An overview of reviews for preventing and treating sleep problems in infants

Individualized approaches to pediatric chronic insomnia: Advancing precision medicine in sleep disorders

The manifestations of chronic insomnia undergo age-related changes. In younger infants and children, behavioral insomnia emerges as the most prevalent form and typically responds to behavioral interventions. However, distinct clusters of clinical presentations suggest the presence of various phenotypes, potentially implicating the primary involvement of specific neurotransmitters. These conceptualizations, coupled with genetic studies on pleiotropy and polygenicity, may aid in identifying individuals at risk of persistent insomnia into adulthood and shed light on novel treatment options. In school-age children, the predominant presentation is sleep-onset insomnia, often linked with nighttime fears, anxiety symptoms, poor sleep hygiene, limit-setting issues, and inadequate sleep duration. The manifestations of insomnia in adolescence correlate with the profound changes occurring in sleep architecture, circadian rhythms, and homeostatic processes. The primary symptoms during adolescence include delayed sleep onset, sleep misperception, persistent negative thoughts about sleep, and physiological hyperarousal-paralleling features observed in adult insomnia. An approach centered on distinct presentations may provide a framework for precision-based treatment options. Enhanced comprehension of insomnia's manifestations across diverse developmental stages can facilitate accurate assessment. Efforts to subtype insomnia in childhood align with this objective, potentially guiding the selection of appropriate treatments tailored to individual neurobiological, clinical, and familial features.

Early sleep intervention for improving infant sleep quality: a randomized controlled trial, preliminary result

BACKGROUND

Healthy sleep issues should provide to family within first 6 months of infant's life. This study aimed to evaluate the effect of early sleep intervention on nighttime sleep quality.

METHODS

Eligible infants aged 4 months ± 2 weeks were randomized to receive early sleep intervention or usual care. Data on sleep variables were obtained via parental interview at baseline and 6 months of age. Using logistic regression to analyze the efficacy of early sleep intervention.

RESULTS

At baseline, 335 eligible infants were enrolled and randomized. In total, 306 participants were final analyzed: early sleep intervention group (n = 148) and the usual care group (n = 158). The early sleep intervention group had a significantly longer nighttime sleep duration and a shorter night waking duration than the usual care group (585.20 ± 80.38 min vs. 496.14 ± 87.78 min, p < .001 and 61.01 ± 36.38 min vs. 89.72 ± 45.54 min, p < .001). At 6 months of age, the early sleep intervention group had a longer night sleep duration (≥ 4 h/time) than the usual care group (adjusted odds ratio: 2.39, 95% confidence interval: 1.34-4.28).

CONCLUSIONS

Early sleep intervention should be recommended to infants at 4 months of age as a part of well childcare to improve infant sleep quality.

TRIAL REGISTRATION

Thai Clinical Trials Registry (thaiclinicaltrial.org). Retrospective registered TCTR20230117001 (17/01/2023).

Annual Research Review: The power of predictability - patterns of signals in early life shape neurodevelopment and mental health trajectories

The global burden of early life adversity (ELA) is profound. The World Health Organization has estimated that ELA accounts for almost 30% of all psychiatric cases. Yet, our ability to identify which individuals exposed to ELA will develop mental illness remains poor and there is a critical need to identify underlying pathways and mechanisms. This review proposes unpredictability as an understudied aspect of ELA that is tractable and presents a conceptual model that includes biologically plausible mechanistic pathways by which unpredictability impacts the developing brain. The model is supported by a synthesis of published and new data illustrating the significant impacts of patterns of signals on child development. We begin with an overview of the existing unpredictability literature, which has focused primarily on longer patterns of unpredictability (e.g. years, months, and days). We then describe our work testing the impact of patterns of parental signals on a moment-to-moment timescale, providing evidence that patterns of these signals during sensitive windows of development influence neurocircuit formation across species and thus may be an evolutionarily conserved process that shapes the developing brain. Next, attention is drawn to emerging themes which provide a framework for future directions of research including the evaluation of functions, such as effortful control, that may be particularly vulnerable to unpredictability, sensitive periods, sex differences, cross-cultural investigations, addressing causality, and unpredictability as a pathway by which other forms of ELA impact development. Finally, we provide suggestions for prevention and intervention, including the introduction of a screening instrument for the identification of children exposed to unpredictable experiences.

Identifying and developing strategies for implementation of a guided internet- and mobile-based infant sleep intervention in well-baby and community mental health clinics using group concept mapping

BACKGROUND

This study aimed to identify strategies for the implementation of a guided internet- and mobile-based intervention (IMI) for infant sleep problems ("Sleep Well, Little Sweetheart") in well-baby and community mental health clinics.

STUDY DESIGN

We used group concept mapping, a two-phased mixed methods approach, conducted as a two-day workshop in each clinic. We recruited 20 participants from four clinics and collected sorting and rating data for implementation strategies based on the Expert Recommendations for Implementing Change taxonomy and brainstorming sessions. Data were analyzed using descriptive statistics, multidimensional scaling, and hierarchical cluster analysis to create cluster maps, laddergrams, and Go-Zone graphs. Participants were presented with the results and discussed and interpreted the findings at each of the clinics in spring 2022.

RESULTS

Participants identified 10 clusters of strategies, of which Training, Embedding and Coherence, User Involvement and Participation, and Clinician Support and Implementation Counseling were rated as most important and feasible. Economy and Funding and Interactive and Interdisciplinary Collaboration were rated significantly lower on importance and feasibility compared to many of the clusters (all ps < 0.05). There was a correlation between the importance and feasibility ratings (r =.62, p =.004).

CONCLUSIONS

The use of group concept mapping made it possible to efficiently examine well-baby and community clinics' perspectives on complex issues, and to acquire specific knowledge to allow for the planning and prioritization of strategies for implementation. These results suggest areas of priority for the implementation of IMIs related to infant sleep problems.

TRIAL REGISTRATION

The study was pre-registered at Open Science Framework ( www.osf.io/emct8 ).