Behavioral sleep interventions in children aged 0-5 years: A systematic review of content, delivery, and 24-hour sleep outcomes.

BACKGROUND

Behavioral sleep interventions are widely implemented to address sleep difficulties in early childhood, yet existing reviews primarily evaluate intervention effectiveness in specific populations or focus on isolated outcomes such as nighttime sleep duration. A comprehensive synthesis mapping intervention characteristics across early childhood and identifying understudied areas is lacking. This systematic review aimed to (1) identify behavioral sleep interventions for typically developing children aged 0-5 years (0-71 months), (2) summarize the core sleep-related components addressed, (3) describe delivery characteristics (e.g., target population, format, setting, providers), and (4) summarize the sleep outcomes assessed and measurement methods used.

METHODS

Four databases (PubMed, Scopus, CINAHL, PsycINFO) were searched on May 22, 2025. Eligible studies included quantitative interventions targeting sleep among typically developing children <6 years, reporting at least one child-sleep outcome. Both sleep-only and multi-component interventions were included. Risk of bias was evaluated with the Mixed Methods Appraisal Tool.

RESULTS

Fifty-nine studies met inclusion criteria (49 sleep-only; 10 multi-component). Most interventions targeted parents, used behavioral-educational approaches, and were delivered individually by health professionals or psychologists, often in clinical or home settings. Programs most frequently addressed sleep independence/self-soothing (68%), bedtime routines (53%), and sleep hygiene (47%). Nighttime outcomes, especially sleep duration (49%) and night wakings (47%), were most assessed, predominantly via parent-reported questionnaires and sleep diaries. Daytime sleep was infrequently measured.

CONCLUSIONS

Behavioral sleep interventions for typically developing children commonly emphasize parental guidance, bedtime routines, and independent settling. Evidence is concentrated on nighttime sleep, with less explicit focus on naps and 24-h sleep organization.