The Impact of a Infant Sleep Hygiene Training Program on Infant Sleep Habits and Parental Self-Efficacy

Sleep is a critical determinant of infants' neurodevelopment, emotional regulation, and physical health, and early sleep problems are associated with adverse outcomes for both children and families. Parental perceptions of infant sleep and parental self-efficacy play a central role in shaping sleep-related caregiving practices. Although various infant sleep interventions exist, many are heterogeneous in content and intensity, and some behaviorally oriented approaches raise ethical and developmental concerns due to potential negative effects on parent-infant attachment and stress regulation. Moreover, structured, attachment-sensitive, and sleep hygiene-based educational interventions initiated during pregnancy remain limited in the literature.

This randomized controlled trial will evaluate the effectiveness of a structured Infant Sleep Hygiene Education Program delivered prenatally to pregnant women, with continued postnatal follow-up, on infant sleep habits and parental self-efficacy related to infant sleep. The intervention is grounded in developmental and attachment-informed principles and emphasizes ethical, responsive caregiving strategies rather than extinction-based sleep training methods. Core components of the program include:

developmentally appropriate sleep expectations, infant temperament-sensitive approaches, establishment of consistent and predictable bedtime routines, environmental sleep hygiene (light, noise, temperature), responsive soothing strategies, and parental coping and stress regulation skills. Participants will be randomly allocated to an intervention group or a control group receiving routine antenatal care. The education program will be delivered in multiple structured sessions during pregnancy and reinforced with postnatal follow-up support. Outcomes will be assessed at baseline (prenatal) and at 1, 3, and 6 months postpartum.

Primary outcomes are parental self-efficacy regarding infant sleep and infant sleep habits (e.g., night waking frequency, sleep duration, sleep onset latency, and routine consistency). Secondary outcomes include adherence to recommended sleep-supportive parenting practices and infant sleep diary indicators. In addition, the mediating role of parental self-efficacy in the relationship between the intervention and infant sleep outcomes will be examined.

Process and program evaluation outcomes will assess parental knowledge about infant sleep hygiene before and after the education program, adherence to the intervention content, completion of sleep diaries, and parental satisfaction with the education sessions.

This study aims to contribute to the development of an ethical, developmentally appropriate, and preventive infant sleep education model that supports healthy sleep habits while strengthening parental competence and promoting sustainable sleep-supportive caregiving practices. Findings may inform maternal-child health services and early preventive interventions integrated into routine prenatal care.

In addition to primary and secondary clinical outcomes, a process evaluation framework will be used to assess the implementation quality and feasibility of the education program. This will include assessment of parental knowledge about infant sleep before and after the education sessions, adherence to recommended sleep-supportive parenting practices, completion of infant sleep diaries, and participant satisfaction with each education session. Furthermore, the mediating role of parental self-efficacy in the relationship between the intervention and infant sleep outcomes will be examined to better understand the mechanisms of change.

Inclusion criteria

• Being a primiparous pregnant woman (first pregnancy)
• Being between 24 and 32 weeks of pregnancy
• Having a risk-free pregnancy
• Not having a mental disorder
• Speaking and understanding Turkish as a native language
• Being literate
• Not having received training on infant sleep
• Agreeing to participate in the study

Exclusion criteria

• The baby being born outside of the 38th to 42nd week of pregnancy
• The baby having a birth weight of less than 2,500 grams or more than 4,000 grams
• The baby being admitted to the neonatal intensive care unit after birth
• The baby having a condition that affects sleep, such as colic or hernia
• The baby having a chronic illness
• The parent wanting to leave work