Blunden Sarah, Dawson Drew
Appleton Institute of Behavioural Science, Central Queensland University, Adelaide, South Australia, Australia.
J Paediatr Child Health. 2020 May;56(5):675-679. doi: 10.1111/jpc.14818. Epub 2020 Feb 19.
In families with infants between the ages of 6 and 18 months, sleep disruption can be significant, often putting parents at risk of a range of negative psychological and psychosocial consequences. Commonly prescribed sleep interventions typically involve 'extinction' methods, which require parents to completely or periodically ignore their infant's overnight cries. These methods can be effective in many, but not all cases. For over 40 years 30-40% of parents have consistently reported difficulty ignoring their child. For this group, ignoring their child is behaviourally and/or ideologically difficult with attrition often leading to a perceived sense of failure. For these parents the treatment may be worse than the problem. On the other hand, there is emerging evidence to support the use of more responsive methods for those who find extinction approaches behaviourally or ideologically challenging. In this paper we propose an integrated, less polarised approach to infant behavioural sleep interventions that better caters to those who have difficulty with extinction methods - our so-called 'Plan B'. This approach potentially resolves the often opposing ideological and theoretical perspectives of extinction versus responsiveness into a practical, complementary and pragmatic treatment framework. Recommendations on how best to implement Plan B are also presented. In our view, Plan B could provide practitioners with a logically integrated well-targeted suite of clinical interventions that could potentially improve compliance, reduce attrition and ultimately benefit the sleep and well-being of all infants and their parents, especially those who struggle with traditional extinction methodologies.
在有6至18个月大婴儿的家庭中，睡眠中断可能很严重，常常使父母面临一系列负面心理和社会心理后果的风险。通常规定的睡眠干预措施通常涉及“消退”方法，即要求父母完全或定期忽略婴儿夜间的哭声。这些方法在许多情况下有效，但并非所有情况都如此。40多年来，30%至40%的父母一直表示难以忽略孩子的哭声。对于这一群体来说，忽略孩子在行为上和/或观念上都很困难，治疗的半途而废往往会导致一种失败感。对这些父母来说，治疗可能比问题本身更糟糕。另一方面，越来越多的证据支持对那些认为消退方法在行为或观念上具有挑战性的人使用更具响应性的方法。在本文中，我们提出了一种综合的、不那么两极分化的婴儿行为睡眠干预方法，这种方法能更好地满足那些难以采用消退方法的人——我们所谓的“B计划”。这种方法有可能将消退与响应性这两种通常相互对立的观念和理论观点整合到一个实用、互补且务实的治疗框架中。我们还提出了关于如何最好地实施B计划的建议。我们认为，B计划可以为从业者提供一套逻辑上综合、针对性强的临床干预措施，这有可能提高依从性、减少治疗半途而废的情况，并最终有益于所有婴儿及其父母的睡眠和福祉，尤其是那些在传统消退方法上遇到困难的人。
