Preventing Early Infant Sleep and Crying Problems and Postnatal Depression: A Randomized Trial

OBJECTIVE: To evaluate a prevention program for infant sleep and cry problems and postnatal depression. METHODS: Randomized controlled trial with 781 infants born at 32 weeks or later in 42 well-child centers, Melbourne, Australia. Follow-up occurred at infant age 4 and 6 months. The intervention including supplying information about normal infant sleep and cry patterns, settling techniques, medical causes of crying and parent self-care, delivered via booklet and DVD (at infant age 4 weeks), telephone consultation (8 weeks), and parent group (13 weeks) versus well-child care. Outcomes included caregiver-reported infant night sleep problem (primary outcome), infant daytime sleep, cry and feeding problems, crying and sleep duration, caregiver depression symptoms, attendance at night wakings, and formula changes. RESULTS: Infant outcomes were similar between groups. Relative to control caregivers, intervention caregivers at 6 months were less likely to score .9 on the Edinburgh Postnatal Depression Scale (7.9%, vs 12.9%, adjusted odds ratio [OR] 0.57, 95% confidence interval [CI] 0.34 to 0.94), spend .20 minutes attending infant wakings (41% vs 51%, adjusted OR 0.66, 95% CI 0.46 to 0.95), or change formula (13% vs 23%, P, .05). Infant frequent feeders (.11 feeds/24 hours) in the intervention group were less likely to have daytime sleep (OR 0.13, 95% CI 0.03 to 0.54) or cry problems (OR 0.27, 95% CI 0.08 to 0.86) at 4 months. CONCLUSIONS: An education program reduces postnatal depression symptoms, as well as sleep and cry problems in infants who are frequent feeders. The program may be best targeted to frequent feeders. Pediatrics 2014;133:e346–e354 AUTHORS: Harriet Hiscock, MBBS, MD,abc Fallon Cook, BSci, PhD,b,d Jordana Bayer, PhD M, Clin Pscyh,b,e Ha ND Le, MHEcon, MBA,f Fiona Mensah, BSc, MSc, PhD,cg Warren Cann, BBSc, MSc,d Brian Symon, BSc, MBBS, MD,h and Ian St James-Roberts, PhDi aCentre for Community Child Health, The Royal Children’s Hospital, Parkville, Australia; bMurdoch Childrens Research Institute, and gClinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, The Royal Children’s Hospital, Melbourne, Australia; cDepartment of Paediatrics, University of Melbourne, Melbourne, Australia; dParenting Research Centre, East Melbourne, Australia; eSchool of Psychological Science, La Trobe University, Bundoora, Australia; fDeakin Health Economics, Deakin University, Burwood, Australia; hDepartment of General Practice, University of Adelaide, Australia; and iThomas Coram Research Unit, Institute of Education, University of London, United Kingdom