For more information, contact: Vicky Cerino, UNMC Public Affairs Phone: (402) 559-4353 Dec. 22, 1998

UNMC Research Study Shows Parents Prefer ‘Cry it Out’ Approaches to Bedtime Problems
 
University of Nebraska Medical Center researchers recently found surprising information on parents’ preference to their children’s bedtime problems. Previous studies have shown that parents do not like their children to “cry it out.” But a survey of 2,000 parents in the Omaha area shows they overwhelmingly prefer three “cry it out” strategies for their children at bedtime.

Most parents have had to deal with children who don’t want to go to bed or who wake up frequently throughout the night. There are numerous methods proposed by child psychologists and experts to help parents cope with these bedtime problems. Deciding on the best method isn’t easy.

Brett Kuhn, Ph.D., assistant professor, pediatrics, and a psychologist at the Munroe-Meyer Institute at UNMC, had seen information from studies that surveyed parents who sought professional help with their child’s sleep problems.

“The studies had been conducted on parents who visited physicians and sleep clinics, not the general population. Parents presenting to sleep clinics are more likely to have unsuccessfully tried the `cry it out’ approach. It was my hunch that many parents in the general population use this approach successfully and find it a reasonable method for their children,” he said.

In his survey, Dr. Kuhn gave parents a scenario in which a 2½-year-old child never sleeps through the night, cries when put to bed, frequently awakens and has difficulty settling after each episode. The highest score any method could receive on the survey was 45 and the lowest was nine. The top two parents’ choices of the eight methods were the “cry it out” approaches.

The eight methods are listed below in order of popularity:

1. Graduated extinction—a “cry-it-out” approach referred to graduated ignoring or progressive delay responding, made popular by psychiatrist Richard Ferber’s 1985 best-selling book on children’s sleep disorders. It is similar to the quick check method, except the time interval between parental checks is gradually increased, typically in five-minute intervals. (scored 32 of 45 points)

2. Extinction with quick check acceptability – a “cry-it-out” approach similar to the straight extinction procedure, except that parents may enter the child’s bedroom at preplanned intervals (every 10 minutes) to briefly check on the child’s well being. (scored 31 of 45 points)

3. Scheduled awakenings –After the parent has kept track of the child’s awakening pattern for one week, the parent wakes the child 15 to 30 minutes prior to an expected awakening. The parent then does what he or she normally does, rub the child’s back or give a bottle, for example, if the child awakens. The duration between scheduled awakenings is gradually increased until they can be eliminated altogether. (scored 28 of 45 points)

4. Extinction – this “cry-it-out” approach is ignoring the crying until the child falls asleep. (scored 27 of 45 points)

5. Faded bedtime with response-cost –this procedure involves setting the initial bedtime when the child is likely to fall asleep, then adjusting the bedtime by 30 minutes (earlier or later) each subsequent night based on how quickly the child falls asleep. If the child does not fall asleep within a reasonable amount of time, 15 to 30 minutes, the child is removed from the bedroom for 30 minutes before given another opportunity to fall asleep. (scored 26 of 45 points)

6. Extinction with parental presence –This is no different from straight extinction, except that the parent pretends to be asleep (ignores child) while remaining in the same room with the child – gradually working way out of bedroom over time. (scored 25 of 45 points)

7. Bed-sharing – referred to as the “family bed,” or co-sleeping, this strategy involves the child sleeping with the parents in the same bed. For his study, Dr. Kuhn defined bed-sharing as parent and child sleeping together every night, for the entire night. (21 of 45 points)

8. Sedative medication –This treatment involves giving the child a prescription “sleeping pill” at bedtime to make the child drowsy. No specific medication was named in the survey. (18 of 45 points)

Dr. Kuhn will present the results of his study at the Association of Professional Sleep Societies conference in Orlando next June. Data for future sleep disturbance studies are now being collected on all the children being seen in the pediatric sleep clinic at MMI. He also is gathering information on how these sleep disturbances affect the stress level of parents and what treatment methods they find acceptable.

For more information about children’s sleep disorders, call 559-6408.

UNMC is the only public academic health science center in the state.  Through its commitment to research, education and patient care, UNMC has established itself as one of the country's leading centers for cancer research and treatment and solid organ transplantation.  More than $34 million in research grants and contracts are awarded to UNMC scientists annually.  In addition, UNMC's educational programs are responsible for training more health professionals practicing in Nebraska than any other institution.