Treating Treatment-Resistant Infant Sleep Disturbance with Combination Pharmacotherapy and Behavioural Family Interventions

Behavioural family interventions, alone or in combination with sedative medication, have been shown to be effective treatments for infant sleep disturbance (ISD), especially night waking and crying. Nevertheless, some infants become treatment resistant and ISD persists despite multiple treatments on multiple occasions. Parents of six infants aged 9-27 months with treatment-resistant ISD responded to night wakings by lying noninteractively near their child until sleep resumed (parental presence treatment). They also administered a physician-prescribed, prebed-time sedative (trimeprazine tartrate), the dosage reducing from an initial 30 mg/night by 1/5th every second night. The treatment was introduced according to a multiple-baseline-across-infants design, and faded out over 10 days. Thereafter, night wakings were responded to by planned ignoring or with minimal-check procedures when infant welfare required. Combined treatment reduced night waking below baseline levels, although there was some later deterioration associated with illness or rebound at medication termination. Clinically significant reductions in ISD were evident at the end of treatment for all infants, and this was maintained at follow-up for five infants. Parents found the intervention helpful, satisfying and nonstressful.