title: Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial.
abstract: OBJECTIVE
  Randomized trials have demonstrated the short- to medium-term effectiveness of behavioral infant sleep interventions. However, concerns persist that they may harm children's emotional development and subsequent mental health. This study aimed to determine long-term harms and/or benefits of an infant behavioral sleep program at age 6 years on (1) child, (2) child-parent, and (3) maternal outcomes.
  
  
  METHODS
  Three hundred twenty-six children (173 intervention) with parent-reported sleep problems at age 7 months were selected from a population sample of 692 infants recruited from well-child centers. The study was a 5-year follow-up of a population-based cluster-randomized trial. Allocation was concealed and researchers (but not parents) were blinded to group allocation. Behavioral techniques were delivered over 1 to 3 individual nurse consultations at infant age 8 to 10 months, versus usual care. The main outcomes measured were (1) child mental health, sleep, psychosocial functioning, stress regulation; (2) child-parent relationship; and (3) maternal mental health and parenting styles.
  
  
  RESULTS
  Two hundred twenty-five families (69%) participated. There was no evidence of differences between intervention and control families for any outcome, including (1) children's emotional (P = .8) and conduct behavior scores (P = .6), sleep problems (9% vs 7%, P = .2), sleep habits score (P = .4), parent- (P = .7) and child-reported (P = .8) psychosocial functioning, chronic stress (29% vs 22%, P = .4); (2) child-parent closeness (P = .1) and conflict (P = .4), global relationship (P = .9), disinhibited attachment (P = .3); and (3) parent depression, anxiety, and stress scores (P = .9) or authoritative parenting (63% vs 59%, P = .5).
  
  
  CONCLUSIONS
  Behavioral sleep techniques have no marked long-lasting effects (positive or negative). Parents and health professionals can confidently use these techniques to reduce the short- to medium-term burden of infant sleep problems and maternal depression.
authors.affiliation: Centre for Community Child Health, The Royal Children's Hospital, Flemington Rd, Parkville VIC 3052, Australia. anna.price@mcri.edu.au
authors.forename: Anna M H
authors.initials: AM
authors.lastname: Price
authors.forename: Melissa
authors.initials: M
authors.lastname: Wake
authors.forename: Obioha C
authors.initials: OC
authors.lastname: Ukoumunne
authors.forename: Harriet
authors.initials: H
authors.lastname: Hiscock
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods* / Q000523:psychology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D009035:Mothers / Q000523:psychology; D010287:Parent-Child Relations; D016487:Parenting / Q000523:psychology; D002666:Psychology, Child; D016037:Single-Blind Method; D012893:Sleep Wake Disorders / Q000523:psychology / Q000628:therapy*; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D016896:Treatment Outcome