Takeaways
- Infant mortality is a significant issue in the United States, with sleep-related infant deaths (SRIDs) ranking as the third leading cause of infant mortality.
- Despite awareness of safe-sleep recommendations from the American Academy of Pediatrics (AAP), many parents do not fully adhere to these guidelines, with co-sleeping being a common unsafe practice.
- Psychosocial factors, such as parental mental health, exhaustion, and financial constraints, play a crucial role in influencing parents' decisions about infant sleep practices.
- Establishing nonjudgmental, trusting relationships between parents and pediatricians can positively impact parental decisions and promote safer sleep practices.
- Successful practices with a first child often continue with subsequent children, even when parents are advised that these practices are unsafe, indicating the importance of targeted education and support.
Infant mortality in the United States is an increasing concern, ranking 33rd among developed nations, wrote the authors of a study recently highlighted at the 2023 American Academy of Pediatrics National Conference & Exhibition.
Sleep-related infant deaths (SRIDs) are the third leading cause of infant mortality, and despite national efforts like the "Back to Sleep Campaign," their numbers are on the rise. A recent study sought to understand how parents make decisions about their infants' sleep environment and whether these decisions change between children over time.
The study, conducted in an urban children's emergency department, used purposeful sampling to recruit parents who met specific criteria. Participants had to be parents or primary caregivers of at least two children, with the youngest aged between 2 to 6 months at the time of the interview. They needed to be 18 years or older, responsible for placing each child to sleep during infancy, and proficient in either English or Spanish. Parents with infants born before 37 weeks’ gestation or facing chronic illnesses were excluded, as were those without access to technology for a Zoom interview. Semi-structured qualitative interviews were conducted, with analysis using NVivo coding. Ethical approval was obtained from the Institutional Review Board (IRB).
A total of 14 parents were interviewed. Their ages ranged from 22 to 41 years, with a median age of 30.5 years. Half of them relied on public insurance, and 57.1% received WIC assistance.
All 14 families were aware of the American Academy of Pediatrics (AAP) safe-sleep recommendations. However, 57.1% did not fully follow these guidelines. The most common unsafe sleep practice was co-sleeping, observed in 42.9% of families, followed by the presence of stuffed animals or blankets (28.6%) and non-supine sleep positions (21.4%).
The study identified several barriers to guideline adherence, including parental mental health, exhaustion, and financial constraints. These factors significantly influenced parents' choices, according to the study data.
The presence of common facilitators, such as a strong support system and a trusting, nonjudgmental relationship with their pediatrician, played a role in promoting safe sleep practices. Also, parents often continued with practices that had worked for them with their first child, even if advised that these practices were unsafe.
The authors concluded that this qualitative assessment suggests that a lack of knowledge or education is not the primary cause of unsafe sleep environments. Instead, psychosocial factors are significant contributors to parents' decisions. The importance of nonjudgmental, trusting relationships between parents and pediatricians is evident, as these relationships can influence parental decisions regarding infant sleep practices, wrote the authors.
Reference:
Ormanoski MA, Duffy S. P2A004: How to Keep Infants Safe While Sleeping - A Qualitative Analysis of Differences Between Siblings. Poster. Presented at: 2023 American Academy of Pediatrics National Conference & Exhibition.
