Detailed overview of the sub-elements of the study
The survey consists of several sub-elements, and below we provide an overview of the texts on the website that cover the full study.
Some pages have yet to be translated to english – google translate function from Chrome is often quite capable of translating, but naturally there might be translations that are wrong.
These sections have a greyish color.
Here we review the most important findings from the study. The focus is especially on the results of a questionnaire survey for parents about received guidance in children’s sleep. We also look at information from access to documents and inquiries to Danish municipalities regarding the health visitors’s guidance in sleep and sleep training – including cry it out sleep training.
Based on the study’s overall material, we have summarized the overall trends in relation to how parents are guided in children’s sleep. We show how the current guidance from the public health authorities as well as major health professional websites is in stark contrast to the research in the field, and substantiate this by referring to more than 100 different professional sources.
Finally, we present a specific list to the National Board of Health with recommendations for how we believe their guidelines and recommendations on sleep should be updated, nuanced and elaborated.
On the basis of the study, we have written a letter to the National Board of Health, in which we present the results of the study, and encourage them to initiate several concrete initiatives.
Health visitors, etc. must advise in line with the Danish National Board of Health’s recommendations and guidelines, and therefore it is absolutely essential that the Danish National Board of Health makes a clear statement in relation to approaches that can be described as sleep training, as described in our study, including approaches where the child is left screaming. crying or calling out and other approaches where the child’s contact attempts are ignored. In addition, their guidelines on children’s sleep for health visitors and doctors should be updated, nuanced and elaborated, so that in the future parents will be guided in line with updated knowledge and research.
We have received a response from the National Board of Health, which, however, does not answer or even relate to the stated problem.
On the website, the terms sleep training and cry it out sleep training are used repeatedly. Here we give a thorough explanation of what the terms cover.
Psychologist Camilla Juhl Dorland, who has written a thesis on cry it out-sleep training, reviews the research in the field, and with reference to research substantiates why cry it out-sleep training should be discouraged.
In this text, we show inconsistencies in the Danish National Board of Health’s own recommendations and guidelines regarding children’s sleep. We also point out that the Danish National Board of Health’s publications include guidance that contradict the recommendations on achiving a secure attachment by parental sensitive response to the signals of the child. Based on this, we call for the Danish National Board of Health’s material to be revised and updated.
To investigate how the municipal health visitors guide parents on sleep, and whether there is guidance in cry it out-sleep training and sleep training more generally, we have asked for access to documents and sent inquiries to the leaders of the health visitors in all Denmark’s municipalities. We review and compare their responses with the results of a questionnaire sent to parents about received sleep counseling. This shows that there are major discrepancies between the municipalities’ own answers and those of the parents.
Finally, we review what the Danish National Board of Health says – and does not say – about sleep training and cry it out-sleep training, since health visitors are mandated to use the guildelines of the Danish National Board of Health as a reference, when advising parents. Taking this into consideration, we describe concrete recommendations for the Danish National Board of Health to update their material.
We sent out a voluntary questionnaire about received sleep guidance, and received responses from 3,627 parents from all of Denmark’s 98 municipalities as well as Greenland and the Faroe Islands. 2,711 of the responses were from parents to children born in 2017-2019, the primary focus of the study.
42% of parents with children born in 2017-2019 had personally been recommended to use cry it out sleep training by either professionals or private contacts. In addition, some had been recommended or read about the method in print media or on social media, and when these were added, more than half of the parents (54%) had been exposed to or had been recommended cry it out.
The questionnaire also shows how far more separation-based guidance is given when the child has to sleep, rather than contact-based guidance.
We have made an overview of the Danish municipalities, the Faroe Islands and Greenland, where we have information that health visitors have recommended cry it out-sleep training. We recommend that the overview primarily serves to show the large geographical distribution.
We have reviewed the municipalities’ written guidelines about sleep from their websites, in pamphlets they use and their references to other sources. The review shows that there is a big difference in how the National Board of Health’s recommendations and guidelines are interpreted from municipality to municipality, and the variation in the municipal pamphlets is large and seems arbitrary.
Much of the municipal material recommend approaches that meet our criteria for ‘sleep training’ and in several cases also ‘cry it out-sleep training’. In many places, the guidelines go against the Danish National Board of Health’s recommendations.
Thorough reviews can be found here:
- Health visitors information on sleep in their pamphlets and on their websites (Appendix)
- Health visitors links about sleep on their websites (Appendix)
We have looked at how public and health care websites guide parents about sleep.
In the links below, we review the guidelines from:
- “Ready for baby”: The National Board of Health and Welfare’s parental pre- and postnatal support program (Klar til barn)
- “Health.dk”: The official medical handbook of Denmark, online version (Sundhed.dk)
- “Countryhospital.dk”: The National Hospital of Denmark (Rigshospitalet.dk)
- “My baby”: App developed by the Committee for Health Information and the Danish National Board of Health and described as ‘a pocket version of a health visitor’ (Min baby)
- “WebMD.dk”: A danish website run by doctors and other health professionals, providing health information funded by advertisements (Netdoktor.dk)
- “Allaboutchildren.dk”: A webpage (subpage) owned by Netdoktor.dk (Altombørn.dk)
- “Center for Childrens lives”: A non-profit NGO specializing in guiding health peofessionals and other professionals in the newest research i relation to the lives of children and families (Center for Børnliv)
(The organisation has been merged with the danish NGO “The Conditions of Children” (Børns Vilkår) efter the study was finished. The purpose of the NGO is stated as “The purpose of Børns Vilkår is to work to strengthen and improve the conditions, upbringing and development opportunities of children and young people in Denmark.”)
The review shows that websites with health professional credibility guide in sleep training and in some cases also cry it out-sleep training, and that there is an absence of alternative options.
A detailed review of the guidelines for sleep on the above websites without our comments is available as an appendix: What guidance on children’s sleep can be found on the Internet? (Appendix)
Go to the summary: What guidance on children’s sleep can be found on the Internet?