Implementation of Behavioral Interventions for Infant Sleep Problems in Real-World Settings

Michal Kahn, Natalie Barnett, and Michael Gradisar


To compare the real-world frequency, timing, duration, difficulty, and helpfulness of 3 infant Behavioral Sleep Intervention (BSI) approaches: Unmodified Extinction, Modified Extinction, and Parental Presence and to examine the effectiveness and safety of these approaches by comparing infant sleep, parent sleep, daytime sleepiness, depression, and parent-infant bonding between parents who had and had not implemented these interventions.

Study design

Participants were 2090 parents (75% mothers, 79% White/Caucasian) of US infants (49% girls) aged 3-18 months (M = 9.1, SD = 4.1). Parents completed online questionnaires regarding their infant's sleep, their own sleep, daytime sleepiness, depression levels, and parent-infant bonding. Infant sleep was assessed via objective-albeit exploratory-autovideosomnography data obtained from the 14 days prior to survey completion.


Sixty-four percent of parents reported implementing BSIs. The average age at intervention was 5.3 months (SD = 2.6). Unmodified and Modified Extinction were rated as significantly more difficult to implement compared with Parental Presence but also as more helpful, shorter, and quicker to show improvements. Infant nighttime sleep was longer and more consolidated in the Unmodified and Modified Extinction groups compared with the Parental Presence and non-BSI groups. No differences were found between BSI groups in parent sleep, sleepiness, depression, or parent-infant bonding.


Implementation of BSIs outside clinical settings is pervasive and occurs earlier than generally recommended. Unmodified and Modified Extinction were associated with longer and more consolidated infant sleep. Despite concerns regarding the potential harm of BSIs, implementation of these approaches was not linked with negative outcomes, providing additional evidence for their safety and effectiveness.


autovideosomnography; behavioral interventions; infant; pediatric insomnia; sleep.

About the Researchers

The researchers included Michal Kahn, Natalie Barnett, and Michael Gradisar

Nanit Lab logo
  • Dr. Michal Kahn is a sleep researcher and licensed clinical psychologist, specializing in pediatric insomnia and sleep development. She is a senior lecturer (assistant professor) at the School of Psychological Sciences at Tel Aviv University, Israel.
  • Dr. Natalie Barnett serves as VP of Clinical Research at Nanit. Natalie initiated sleep research collaborations at Nanit and in her current role, Natalie oversees collaborations with researchers at hospitals and universities around the world who use the Nanit camera to better understand pediatric sleep and leads the internal sleep and development research programs at Nanit. Natalie holds a Ph.D. in Genetics from the University of New England in Australia and a Postgraduate Certificate in Pediatric Sleep Science from the University of Western Australia. Natalie was an Assistant Professor in the Neurogenetics Unit at NYU School of Medicine prior to joining Nanit. Natalie is also the voice of Nanit's science-backed, personalized sleep tips delivered to users throughout their baby's first few years.
  • Dr. Michael Gradisar is a Professor and Director and Clinical Psychologist at the Child & Adolescent Sleep Clinic at WINK Sleep in Australia, and the Head of Sleep Science at Sleep Cycle in Sweden. Dr. Gradisar has specialized in the treatment of pediatric sleep problems since 2006. He has provided training to over 420 psychologists throughout Australia on the treatment of pediatric sleep disorders, and published several research studies evaluating the treatment of insomnia and circadian rhythm disorders in children, adolescents and adults. In all, Dr. Gradisar has over 100 publications in peer-reviewed journals, has authored several book chapters, and has presented on sleep-related research and intervention internationally.

This paper was published in the Journal of Pediatrics. Access the full article here

Nanit Lab Research

Additional peer-reviewed published studies and abstracts from Nanit Lab

About Nanit Lab

We've put together a cutting-edge think tank of scientists, engineers, physicians, academic experts, and thought leaders to develop best-in-class research among three primary pillars: Sleep Health, Postpartum Anxiety & Depression, and Pediatric Health and Wellness.