Infant crying and sleep research: soothing babies and helping parents
Submitting InstitutionUniversity College London
Unit of AssessmentEducation
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Paediatrics and Reproductive Medicine, Public Health and Health Services
Summary of the impact
Parents, healthcare professionals and policy makers across the globe have
benefited from Professor Ian St James-Roberts's research and writing on
understanding infant sleep and crying. His findings over 20 years underpin
government and third-sector guidance for health staff in the UK, US,
Canada and Australia. His research has also informed — and eased the minds
of — countless parents in these and many other countries. It features in
the practical advice provided by the National Childbirth Trust (NCT), the
UK's biggest parenting charity, and is cited on many other authoritative
websites for parents around the world.
Context: For many years parents, particularly in the West, have
been offered conflicting advice on how to respond to very young babies who
cry excessively or have problematical sleep patterns. Many parents have
consequently not known whether to try to stick to a predetermined sleeping
and eating schedule or react to their child's every demand. Nevertheless,
until Professor St-James Roberts of the IOE conducted his breakthrough
study (see reference R1), researchers had struggled to identify a
methodology that would provide the reliable answers that parents craved.
Research methods: The 2006 study led by St James-Roberts compared
the crying and sleeping of three groups of infants whose parents had
elected to adopt different forms of care. The researchers focused on
1) London (who indicated that they were most likely to follow a schedule)
2) Copenhagen (who were expecting to be more responsive to their babies)
3) a `proximal' group drawn from both countries who planned to hold their
infants for much of the time that they were awake and respond rapidly if
Mothers in the first two groups were recruited via maternity wards within
three days of their babies' birth while those in the third group were
identified through natural parenting networks. All the mothers (275 in
total) were asked to keep a diary of their infants' crying and night
waking as well as their own responses at 8-14 days, 5-6 weeks and 10-14
weeks of age. They also completed questionnaires on their babies' feeding
and sleeping patterns. Researchers made home visits and carried out
Key findings: The study revealed that the `proximal' parents held
their infants for 15 to 16 hours a day and were more likely than the other
two groups to sleep with them. They also fed their babies more often.
London parents had 50 per cent less physical contact with their infants
and stopped breastfeeding earlier than the other groups. They also left
their crying babies for longer. Copenhagen parents fell between the other
groups in terms of the amount of contact they had with their infants. The
study also found that:
- comforting babies may work better than leaving them to cry — at least
during the first few weeks of life. The London infants cried 50 per cent
more than babies who received more attention at two and five weeks of
- colicky crying (unexplained bouts of crying that affect between one in
five and one in seven healthy children) at 5 weeks are unaffected by
- As the infants got older, switching from comforting on demand to care
that emphasised routines was beneficial: it helped to reduce crying out
in the night, probably because it helped infants to learn to remain
settled at night. (This finding is supported by controlled trials by St
James-Roberts and others (R3).)
St James-Roberts and his colleagues concluded that different parenting
styles are associated with different sets of advantages and disadvantages.
Overall, it was the Copenhagen parents who followed a middle path —
neither remaining `hands off' nor responding to every demand — and their
infants who fared best.
Researchers: The work of St James-Roberts and his colleagues sits
within a highly-respected body of health education and family research at
the IOE's Thomas Coram Research Unit (TCRU). This includes influential
work on sex education, family breakdown, parenting, childhood wellbeing
and children from care backgrounds.
The study described here was conducted by Professor St. James-Roberts
(PI), Emese Csipke, Tanya Abramsky and Jennifer Goodwin (all TCRU) and
Marissa Alvarez and Esterh Sorgenfrei (both University of Copenhagen).
Related research: More recently, St James-Roberts and his IOE
colleague Emma Peachey have sought to distinguish prolonged crying
behaviour from sleep-waking problems. They demonstrated that most colicky
infants at 5-6 weeks were no more likely than other children to be
unsettled in the night by 12 weeks (R2). St James-Roberts has also
helped to dispel the myth that colicky crying in early infancy is
attributable to gastro-intestinal disturbance. He has summarised evidence
that such disturbances affect only about 1 in 100 infants. Many infants
who are taken to see doctors are simply at the extreme of the normal range
of crying behaviour. At the same time, St James-Roberts has acknowledged
that many parents are left seriously distressed by their babies' crying (R3).
In extreme cases, this has been known to trigger `shaken baby syndrome',
resulting in brain damage or death. He and his fellow researchers have
also highlighted the hidden financial costs of infant crying and sleep
problems. A 2001 study he co-authored estimated that the professional time
devoted to discussing such issues with parents of infants was costing the
NHS about £65 million per year (R4).
References to the research
R1: St James-Roberts,
J., & Sorgenfrei,
E. (2006) Infant crying and sleeping in London, Copenhagen and when
parents adopt a `proximal' form of care, Pediatrics 117(6),
R2: St James-Roberts, I. & Peachey E. (2011) Distinguishing infant
prolonged crying from sleep-waking problems, Archives of Disease in
Childhood (BMJ group), 96, 340-344.
R3: St James-Roberts, I., Sleep, J., Morris, S., Owen, C. & Gillham,
P. (2001) Use of a behavioural programme in the first 3 months to prevent
infant crying and sleeping problems, Journal of Paediatrics and Child
Health, 37, 289-97.
R4: Morris, S., St James-Roberts, I., Sleep, J. & Gillham, P. (2001)
Economic evaluation of strategies for managing crying and sleeping
problems, Archives of Diseases of Childhood, 84,15-9.
R5: St James-Roberts, I. (2012) The origins, prevention and treatment
of infant crying and sleeping problems: an evidence-based guide for
healthcare professionals and the families they support, London:
R6: St James-Roberts, I. (2007) Infant crying and sleeping: helping
parents to prevent and manage problems, Sleep Medicine Clinics, 2,
Indicators of quality:
IQ1: St James-Roberts's British Psychological Society fellowship citation
says one of his assessors "was led to comment that `no psychologist could
tackle the issue of infant crying without drawing heavily on Dr St
James-Roberts' work' ". (See Impact source S1)
IQ2: The Crying Patterns questionnaire, which St James-Roberts developed,
has been used by researchers around the world.
Indicative funding: St James-Roberts was the grantholder for each
of these studies (G1) and Co-Applicant for G2.
G1: Wellcome Trust: £187,000 to assess the aetiology and outcome of
persistent infant crying (1993-5); £118,000 to assess whether the crying
of infants with colic is distinct (1998-2001); £204,000 for a comparative,
cross-cultural study of infant crying and sleep (2002-5); £314,000 to
assess the role of infant learning in the development of `sleeping through
the night' (2009-12).
G2: NHS Executive grant of £176,000 for a randomised controlled trial of
the effects of a parental intervention package on infant crying and
Details of the impact
Reach and significance: Research by St James-Roberts, conducted
over several decades, has helped to achieve a paradigm shift in the
understanding and treatment of infant colic, crying and sleep problems. It
has informed millions of parents and has paved the way for the development
of interventions to help families and substantially reduce governments'
health costs. It is also contributing to the work of others designed to
prevent shaken baby syndrome.
Principal beneficiaries and dates: Parents around the world who
visit authoritative websites, clinics or healthcare professionals to seek
information on infant crying or sleeping. Healthcare and medical
professionals have benefited too as they now have more reliable evidence
to offer parents. The impact began before 2008 and continues to accumulate
as more and more guides for parents and guidelines for professionals cite
St James-Roberts's research.
Impact on policy and practice: Colicky crying: His work
has added to evidence that different parenting approaches have little
effect on colicky crying, which is common in early infancy. This has
provided reassurance that parents are not to blame for this type of infant
crying. In the UK, this evidence has resulted in a move towards health
services that focus on providing parents with information and practical
support in managing infant crying. For example the wording of the
National Institute for Health Research's 2012 call for research to
underpin an intervention package for parents of infants who cry
excessively shows the influence of this research, by focusing directly on
supporting parents rather than trying to treat an infant presumed to be
unwell (S2). In 2012, St James-Roberts was also invited by the Rome
Foundation, a charity concerned with Functional Gastrointestinal (GI)
Disorders, to join the expert panel that is developing international
guidelines for clinicians diagnosing paediatric GI disorders.
Shaken baby syndrome: Findings from his research form part
of the body of work that is helping to combat this syndrome. The Period Of
Purple Crying website, sponsored by the US National Center on Shaken Baby
Syndrome, includes three Infant Sleep pages by St James-Roberts (S3),
which have had more than 60,000 views since publication in October 2009.
One parent emailed: "You have no idea how difficult it is to find an
un-biased summary of ways to deal with night waking ... It is very easy to
find information on how to execute the methods, but next to impossible to
find a backgrounder that simply describes the problem so that as a parent
you can assess the behaviour before deciding how to deal with it" (S11).
A paper St James-Roberts published in Child Abuse Review (S4)
also appears in the section on parent education and child abuse prevention
in the library of the US National Criminal Justice Reference Service. The
reach of his research is enhanced by the citation of his work in A
Journalist's Guide to Shaken Baby Syndrome (S5). This guide
is published by the US Department of Health and Human Services Centres for
Disease Control and Prevention. The guide says: "The key here is that
crying is normal and is not the problem. The problem is how
caregivers respond to a baby's cry."
Professional and public engagement: St James-Roberts works closely
with organisations that educate new parents about infant sleep and crying
issues — and the professionals who advise them. For example, his 2012
guide for professionals and families (R5) is helping to underpin an
Institute of Health Visiting sleep campaign designed to update
practitioners (S6); it is recommended in the Institute's
practitioner training sessions, including those run jointly with NetMums.
NCT adviser: St James-Roberts has been a member of the
NCT's Research Advisory Panel since 2010. Mary Newburn, NCT head of
research (S7), says: "Ian understands our commitment to being both
parent-centred and evidence-based. We are using two questions on
persistent crying from his earlier research in our longitudinal study of
parents, as this is an aspect of parenting that causes considerable stress
and concern. We ... feel it is invaluable to have his support, based on
his detailed empirical comparative research". St James-Roberts is cited in
the NCT's information for health workers (S8) and its web articles
for parents and professionals.
Trusted websites: His findings also substantiate advice on
the most widely-trusted national and international websites, including
those of NHS Direct and Unicef (S9). Leading commercial
organisations such as Mothercare also cite his research.
International reach: Articles both by St James-Roberts and
about his work are included in the Encyclopedia on Early Childhood
Development (S10). Produced by Montreal University, the Encyclopedia
has been translated into French, Spanish and Portuguese and is presented
in three levels of language for different needs. His work is also cited by
many parents' organisations and health websites in countries including the
US, Australia, Canada and Singapore, as well as the UK. He is, for
example, an `expert panellist' on websites for new parents such as
babycentre.co.uk. His advice for parents has been translated into many
languages, including French, Spanish, Romanian, Croatian and Turkish.
Sources to corroborate the impact
S1: BPS Fellowship citation (2002) http://www.thepsychologist.org.uk/archive/archive_home.cfm/volumeID_15-editionID_83-ArticleID_449-getfile_getPDF/thepsychologist%5C0802soci.cfm.pdf
S2: NIHR Health Technology Assessment programme specification
: National Criminal Justice Reference Service, US Dept. of Justice. Part
of NCJRS library collection.
Journalists' Guide to Shaken Baby Syndrome: A Preventable Tragedy (CDC)
S6: Statement from Maggie Fisher, Institute of Health Visitors and
S7: Statement from Mary Newburn, head of research and quality, NCT
S8: Semple, A. (2011) Self-regulated sleep and unsettled babies — what
can we usefully tell parents', in Perspective (NCT journal), June
2011, pp 14-15
S9: Unicef health professional's guide for use with parents' guide:
(see p 11)
S11: Two emails available from a parent and a health worker (2012)
All web links accessed 13/10/13