Be firm about "firm": Parents don't always get message on infant bedding

Pediatricians need to make sure that parents understand that soft bedding is not safe for infants and help them to understand what is meant by a “firm” sleep surface, according to researchers who looked at factors influencing sleep-surface decisions made by black parents.

The American Academy of Pediatrics recommends that, to reduce the risk of sudden infant death syndrome (SIDS), infants should sleep on their backs, on a firm sleep surface (such as a crib), and separate from their parents and that the crib should be free of any blankets, toys, or other items.

Through focus groups, researchers from Children’s National Medical Center in Washington conducted a study and found that black mothers often misunderstood the meaning of a “firm” sleep surface and also expressed concerns about their infant’s comfort.

Focus group participants reported putting pillows and soft items underneath sheets, thinking that a taut sheet made the surface firm and safe. Blankets, bumpers, and pillows were used as a way to provide comfort and safety to infants, the mothers said. In addition, bedding was used to prevent infant rollover and falls, especially for infants sleeping on a bed or sofa. In some cases, the participants reported, the soft bedding was simply used to create an attractive space for the infant.

Socioeconomic status did not have a bearing on the findings.

“As healthcare providers, we have to be proactive in talking about an infant’s sleep environments so that parents have a clear understanding about the safest environment for their babies,” said lead researcher, Rachel Moon, MD, a pediatrician and SIDS researcher at Children’s National.

Moon recommended that further studies be done to examine beliefs and practices among other population segments.

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