The technique aims to promote the child’s capacity to self-soothe and return to sleep, without undesirable associations or parental interference.1, CX5461 2 and 36 When assessing 79 children with a mean age of 10.2 months (3-24 months) whose parents were instructed to implement the gradual extinction technique during nocturnal sleep, Skuladottir et al. observed that the duration of nocturnal sleep increased from 10.27 hours

to 10.57 hours (p < 0.001) after the intervention, as well as reducing the frequency of nocturnal awakenings (from 4.57 to 1.57 per night, p < 0.001).18 Eckerberg conducted a study to assess whether recommendations provided only in written form to the parents of children treated at a clinic for sleep disorders would work as well as clinical follow-up, which had been previously advocated.19 Guidance to parents of children included in the study followed the gradual extinction method, the same provided by the physician during routine consultations. A total of 39 children between 4 and 30 months of age participated in the study, divided into an intervention group (written information sent by email, without contact with the clinician) and a control group (information given by the clinician). After the intervention, PD0332991 in vitro children from both groups fell asleep faster (p < 0.001) and earlier (p < 0.01), which amounted to 30 minutes earlier after a one-month intervention. In both groups, there was also a significant reduction in nocturnal

awakenings (from 4.6 to 4.2 awakenings in the control and from 3.3 to 2.8 in the intervention group, p < 0.001) in the two weeks following the intervention. The probability of resume sleep on their own also increased after the intervention

(2.1-fold in the control and 2.0-fold in the intervention group, p < 0.001). After three months, this decrease continued in both groups, and there was an increase in the duration of nocturnal sleep (by 59 minutes in the 3-mercaptopyruvate sulfurtransferase control and by 72 minutes in the intervention group) and a decrease in time of wakefulness during the night (from 82 to 18 minutes, p < 0.001), with no differences between the groups. In an Australian case-control study carried out by Hiscock & Wake, 146 children between 7 and 9 months of age were recruited from an outpatient setting.22 The intervention group received specialized guidance on the physiology of sleep and the application of the gradual extinction method, whereas the control group received a newsletter about normal sleep patterns at the age range of 6-12 months. Two months later, children in the intervention group had resolved more sleep problems than those in the control group (p = 0.005), and the remaining problems were less intense in the intervention group. Maternal depressive symptoms decreased in both groups after two months, but decreased more significantly in the intervention group (p = 0.02), the group whose mothers also reported that their own sleep was of better quality (p = 0.