A behavioral-educational intervention to promote maternal and infant sleep: a pilot randomized, controlled trial. Effects of parent training on infant sleeping patterns, parents' stress, and perceived parental competence. Effect of a consultation teaching behaviour modification on sleep performance in infants: a randomised controlled trial. First-time mothers' selection of infant supine sleep positioning. The role of an early intervention on enhancing the quality of mother-infant interaction. Use of a behavioural programme in the first 3 months to prevent infant crying and sleeping problems. Increasing breast milk production for premature infants with a relaxation/imagery audiotape. A randomized trial of a combined physical activity and environmental intervention in nursing home residents: do sleep and agitation improve? Promoting awareness: the mother and her baby. Does relaxation education in anxious primigravid Iranian women influence adverse pregnancy outcomes?: a randomized controlled trial. Salivary cortisol and behavioral state responses of healthy newborn infants to tactile-only and multisensory interventions. Infant massage improves mother-infant interaction for mothers with postnatal depression. Effects of vestibular stimulation on sleep states in premature infants. Randomized clinical trial of an oscillating air mattress in preterm infants: effect on apnea, growth, and development. Reduction of sleep apnea and bradycardia in preterm infants on oscillating water beds: a controlled polygraphic study. Effects of an educational intervention on mothers of male children with attention deficit hyperactivity disorder. Effect of training for care providers on practice of essential newborn care in hospitals in Sri Lanka. The effects of a prefeeding stimulation program on preterm infants. Reducing sleep disruptions in young children: evaluation of therapist-guided and written information approaches: a brief report. Health and safety intervention with first-time mothers.
Maternal and infant sleep are significant health concerns for postpartum families. The results of previously published studies have indicated that behavioral-educational strategies promote infant sleep, but these reports relied on parental report and did not include maternal sleep. This pilot study of a maternal-infant sleep intervention evaluated feasibility, acceptability, and effects on sleep and other outcomes in the early postpartum period.
                Randomized controlled trial with concealed-group allocation.
                Hospital postpartum unit with home follow-up.
                First-time mothers and their infants randomly assigned to sleep intervention (n = 15) or control group (n = 15).
                The sleep intervention included a 45-minute meeting with a nurse to discuss sleep information and strategies, an 11-page booklet, and weekly phone contact to reinforce information and problem solve. The control group received a 10-minute meeting during which only maternal sleep hygiene and basic information about infant sleep were discussed, a 1-page pamphlet, and calls at weeks 3 and 5 to maintain contact without provision of advice.
                Questionnaires were completed at baseline and 6 weeks; sleep diaries and mother and infant actigraphy were completed at 6 weeks. The mothers in the sleep intervention group averaged 57 minutes more nighttime sleep, and fewer rated their sleep as a problem, as compared with the mothers in the control group. Infants in the sleep intervention group had fewer nighttime awakenings and had maximum lengths of nighttime sleep that were, on average, 46 minutes longer than those in the control group.
                A behavioral-educational intervention with first-time mothers in the early postpartum period promotes maternal and infant sleep. Further evaluation of the intervention in a larger, more diverse sample is needed. First-time parent couples from childbirth classes were randomly assigned to a four-session training group (n = 29) or a control group (n = 31). Members of the training group were taught behavioral strategies to promote healthy, self-sufficient sleep patterns in their infants, whereas the control group received the same amount of personal contact without the behavioral training. Six sleep variables were derived from a daily infant sleep diary completed by parents at two time points. Results show that at age 6-9 weeks, infants in the training group displayed significantly better sleeping patterns than did control infants. Training group parents awakened and responded less often to infant signaling and reported greater parental competence. By contrast, control group parents indicated increased stress over time. To evaluate the effect of a behaviour modification program, taught to parents in a single visit to a trained nurse, in improving sleep performance in newborn infants, Australia.
                Randomised controlled trial.
                268 families with normal newborn infants in the community, recruited between October 1996 and March 1997 from birth notices published in a South Australian daily newspaper.
                A 45-minute consultation with a nurse 2-3 weeks after the birth, including a tutorial discussion on normal sleep patterns in newborn infants, supported by retained written material and, for infants with weight gain < 30 g daily, referral to their usual postnatal care provider.
                Hours of daytime sleep (0600-1800), night sleep (1800-0600) and total sleep per 24 h; and number of daily records with total sleep >/= 15 h per 24 h, assessed by 7-day sleep diary at ages 6 and 12 weeks.
                268 families returned at least one sleep diary (137/171 intervention, 131/175 control), recording 3273 days. Two intervention infants were referred for low weight gain. Total sleep time was 15 h or more per 24 h on 62% of recorded days in the intervention group, compared with 36% in the control group (P < 0.001). At 6 weeks of age, intervention infants slept a mean 1.3 h per day more than control infants (95% CI, 0.95-1.65), comprising a mean 0.5 h more night sleep (95% CI, 0.32-0.69) and 0.8 h more daytime sleep (95% CI, 0.56-1.07). At 12 weeks, intervention infants slept a mean 1.2 h per day more (95% CI, 0.94-2.14), comprising 0.64 h more night sleep (95% CI, 0.19-0.89) and 0.58 h more daytime sleep (95% CI, 0.39-1.03). There was no significant difference in crying time between the groups.
                A single consultation supported by written material in the first 3 weeks of a child's life improves sleep performance at 6 weeks of age. This improvement is maintained at 3 months. The incidence of Sudden Infant Death Syndrome (SIDS) has decreased dramatically since the inception of the "Back to Sleep" campaign initiated by the American Academy of Pediatrics in 1992. However, that decrease has leveled off and many new parents cease to follow the recommendation to place their infants in the supine position for sleep between 1 and 3 months of age, the peak age for the incidence of SIDS. Shortened hospital stays for new mothers and the overwhelming amount of required patient teaching dictate the need to find the best method of instruction. The purpose of this study was to determine if a one-on-one teaching intervention improved the effectiveness of patient education and led to an increase in the desired behavior of placing the infant to sleep in the supine position. A quantitative experimental approach was used to examine the difference in compliance of supine infant positioning. Participants were drawn from a convenience sample of 61 primiparous women between the ages of 18 and 35 years with random assignment to either the experimental or control group. Compared to mothers in the control group, mothers in the experimental group demonstrated greater compliance in selecting supine sleep position in the first week home from the hospital and on the day of follow-up 6 weeks later. However, no difference in "usual position" was reported at 6 weeks and for the night previous to follow-up. The study examines an intervention designed to influence mothers' sensitive responsiveness toward their infant by presenting information about the newborn's competence to interact and promoting affectionate handling and interaction with the infant. Thirty-six primiparous mothers and their newborn infants participated in the study. On day 2/3 after delivery, mother-infant dyads were assigned to either: (1) an experimental group that received an intervention program designed to enhance mother-infant interaction; or (2) a control group that was presented with an intervention that emphasized basic caregiving skills. One month later an observation was undertaken in the home to assess mother-infant synchronous and asynchronous co-occurrences during free-play and infant bathing. The enhancement group showed a reliably greater frequency of co-occurrences involving vocal exchanges, looking to the partner, and physical contact. There also were differences in mothers' responsiveness to infant crying and involuntary responses. The findings show that even a modest videotaped early intervention can enhance mothers' sensitive responsiveness to the infant. To assess the effectiveness of a behavioural programme introduced in the first 3 months of age in preventing infant crying and sleeping problems. Two issues were addressed: (i) which elements of the behavioural programme would parents implement; and (ii) whether the behavioural programme was more effective in reducing infant crying and encouraging night-time sleeping than an educational intervention or the routine services.
                Mothers and newborns were assigned at random to the behavioural programme (n = 205), educational intervention (n = 202), or control (n = 203) group. Behaviour diaries kept before randomization and at 3, 6, 9 and 12 weeks of age were used to measure implementation of the interventions and infant behaviour, including crying and sleeping. Crying and sleeping problems were followed up using questionnaire measures at 9 months of age.
                The educational intervention did not change parental care behaviour. One element of the behavioural programme, a focal feed between 10 PM and midnight, was not implemented. A second element, stretching of interfeed intervals after 3 weeks of age, was implemented initially, but not maintained at older ages. The third element, which asked parents to emphasise day and night differences in the environment, and to settle their babies in the cot and minimise interaction at night, was carried out by more parents in the behavioural group than in the other groups. This led to an increase of around 10% in the number of babies who slept for 5 or more hours at night (a definition of sleeping through the night) at 12 weeks of age. Fewer behavioural programme parents sought help for crying and sleeping problems between 3 and 9 months of age.
                The behavioural programme produced a modest increase in the number of infants who slept through the night by 12 weeks of age. The results are discussed in relation to other findings, which bear on the programme's adoption for routine health-care policy and practice. Many women whose premature infants are hospitalized in a newborn intensive care unit choose to express breast milk for their babies. Yet anxiety, fatigue, and emotional stress are powerful inhibitors of lactation. To facilitate the breast-feeding experience, intervention mothers were given a 20-minute audio cassette tape based on relaxation and visual imagery techniques. At a single follow-up expression of milk at the hospital approximately 1 week after enrollment, they expressed 63% more breast milk than a randomized group of control mothers. The fat content of the breast milk in the two groups was not significantly different. Among a small group of mothers whose infants were receiving mechanical ventilation, the increase in milk volume compared with that of control mothers was 121%. Longer-term effects of the relaxation/imagery approach (such as extending the duration of breast-feeding or reducing parental stress after hospital discharge) and the physiologic basis for the increased volume of expressed milk (improved milk production v more efficient milk ejection) are appropriate topics for future research. The purpose of this study was to test whether an intervention combining increased daytime physical activity with improvement in the nighttime environment improves sleep and decreases agitation in nursing home residents.
                A randomized trial.
                One community nursing home in the Los Angeles, California area.
                Twenty-nine incontinent residents (mean age 88.3 years, 90% female).
                Subjects were randomized to receive either (1) an intervention combining increased daytime physical activity (14 weeks in duration) plus a nighttime program (5 nights in duration) to decrease noise and sleep-disruptive nursing care practices (intervention group), or (2) the nighttime program alone (control group).
                Daytime physical activity monitors and structured physical function assessments; nighttime wrist activity monitors to estimate nighttime sleep; and timed daytime behavioral observations of sleep versus wakefulness, either in or out of bed, and agitation.
                Physical function measures did not change significantly (MANOVA for repeated measures, group by time effect). Wrist actigraphy estimation of nighttime percent sleep (time asleep over time monitored in bed at night) increased in intervention subjects from 51.7% at baseline to 62.5% at follow-up compared with 67.0% at baseline to 66.3% at follow-up in controls (MANOVA, group by time, F = 4.42, P = .045, df = 27). At follow-up, intervention subjects averaged a 32% decrease in the percent of daytime observations in bed compared with baseline, with essentially no change in controls (MANOVA, group by time, F = 5.31, P = .029, df = 27). Seven of 15 intervention subjects had a decrease in observed agitation at follow-up, compared with baseline, versus only 1 of 14 controls with a decrease in observed agitation.
                This study provides preliminary evidence that an intervention combining increased physical activity with improvement in the nighttime nursing home environment improves sleep and decreases agitation in nursing home residents. This study considered the problem of how to increase a mother's awareness of her infant's behavior and her own behavior as a beginning step toward the promotion of quality interaction between mother and infant. The impact of informing 108 mothers of term infants and 32 mothers of preterm infants about: (a) neonatal interactive, motoric, state control, and response to stress behavior patterns; and (b) maternal behaviors to enhance and support infant behavior was tested with four groups. In describing the behavior that occurred during a feeding session, mothers in two treatment groups reported significantly more of their own behavior than that of their neonate. They more closely resembled the trained observers' report of the behavior than did mothers in two control groups. Recommendations include incorporating an educative treatment in plans of nursing care for mothers and infants and further research to determine the optimal timing and long-term effects of such an intervention. Maternal anxiety and stress are found to be predictors of adverse pregnancy outcomes, including low birth weight and prematurity.
                The aim of the study was to determine whether relaxation education in anxious pregnant Iranian women in their first pregnancy affects selected pregnancy outcomes, including birth weight, preterm birth, and surgical delivery rate.
                A total of 110 obstetrically and medically low-risk primigravid women in Iran with a high anxiety level demonstrated by Spielberger's State-Trait Anxiety Inventory were randomly assigned into experimental and control groups.
                In this randomized controlled trial, the experimental group received routine prenatal care along with 7-week applied relaxation training sessions, while the control group received only routine prenatal care. Anxiety and perceived stress were measured by pre-educational and post-educational intervention. Data related to pregnancy outcomes include birth weight, gestational age at birth, and type of delivery.
                Significant reductions in low birth weight, cesarean section, and/or instrumental extraction were found in the experimental group compared with the control group. No significant differences were found in the rate of preterm birth.
                The findings suggest beneficial effects of nurse-led relaxation education sessions during the prenatal period. This intervention could serve as a resource for improving pregnancy outcomes in women with high anxiety. To compare changes in stress reactivity (measured via the biomarker salivary cortisol) and behavioral state in healthy newborn infants immediately following 1 of 2 interventions: (1) tactile-only stimulation or (2) a multisensory, auditory, tactile, visual, and vestibular stimulation with a control group.
                A randomized prospective design pilot study.
                Normal newborn nurseries of 2 midwestern perinatal centers.
                Forty healthy newborn infants receiving standard nursing care.
                Infants were randomly assigned to receive 15 minutes of tactile-only, auditory, tactile, visual, and vestibular, or no stimulation 30 minutes before feeding. Saliva samples were collected before, immediately following, and 10 minutes postintervention. Behavioral state was judged every minute.
                Tactile-only group infants had the largest increase in cortisol levels, followed by control group infants. In contrast, infants who received the multisensory intervention showed a significant steady decline in cortisol. Asleep was the predominant state for all 3 groups and cry was minimal.
                Tactile-only stimulation may increase infant stress reactivity while the benefit of the multisensory auditory, tactile, visual, and vestibular intervention may be in the reduction of infant stress reactivity. Interventions appeared to have minimal effect on stress reactivity based on behavioral state. Postnatal depression can have long term adverse consequences for the mother-infant relationship and the infant's development. Improving a mother's depression per se has been found to have little impact on mother-infant interaction. The aims of this study were to determine whether attending regular massage classes could reduce maternal depression and also improve the quality of mother-infant interaction.
                Thirty-four primiparous depressed mothers, median 9 weeks postpartum, identified as being depressed following completion of the Edinburgh Postnatal Depression Scale (EPDS) at 4 weeks postpartum, were randomly allocated either to an infant massage class and a support group (massage group) or to a support group (control group). Each group attended for five weekly sessions. Changes in maternal depression and mother-infant interaction were assessed at the beginning and the end of the study by comparing EPDS scores and ratings of videotaped mother-infant interaction.
                The EPDS scores fell in both groups. Significant improvement of mother-infant interaction was seen only in the massage group.
                The sample size was small and had relatively high dropout. It was not possible to distinguish which aspects of the infant massage class contributed to the benefit.
                This study suggests that learning the practice of infant massage by mothers is an effective treatment for facilitating mother-infant interaction in mothers with postnatal depression. Seventeen appropriate-for-gestational-age premature infants (birthweights 1000-1530 gm) were randomly assigned to control (7) and vestibular stimulation (10) groups. Those in the treatment group were exposed daily to three 15-minute sessions of sinusoidal vestibular stimulation over a 2-week period. At the end of that period, postconceptional age ranged from 34 to 37 weeks. As a measure of neurologic maturation, behavioral and physiologic parameters characterizing sleep states were recorded at the onset and termination of the 2-week period. The ratio of active-to-quiet sleep did not change significantly in control patients. Those exposed to vestibular stimulation showed a significant decrease in proportion of active and a concomitant increase in the proportion of quiet sleep. These results may indicate that vestibular stimulation, even at this early postconceptional age, results in a more mature sleep pattern. To investigate claims that oscillating mattresses reduce apnea of prematurity and improve growth and neurobehavioural development, we performed a randomized clinical trial using a predetermined sample size. Preterm infants weighing from 750 to 1750 gm at birth were randomly assigned, by 250 gm strata, to either a conventional mattress (n = 63) or to an air mattress (n = 59) oscillating at 14 to 16 regular pulses per minute. Infants remained on the oscillating air mattress for at least 7 days or until 34 weeks postmenstrual age. Apneic episodes occurred and required treatment equally in the two groups; this lack of an effect was seen for both sexes and all weight groups. Both weight and energy intake were similar. Neurobehavioral development as shown by sleep state, habituation testing, and behavioral assessment at term, 3, 6, and 12 months was similar in the two groups. There was no difference in the incidence of neurologic abnormalities. We conclude that an oscillating air mattress has no prophylactic value in reducing apnea and does not enhance growth and development. The sleep and respiratory patterns of eight apneic preterm infants were polygraphically recorded for 24 hours. This polygraphic study was designed to test and extend our previous finding that gently oscillating water beds reduce apnea in premature infants. The infants who ranged in gestational age from 27 to 32 weeks and in birth weight from 1,077 to 1,650 gm served as their own controls, off and on the water bed. The 24-hour recordings were divided into four time blocks with the infant being placed on the water bed during alternate six-hour periods. Apnea was significantly reduced while the infants were on the oscillating water beds, with the longest apneic periods and those associated with severe bradycardia being reduced the most. Reduction of apnea was most consistent during indeterminate sleep and most pronounced during quiet sleep. Short respiratory pauses and periodic breathing were not significantly reduced. Reductions of central, obstructive, and mixed apneas were approximately equal. An experimental research study was done to determine whether an educational intervention about attention deficit hyperactivity disorder (ADHD) would improve a mother's knowledge about ADHD and her feelings of competence as a parent. 20 low socioeconomic status mothers who had a male child between the ages of 5 and 11 diagnosed with ADHD and placed on methylphenidate were randomly selected for the study. An experimental group of 10 mothers was given a 5-week educational intervention on ADHD; the remaining 10 mothers served as a control group. Differences between the experimental and non-experimental mothers in knowledge and opinions about ADHD and parental sense of competency were measured. Scores improved in parental satisfaction and parental sense of competency in mothers who participated in the educational intervention. The research findings support the idea that nurses can assist a family in learning and dealing with their child's ADHD, a chronic condition. To evaluate the effectiveness of a training program for care providers in improving practice of essential newborn care in obstetric units.
                Before-and-after study with an intervention and a control group.
                Five hospitals in the Puttalam district in Sri Lanka.
                Eight hundred and ninety-two mother-newborn pairs (446 before and 446 three months after).
                A 4-day training program on essential newborn care for doctors, nurses, and midwives of the obstetric units in two hospitals.
                By direct observation, practices of essential newborn care at delivery in the labor room on a subsample. By interviewing mothers, immediate skin-to-skin contact and early initiation of breastfeeding. From health records, "undesirable health events" of the newborns.
                Practices of cleanliness, thermal protection, and neonatal assessment improved significantly in the intervention group. The intervention was effective in improving skin-to-skin contact by 1.5 times and early initiation of breastfeeding by 3.4 times. Undesirable health events declined from 32 to 21 per 223 newborns in the intervention group and from 20 to 17 per 223 newborns in the control group.
                A comprehensive 4-day training program can be followed by a significant improvement in essential newborn care practices in obstetric units. This study examined the effects of stroking and a perioral and intraoral prefeeding stimulation program on healthy, growing, preterm infants in a Level II special care nursery. Only infants without cardiac, gastrointestinal, or central nervous system problems were included in the study.
                Two groups of nine randomly assigned, medically stable preterm infants, born between 30 weeks and 34 weeks gestation, were selected for the study. All infants were introduced to nipple feeding at approximately 34 weeks postconceptual age. The infants in the control group received a 5-min stroking protocol before feeding; the infants in the experimental group received a 5-min stroking protocol in addition to a perioral and intraoral stimulation program.
                Compared with the control group, the experimental group had a decreased number of gavage feedings, greater weight gain, and fewer days of hospitalization. The experimental group also had higher scores on the Revised-Neonatal Oral Motor Assessment nutritive suck scale than the control group.
                On a preliminary basis, the findings from this study establish the efficacy of occupational therapy in a Level II special care nursery for healthy, growing, preterm infants. Further, the specific treatment strategies conducted with the infants receiving the experimental procedures have also been preliminary established as effective in enhancing the infants' feeding skills, resulting in weight gain and decreased hospital stays as compared with their counterparts in the control group. However, our findings cannot be generalized to preterm infant populations who are at greater medical risk than the infants in our study because of the potentially hazardous effects that could result. Implications of the results for intervention programs and future research are discussed. Regular night waking of young children is one of the most common problems encountered by parents. This study compared a standardized night waking programme that involved organized bedtime routines, procedures for settling the child and for the handling of crying, calling out and getting out of bed, with a group which received written information only and a waiting list control group. The children receiving the standard programme and those receiving written information only showed significant improvement over children in the waiting list group. This result supports the use of written parent instructions with or without therapist support. A health education program was evaluated which used child development specialists as home visitors and served a population of first-time mothers living in rural communities. The evaluation compared health and safety outcomes between intervention and control groups. The research staff, separate from the intervention staff, collected data in the homes of 156 intervention and 107 control mothers when the infants were 6 and 12 months old. Significant group differences were found on health and safety outcomes. As compared with controls, the intervention mothers (i) had safer homes; (ii) were more likely to use birth control, thus had fewer pregnancies since birth of their first child; (iii) reported smoking fewer cigarettes; (iv) knew more about effects of smoking on their child's health and (v) were more likely to use health department services. In sum, mothers who received early education home visits from child development specialists experienced positive health and safety outcomes. It is highly recommended that a program such as this be implemented as part of health delivery program with new mothers and infants.
The benefits of educational programs to participants and their newborns remain unclear. Education on sleep enhancement appears to increase infant sleep and education about infant behaviour potentially enhances mothers' knowledge; however more and larger, well-designed studies are needed to confirm this.