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Understanding the barriers and facilitators to safe infant sleep for mothers of preterm infants. J Perinatol 2021; 41:1992-1999. [PMID: 33288866 PMCID: PMC8855739 DOI: 10.1038/s41372-020-00896-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/30/2020] [Accepted: 11/20/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To identify barriers and facilitators to adherence to safe sleep practices (SSP) among mothers of preterm infants using qualitative methodology. DESIGN We conducted 23 in-depth interviews in English or Spanish with mothers of preterm infants who were recently discharged from four hospitals, utilizing a grounded-theory approach and framework of the Theory of Planned Behavior (attitudes, perceived control, social norms). RESULTS For attitudes, mothers' fear about their infants' vulnerable preterm state related to suffocation, apnea of prematurity, and reflux influenced infant sleep practices. For social norms, education received in the NICU and advice from other health care providers, family, friends, and media impacted their choices. For perceived control, mothers adapted infant sleep practices to meet their own needs and address the perceived safety and comfort of infants. CONCLUSION Factors identified that influence maternal decision-making about infant sleep practices can inform interventions to address sudden unexpected infant death reduction in preterm infants.
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Neuharth-Pritchett S, Salm Ward T, McLaughlin KC, Jackson VM. A comparison of safe sleep violations in child care and family child care learning homes in Georgia. Child Care Health Dev 2021; 47:184-190. [PMID: 33125758 DOI: 10.1111/cch.12821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/04/2020] [Accepted: 10/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND High rates of infant death associated with sleeping practices continue to persist in the United States. Infants spend a large portion of their day with child care and family child care learning home providers. Safe sleeping practices continue to be an area of need for care providers of young children. METHOD The current study examines data drawn from a publicly available database of child care licensing reports in Georgia (n = 3,501), which contained data on child care centres and family child care learning homes. Information in the database included characteristics of the centres, year of data collection and the specific violations by child care provider type. RESULTS Results indicated clear differences in the prevalence of violations between child care centres and family child care learning homes. Within the overall sample, 13.3% of centres and family child care learning homes were cited for safe sleeping practice violations with higher prevalence in licensed child care centres and unaccredited centres. Violations were consistent with those commonly found in child care environments and inconsistent with the American Academy of Pediatrics safe sleep recommendations. CONCLUSIONS Data from the current study suggest a continued need for professional learning on safe sleep practices.
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Affiliation(s)
| | - Trina Salm Ward
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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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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Cottengim C, Parks SE, Erck Lambert AB, Dykstra HK, Shaw E, Johnston E, Olson CK, Shapiro-Mendoza CK. U-Shaped Pillows and Sleep-Related Infant Deaths, United States, 2004-2015. Matern Child Health J 2020; 24:222-228. [PMID: 31828577 PMCID: PMC10961735 DOI: 10.1007/s10995-019-02847-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe infant deaths where a u-shaped pillow was under or around an infant and to describe cases classified as Explained Suffocation. METHODS We examined demographics and circumstances of 141 infant deaths during 2004-2015 in the US National Fatality Review Case Reporting System with u-shaped pillows in the sleep environment. RESULTS Most infants were < 6 months old (92%), male (58%), non-Hispanic White (53%), and of the nine explained suffocation deaths, four occurred when the u-shaped pillow obstructed the infant's airway; five occurred when the infant rolled off the pillow and their airway was obstructed by another object. CONCLUSIONS FOR PRACTICE Although infrequent, infant deaths with u-shaped pillows have occurred. Health care providers may include discussion of the importance of caregivers following infant product packaging precautions and warning labels for commonly used consumer products, such as u-shaped pillows in their advice to caregivers.
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Affiliation(s)
- Carri Cottengim
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, N.E. MS S107-2, Chamblee, GA, 30341, USA.
| | - Sharyn E Parks
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Heather K Dykstra
- National Center for Fatality Review and Prevention, Michigan Public Health Institute, Okemos, MI, USA
| | - Esther Shaw
- National Center for Fatality Review and Prevention, Michigan Public Health Institute, Okemos, MI, USA
| | - Emily Johnston
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine K Olson
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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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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Reports of Injury Risks and Reasons for Choice of Sleep Environments for Infants and Toddlers. Matern Child Health J 2019; 23:1613-1620. [PMID: 31250240 PMCID: PMC6823298 DOI: 10.1007/s10995-019-02803-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective Compare mothers’ reports of injuries for infants and toddlers sleeping with crib-bumpers/mesh-liners/no-barriers and reasons for these sleep environment choices. Methods A cross-sectional survey of mothers subscribing to a parenting magazine and using crib bumpers (n = 224), mesh liners (n = 262), and no barriers (n = 842). Analyses of four possible injuries (face-covered, climb-out/fall, slat-entrapment, hit-head) including multivariate logistic regression adjusted for missing data/demographics and Chi squared analyses of reasons for mothers’ choices. Results Maternal reports of finding infants/toddlers with face covered had 3.5 times higher adjusted odds (aOR) for crib bumper versus mesh liner use. Breathing difficulties and wedgings were reported for infants/toddlers using crib bumpers but not mesh liners. Climb-outs/falls showed no significant difference in aORs for crib bumpers versus no-barriers and mesh liners versus no barriers. Reports of slat-entrapment were less likely for mothers using crib bumpers and mesh liners than using no barrier (aOR = .28 and .32). Reports of hit-heads were less likely for crib bumpers vs no barrier (aOR = .38) with no significant difference between mesh liners versus no barrier use. Mothers using crib bumpers and mesh liners felt their choice prevented slat-entrapment (89%, 91%); 93.5% of crib bumper users felt their choice prevented hit-heads. Significantly more mesh liner than crib bumper users chose them because “There is no suffocation risk” (64.1% vs. 40.6%), while 83.6% of no-barrier users chose them because “I was concerned about suffocation risk.” Conclusions for Practice Mothers appeared to be more concerned about preventing minor risks than suffocation. Understanding reasons for mothers’ use of barriers/no-barriers is important in tailoring counseling for mothers with infants/toddlers. Electronic supplementary material The online version of this article (10.1007/s10995-019-02803-7) contains supplementary material, which is available to authorized users.
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Chesser AK, Ahlers-Schmidt CR, Schunn C. Grandparent Knowledge of Infant Safe Sleep. Glob Pediatr Health 2019; 6:2333794X19852008. [PMID: 31211184 PMCID: PMC6545637 DOI: 10.1177/2333794x19852008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 11/17/2022] Open
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Erck Lambert AB, Parks SE, Cottengim C, Faulkner M, Hauck FR, Shapiro-Mendoza CK. Sleep-Related Infant Suffocation Deaths Attributable to Soft Bedding, Overlay, and Wedging. Pediatrics 2019; 143:e20183408. [PMID: 31010907 PMCID: PMC6637427 DOI: 10.1542/peds.2018-3408] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Unintentional suffocation is the leading cause of injury death among infants <1 year old in the United States, with 82% being attributable to accidental suffocation and strangulation in bed. Understanding the circumstances surrounding these deaths may inform prevention strategies. METHODS We analyzed data from the population-based Sudden Unexpected Infant Death Case Registry from 2011 to 2014. Cases categorized as explained suffocation with unsafe sleep factors (suffocation), per the Centers for Disease Control and Prevention's Sudden Unexpected Infant Death Case Registry classification system, were included and assigned a mechanism of obstruction, including soft bedding, overlay, or wedging. We calculated frequencies and percentages of suffocation deaths by mechanism and selected demographic and sleep-environment characteristics. RESULTS Fourteen percent of sudden unexpected infant death cases were classified as suffocation; these cases were most frequently attributed to soft bedding (69%), followed by overlay (19%) and wedging (12%). Median age at death in months varied by mechanism: 3 for soft bedding, 2 for overlay, and 6 for wedging. Soft-bedding deaths occurred most often in an adult bed (49%), in a prone position (82%), and with a blanket (or blankets) obstructing the airway (34%). Overlay deaths occurred most often in an adult bed (71%), and infants were overlaid by the mother (47%). Wedging deaths occurred most often when the infant became entrapped between a mattress and a wall (48%). CONCLUSIONS Safe sleep environments can reduce infant suffocation deaths. Increased knowledge about the characteristics of suffocation deaths can help inform prevention strategies by targeting highest-risk groups.
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Affiliation(s)
| | - Sharyn E Parks
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carri Cottengim
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meghan Faulkner
- Center for National Prevention Initiatives, Michigan Public Health Institute, Okemos, Michigan; and
| | - Fern R Hauck
- Department of Family Medicine, University of Virginia, Charlottesville, Virginia
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