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Blair PS, Ball HL, Pease A, Fleming PJ. Bed-sharing and SIDS: an evidence-based approach. Arch Dis Child 2023; 108:e6. [PMID: 35256354 DOI: 10.1136/archdischild-2021-323469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/21/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Peter S Blair
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | | | - Anna Pease
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Peter J Fleming
- Centre for Academic Child Health, University of Bristol, Bristol, UK
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Mothers' Decision Making Concerning Safe Sleep for Preterm Infants: What Are the Influencing Factors? Adv Neonatal Care 2022; 22:444-455. [PMID: 34967776 DOI: 10.1097/anc.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Parental decisions regarding infant sleep practices vary widely, resulting in a lack of adherence to the American Academy of Pediatrics safe sleep recommendations (SSR) and consequently an increased risk of sudden infant death syndrome (SIDS). Preterm infants are among those at a highest risk for SIDS, yet few studies focus on parental decision-making surrounding sleep practices for preterm infants. PURPOSE The purpose of this study was to identify factors influencing decisions concerning infant sleep practices of mothers of preterm infants. METHODS This study used a mixed-methods design. Recruitment was through social media messaging by 2 parent support organizations. An online survey was used to assess factors influencing mothers' decisions regarding sleep practices for preterm infants. FINDINGS/RESULTS Survey participants (n = 98) were from across the United States. Mothers of preterm infants (mean gestational age at birth = 29.42 weeks) most often reported positioning infants on their back to sleep (92.3%) and a low (15.4%) use of a pacifier at sleep time. Three themes emerged for the decisions made: adherence to SSR; nonadherence to SSR; and infant-guided decisions. Regardless of the decision, mothers indicated that anxiety over the infant's well-being resulted in a need for sleep practices that facilitated close monitoring of the infant. IMPLICATIONS FOR PRACTICE AND RESEARCH The findings of this study indicate the need for understanding the underlying anxiety preventing mothers from adhering to SSR despite knowing them, along with tailoring infant sleep messaging and education to improve safety of sleep practices for preterm infants. Research is needed to examine decision making in more diverse populations.
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Bryan MA, Florence A, Gower AD, Evans YN, Moreno MA. Safe Sleep Behaviors and Factors Associated With Infant Second Sleep Practices. Pediatrics 2022; 149:e2021053935. [PMID: 35634879 DOI: 10.1542/peds.2021-053935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine the prevalence and safety of infant second-sleep practices. METHODS A cross-sectional online survey of parents with infants ≤12 months assessed parent-reported sleep practices: position, use of a separate sleep surface, and sleep location at 2 time points (sleep onset and after nighttime waking). A composite score examined if all 3 safe sleep practices were used at each time point. Safe sleep was defined as: supine position, sleeping in a separate space, and in a crib, bassinet, cradle, or playard. Wilcoxon sign rank test was used to examine changes between the time points. Poisson regression models compared parents who reported a second-sleep location with those who did not. RESULTS Of participants (n = 1500), 74% were female, 65% were White, 12% were Black, and 17% were of Hispanic ethnicity. Thirty-nine percent (n = 581) reported a second-sleep practice. Of parents who reported a second-sleep practice, 28% (n = 137) met all 3 safe sleep criteria at sleep onset; 9% (n = 42) met all 3 safe sleep criteria at both time points. A higher proportion of changes in sleep practices were to less-safe practices (P <.001). Factors associated with a second-sleep practice were parental age <25 years, parental race and ethnicity, first-time parents, homes with smoke exposure, and infants born at <37 weeks. CONCLUSIONS Less than 10% of infants met all 3 safe sleep criteria at sleep onset and after nighttime waking. Interventions focused on safe sleep should highlight the importance of safe sleep practices after nighttime waking.
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Affiliation(s)
- Mersine A Bryan
- University of Washington, Seattle, Washington
- Seattle Children's Research Institute, Seattle, Washington
| | | | | | - Yolanda N Evans
- University of Washington, Seattle, Washington
- Seattle Children's Research Institute, Seattle, Washington
| | - Megan A Moreno
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin
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Ellis C, Pease A, Garstang J, Watson D, Blair PS, Fleming PJ. Interventions to Improve Safer Sleep Practices in Families With Children Considered to Be at Increased Risk for Sudden Unexpected Death in Infancy: A Systematic Review. Front Pediatr 2022; 9:778186. [PMID: 35047461 PMCID: PMC8762353 DOI: 10.3389/fped.2021.778186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Advice to families to follow infant care practices known to reduce the risks of Sudden Unexpected Death in Infancy (SUDI) has led to a reduction in deaths across the world. This reduction has slowed in the last decade with most deaths now occurring in families experiencing social and economic deprivation. A systematic review of the literature was commissioned by the National Child Safeguarding Practice Review Panel in England. The review covered three areas: interventions to improve engagement with support services, parental decision-making for the infant sleep environment, and interventions to improve safer sleep practices in families with infants considered to be at risk of SUDI. Aim: To describe the safer sleep interventions tested with families with infants at risk of SUDI and investigate what this literature can tell us about what works to reduce risk and embed safer sleep practices in this group. Methods: Eight online databases were systematically searched in December 2019. Intervention studies that targeted families with infants (0-1 year) at increased risk of SUDI were included. Studies were limited to those from Western Europe, North America or Australasia, published in the last 15 years. The Quality Assessment Tool for Studies with Diverse Designs was applied to assess quality. Data from included studies were extracted for narrative synthesis, including mode of delivery using Michie et al.'s Mode of Delivery Taxonomy. Results: The wider review returned 3,367 papers, with 23 intervention papers. Five types of intervention were identified: (1) infant sleep space and safer sleep education programs, (2) intensive or targeted home visiting services, (3) peer educators/ambassadors, (4) health education/raising awareness interventions, (5) targeted health education messages using digital media. Conclusion: Influencing behavior in families with infants at risk of SUDI has traditionally focused on "getting messages across," with interventions predominantly using education and awareness raising mechanisms. This review found evidence of interventions moving from "information giving" to "information exchange" models using personalized, longer term relationship-building models. This shift may represent an improvement in how safer sleep advice is implemented in families with infants at risk, but more robust evidence of effectiveness is required. Systematic Review Registration: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/901091/DfE_Death_in_infancy_review.pdf, identifier: CRD42020165302.
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Affiliation(s)
- Catherine Ellis
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Anna Pease
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom
| | - Debbie Watson
- Children and Families Research Centre, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Peter S. Blair
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Peter J. Fleming
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Al-shehri H, Almozaai R, Kariri M, Alhazmi Y, AlDakhel S, Alhunaishel R, Aladhadhi D. Factors Associated with Safe Infant Sleep Practices in Saudi Arabia. Pediatric Health Med Ther 2021; 12:533-541. [PMID: 34955665 PMCID: PMC8694400 DOI: 10.2147/phmt.s343535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose To assess mothers’ approaches to infant sleep practices. Patients and Methods A cross-sectional survey study was conducted on mothers with babies aged below five months who were attending paediatric clinics between November 1st, 2020, and January 5th, 2021, in Riyadh, Saudi Arabia. Results A total of 522 mothers participated in this study. A total of 38.9% practised exclusive formula feeding. A total of 61.9% of the participants practised the supine position. The majority (93.3%) of the mothers shared a room with their babies, while 34.7% shared a bed. Only 6.9% did not use any soft bedding. Age was a significant predictor associated with participant practices regarding sleeping and feeding positions (p < 0.05). Having two or more children was associated with improper sleeping practices (p < 0.05). Being non-Saudi and having a university degree or higher were associated with having a higher risk of unsafe practices regarding bed-sharing (p < 0.05). On the other hand, being contacted by a doctor, nurse, or other healthcare worker about safe sleep practices were an important factor that influenced safe practices regarding feeding (p < 0.05). Receiving care at a private hospital was associated with safer practices regarding sleeping position and bed-sharing (p < 0.05). Conclusion We observed high-risk sleeping practices among Saudi mothers. This includes using soft bedding and unsafe sleeping positions. The importance of this study lies in the future implementation of this result through public health measures aimed at at-risk populations.
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Affiliation(s)
- Hassan Al-shehri
- Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
- Correspondence: Hassan Al-shehri Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi ArabiaTel +966112582759 Email
| | - Rahaf Almozaai
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Marwh Kariri
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Yara Alhazmi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Shatha AlDakhel
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Reyouf Alhunaishel
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Dina Aladhadhi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Hwang SS, Tong S, Smith RA, Barfield WD, Pyle L, Battaglia C, McManus B, Niermeyer S, Sauaia A. Persistent Racial/Ethnic Disparities in Supine Sleep Positioning among US Preterm Infants, 2000-2015. J Pediatr 2021; 233:51-57.e3. [PMID: 33676934 DOI: 10.1016/j.jpeds.2021.02.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess trends in racial disparity in supine sleep positioning (SSP) across racial/ethnic groups of infants born early preterm (Early preterm; <34 weeks) and late preterm (Late preterm; 34-36 weeks) from 2000 to 2015. STUDY DESIGN We analyzed Pregnancy Risk Assessment Monitoring System data (a population-based perinatal surveillance system) from 16 US states from 2000 to 2015 (Weighted N = 1 020 986). Marginal prevalence of SSP by year was estimated for infants who were early preterm and late preterm, adjusting for maternal and infant characteristics. After stratifying infants who were early preterm and late preterm, we compared the aOR of SSP trends across racial/ethnic groups by testing the time-race interaction. RESULTS From 2000 to 2015, Non-Hispanic Black infants had lower odds of SSP compared with Non-Hispanic White infants for early preterm (aOR 0.61; 95% CI 0.47-0.78) and late preterm (aOR 0.44; 95% CI 0.34-0.56) groups. For Hispanic infants, there was no statistically significant difference for either preterm group when compared with Non-Hispanic White infants. aOR of SSP increased (on average) annually by 10.0%, 7.3%, and 7.7%, respectively, in Non-Hispanic White, Non-Hispanic Black, and Hispanic early preterm infants and by 5.8%, 5.9%, and 4.8% among Non-Hispanic White, Non-Hispanic Black, and Hispanic late preterm infants. However, there were no significant between-group differences in annual changes (Early preterm: P = .11; Late preterm: P = .25). CONCLUSIONS SSP increased for all racial/ethnic preterm groups from 2000 to 2015. However, the racial/ethnic disparity in SSP among early preterm and late preterm groups persists.
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Affiliation(s)
- Sunah S Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, CO.
| | - Suhong Tong
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Department of Biostatistics, Colorado School of Public Health, Aurora, CO
| | - Ruben A Smith
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Wanda D Barfield
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Laura Pyle
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Department of Biostatistics, Colorado School of Public Health, Aurora, CO
| | - Catherine Battaglia
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, CO; Department of Veterans Affairs Eastern Colorado Health Care System, Aurora, CO
| | - Beth McManus
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, CO
| | - Susan Niermeyer
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Angela Sauaia
- Department of Biostatistics, Colorado School of Public Health, Aurora, CO
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Feasibility and Acceptability of a Tailored Infant Safe Sleep Coaching Intervention for African American Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084133. [PMID: 33919783 PMCID: PMC8070675 DOI: 10.3390/ijerph18084133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022]
Abstract
Background: Approximately 3600 infants die suddenly and unexpectedly annually in the United States. Research suggests limitations of current behavioral interventions to reduce the risk for sleep-related deaths among African American families living in under-resourced neighborhoods. Guided by the theory of planned behavior and the socio-ecological model, the My Baby’s Sleep (MBS) intervention intends to reduce the risk for sleep-related infant deaths while addressing complex needs of African American families living in under-resourced neighborhoods. Objective: To assess feasibility and acceptability of MBS, a 7-month intervention that includes four home visits and multiple check-ins via phone and text message. Methods: This was a single-arm feasibility and acceptability study with quantitative and qualitive measures. African American families were recruited from community agencies that served an under-resourced metropolitan area. Results: Eight families (eight mothers, nine co-caregivers) completed the intervention. Families reported high acceptability of MBS content, process, and format, as evidenced by qualitative data and mean evaluation scores. Conclusion: MBS is feasible and acceptable among African American families living in under-resourced neighborhoods. These results suggest further investigation of MBS intervention efficacy in a large-scale randomized controlled trial.
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Supporting African American Mothers during Nurse Home Visits in Adopting Safe Sleep Practices. MCN Am J Matern Child Nurs 2020; 45:214-220. [PMID: 32271201 DOI: 10.1097/nmc.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nurses providing home visits were concerned that some mothers were not routinely using safe sleep practices for their newborns and infants. PURPOSE The purpose of this study was to listen to how home visit nurses offer education to their African American clients about the safe to sleep guidelines during the prenatal and postpartum periods and discuss ways nurses could support mothers to be more successful in using safe sleep practices. STUDY DESIGN AND METHODS A focus group was conducted with home visit nurses who partner with pregnant mothers and follow them through the first 2 years of their child's life. We asked the nurses to discuss how they offer information and education to their African American clients about safe sleep practices and what could be done to support adoption of the guidelines. A qualitative narrative approach was used for data analysis. RESULTS Seventeen home visit nurses participated in the focus group. We identified two overall themes with eight subthemes. The first theme focused on nurses' perceptions about challenges some mothers have in following the recommendations. The second theme included nurses' perspectives on how to better promote the safe sleep message and educating mothers within their cultural context. CLINICAL IMPLICATIONS Expectant and new mothers need advice and knowledge about the Safe to Sleep guidelines that provide ways to decrease risk of infant death. Nurses must be aware of their clients' culture and beliefs so they can offer support and information on infant safety within that context.
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Middlemiss W, Brownstein NC, Nelson SP, Manchiraju S, Leddy M, Steliotes N, Grzywacz JG. Crafting effective messages to enhance safe infant sleep. J Am Assoc Nurse Pract 2020; 33:441-450. [PMID: 32039958 DOI: 10.1097/jxx.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/01/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health care professionals are continually challenged by the need to provide health information in a way that successfully changes health practices. Research has documented this as a concern in relation to safe infant sleep health campaigns. Often, caregivers' knowledge of recommended practices is not associated with a change in infant sleep choices. PURPOSE Health campaigns, including most safe infant sleep efforts, often share specific risk factors and steps for avoiding risk, that is, in a verbatim format. Research has shown that caregivers' behavior may be more likely to change when presented with messages based on their general understanding of risk, that is, gist-based format. This research examines caregivers' responses as related to verbatim- and gist-based safe sleep information. METHODS Five hundred forty-one caregivers of infants were shown 12 images depicting infants in safe or unsafe sleep spaces. Images varied across three commercially available spaces, infant race, and presence/absence of one policy-based risk factor. RESULTS Differences in caregivers' discernment of safe and unsafe sleep images paralleled reported differences in knowledge of safe sleep recommendations. Discernment of safe/unsafe images was greater for White than Black caregivers, as well as for females in comparison with male caregivers. Gist-based considerations, such as familiarity with the sleeper depicted or infant race, were also associated with caregivers' discernment of safe/unsafe images. IMPLICATIONS FOR PRACTICE Attending to both gist- and verbatim-based knowledge regarding safe infant sleep campaign information may help to effectively facilitate caregivers' ability to always create safe sleep spaces for their infants.
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Affiliation(s)
- Wendy Middlemiss
- Department of Educational Psychology, University of North Texas, Denton, Texas
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida
| | - Scott P Nelson
- College of Medicine, Florida State University, Tallahassee, Florida
| | - Srikant Manchiraju
- The Jim Moran School of Entrepreneurship, Florida State University, Tallahassee, Florida
| | - Miranda Leddy
- Department of Educational Psychology, University of North Texas, Denton, Texas
| | - Nicole Steliotes
- Department of Nutrition, Food, and Exercise Science, Florida State University, Tallahassee, Florida
| | - Joseph G Grzywacz
- Department of Family and Child Sciences, Florida State University, Tallahassee, Florida
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Stiffler D, Matemachani SM, Crane L. Considerations in Safe to Sleep® messaging: Learning from African-American mothers. J SPEC PEDIATR NURS 2020; 25:e12277. [PMID: 31742922 PMCID: PMC6980322 DOI: 10.1111/jspn.12277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/19/2019] [Accepted: 10/11/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to identify why African-American mothers do not tend to follow the Safe to Sleep® recommendations and to begin to identify a way to frame the Safe to Sleep® message so that African-American mothers might be more likely to follow these recommendations. DESIGN We recruited African-American mothers with infants over the age of 6 months to participate in two focus groups facilitated by a community engagement manager experienced in focus group facilitation. We used ethnography to find shared patterns of behavior and beliefs in African-American women related to safe sleep. RESULTS We identified 14 concepts and formulated them into three categories: it's just easier; can't fight culture and grandma; and Effectively teaching mother. From these we were able to identify the shared value of multifaceted learning. PRACTICE IMPLICATIONS African-American mothers say that they are generally aware of the Safe to Sleep® recommendations, even though the majority of mothers do not follow them. The reasons they give for not following them are that they are not comfortable doing so, they feel they are unable to do so, or find it unnecessary. Many of the mothers attempted to follow the Safe to Sleep® recommendations but abandoned the effort due to the stress of their crying infant. Trying to follow the Safe to Sleep® recommendations were stressful for the mothers, even though there was concern expressed by some that their infant could indeed suffocate or die from sudden infant death syndrome. The mothers gave suggestions on how they would change the message or the delivery of the message.
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Affiliation(s)
| | | | - Lisa Crane
- Goodwill of Central and Southern Indiana, Nurse-Family Partnership, Indianapolis, Indiana
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Blair PS, Ball HL, McKenna JJ, Feldman-Winter L, Marinelli KA, Bartick MC, Noble L, Calhoun S, Elliott-Rudder M, Kair LR, Lappin S, Larson I, Lawrence RA, Lefort Y, Marshall N, Mitchell K, Murak C, Myers E, Reece-Stremtan S, Rosen-Carole C, Rothenberg S, Schmidt T, Seo T, Sriraman N, Stehel EK, Wight N, Wonodi A. Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, Revision 2019. Breastfeed Med 2020; 15:5-16. [PMID: 31898916 DOI: 10.1089/bfm.2019.29144.psb] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Peter S Blair
- Centre for Academic Child Health, University of Bristol, Bristol, United Kingdom
| | - Helen L Ball
- Infancy and Sleep Centre, Department of Anthropology, Durham University, Durham, United Kingdom
| | - James J McKenna
- Department of Anthropology, Santa Clara University, Santa Clara, California.,Mother-Baby Sleep Lab, Department of Anthropology, University of Notre Dame, South Bend, Indiana
| | - Lori Feldman-Winter
- Department of Pediatrics, Division of Adolescent Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Kathleen A Marinelli
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut.,Connecticut Children's Medical Center, Division of Neonatology, Hartford, Connecticut
| | - Melissa C Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge Massachusetts
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Salm Ward TC, McClellan MM, Miller TJ, Brown S. Evaluation of a Crib Distribution and Safe Sleep Educational Program to Reduce Risk of Sleep-Related Infant Death. J Community Health 2019; 43:848-855. [PMID: 29497933 DOI: 10.1007/s10900-018-0493-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
To increase access to safe infant sleep surfaces and reduce risk of sleep-related infant deaths, the Georgia Department of Public Health implemented a portable crib distribution and safe sleep educational program. The aim of this evaluation was to compare parental knowledge and practices related to infant sleep before and after receipt of the safe sleep educational program and crib. A prospective, matched pre- and post-test cohort design with a follow-up survey was utilized to evaluate changes in knowledge and practices. Female participants were recruited through the county health department and met the following criteria: (1) between 32 and 40 weeks pregnant or within 3 months postpartum, and (2) demonstrated financial need. Participants completed a survey prior to the start of a group educational program and upon program completion. For those who agreed, a follow-up phone survey was conducted approximately 10 weeks after program completion or after the infant's birth. McNemar's Chi square tests were conducted to detect significant differences between specific items on pre-test, post-test, and follow-up surveys, and paired sample t tests were conducted to compare differences in knowledge and practice scores. A total of 132 participants completed matched pre- and post-test surveys and 76 completed follow-up surveys. Knowledge of recommendations regarding position, surface, environment, smoking, breastfeeding, and pacifier use increased significantly between pre- and post-test, with most participants maintaining knowledge at follow-up. The proportion of recommended practices also increased significantly. A group-based safe sleep educational program can be effective in reducing risky infant sleep practices.
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Affiliation(s)
- Trina C Salm Ward
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, 2400 E Hartford Ave, Milwaukee, WI, 53211, USA.
| | - Marcie M McClellan
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, USA
| | | | - Shannon Brown
- Georgia Department of Public Health, Atlanta, GA, USA
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Marinelli KA, Ball HL, McKenna JJ, Blair PS. An Integrated Analysis of Maternal-Infant Sleep, Breastfeeding, and Sudden Infant Death Syndrome Research Supporting a Balanced Discourse. J Hum Lact 2019; 35:510-520. [PMID: 31184521 DOI: 10.1177/0890334419851797] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breastfeeding and the place of sleep for the mother and the infant have been controversial internationally due to reported concerns regarding infant deaths despite the known benefits of exclusive and prolonged breastfeeding, which are increased by breastfeeding at night. The aims of this integrated analysis were to (a) review breastfeeding and maternal and infant sleep research literature via historical, epidemiological, anthropological, and methodological lenses; (b) use this information to determine where we are currently in safeguarding both infant lives and breastfeeding; and (c) postulate the direction that research might take from this point forward to improve our knowledge and inform our policy and practice. Despite well-meaning but unsuccessful campaigns in some countries to dissuade parents from sleeping with their babies, many breastfeeding mothers and caregivers do sleep with their infants whether intentionally or unintentionally. Taking cultural contexts and socio-ecological circumstances into consideration, data supports policies to counsel parents and caregivers on safe sleep practices, including bed-sharing in non-hazardous circumstances, particularly in the absence of parental smoking, recent parental alcohol consumption, or sleeping next to an adult on a sofa. Further research with appropriate methodology is needed to drill down on actual rates of infant deaths, paying close attention to the definitions of deaths, the circumstances of the deaths, and confounding factors, in order to ensure we have the best information with which to derive public health policy. Introduction and use of the concept of "breastsleeping" is a plausible way to remove the negative connotations of "co-sleeping" and redirect ongoing data-driven discussions and education of best practices of breastfeeding and sleep.
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Affiliation(s)
| | - Helen L Ball
- 2 Infancy & Sleep Centre, Department of Anthropology, Durham University, Durham, UK
| | - James J McKenna
- 3 Mother-Baby Behavioral Sleep Laboratory, Department of Anthropology, University of Notre Dame, Notre Dame, Indiana, USA
| | - Peter S Blair
- 4 Centre of Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
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Raines DA. Factors That Influence Parents' Adherence to Safe Sleep Guidelines. J Obstet Gynecol Neonatal Nurs 2018; 47:316-323. [DOI: 10.1016/j.jogn.2018.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 11/25/2022] Open
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Austin JE, Nashban CJ, Doering JJ, Davies WH. Prevention Messages in Parent-Infant Bed-Sharing: Message Source, Credibility, and Effectiveness. Glob Pediatr Health 2017; 4:2333794X17743403. [PMID: 29201949 PMCID: PMC5700781 DOI: 10.1177/2333794x17743403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/20/2017] [Indexed: 11/15/2022] Open
Abstract
Objective. Despite educational outreach, bed-sharing prevalence is rising. Mothers’ and fathers’ bed-sharing practices, prevention message source, perceived source credibility, and the effectiveness of the prevention message were evaluated. Methods. Data were collected from 678 community parents via an online survey. Results were analyzed using descriptive statistics and phi tests. Results. Bed-sharing reasons focused on comfort and ease. Mothers were more likely to receive prevention messages from individual professionals or organizations, whereas fathers were more likely to hear prevention messages from spouses/coparents and grandfathers. Physicians were the most common source, and physicians and grandmothers were rated as the most credible and effective. Conclusions. Prevention message source varies between mothers and fathers, highlighting the need for continued research with fathers. Grandmothers and physicians are effective and credible sources of prevention messages. Although less frequent, prevention messages from grandmothers were most effective. There was no evidence of effective messages from educational campaigns.
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Affiliation(s)
- Jillian E Austin
- University of Wisconsin-Milwaukee, WI, USA.,Nemours Children's Specialty Care, Jacksonville, FL, USA
| | - Chad J Nashban
- Wisconsin School of Professional Psychology, Milwaukee, WI, USA
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Parker MGK, Colson ER, Provini L, Rybin DV, Kerr SM, Heeren T, Corwin MJ. Variation in Safe Sleep and Breastfeeding Practices Among Non-Hispanic Black Mothers in the United States According to Birth Country. Acad Pediatr 2017; 17:887-892. [PMID: 28729127 DOI: 10.1016/j.acap.2017.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine variation in safe sleep and breastfeeding practices among US non-Hispanic black (NHB) mothers according to birth country. METHODS We analyzed NHB mothers who were surveyed regarding safe sleep and breastfeeding practices when their infants were 2 to 6 months of age in 2011 to 2014, as part of a larger national study. We examined prevalences of safe sleep and breastfeeding practices according to birth country and examined odds of adherence to American Academy of Pediatrics recommended safe sleep and breastfeeding practices in foreign-born NHB mothers, compared with US-born NHB mothers. Our multivariate models included adjustment for maternal age, education, income, and US geographic region, and infant age at the time of the survey. RESULTS Among 828 NHB mothers, 690 (83%) were US-born, 42 (5%) were African-born, 47 (6%) were Haitian-born, 24 (3%) were Jamaican-born, and 25 (3%) were born elsewhere. In the analysis of 803 US, African-, Haitian-, and Jamaican-born mothers, we found that Jamaican-born mothers had a lower rate of supine sleep compared with US-born mothers (40% vs 66%; adjusted odds ratio, 0.34; 95% confidence interval, 0.18-0.63). African-born mothers had lower rates of bedsharing compared with US-born mothers (11% vs 25% adjusted odds ratio, 0.22; 95% confidence interval, 0.11-0.46). Foreign-born mothers had higher rates of any and exclusive breastfeeding, compared with US-born mothers (85% and 40% vs 23% and 13%, respectively). CONCLUSIONS Safe sleep and breastfeeding practices vary among US NHB mothers according to birth country. These data illustrate the importance of recognizing heterogeneity of safe sleep and breastfeeding practices within racial/ethnic groups.
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Affiliation(s)
- Margaret G K Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Mass.
| | - Eve R Colson
- Department of Pediatrics, Yale School of Medicine, New Haven, Conn
| | - Lauren Provini
- Department of Pediatrics, Yale School of Medicine, New Haven, Conn
| | - Denis V Rybin
- Department of Biostatistics, Boston University School of Public Health, Mass
| | | | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Mass
| | - Michael J Corwin
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Mass; Slone Epidemiology Center, Boston University, Mass
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17
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Bartick M, Tomori C, Ball HL. Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution. MATERNAL AND CHILD NUTRITION 2017; 14:e12544. [PMID: 29047226 DOI: 10.1111/mcn.12544] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/29/2017] [Accepted: 09/18/2017] [Indexed: 11/28/2022]
Abstract
Concerns about bedsharing as a risk for sudden infant death syndrome and other forms of sleep-associated infant death have gained prominence as a public health issue. Cardboard "baby boxes" are increasingly promoted to prevent infant death through separate sleep, despite no proof of efficacy. However, baby boxes disrupt "breastsleeping" (breastfeeding with co-sleeping) and may undermine breastfeeding. Recommendations enforcing separate sleep are based on 20th century Euro-American social norms for solitary infant sleep and scheduled feedings via bottles of cow's milk-based formula, in contrast to breastsleeping, an evolutionary adaptation facilitating the survival of mammalian infants for millennia. Interventions that aim to prevent bedsharing, such as the cardboard baby box, fail to consider the implications of evolutionary biology or of ethnocentrism in sleep guidance. Moreover, the focus on bedsharing neglects more potent risks such as smoking, drugs, alcohol, formula feeding, and poverty. Distribution of baby boxes may divert resources and attention away from addressing these other risk factors and lead to a false sense of security wherein we overlook that sudden unexplained infant deaths also occur in solitary sleep environments. Recognizing breastsleeping as the evolutionary and cross-cultural norm entails re-evaluating our research and policy priorities, such as providing greater structural support for families, supporting breastfeeding and safe co-sleeping, investigating ways to safely minimize separation for formula-fed infants, and mitigating the potential harms of mother-infant separation when breastsleeping is disrupted. Resources would be better spent addressing such questions rather than on a feel-good solution such as the baby box.
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Affiliation(s)
- Melissa Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts, USA
| | - Cecília Tomori
- Department of Anthropology, Durham University, Durham, UK
| | - Helen L Ball
- Department of Anthropology, Parent-Infant Sleep Lab, Durham University, Durham, UK
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18
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Abstract
Although the incidence of sudden unexpected infant death declined by nearly 50% in the 1990s, there has been little improvement in the past 15 years. Significant disparities in infant sleep practices and sleep-associated death exist, particularly by maternal race/ethnicity. This article provides a brief overview of recent observational and intervention studies related to infant sleep practices to describe the context and motivation for the population-based Study of Attitudes and Factors Effecting Infant Care (SAFE). [Pediatr Ann. 2017;46(8):e291-e296.].
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