Sudden Infant Death Syndrome (SIDS) risk reduction and infant sleep location – Moving the discussion forward

An evaluation of portable sleeping spaces for babies following the Christchurch earthquake of February 2011

AIM

To describe how recipients of portable sleeping spaces (PSSs) for babies received and used these devices, offered as emergency baby beds in earthquake-ravaged Christchurch, New Zealand, 2011.

METHOD

The PSS package responded to increased risk to babies from disrupted living and sleeping conditions in families. 'Door-to-door' distribution offered easy access to those in need. A subgroup of recipients gave feedback via a survey.

RESULTS

From 642 families who received PSSs between March and August, 139 were invited to complete a survey on usage and 100 (72%) responded. Risks identified were 'earthquake related' (82%), bed-sharing (41%), smoking in pregnancy (26%) and prematurity or low birthweight (11%). PSSs were used for same-bed co-sleeping by 87%. They were used even though most families (96%) also had a cot or bassinet. Features most appreciated were 'having baby close' (90%), 'peace of mind' (88%) and portability (74%).

CONCLUSION

PSSs were acceptable to parents and used as instructed. Enabling physical protection of babies when same-bed co-sleeping, they gave peace of mind to parents. PSSs could be considered in ordinary times for protecting babies from sudden infant death.

Nighttime parenting strategies and sleep-related risks to infants

A large social science and public health literature addresses infant sleep safety, with implications for infant mortality in the context of accidental deaths and Sudden Infant Death Syndrome (SIDS). As part of risk reduction campaigns in the USA, parents are encouraged to place infants supine and to alter infant bedding and elements of the sleep environment, and are discouraged from allowing infants to sleep unsupervised, from bed-sharing either at all or under specific circumstances, or from sofa-sharing. These recommendations are based on findings from large-scale epidemiological studies that generate odds ratios or relative risk statistics for various practices; however, detailed behavioural data on nighttime parenting and infant sleep environments are limited. To address this issue, this paper presents and discusses the implications of four case studies based on overnight observations conducted with first-time mothers and their four-month old infants. These case studies were collected at the Mother-Baby Behavioral Sleep Lab at the University of Notre Dame USA between September 2002 and June 2004. Each case study provides a detailed description based on video analysis of sleep-related risks observed while mother-infant dyads spent the night in a sleep lab. The case studies provide examples of mothers engaged in the strategic management of nighttime parenting for whom sleep-related risks to infants arose as a result of these strategies. Although risk reduction guidelines focus on eliminating potentially risky infant sleep practices as if the probability of death from each were equal, the majority of instances in which these occur are unlikely to result in infant mortality. Therefore, we hypothesise that mothers assess potential costs and benefits within margins of risk which are not acknowledged by risk-reduction campaigns. Exploring why mothers might choose to manage sleep and nighttime parenting in ways that appear to increase potential risks to infants may help illuminate how risks occur for individual infants.