj.com/ Downloaded from