REST Routine

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.

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The REST (reassurance, empathy, support, time-out) 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.

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 first home visit, nurses assessed the family’s general medical history and the infant’s irritability, including predisposing factors or triggers to crying, sleeping and feeding patterns, description of the age at onset, and daily patterns of fussiness. In subsequent visits, parents described in detail the events of the past week, the coping strategies they utilized, and their successes. 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.

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

The REST (reassurance, empathy, support, time-out) 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.

The REST Routine was developed by Maureen R. Keefe, RN, PhD, FAAN, at the College of Nursing, University of Utah, Salt Lake City.

No information was available on technical assistance.

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

REST Routine aimed to reduce infant irritability and unexplained crying and to relieve parental stress. The four specific objectives were to (1) promote compatibility in the parent-infant dyad, (2) decrease intensity and duration of infant irritability, (3) promote state regulation and organization in the infant, and (4) provide information and support to the parents.

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 first home visit, nurses assessed the family’s general medical history and the infant’s irritability, including predisposing factors or triggers to crying, sleeping and feeding patterns, description of the age at onset, and daily patterns of fussiness. In subsequent visits, parents described in detail the events of the past week, the coping strategies they utilized, and their successes. 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.

REST Routine consisted of weekly one-hour home visits for four weeks.

No information was available about model adaptations or enhancements.

No information was available about the type or characteristics of organizations that could implement the model or ongoing fidelity guidelines.

Pediatric, master’s level nurse specialists individualized and delivered home visits. No information was available about other staff required to implement REST Routine.

No information was available on supervision requirements.

REST Routine required nurse home visitors to receive training in the intervention model and concepts, as well as on program materials. No information was available on ongoing professional development requirements.

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