To decrease sleep related infant mortality, we need an individualized approach
By Mary Beth Howard
The death of a child is one of the most devastating problems facing clinicians, communities, and families. Sudden unexplained infant death (SUID) remains the leading cause of infant mortality in the United States, accounting for more than 3400 infant deaths annually. The majority of SUID deaths are due to unsafe sleep practices. There are striking geographic variations in SUID, with rates that often parallel other risk factors for SUID such as smoking, pre-term birth, and differential access to prenatal care. An initial decrease in SUID rates following the “Back to Sleep” public awareness campaign in 1996 suggests that targeted educational interventions in this area were initially effective. Continuation of similar, broadly disseminated interventions have not led to further decline, suggesting that novel and targeted interventions are necessary to make further progress in this area. The regional variation in SUID rates suggest that a better understanding of safe sleep practices in areas with high rates of infant mortality is key to improving adherence to safe sleep guidelines.
This qualitative study sought to explore experiences of caregivers in a high-risk infant mortality area through focus groups. Participants were asking about their experiences with infant sleep, including awareness of safe sleep recommendations and why they chose or chose not to implement them with their infants.
Themes that emerged included sources of infant sleep knowledge, challenges for infant sleep, and motivators for infant sleep choice. While all caregivers reported knowledge of safe sleep recommendations, actual safe sleep practices varied. Motivators for infant sleep choices included better sleep, convenience, tradition, safety, and emotional needs. Parents noted that infants (and as a result, parents themselves) often slept better and were more comforted when they co-slept with a caregiver. It was easier for parents to tend to the infant’s needs when he or she was in the same room as them. Some parents reported they based their decisions around infant sleep around how they had slept as a child, or how others in their family or social circle slept with their infant. Safety concerns – including close monitoring of their infant during sleep and protecting him/her from harm – were also raised.
Clinicians, providers, community outreach workers, families, and friends can provide endless, iterative education regarding infant safe sleep recommendations, but adherence to these recommendations is variable, and motivators for infant sleep practices are complex and diverse.
In order to decrease infant mortality due to SUID, caregivers must be engaged through discussions of issues that are a priority to them and their family. Addressing the family’s needs- from housing to childcare to community safety - may be most effective in encouraging safe sleep practices.
Caring for an infant is hard. And sleep is often one of the most challenging aspects of infant care. All practitioners, from health care providers to community supports should be aware of the need for assessment of the safety of the infant sleep environment and enforcement of safe sleep practices during encounters with parents of infants. Our findings suggest that this comprehensive, individualized approach to safe sleep education will support parental adherence to safe sleep recommendations, and in turn, decrease sleep related infant mortality.
Read my article Infant Safe Sleep in the District of Columbia: Better for Both to learn more about barriers and facilitators for families to follow safe sleep recommendations, and how we can support families of infants follow these recommendations.
Article Details
Infant Safe Sleep in the District of Columbia: Better for Both
Mary Beth Howard, MD, MSc, Benjamin T. Parrish, BS, Judith Singletary, PhD, and Lenore Jarvis, MD, MEd
First published online November 11, 2022
DOI: 10.1177/15248399221131834
Health Promotion Practice
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