Jump to comment:

• Preventing infant regulation problems: considering the roles of biology and parenting
  Fallon Cook, Harriet Hiscock
  Published on: 14 October 2021

• Published on: 14 October 2021

  Preventing infant regulation problems: considering the roles of biology and parenting

  • Fallon Cook, Postdoctoral fellow, infant regulation and child development researcher Murdoch Children’s Research Institute; Department of Paediatrics, University of Melbourne, Melbourne, Australia
  • Other Contributors:
    • Harriet Hiscock, Paediatrician and senior research fellow

  Infant sleeping, crying and feeding problems can be hugely concerning for parents. As Wolke points out,(1) a growing body of evidence points to a range of poor longer term outcomes for infants who experience persistent, severe, regulatory difficulties. Olsen and colleagues’ study(2) is important because it aims to help our understanding of the early factors that predict persistent regulatory difficulties. If we can identify these early risk factors, perhaps we can better focus our efforts to prevent these difficulties from arising.

  There have been several attempts to prevent infant sleeping and crying difficulties via parent education and support programs. Randomized controlled trials of these programs have reported small increases in infant sleep duration, increased likelihood of ‘sleeping through the night’,(3–5) reduced parent depressive symptoms, and less doubt about parenting ability at bedtime.(6) Parent education programs may modestly reduce infant sleep difficulties. Whether these infants are then less likely to develop complex regulatory problems that precede poor childhood outcomes, remains to be tested.

  We agree with Wolke’s assertion that ‘there is a major need to educate parents on how to support infants in regulatory adaptation.’ Parenting practices such as having a consistent bedtime routine, and encouraging independent settling, have been shown to improve infant sleep.(7) However, we must consider that some infants’ sleep difficulties may have...

  Show More

  Infant sleeping, crying and feeding problems can be hugely concerning for parents. As Wolke points out,(1) a growing body of evidence points to a range of poor longer term outcomes for infants who experience persistent, severe, regulatory difficulties. Olsen and colleagues’ study(2) is important because it aims to help our understanding of the early factors that predict persistent regulatory difficulties. If we can identify these early risk factors, perhaps we can better focus our efforts to prevent these difficulties from arising.

  There have been several attempts to prevent infant sleeping and crying difficulties via parent education and support programs. Randomized controlled trials of these programs have reported small increases in infant sleep duration, increased likelihood of ‘sleeping through the night’,(3–5) reduced parent depressive symptoms, and less doubt about parenting ability at bedtime.(6) Parent education programs may modestly reduce infant sleep difficulties. Whether these infants are then less likely to develop complex regulatory problems that precede poor childhood outcomes, remains to be tested.

  We agree with Wolke’s assertion that ‘there is a major need to educate parents on how to support infants in regulatory adaptation.’ Parenting practices such as having a consistent bedtime routine, and encouraging independent settling, have been shown to improve infant sleep.(7) However, we must consider that some infants’ sleep difficulties may have less to do with parenting practices, and more to do with prenatal exposure to stress and other adversities. For these infants, sleep may not be easily improved with typical infant sleep interventions.

  Prenatal maternal depression, anxiety, and stress are associated with increased risk for poorer infant health, greater infant stress reactivity and increased risk for preterm birth and low birth weight - factors that are known to contribute to increased regulatory problems.(8,9) Epigenetic influences on NR3C1 gene expression have been suggested to explain the association between heightened stress during pregnancy and later infant neuroendocrine function, behavior regulation and temperament.(10–12) Other research indicates that neurodevelopmental vulnerabilities and prenatal exposure to stress, better predict persistent regulatory difficulties than parenting style.(2,9,13)

  While there is strong evidence that parenting practices influence infant sleep and crying behaviors,(7) emerging evidence seems to suggest that prenatal biological factors may also play a critical role. We do not yet know whether the effect of prenatal stress and adversity on later infant sleep can be changed via improved/altered parenting practices. Perhaps this explains why a small proportion of parents who report infant regulation problems insist that nothing helps their infant to sleep better. Instead of asking these parents to keep trying/try harder, it may be more beneficial to consider what other supports can help these families cope.

  Further research is necessary to understand how nature and nurture intersect to influence the development of infant regulation. Findings will ultimately inform development of targeted, early prevention strategies that might improve outcomes for all dysregulated infants and their families.

  1. Wolke D. Persistence of infant crying, sleeping and feeding problems: Need for prevention. Vol. 104, Archives of Disease in Childhood. 2019. p. 1022–3.
  2. Olsen AL, Ammitzbøll J, Olsen EM, Skovgaard AM. Problems of feeding, sleeping and excessive crying in infancy: A general population study. Arch Dis Child. 2019 Jul 3 ;Epub ahead.
  3. St James-Roberts I, Sleep J, Morris S, Owen C, Gillham P. Use of a behavioural programme in the first 3 months to prevent infant crying and sleeping problems. J Paediatr Child Health. 2001 Jun;37(3):289–97.
  4. Symon BG, Marley JE, Martin AJ, Norman ER. Effect of a consultation teaching behaviour modification on sleep performance in infants: a randomised controlled trial. Med J Aust. 2005 Mar 7;182(5):215–8.
  5. Pinilla T, Birch LL. Help me make it through the night: behavioral entrainment of breast-fed infants’ sleep patterns. Pediatrics. 1993 Feb;91(2):436–44.
  6. Hiscock H, Cook F, Bayer J, Le HND, Mensah F, Cann W, et al. Preventing Early Infant Sleep and Crying Problems and Postnatal Depression: A Randomized Trial. Pediatrics. 2014 Feb 1;133(2):e346-54.
  7. Sadeh A, Tikotzky L, Scher A. Parenting and infant sleep. Sleep Med Rev. 2010 Apr;14(2):89–96.
  8. Nazzari S, Fearon P, Rice F, Dottori N, Ciceri F, Molteni M, et al. Beyond the HPA-axis: Exploring maternal prenatal influences on birth outcomes and stress reactivity. Psychoneuroendocrinology. 2019 Mar 14;101:253–62.
  9. Bilgin A, Wolke D. Development of comorbid crying, sleeping, feeding problems across infancy: Neurodevelopmental vulnerability and parenting. Early Hum Dev. 2017 Jun;109(March 2017):37–43.
  10. Conradt E, Fei M, LaGasse L, Tronick E, Guerin D, Gorman D, et al. Prenatal predictors of infant self-regulation: the contributions of placental DNA methylation of NR3C1 and neuroendocrine activity. Front Behav Neurosci. 2015 May 29;9:130.
  11. Glover V, O’Donnell KJ, O’Connor TG, Fisher J. Prenatal maternal stress, fetal programming, and mechanisms underlying later psychopathology—A global perspective. Dev Psychopathol. 2018 Aug 2;30(03):843–54.
  12. Van den Bergh BRH, Mulder EJH, Mennes M, Glover V. Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. Neurosci Biobehav Rev. 2005 Apr;29(2):237–58.
  13. Cook F, Conway L, Gartland D, Giallo R, Keys E, Brown S. Profiles and Predictors of Infant Sleep Problems Across the First Year. J Dev Behav Pediatr. 2019 Sep;1.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top