Behavioral insomnia in young children: Integrating behavioral and cognitive approaches for a comprehensive treatment strategy

Behavioral insomnia, usually manifested in difficulties initiating and/or maintaining sleep without the help of a caregiver, affects approximately one in three infants and young children [1]. While it may be normal for an infant to cry before falling asleep, these nighttime cries can induce anxiety and stress in parents. Parental soothing during the night is crucial in the first months of life to tend to the child's needs (e.g., feeding) and foster secure attachment. However, some infants become overly dependent on parental facilitation of sleep in the longer term. If these interventions help the child fall back asleep quickly and reassure the parents, according to the behavioral approach they may act as negative reinforcers, increasing the frequency of the child's demands and potentially hindering the development of self-soothing skills that are necessary for achieving consolidated sleep [2].