Behavioral interventions for pediatric insomnia: One treatment may not fit all.
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.
Sleep