SLEEP-DEPRIVATION OR POSTNATAL DEPRESSION IN LATER INFANCY - SEPARATING THE CHICKEN FROM THE EGG

Objectives: To explore the association between maternal distress and d epression in the first years of a newborn's life and the child's sleep ing behaviour and problems associated with this behaviour. To asses th e effectiveness of an outpatient-based individualised behaviour modifi cation programme to modify children's sleep behaviour and to decrease levels of maternal distress and depression. Method: Families were refe rred to an outpatient childhood sleep problems clinic. Intervention co nsisted of an individualised management programme including recognised modes of child sleep behaviour management ('controlled crying','cold turkey, rewards) together with occasional use of short-term (less than 2 weeks) tapering dose sedating medication for the child. Two months after the initial contact with the clinic, families completed a second questionnaire collating similar data to that collected at time of enr olment. Results: A total of 114 consecutive families referred to the c linic provided initial data. Follow-up questionnaires were returned by 70 (61%). Significant change was recorded in children's sleep paramet ers including reduction in mean number of night time awakenings (4.1-1 .3, P<0.001), proportion of children requiring longer than 30 min to s ettle at night (49% to 21%, P<0.01) and in the proportion of children settling after 8 pm (51% to 33%, P<0.01). Sleep problem rating on a 0- 10 scale decreased from a mean of 8.1-3.1 (P< 0.001). On initial asses sment, 40% of mothers had Edinburgh Postnatal Depression Scale (EPNDS) scores greater than 12 (screening cut-off point). At repeat assessmen t, 4.3% had scores greater than 12. The mean score on the EPNDS fell f rom 11.2 to 5.8 (P <0.001). Conclusions: An outpatient-based individua lised approach to modifying children's problematic sleep behaviour usi ng recognised behaviour management techniques is effective. Modificati on of problematic childhood sleep behaviour is associated with signifi cant improvement in maternal mood, Given the high incidence of childho od sleep problem and diagnosed postnatal depression, it is likely sign ificant numbers of mothers being diagnosed as having postnatal depress ion are suffering the effects of chronic sleep deprivation. Management of postnatal mood disorder and childhood sleep behaviour must occur w ith due recognition to their close association.