REST Routine

Manuscripts

Released in 1979 through 2011

Manuscripts

Impact studies rated high or moderate quality

Services intended at ages

0-11 months (WILL BE REMOVED)

Favorable results from well-defined research

Child development and school readiness

Skip to: Effectiveness Implementation

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.

Effectiveness

Does not meet criteria established by the U.S. Department of Health and Human Services for an evidence-based home visiting model.

Does not meet criteria for an evidence-based home visiting model for Indigenous peoples and communities.

Extent of Evidence

For more information about manuscripts, search the research database.

For more information on the criteria used to rate research, please see details of HomVEEʼs methods and standards.

Manuscripts

Released in 1979 through 2011

Manuscripts

Eligible for review

Manuscripts

Impact studies rated high or moderate quality

Summary of Findings

To see details on each manuscript HomVEE reviewed in well-designed research, click on the manuscript counts in the table.

Favorable:
A finding showing a statistically significant impact on an outcome measure in a direction that is beneficial for children and parents.

No effect:
Findings are not statistically significant.

Unfavorable:
A finding showing a statistically significant impact on an outcome measure in a direction that may indicate potential harm to children and/or parents.

Outcomes	Manuscripts	Favorable Findings	No Effects Findings	Unfavorable Findings
Child development and school readiness	View 1 Manuscript	2	0	0
Child health	Not measured	-	-	-
Family economic self-sufficiency	Not measured	-	-	-
Linkages and referrals	Not measured	-	-	-
Maternal health	View 1 Manuscript	0	1	0
Positive parenting practices	Not measured	-	-	-
Reductions in child maltreatment	Not measured	-	-	-
Reductions in juvenile delinquency, family violence, and crime	Not measured	-	-	-

Research Characteristics

Well-designed impact studies about this model included participants with the following characteristics:

Race/Ethnicity

Black or African American

6.60%

Hispanic or Latino

10.80%

White

75.90%

Unknown

6.70%

Implementation

In this section:

Overview

Theoretical approach, intended population, and targeted outcomes.

Support Availability

Service Delivery

Model services, adaptions and enhancements, model intensity and length.

Requirements

Staffing and organizational requirements.

Overview

Theoretical approach

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.

Intended population

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

Targeted outcomes

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.

Highlights

Services intended at ages

0-11 months (WILL BE REMOVED)

Support Availability

Implementation support availability

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.

Service Delivery

Model services

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.

Model intensity and length

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

Adaptations and enhancements

No information was available about model adaptations or enhancements.

Requirements

Staffing requirements

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.

Organizational requirements

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

HomVEE requests input and feedback from the model developers on their profiles. The information in this implementation profile reflects feedback, if provided, from this model’s developer as of the above date. HomVEE reserves the right to edit the profile for clarity and consistency. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Model developers are encouraged to notify HomVEE of any changes to their contact information on this page.