How EBM helped me…at 3am

I’ve just become a Dad. It is probably been one of the most memorable and amazing times of my life, which has now changed completely. My wife and I, being both very pragmatic, systematic people, “prepared” for the arrival by trying to read various books about the contended little baby, whispering babies, what to expect, week by week guides and so on.

Nothing. Nothing at all prepares you for having a new born in the house and the thing we learnt very quickly was to try and figure out why our baby was crying. Given he is otherwise well he seems to be generally sticking to “I’m hungry”, “I would like a cuddle”, “I need my nappy changed” “I’m windy” or “I’m tired”.  Which means as a parent we can feed him, give him a cuddle, change his nappy, burp him or put him in his cot.

However it’s the times outside of these that can be a bit more confusing as new parents. For example “I’ve got colic, but don’t know how to tell you”, “I’m having a growth spurt”, “I’m tired, but can’t get to sleep”.

The last point we realised quite recently. Let me set the scene. its 3 am and our little one awoke for a feed and had a good burp before he started expressing all the signs of being tired again and ready to go back into his cot….great! we thought as we were also quite tired…..but he didn’t settle. We checked all the things we should be looking for and they all seemed fine. He just seemed like he didn’t want to sleep again. By 4am we were both two bleary eyed new parents scratching our heads and now fully awake, so I decided to make a cup of tea for us and while the kettle boiled I looked for any evidence to help babies sleep.

I first came across an article in the journal Paediatrics entitled Influence of swaddling on sleep and arousal characteristics of healthy infants. In this observational study the authors selected 16 healthy infants with a median age of 10 weeks and observed how they slept either swaddled one night or unswaddled another night.  They found that swaddling was associated with better and deeper sleep. However the caveat was that the swaddled babies appeared to be more prone to arousals with less stimulating sounds that the unswaddled babies.  Hhmmmmm….that might not be so good for us. Plus the study was an observational one and I needed to appraise it for its external validity. Interestingly, both times the babies were also exposed to “white noise” (the sound your radio makes when it isn’t tuned) which is supposed to mimic the sounds in utero. So while the tea was brewing, I decided to look up any studies that looked solely at the effect of white noise on babies sleep and came across a randomised controlled trial in the Archives of Disease in Childhood from 1990. In this study the authors recruited 40 neonates (between 2 and 7 days old) and randomised them to either have a white noise device placed 12 to 20 inches away from their cot or no device.  The white noise was played for 5 minutes while a researcher noted if the sound put the baby to sleep or not. Sixteen (80%) fell asleep within five minutes in response to white noise compared with only five (25%) who fell asleep spontaneously in the control group (p<0.001).  Wow…my wife thought we were on to a winner….until of course I pointed out that there was no details of the methods of randomisation and the study was unblinded. In return she pointed out that both groups were similar at the start of the trial, were otherwise treated equally, there was no loss to follow up, that measuring the sleep as an outcome was pretty objective, and the “treatment effect” was fairly large (she has picked up a few EBM tools through me over the years).

So we decided to give it a go, and downloaded an application from an online application store to our smart phone that played white noise for babies.

The result? The little fella was asleep in 15 minutes, and after our cup of tea, so were we.

Thank you EBM.

Sweet dreams for a Happy Christmas

Kamal Mahtani

About Kamal Mahtani

Kamal R. Mahtani is a GP and and Clinical Lecturer at the University of Oxford

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