REST Routine

Implementation support is not currently available for the model as reviewed.

Last updated: October 2012

Model Overview

Theoretical Model

REST Routine was based on a theoretical model that conceptualizes infant colic using a developmental psychobiological perspective. Colic, also referred to as irritable infant syndrome, is viewed as a delay or disturbance in the infant’s sleep-wake cycling. Colicky or irritable infants have a disorganized or undeveloped sleep-wake cycle that leads to excessive crying and difficulty initiating sleep. This behavior instability may be exacerbated by parental inconsistency and environmental disruptions.

From this framework, irritable infants are viewed as sensitive and more easily over-stimulated by busy chaotic environments. As they become overwhelmed and fatigued, they cannot self-soothe or reduce their arousal level sufficiently to fall asleep. Parents may actually reinforce the irritable behavior pattern by using inconsistent strategies that are not compatible with the infant’s unclear signals and erratic cues. To address these issues, REST Routine provided support for the parents and modification of the infant’s environmental care routines.

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Model Components

REST Routine was a home-based intervention model with activities for infants and parents. For infants, nurses developed specific recommendations and care plans based on four guiding principles:

  • Regulation, the support required to assist infants in regulating their state behavior and to protect them from becoming overstimulated and exhausted during the first few months of life
  • Entrainment, whereby the infant’s basic sleep-wake cycles were synchronized with relevant aspects of the environment
  • Structure, or repetition, to create a predictable and recurrent pattern of events for infants who were not intrinsically well organized
  • Touch, which included various infant holds and positions

Similarly, four concepts guided nurses in working with parents:

  • Reassurance focused on the infant’s health and the parent’s competence
  • Empathy from nurses, who listened and acknowledged the challenge of parenting high-need and high-maintenance infants
  • Support from nurses, who served as an advocate and resource for parents in obtaining assistance and creating a support network
  • Time-out legitimized the primary caregivers’ critical need to take care of themselves. A specific period of time-out from parenting (at least one hour) was scheduled into each day

During the last home visit, nurses assessed the need and options for ongoing support and intervention. Home-visiting nurses also could conduct follow-up phone calls to check in with families.

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Target Population

REST Routine targeted families with healthy, full-term infants who had excessive and unexplained irritability or colic.

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Where to Find Out More

Maureen R. Keefe, RN, PhD, FAAN
College of Nursing, University of Utah
10 South 2000 East, Room 410
Salt Lake City, UT 84112-5880.

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Effects Shown in Research & Outcome Measure Details

Summary of Findings

Please read Describing Effects for more information on these categories. Only results from studies that meet the standards for the high or moderate ratings are included above.

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Maternal Health

Outcomes Rated High

REST Routine
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Parenting Stress Index-Short Form
FavorableUnfavorableNo Effect
4 weeks Full sample 121 mother/child dyads <abbr title"not reported">NR</abbr> <abbr title"not reported">NR</abbr> Repeated Measures = 2.30 HomeVEE calculated = 0.27 Not statistically significant, p > 0.05 Primary
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Outcome Measure Outcome Measure Description Collection method Properties Outcome Type Operations links

Parenting Stress Index-Short Form

The Parenting Stress Index (PSI)-Short Form assesses stress in the parent-child relationship arising from child temperament, parental depression, and negatively reinforcing parent-child interactions. The PSI includes three domains (Parent Distress, Difficult Child, and Parent–Child Dysfunctional) and items are rated on a 5-point scale from strongly disagree to strongly agree . Parent/caregiver report

For a subsample of participants, Cronbach’s α = 0.92 (total scale) Cronbach’s α = 0.83 to 0.88 (across subscales)

Primary
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Child Health

Outcomes Rated High

REST Routine
Show Study Effects Details
Outcome measure Effect Follow-up Timing Sample Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Parent Report on Hours of Crying
FavorableUnfavorableNo Effect
4 weeks Full sample 121 mother/child dyads Unadjusted mean = 1.29 Unadjusted mean = 2.94 Mean difference = -1.65 Study reported = 0.70 Statistically significant, p = 0 Secondary
Parent Report on Intensity of Fussiness
FavorableUnfavorableNo Effect
4 weeks Full sample 121 mother/child dyads Unadjusted mean = 1.97 Unadjusted mean = 2.79 Mean difference = -0.82 Study reported = -0.52 Statistically significant, p = 0.01 Secondary
Show Study Outcome Measure Summary
Outcome Measure Outcome Measure Description Collection method Properties Outcome Type Operations links

Parent report on hours of crying

The Fussiness Rating Scale assesses the following dimensions of unexplained infant irritability: hours of unexplained crying per day, intensity of fussiness, and amount of fussiness per day. Parents were asked to estimate the average number of hours per day over the past week that the infant engaged in unexplained crying. The intensity and amount of fussiness were measured on a 7-point scale from no fussiness to constant fussiness. Parent/caregiver report

Not reported by author

Secondary
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In Brief

Evidence of Model Effectiveness

This model does not meet the criteria established by the Department of Health and Human Services (HHS) for an “evidence-based early childhood home visiting service delivery model” for the general population or for tribal populations.

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Model Description

REST (Reassurance, Empathy, Support, and Time-Out) Routine aimed to reduce infant irritability and unexplained crying and to relieve parental stress. It targeted families with healthy, full-term infants who had excessive and unexplained irritability and colic. Pediatric nurse specialists individualized and delivered home visits weekly, one-hour home visits for four weeks. Nurses helped parents prevent their infants from being over-stimulated, synchronize the infants’ sleep-wake cycles with the environment, create structure and routine, and practice holds and positions. The nurses also provided emotional support and reassurance to the parents and helped them find other resources and a support network. During the last home visit, nurses assessed the need and options for ongoing support and intervention. For more information, please read the Model Overview.

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Extent of Evidence

Results of Research and Review
Number of studies
Eligible for review
3
Rated high
2
Rated moderate
0
Rated low
0
Additional source1
1

For more information, see the study database. For more information on the criteria used to determine the study ratings, please read Producing Study Ratings.

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Summary of Findings

Please read Describing Effects for more information on these categories. Only results from studies that meet the standards for the high or moderate ratings are included above.

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Criteria Established by the Department of Health and Human Services

Information Based on Comprehensive Review of All High- and Moderate-Impact Studies for this Model
High- or moderate-quality impact study?
Yes
Across high- or moderate-quality studies, favorable impacts in at least two outcome domains within one sample OR the same domain for at least two non-overlapping samples?
No
Favorable impacts on full sample?
Yes
Any favorable impacts on outcome measures sustained at least 12 months after model enrollment?1
No
One or more favorable, statistically significant impact reported in a peer-reviewed journal?1
Yes

Please read the HHS Criteria for Evidence-Based Models for more information.

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