Contextual considerations in infant sleep: offering alternative interventions to families

Infant sleep problems are one of the commonly reported reasons parents seek professional help, yet what constitutes a “sleep problem” depends on the models used to explain the development of infant sleep. The current models are based on research conducted in the western context where infant solitary sleeping is the norm. Parent-child co-sleeping is the norm in many cultures around the world. We argue that the primary focus of current research on parent-child interactions as the mediating context for the development of infant sleep problems has inherently made these models and ensuing interventions less sensitive and applicable to infant sleep problems in the context of co-sleeping families. When families present for help with infant sleep difficulties, extinction based behavioral interventions or interventions focused on reducing parental presence at bedtime are commonly recommended. These recommendations may not always align with cultural values and parenting practices of all families, therefore precluding these families from getting necessary help. In attempting to provide families with choices that depart from behavioral based interventions, this paper draws on research and adapts current models to propose an alternative to conceptualize perceptions of infant sleep problems that may be sensitive to and applied across various cultural and personal contexts. We attempt to provide a rationale for interventions that are inclusive and sensitive to families where reduced parental nighttime responsiveness may not be a preferred choice.