Sleep training 101: The INSIGHT Responsive Parenting Approach
As a parent, researching the array of sleep methods and approaches can be overwhelming. From the Ferber Method to pick-up-put-down, to baby-led approaches, there’s no shortage of advice on how to help your baby sleep better. The focus of this blog is the INSIGHT Responsive Parenting approach to infant sleep, which has gained attention for its focus on being attuned to your baby’s needs while promoting healthy sleep habits. As always, don't take this blog as an endorsement of this particular method, our goal is to simply provide you with evidence-based resources so that you can make an informed decision for your family.
The Science
The INSIGHT Responsive Parenting approach to sleep is rooted in the concept of responsive parenting, which emphasizes recognizing and responding to your baby’s cues for sleep, hunger, and comfort. This approach was studied as part of the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) trial, a randomized clinical trial designed to evaluate the impact of responsive parenting on infant sleep and other health outcomes.
What does the research say?
Research from the INSIGHT trial suggests that responsive parenting can help parents establish healthy sleep habits for their babies. A study published in Pediatrics found that infants in the responsive parenting group had longer sleep durations and fewer night wakings compared to a control group. The approach is based on the idea that by understanding and responding to your baby’s cues, you can create a more predictable and supportive sleep environment.
How does it work?
The INSIGHT Responsive Parenting approach focuses on three key sleep-related areas:
Bedtime Routine: Promoting a consistent bedtime routine at an age-appropriate time and avoiding feeding and rocking to sleep
Sleep Location and Behaviors: Transition to own room by 3 months,* consistently put to bed "drowsy but awake" by 4 months, swaddling, using white noise, avoiding stimulating activity before bed, age-appropriate naps
Night Waking: Allowing time to "self settle," keep interactions boring, avoid dream feeds after 4 months, avoid overnight feeds after 28 weeks,** prepare for developmental changes that affect sleep (e.g., at 4 months, 9 months etc.,)
*Note that this conflicts with the American Academy of Pediatrics recommendation room sharing until one year.
**We don't usually recommend such a strict cutoff, this is specific to INSIGHT.
What else should you know?
The principles described in this study are great best practices but don’t expect that implementing these concepts will prevent all sleep issues. This approach has only been tested in one study. The study showed that the approach resulted in more babies falling asleep in less than 45 minutes and before 8 pm compared to babies in the control group. It also showed that babies in the responsive parenting group slept longer at 8, 16, and 40 weeks (by 35, 25, and 22 minutes, respectively). Importantly though, averages don't tell the whole story. This approach didn’t actually improve sleep for a large proportion of babies. For example, 33% of babies fell asleep independently at 16 weeks using responsive parenting, meaning 67% did not. Similarly, at 40 weeks 46% of the responsive parenting group fell asleep independently compared to 37% of controls, meaning more than half of babies in the study didn't learn that skill by the end of the study. Finally, there were no differences between responsive parenting and the control group in the proportion of babies who woke >2 times per night during the study. These findings highlight the complexity of infant sleep. Skill-building can only happen effectively if a baby is free of illness, reflux, allergies, colic, and other issues that disrupt sleep. In addition, any lifestyle-based intervention like this needs to be something that caregivers can implement consistently, even when work schedules are variable and when children have multiple caregivers. It's hard to know why such a large proportion of babies didn't improve with these techniques but our experience suggests that there were likely a variety of barriers for some families.
How to Implement Responsive Parenting for Sleep
The implementation of the INSIGHT Responsive Parenting approach involved meeting with a nurse at 3, 16, 28, and 40 weeks to adjust parenting practices and promote better sleep. Most parents won't have access to a trained nurse to deliver content, so here are some tips for implementing these concepts on your own:
Educate Yourself: Understand sleep and feeding norms for your baby's age and developmental stage.
Check in with Yourself: It can be overwhelming to constantly work on sleep. Instead, consider taking a deliberate moment each month to check in with yourself to determine whether you need to tweak your baby's schedule or whether you would do anything different in your baby's routines.
Observe and Respond to Sleepy Cues: Pay attention to your baby’s signals for sleep, such as rubbing their eyes, yawning, or becoming fussy. Once you understand your baby's limits, you can build a schedule that aligns with your baby's sleep needs.
Create a Consistent Bedtime Routine: A predictable bedtime routine can signal to your baby that it’s time for sleep. This might include a warm bath, gentle rocking, or reading a book. The key is consistency.
Encourage Self-Soothing: While it’s important to respond to your baby’s needs, gradually encouraging self-soothing can help your baby learn to fall asleep independently. The INSIGHT responsive parenting approach recommends putting your baby down drowsy but still awake.
Be Flexible: Every baby is different, and what works for one may not work for another. The INSIGHT approach encourages flexibility, allowing you to adjust based on your baby’s needs.
The INSIGHT Responsive Parenting approach offers a balanced way to support your baby’s sleep by combining structure with flexibility. If you’re finding it challenging to navigate the complexities of infant sleep, we’re here to help. Our newborn class leverages the core concepts of this approach and combines them with other approaches so that you have the tools to develop and maintain great sleep during the first six months. If you need a bit more personalized support, our team would be happy to work with you in a one-on-one consultation to develop a plan that aligns with your family’s needs and values.
References
Paul, I.M., Williams, J.S., Anzman-Frasca, S., Beiler, J.S., Makova, K.D., Marini, M.E., Hess, L.B., Rzucidlo, S.E., Verdiglione, N., Mindell, J.A. and Birch, L.L., 2014. The intervention nurses start infants growing on healthy trajectories (INSIGHT) study. BMC pediatrics, 14, pp.1-15.