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Huber R, Menon M, Russell RB, Smith S, Scott S, Berns SD. Community infant safe sleep and breastfeeding promotion and population level-outcomes: A mixed methods study. Midwifery 2024; 132:103953. [PMID: 38430791 DOI: 10.1016/j.midw.2024.103953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/14/2023] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
PROBLEM In the U.S., sudden unexpected infant deaths due to accidental suffocation and strangulation in bed are increasing. Though breastfeeding is a protective factor against sudden unexpected infant death, motivations to breastfeed often couple with unsafe infant sleep practices. Racial/ethnic disparities are present in sudden unexpected infant death, accidental suffocation and strangulation in bed, and breastfeeding. BACKGROUND Promoting infant safe sleep and breastfeeding through community-level initiatives could address disparities in related outcomes. AIM Investigate the relationship between community-level strategies and associated state-level outcomes for infant safe sleep and breastfeeding. METHODS We employed an intervention mixed methods framework and exploratory sequential design. The qualitative component entailed a hermeneutical phenomenological framework to analyze key informant interview data from seven U.S. community-level providers participating in a practice improvement initiative. The quantitative component entailed descriptively analyzing infant safe sleep and breastfeeding indicators from the 2019 Pregnancy Risk Assessment Monitoring System and Ohio Pregnancy Assessment Survey. Qualitative and quantitative data were linked through embedded integration. FINDINGS We identified two mixed insights: gaps in promotion and outcomes, and persistent disparities between infant safe sleep and breastfeeding promotion and outcomes. DISCUSSION Our findings indicate conversational approaches could improve infant safe sleep and breastfeeding promotion, outcomes, and relative disparities. We find that community collaboration is needed to address organizational capacity limitations in promoting infant safe sleep and breastfeeding. CONCLUSION Community-level organizations and providers should consider tailoring program offerings and care delivery to include conversational approaches and community collaboration to promote infant safe sleep and breastfeeding and decrease relative disparities in outcomes.
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Affiliation(s)
- Rebecca Huber
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA 02210, USA.
| | - Meera Menon
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA 02210, USA
| | - Rebecca B Russell
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA 02210, USA
| | - Sharla Smith
- Preventive Medicine and Public Health Department, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; Kansas Birth Equity Network, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Stacy Scott
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA 02210, USA
| | - Scott D Berns
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA 02210, USA; Department of Pediatrics, Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Health Services, Policy and Practice, Brown University School of Public Health, 121 S Main St, Providence, RI 02903, USA
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Boedker I, Ball HL, Richter M, South TL, Roberts SGB. Construction of the Views oN Infant Sleep (VNIS) Questionnaire. Early Hum Dev 2024; 191:105989. [PMID: 38513547 DOI: 10.1016/j.earlhumdev.2024.105989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
Parents' beliefs about infant sleep behaviour vary over time and across cultures. No validated instrument exists to understand parents' pre- and postnatal views on infant sleep behaviours, which may influence their caregiving decisions. The Views oN Infant Sleep Questionnaire (VNIS) will be a tool to assess parents' beliefs in order to facilitate tailored perinatal care, increase the reliability of postnatal self-report measures, allow for cross-cultural comparisons, and provide a baseline for researchers to use in longitudinal studies. We recruited an online sample of 971 female participants who were resident in the United Kingdom, at least 28 weeks pregnant, and at least 18 years of age. The initial questionnaire consisted of 31 questions about infant independence, night-waking, infant feeding, touch, and safety, and items were rated on a 5-point Likert scale. The item pool was reduced to 12 using principal component analysis and a structure was found for the three components "Closeness", "Independence", and "Night-waking". Overall, these results suggest that the VNIS can provide a brief scale to measure different aspects of individuals' beliefs about infant sleep. In further research the VNIS needs to be validated with a confirmatory factor analysis in another sample, and to be tested as a cross-cultural instrument.
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Affiliation(s)
- Ingrid Boedker
- School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom.
| | - Helen L Ball
- Department of Anthropology, Durham University, Durham, United Kingdom
| | - Michael Richter
- School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Tina L South
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Sam G B Roberts
- School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
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Manková D, Švancarová S, Štenclová E. Does the feeding method affect the quality of infant and maternal sleep? A systematic review. Infant Behav Dev 2023; 73:101868. [PMID: 37572515 DOI: 10.1016/j.infbeh.2023.101868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/01/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
Breastfeeding brings many benefits to both mother and infant. Although, many women stop breastfeeding their infants too soon. The perceived association between breastfeeding and sleep may influence their decision to terminate breastfeeding. In our systematic review, we focused on mapping the relationship between infant feeding method and total sleep time (TST), number of nocturnal awakenings, awakenings after sleep onset (WASO) of mothers and infants and sleep quality of mothers. We searched four databases according to selected keywords and inclusion criteria - articles published in peer-reviewed journals between 2012 and 2022; English language; a sample consisting of mothers, infants, or both (without psychiatric and health problems); a comparison of the sleep quality of breastfed and formula-fed children or breastfeeding and formula-fed mothers. We read 260 full texts of selected articles. A total of 35 articles were included in this review. Due to significant heterogeneity, meta-analysis was not possible to accomplish. The results are processed according to narrative synthesis. Most studies agree that breastfed infants wake up more often at night. Total sleep time and time spent awake during the night (WASO) did not differ between breastfed and non-breastfed infants. We observed identical results in sleep variables among mothers. Additionally, there was no difference in maternal sleep quality. The synthesis revealed that the results may have differed due to using subjective, objective methods or the infant's age. It is important to remember that night waking is a more complex concept. Infants wake for many reasons, not just due to breastfeeding. The narrative synthesis indicated that the chosen study design, measurement method, the variables, and the infant's age could influence outcomes. In addition, other variables appeared that may affect the entire process. Therefore, we recommend that attention be paid to this in future studies.
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Affiliation(s)
- Denisa Manková
- Department of Psychology, Faculty of Arts, Palacký University Olomouc, Czech Republic.
| | - Soňa Švancarová
- Department of Psychology, Faculty of Arts, Palacký University Olomouc, Czech Republic
| | - Eliška Štenclová
- Department of Psychology, Faculty of Arts, Palacký University Olomouc, Czech Republic
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Pease A, Turner N, Ingram J, Fleming P, Patrick K, Williams T, Sleap V, Pitts K, Luyt K, Ali B, Blair P. Changes in background characteristics and risk factors among SIDS infants in England: cohort comparisons from 1993 to 2020. BMJ Open 2023; 13:e076751. [PMID: 37832988 PMCID: PMC10582842 DOI: 10.1136/bmjopen-2023-076751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVES Using the National Child Mortality Database, this work aims to investigate background characteristics and risk factors in the sleeping environment associated with sudden infant death syndrome (SIDS) and compare the prevalence with previous English SIDS case-control studies. DESIGN Cohort of SIDS in 2020 compared with a combined analysis of two case-control studies conducted in 1993-1996 and 2003-2006. SETTING England, UK PARTICIPANTS: 138 SIDS deaths in 2020 compared with 402 SIDS deaths and 1387 age-equivalent surviving controls, combined from previous studies. RESULTS The increased vulnerability of SIDS infants identified in previous studies has become more marked. The infants who died in 2020 were younger (median=66 days (IQR: 34-118) vs 86 days (IQR: 52-148), p=0.003) with an increased prevalence of low birth weight (30.5% vs 21.6%, p=0.04) and preterm births (29.6% vs 19.3%, p=0.012). The excess of socioeconomically deprived families, male infants and high levels of maternal smoking during pregnancy were still evident. Among recent deaths, fewer infants were put down or found on their side; however, there was no significant change in the proportion of infants who were put down (15.6% vs 14.6%, p=0.81) and found prone (40.4% vs 35.3%, p=0.37), despite population wide risk reduction advice over three decades. The proportional increase observed in 2003-2006 of half the deaths occurring while sleeping next to an adult was maintained in 2020, and for the vast majority (90%), this was in hazardous circumstances (adult had consumed alcohol, smoked, slept on a sofa, or the infant was premature or low birth weight and less than 3 months old). More deaths also occurred when there was a disruption in infant care routine compared with previous observations (52.6% vs 20.7%, p<0.001). CONCLUSIONS A more targeted approach is needed with vulnerable families emphasising the importance of sleeping infants on their back and proactive planning infant sleep when there are disruptions to the normal routine, in particular to avoid hazardous co-sleeping.
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Affiliation(s)
- Anna Pease
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Nicholas Turner
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Jenny Ingram
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Peter Fleming
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Karen Patrick
- Research and Development, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Tom Williams
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Vicky Sleap
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | | | - Karen Luyt
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Becky Ali
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Peter Blair
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
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Schindler-Ruwisch J, Dubar RT, Casale R, Watkins NK, Rubenstein V. Sleeping Like a Baby: An Investigation of Bed-Sharing, Co-Sleeping, and Breastfeeding Among Pregnant Adults During the COVID-19 Pandemic. Breastfeed Med 2023; 18:678-687. [PMID: 37638807 DOI: 10.1089/bfm.2023.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Introduction: Given the lack of clarity in the literature related to the impact of breastfeeding intentions on sleeping practices, the current research aimed to investigate the relationship between co-sleeping or bed-sharing and breastfeeding intentions among a sample of pregnant adults, during the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: Pregnant adults from a large nationally representative sample, responded to a one-time, online Qualtrics survey between October and November 2020. Pregnant adults (n = 544) were asked closed and open-ended questions about their family characteristics, sociodemographic factors, sleeping and breastfeeding habits, and intentions. This protocol was approved by the Wesleyan University Institutional Review Board. Results: Bed-sharing (odds ratio [OR] = 2.47) and co-sleeping (OR = 3.52) intentions doubled and tripled, respectively, intentions to breastfeed at 3 months. Additionally, income at some higher levels (i.e., $150,000+/year) significantly increased breastfeeding intentions at 3 months compared with the lowest income category (OR = 5.74, p = 0.011). There was also a significant relationship between intentions to bed-share (OR = 2.96, p = 0.012) and co-sleep (OR = 3.62, p < 0.001) with breastfeeding at 6 months. Prior breastfeeding experience was significantly associated with breastfeeding intention at 6 months (OR = 1.88, p = 0.035). Based on the qualitative findings, breastfeeding ease was by far the most common motivation for co-sleeping or bed-sharing, followed by security/safety, closeness, and past experience. Conclusion: Plans to bed-share and co-sleep, significantly increased the odds of breastfeeding intentions up to 6 months postpartum. Supporting breastfeeding should include conversations about parent-infant sleeping modality, style, and preference. Future research is necessary to understand the directional impacts of these decisions and the predictive role of prenatal intentions on postpartum behaviors in this context.
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Affiliation(s)
- Jennifer Schindler-Ruwisch
- Egan School of Nursing and Health Studies, Public Health, Fairfield University, Fairfield, Connecticut, USA
| | - Royette T Dubar
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - Rosa Casale
- Egan School of Nursing and Health Studies, Public Health, Fairfield University, Fairfield, Connecticut, USA
| | - Nicole K Watkins
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - Vanessa Rubenstein
- Department of Public Health, Sacred Heart University, Fairfield, Connecticut, USA
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Menon M, Huber R, West DD, Scott S, Russell RB, Berns SD. Community-based approaches to infant safe sleep and breastfeeding promotion: a qualitative study. BMC Public Health 2023; 23:437. [PMID: 36882767 PMCID: PMC9989577 DOI: 10.1186/s12889-023-15227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/06/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND In the U.S., sudden unexpected infant deaths (SUID) due to accidental suffocation and strangulation in bed (ASSB) are increasing, with disparities by race/ethnicity. While breastfeeding is a protective factor against infant mortality, racial/ethnic disparities are present in its uptake, and motivations to breastfeed are also often coupled with non-recommended infant sleep practices that are associated with infant sleep deaths. Combining infant safe sleep (ISS) and breastfeeding promotion on the community level presents opportunities to address racial/ethnic disparities and associated socioeconomic, cultural, and psychosocial influences. METHODS We completed a descriptive qualitative hermeneutical phenomenology using thematic analysis of focus group data. We examined the phenomenon of community-level providers promoting ISS and breastfeeding in communities vulnerable to ISS and breastfeeding disparities. We asked eighteen informants participating in a national quality improvement collaborative about i.) areas requiring additional support to meet community needs around ISS and breastfeeding, and ii.) recommendations on tools to improve their work promoting ISS and breastfeeding. RESULTS We identified four themes: i.) education and dissemination, ii.) relationship building and social support, iii.) working with clients' personal circumstances and considerations, and iv.) tools and systems. CONCLUSIONS Our findings support embedding risk-mitigation approaches in ISS education; relationship building between providers, clients, and peers; and the provision of ISS and breastfeeding supportive material resources with educational opportunities. These findings may be used to inform community-level provider approaches to ISS and breastfeeding promotion.
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Affiliation(s)
- Meera Menon
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA, 02210, USA
| | - Rebecca Huber
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA, 02210, USA.
| | - Dana D West
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA, 02210, USA
| | - Stacy Scott
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA, 02210, USA
| | - Rebecca B Russell
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA, 02210, USA
| | - Scott D Berns
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA, 02210, USA.,Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
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7
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Zimmerman D, Bartick M, Feldman-Winter L, Ball HL. ABM Clinical Protocol #37: Physiological Infant Care-Managing Nighttime Breastfeeding in Young Infants. Breastfeed Med 2023; 18:159-168. [PMID: 36927076 PMCID: PMC10083892 DOI: 10.1089/bfm.2023.29236.abm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
A central goal of the Academy of Breastfeeding Medicine (ABM) 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. The ABM empowers health professionals to provide safe, inclusive, patient-centered, and evidence-based care. Pregnant and lactating people identify with a broad spectrum of genders, pronouns, and terms for feeding and parenting. There are two reasons ABM's use of gender-inclusive language may be transitional or inconsistent across protocols. First, gender-inclusive language is nuanced and evolving across languages, cultures, and countries. Second, foundational research has not adequately described the experiences of gender-diverse individuals. Therefore, ABM advocates for, and will strive to use language that is as inclusive and accurate as possible within this framework. For more explanation, please read ABM Position Statements on Infant Feeding and Lactation-Related Language and Gender (https://doi.org/10.1089/bfm.2021.29188.abm) and Breastfeeding As a Basic Human Right (https://doi.org/10.1089/bfm.2022.29216.abm).
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Affiliation(s)
- Deena Zimmerman
- Maternal-Child and Adolescent Division, Public Health Service, Israel Ministry of Health, Jerusalem, Israel
| | - Melissa Bartick
- Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Lori Feldman-Winter
- Department of Pediatrics, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Helen L Ball
- Durham Infancy and Sleep Centre, Department of Anthropology, Durham University, Durham, United Kingdom
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Menon M, Huber R, Russell RB, Feldman-Winter L, Goodstein MH, Scott S, Berns SD. Maternity Care Clinicians' Experiences Promoting Infant Safe Sleep and Breastfeeding During the COVID-19 Pandemic. Nurs Womens Health 2023; 27:90-102. [PMID: 36803607 PMCID: PMC9937429 DOI: 10.1016/j.nwh.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/25/2022] [Accepted: 01/15/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To explore the phenomenon of clinicians' perceptions and experiences of promoting infant safe sleep (ISS) and breastfeeding during the COVID-19 pandemic. DESIGN Descriptive qualitative hermeneutical phenomenology of key informant interviews conducted as part of a quality improvement initiative. SETTING Maternity care services of 10 U.S. hospitals from April through September 2020. PARTICIPANTS Ten hospital teams, including 29 clinicians. INTERVENTION Participants were part of a national quality improvement intervention focused on promoting ISS and breastfeeding. Participants were asked about challenges and opportunities promoting ISS and breastfeeding during the pandemic. RESULTS We identified four themes summarizing the experiences and perceptions of clinicians promoting ISS and breastfeeding in the COVID-19 pandemic: Strain on Clinicians Related to Hospital Policies, Coordination, and Capacity; Effects of Isolation for Parentsin Labor and Delivery; ReevaluatingOutpatient Follow-Up Care andSupport; and AdoptingShared Decision-Makingaround ISS andBreastfeeding. CONCLUSIONS Our results support the need for physical and psychosocial care to reduce crisis-related burnout for clinicians to encourage the continued provision of ISS and breastfeeding education, particularly while navigating capacity constraints. Our findings also suggest that clinicians perceived that parents may require additional support to enhance potentially limited ISS and breastfeeding education. These findings may be used to inform approaches to parental and clinician maternity care support in future public health crises.
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The Impact of Breastfeeding and Safe Sleep Mobile Health Messaging on Breastfeeding and Bedsharing. Acad Pediatr 2022; 22:927-934. [PMID: 35124281 PMCID: PMC9349472 DOI: 10.1016/j.acap.2022.01.016] [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: 08/24/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Mobile health (mHealth) safe sleep messaging increases rates of safe sleep. Bedsharing is more common among breastfeeders. Advice to not bedshare may negatively impact breastfeeding. We compared the impact of safe sleep or breastfeeding mHealth messaging on bedsharing and breastfeeding at 2 to 5 months. METHODS This is a secondary analysis of mothers who initiated breastfeeding from a cluster randomized clinical trial of mHealth messaging for safe sleep or breastfeeding. A multi-ethnic sample of 1600 mothers was recruited from 16 US birth hospitals and surveyed at 2 to 5 months regarding the previous 2 weeks' breastfeeding and bedsharing practices. Data on 997 mothers who initiated breastfeeding were analyzed with multivariable generalized estimating logistic regression models to examine the association of mHealth messaging with infant care practices. RESULTS Overall, exposure to breastfeeding versus safe sleep messaging was not associated with a difference in any breastfeeding at 2 to 5 months (69.3% vs 65.5%, respectively; adjusted odds ratio [aOR] = 1.33 [95% confidence interval, 0.91, 1.94]). Women with shorter planned duration of breastfeeding who received breastfeeding messaging had increased odds of breastfeeding at 2 to 5 months (50% vs 31%; aOR 3.13 [95% CI, 1.47, 6.65]). Mothers who received safe sleep messaging had lower rates of bedsharing overall when compared to breastfeeding messaging (24.8% vs 35.2%; aOR = 0.58 [95% CI, 0.44, 0.78]). CONCLUSIONS In this large multi-ethnic US sample, receipt of safe sleep mHealth messaging was associated with lower rates of bedsharing without negatively impacting breastfeeding rates. Future research should focus on continued development of interventions to improve adherence to both safe sleep and breastfeeding recommendations.
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Gray MJ, Vazquez CE, Agnihotri O. "Struggle at night - He doesn't let me sleep sometimes": a qualitative analysis of sleeping habits and routines of Hispanic toddlers at risk for obesity. BMC Pediatr 2022; 22:413. [PMID: 35831852 PMCID: PMC9277846 DOI: 10.1186/s12887-022-03434-8] [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: 01/26/2022] [Accepted: 06/15/2022] [Indexed: 11/21/2022] Open
Abstract
Background Hispanic children face disproportionately higher risks for early life obesity and resultant comorbidities such as Type 2 diabetes and fatty liver disease. Sleep habits are modifiable behaviors that impact early childhood obesity; Hispanic infants have been shown to have less nighttime sleep compared to their white counterparts. Pediatricians often coach families on parents’ nighttime responsive feeding and longer child sleep duration as protective factors against early life obesity, but must understand the family context and potential barriers. This study aimed to discover the sleeping habits and routines of Hispanic toddlers at risk for obesity through the perspective of their mothers. Methods This qualitative study used a phenomenological approach. 14 Hispanic mothers were recruited from a Federally Qualified Health Center in Central Texas for qualitative interviews regarding their experience raising a small child. Children aged 6 to 18 months with child weight-for-length ratio ≥ 85% for age were approached for study involvement and consented during well child visits. Interviews occurred over several months during 2018–2019; NVivo software was used for analysis of qualitative themes. Two reviewers coded and used constant comparative methods to identify common themes. Results Mothers diverged from AAP recommended guidelines for infant and toddler feeding and sleep habits. Mothers shared their intentions and the real-life barriers to implementing recommended habits. Mothers discussed wanting to have their child sleep in a separate bed or room but not having the resources (i.e., financial, space) to do so. Additionally, mothers discussed knowing not to feed to soothe at night but couldn’t bring themselves to let their child cry if they knew feeding would soothe them. Co-sleeping, feeding to sleep, middle of the night feeding, and lack of structured sleep habits were common interview themes and potentially modifiable factors. Conclusions Pediatricians need to be sensitive to culture and the real-world needs of families to determine if best practices are “practical.” Themes from these parent interviews can inform tailored interventions for children at high risk of obesity. Interventions should promote responsive nighttime feeding and structured sleep, working with individual family logistics, to coach families towards optimal healthy environments and healthy child weight.
Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03434-8.
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Affiliation(s)
- Megan J Gray
- Departments of Pediatrics and Department of Population Health, Dell Medical School, The University of Texas at Austin, 1601 Trinity St., Bldg B, Austin, TX, 78712, USA.
| | - Christian E Vazquez
- School of Social Work, The University of Texas at Arlington, 211 South Cooper Street, Box 19129, Arlington, TX, 76019, USA
| | - Ojasvie Agnihotri
- UT Health San Antonio Joe R. & Teresa Lozano Long School of Medicine, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
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11
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Boran P, Ergin A, Us MC, Dinleyici M, Velipaşaoğlu S, Yalçın SS, Barutçu A, Gökçay G, Gür E, Çamurdan Duyan A, Aydın A, Celep G, Almış H, Savcı G, Kondolot M, Nalbantoğlu B, Ünver Korgalı E, Yendur Ö, Orhon Şimşek F, Kara Uzun A, Bağ Ö, Koç F, Bülbül S. Young children's sleep patterns and problems in paediatric primary healthcare settings: a multicentre cross-sectional study from a nationally representative sample. J Sleep Res 2022; 31:e13684. [PMID: 35790464 DOI: 10.1111/jsr.13684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
Studies describing paediatric sleep patterns are needed by taking culture into consideration. The aim of this study was to identify parent-reported sleep-wake patterns in young children and explore possible factors influencing sleep problems. The mothers of 2,434 young children enrolled from well-child outpatient clinics in Turkey completed an online survey including sociodemographic variables, Brief Infant Sleep Questionnaire, Edinburgh Postnatal Depression Scale and Generalised Anxiety Disorder scales. Overall, young children in Turkey go to bed late (10:00 p.m.), awaken twice per night for 30 min, and obtain 11.5 h of total sleep, showing no sex-specific differences. Distinct night-time sleep patterns emerged after 18 months of age. Importantly, although currently breastfed healthy children were 3.8-times less likely to sleep through the night, total sleep duration and exclusive breastfeeding duration were higher in children who were not sleeping through the night. Overall, bedsharing was identified in 11.5%, and only room sharing was reported in 52.9%. Parental perception of a child's sleep as problematic was 35.8%. Mothers with higher educational attainment were more likely to perceive their children's sleep as a problem. Maternal depressive and anxious symptoms and a history of excessive infant crying were the determinants predicting the likelihood of both parent-perceived sleep problems and poor sleepers. The present analysis of sleep structure in infancy and toddlerhood provides reference data for well-child visits. These findings highlight the importance of considering maternal anxiety, depression and behaviour management techniques to cope with fussy infants in addressing childhood behavioural sleep problems.
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Affiliation(s)
- Perran Boran
- Department of Social Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey.,Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey
| | - Ahmet Ergin
- Division of Social Pediatrics, Department of Public Health and Department of Pediatrics, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Mahmut Caner Us
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey
| | - Meltem Dinleyici
- Department of Social Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Sevtap Velipaşaoğlu
- Department of Social Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | - Adnan Barutçu
- Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Gülbin Gökçay
- Department of Social Pediatrics, Institute of Child Health, Istanbul University, Istanbul, Turkey
| | - Emel Gür
- Department of Social Pediatrics, Istanbul University-Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Aysu Çamurdan Duyan
- Department of Social Pediatrics, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Adem Aydın
- Department of Social Pediatrics, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Gökce Celep
- Department of Pediatrics, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - Habip Almış
- Department of Pediatrics, Adiyaman University School of Medicine, Adiyaman, Turkey
| | | | - Meda Kondolot
- Department of Pediatrics, Social Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Burçin Nalbantoğlu
- Department of Pediatrics, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Elif Ünver Korgalı
- Departments of Pediatrics, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Özge Yendur
- Department of Pediatrics, Kafkas University School of Medicine, Kars, Turkey
| | - Filiz Orhon Şimşek
- Department of Social Pediatrics, School of Medicine, Ankara University, Ankara, Turkey
| | - Aysun Kara Uzun
- Ankara Children's Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Özlem Bağ
- İzmir Dr. Behçet Uz Child Hospital, İzmir, Turkey
| | - Feyza Koç
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Selda Bülbül
- Department of Pediatrics, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
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12
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Moon RY, Carlin RF, Hand I. Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths. Pediatrics 2022; 150:188305. [PMID: 35921639 DOI: 10.1542/peds.2022-057991] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Every year in the United States, approximately 3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths have remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. In addition, additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, which is included in this issue.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Rebecca F Carlin
- Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York City, New York
| | - Ivan Hand
- Department of Pediatrics, SUNY-Downstate College of Medicine, NYC Health + Hospitals, Kings County, Brooklyn, New York
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Bartick M, Barr AW, Feldman-Winter L, Guxens M, Tiemeier H. The Role of Breastfeeding in Racial and Ethnic Disparities in Sudden Unexpected Infant Death: A Population-Based Study of 13 Million Infants in the United States. Am J Epidemiol 2022; 191:1190-1201. [PMID: 35292797 DOI: 10.1093/aje/kwac050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/15/2022] [Accepted: 03/10/2022] [Indexed: 01/26/2023] Open
Abstract
Sudden unexpected infant death (SUID) disproportionately affects non-Hispanic Black (NHB) and American Indian/Alaskan Native infants, who have lower rates of breastfeeding than other groups. Using 13,077,880 live-birth certificates and 11,942 linked SUID death certificates from 2015 through 2018, we calculated odds ratios and adjusted risk differences of SUID in infants who were not breastfed across 5 racial/ethnic strata in the United States. We analyzed mediation by not breastfeeding in the race/ethnicity-SUID association. The overall SUID rate was 0.91 per 1,000 live births. NHB and American Indian/Alaskan Native infants had the highest disparity in SUID relative to non-Hispanic White infants. Overall, not breastfeeding was associated with SUID (adjusted odds ratio (aOR), 1.14; 95% confidence interval (CI): 1.10, 1.19), and the adjusted risk difference was 0.12 per 1,000 live births. The aOR of not breastfeeding for SUID was 1.07 (95% CI: 1.00, 1.14) in NHB infants and 1.29 (95% CI: 1.14, 1.46) in Hispanic infants. Breastfeeding minimally explained the higher SUID risk in NHB infants (2.3% mediated) and the lower risk in Hispanic infants (2.1% mediated) relative to non-Hispanic White infants. Competing risks likely explain the lower aOR seen in NHB infants of not breastfeeding on SUID, suggesting that social or structural determinants must be addressed to reduce racial disparities in SUID.
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14
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Cassels T, Rosier JG. The Effectiveness of Sleep Training: Fact or Fiction? CLINICAL LACTATION 2022. [DOI: 10.1891/cl-2021-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IntroductionIn Western cultures, parents often view infant sleep as problematic. Family, friends, and doctors may advise parents to “sleep train” assuming it is safe and effective, without considering its possible side effects, including its impact on breastfeeding. Unfortunately, it may reduce night feeds and result in earlier supplementation or weaning. The larger question is whether sleep training is worth the risk (i.e., does it improve infant sleep?). Our goal was to examine the data on the effectiveness of sleep training interventions on infant/toddler sleep.MethodsPubMed and Google Scholar were searched for specific terms to identify articles that included behavioral sleep interventions and objective measures of sleep pre-and postntervention. Two objective infant sleep measures were examined: Night wakings and total sleep duration. Articles were then reviewed for evidence of the effectiveness of these interventions to reduce night wakings and increase total sleep duration.ResultsFive articles were identified that met the criteria for inclusion. Overall, there was no evidence that sleep training improves infant sleep.Applications for PracticeThe claim that sleep training is effective in changing infant sleep is not warranted. Given the potential side effects on breastfeeding, parents should be cautioned about engaging these behavioral sleep interventions if they have breastfeeding goals they want to achieve.
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15
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Kural B, Gökçay G. Association Between Infant Sleep Location and Breastfeeding. Breastfeed Med 2022; 17:305-310. [PMID: 35100039 DOI: 10.1089/bfm.2021.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: Studies have shown that mothers sleeping with their babies have longer breastfeeding duration. Bedsharing (BS) is thought to be a risk factor for Sudden Infant Death Syndrome. The aim was to investigate the frequency of BS and roomsharing (RS) and the effect of those on breastfeeding during the first 2 years of life. Also to evaluate risk-bearing situations regarding sleep environment. Methods and Study Design: This is a cross-sectional study, with retrospective cohort features for the evaluation of some data. The setting was a Well-Child Clinic at Bakırköy Research and Training Hospital. The children were followed from the first month until survey. Feeding history was collected retrospectively from child health records. Parents were surveyed concerning sleeping location and sleeping arrangements with a questionnaire. The study encompassed 351 children and their families. Results: The rate of exclusive breastfeeding was found to be 50.2% for the first 6 months of life and BS increased in exclusively breastfed infants. When breastfeeding continued after 6 months, the trend of increased BS through months was observed. RS, BS, and breastsleeping rates were 80.6%, 22.8%, 56.1%, respectively, in the whole cohort. Working mothers and mothers >35 years of age were significantly more likely to bedshare. Cigarette smoking in BS parents was identified as a child health risk. Unsafe sleep environment was found in 72.4% of the group. Conclusions: BS increases breastfeeding for the first 6 months. Families need guidance on safe sleeping practices and should be advised regarding avoidable risks and unsafe situations in BS. Parents should be counseled to make informed decisions.
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Affiliation(s)
- Bahar Kural
- Department of Pediatrics, Bakırköy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Gülbin Gökçay
- Department of Social Pediatrics, Istanbul University Institute of Child Health, İstanbul, Turkey
- Department of Pediatrics, Istanbul University Istanbul Medical School, İstanbul, Turkey
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16
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Landa-Rivera JL, Pérez-Pérez J, González-Núñez MDP, Gil-Miralles RA, Jover-Escolano Y, Fernández-Pan Astacio V. Population-Based Survey Showing That Breastfed Babies Have a Lower Frequency of Risk Factors for Sudden Infant Death Syndrome Than Nonbreastfed Babies. Breastfeed Med 2022; 17:182-188. [PMID: 34919408 PMCID: PMC8867097 DOI: 10.1089/bfm.2021.0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Justification: Breastfeeding provides the best infant food, and closeness to the mother is crucial for successful breastfeeding. However, sharing parents' beds and sleeping on the stomach poses a high risk for sudden infant death syndrome (SIDS). There is little information on these practices regarding the Spanish population. Objective: To explore breastfeeding and bed-sharing practices in the study population Materials and Methods: A cross sectional observational study was conducted through an anonymous telephone survey with a representative random sample of babies born in the Health Area of La Marina Baixa, Alicante, between 2018 and 2019. A previous-day strategy was implemented to determine the feeding and bed-sharing variables. Results: The total breastfeeding and formula-feeding rates were 47.0% and 52.9%, respectively. The overall bed-sharing rate was 66.5%. The breastfeeding rate was 86.4% with bed-sharing and 13.6% without bed-sharing. The rate of prone sleeping position in children younger than 6 months of age was 9.3-3.5% with breastfeeding and 5.8% with formula feeding. Lower frequencies of tobacco, alcohol, and nonsupine sleeping positions were observed among mothers who practiced breastfeeding and bed-sharing. Conclusions: We found a close relationship between breastfeeding and bed-sharing and a lower frequency of SIDS risk factors associated with both practices. Families should be informed about the risk factors associated with SIDS to encourage safe bed-sharing while avoiding recommendations that discourage breastfeeding.
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Affiliation(s)
- José Leonardo Landa-Rivera
- Marina Baixa Hospital, Association for the Promotion of and Scientific and Cultural Research into Breastfeeding (APILAM), Alicante, Spain
| | - Juan Pérez-Pérez
- Pediatric Service, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
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17
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Bartick M, Young M, Louis-Jacques A, McKenna JJ, Ball HL. Bedsharing may partially explain the reduced risk of sleep-related death in breastfed infants. Front Pediatr 2022; 10:1081028. [PMID: 36582509 PMCID: PMC9792691 DOI: 10.3389/fped.2022.1081028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Melissa Bartick
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Michal Young
- Department of Pediatrics and Child Health, Howard University College of Medicine, Washington, DC, United States
| | - Adetola Louis-Jacques
- Department of Obstetrics and Gynecology, University of Florida Health, Gainesville, FL, United States
| | - James J McKenna
- Department of Anthropology, Santa Clara University, Santa Clara, CA, United States.,Department of Anthropology, University of Notre Dame, South Bend, IN, United States
| | - Helen L Ball
- Department of Anthropology, Durham Infancy & Sleep Centre, Durham University, Durham, United Kingdom
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18
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Gutierrez-de-Terán-Moreno G, Ruiz-Litago F, Ariz U, Fernández-Atutxa A, Mulas-Martín MJ, Benito-Fernández E, Sanz B. Successful breastfeeding among women with intention to breastfeed: From physiology to socio-cultural factors. Early Hum Dev 2022; 164:105518. [PMID: 34864612 DOI: 10.1016/j.earlhumdev.2021.105518] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Even if women have intention to breastfeed, they do not always achieve a successful breastfeeding. AIM This study aims to analyse factors affecting breastfeeding prevalence among mothers that intended to breastfeed. METHODS This is a prospective observational study involving 401 pregnant women that intended to breastfeed (asked at the 20th week). Breastfeeding prevalence was evaluated in reference to health-related, socio-cultural factors and healthcare professionals' interventions at 1 month, 6 months and 12 months after birth. Data were analysed using descriptive statistical methods, bivariate logistic regression and multivariate logistic regression modelling. RESULTS Independent factors negatively affecting breastfeeding prevalence related to mothers' and newborns' health parameters and birth characteristics included smoking during pregnancy, anaemia and use of analgesia during labour. Regarding sociocultural parameters, being an immigrant, higher education level, intention to breastfeed before pregnancy, comfort with public breastfeeding and bedsharing were positively linked to breastfeeding, while teat or pacifier use in the first week was negatively linked. Regarding healthcare professionals' practices, mother and father/partner antenatal education course attendance and exclusive breastfeeding at the hospital were positively associated with breastfeeding. CONCLUSION Breastfeeding is a very complex phenomenon affected by multiple and diverse variables. Physiological factors only affect the short term (1st month), while middle and long term BF affecting variables are mainly identical and include mostly socio-cultural factors and also BF related practices, especially in the first days after birth. These data should help to develop more effective breastfeeding promotion strategies.
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Affiliation(s)
- Gloria Gutierrez-de-Terán-Moreno
- Osakidetza, Basque Health Service, La Peña Health Center, Bilbao, Spain; Midwifery Teaching Unit, Osakidetza, Basque Health Service, Spain.
| | - Fátima Ruiz-Litago
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain.
| | - Usue Ariz
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain.
| | - Ainhoa Fernández-Atutxa
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain.
| | - María-Jesús Mulas-Martín
- Midwifery Teaching Unit, Osakidetza, Basque Health Service, Spain; Osakidetza, Basque Health Service, Otxarkoaga Health Center, Bilbao, Spain.
| | | | - Begoña Sanz
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.
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19
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Chen Z, Dai Y, Liu X, Liu J. Early Childhood Co-Sleeping Predicts Behavior Problems in Preadolescence: A Prospective Cohort Study. Behav Sleep Med 2021; 19:563-576. [PMID: 32946284 PMCID: PMC10117418 DOI: 10.1080/15402002.2020.1818564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE/BACKGROUND Co-sleeping is common practice around the globe. The relationship between early childhood co-sleeping and adolescent behavior problems remains uncertain. We aim to identify whether early childhood co-sleeping can predict behavior problems in preadolescence. PARTICIPANTS A cohort of 1,656 Chinese preschool children were followed up in adolescence. METHODS Prospective cohort study design involving two waves of data collection from the China Jintan Cohort (1,656 children aged 3-5 years). Co-sleeping history was collected at 3-5-years-old via parent-reported questionnaire at wave I data collection. Behavior problems were measured twice in childhood and preadolescence, respectively. Adolescent behavior problems were measured by integrating data from self-report, parent-report and teacher-report using the Achenbach System of Empirically Based Assessment. Predictions were assessed using the general linear model with mixed effects on the inverse probability weight propensity-matched sample. RESULTS 1,656 children comprising 55.6% boys aged 4.9 ± 0.6 were initially enrolled in the first wave of data collection. In the second wave of data collection, 1,274 children were 10.99 ± 0.74 (76.9%) aged 10-13 years were retained. Early childhood co-sleeping is significantly associated with increased behavior problems in childhood (Odds Ratio [OR] 1.22-2.06, ps<0.03) and preadolescence (OR 1.40-2.27, ps<0.02). Moreover, co-sleeping history significantly predicted multiscale increase in internal (OR 1.63-2.61, ps<0.02) and external behavior problems in adolescence. CONCLUSIONS Early childhood co-sleeping is associated with multiple behavioral problems reported by parents, teachers, and children themselves. Early childhood co-sleeping predicts preadolescent internalizing and externalizing behavior after controlling for baseline behavior problems.
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Affiliation(s)
- Zehang Chen
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Surgery, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ying Dai
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xianchen Liu
- Kelin Health Research, Montgomery, New Jersey, USA
| | - Jianghong Liu
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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20
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Abstract
BACKGROUND There is great global variation in the sleeping arrangements for healthy newborn infants. Bed sharing is a type of sleeping practice in which the sleeping surface (e.g. bed, couch or armchair, or some other sleeping surface) is shared between the infant and another person. The possible physiological benefits include better oxygen and cardiopulmonary stability, fewer crying episodes, less risk of hypothermia, and a longer duration of breastfeeding. On the other hand, the most important harmful effect of bed sharing is that it may increase the risk of sudden infant death syndrome (SIDS). Studies have found conflicting evidence regarding the safety and efficacy of bed sharing during infancy. OBJECTIVES To evaluate the efficacy and safety of bed sharing, started during the neonatal period, on breastfeeding status (exclusive and total duration of breastfeeding), incidence of SIDS, rates of hypothermia, neonatal and infant mortality, and long-term neurodevelopmental outcomes. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 7) in the Cochrane Library; MEDLINE via PubMed (1966 to 23 July 2020), CINAHL (1982 to 23 July 2020), and LILACS (1980 to 23 July 2020). We also searched clinical trials databases, and the reference lists of retrieved articles, for randomised controlled trials (RCTs) and quasi-RCTS. SELECTION CRITERIA We planned to include RCTs or quasi-RCTs (including cluster-randomised trials) that included term neonates initiated on bed sharing within 24 hours of birth (and continuing to bed share with the mother in the first four weeks of life, followed by a variable time period thereafter), and compared them to a 'no bed sharing' group. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as recommended by Cochrane. We planned to use the GRADE approach to assess the certainty of evidence. MAIN RESULTS Our search strategy yielded 6231 records. After removal of duplicate records, we screened 2745 records by title and abstract. We excluded 2739 records that did not match our inclusion criteria. We obtained six full-text studies for assessment. These six studies did not meet the eligibility criteria and were excluded. AUTHORS' CONCLUSIONS We did not find any studies that met our inclusion criteria. There is a need for RCTs on bed sharing in healthy term neonates that directly assess efficacy (i.e. studies in a controlled setting, like hospital) or effectiveness (i.e. studies conducted in community or home settings) and safety. Future studies should assess outcomes such as breastfeeding status and risk of SIDS. They should also include neonates from high-income countries and low- and middle-income countries, especially those countries where bed sharing is more prevalent because of cultural practices (e.g. Asian countries).
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Affiliation(s)
- Rashmi R Das
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Mari Jeeva Sankar
- Newborn Health Knowledge Centre, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
| | - Ramesh Agarwal
- Newborn Health Knowledge Centre, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
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21
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O’ Brien N, McGarvey C, Hamilton K, Hayes B. Maternal intentions towards infant sleeping practices in Ireland. Acta Paediatr 2021; 110:184-193. [PMID: 32415996 DOI: 10.1111/apa.15352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/23/2022]
Abstract
AIM Mortality from Sudden Infant Death Syndrome (SIDS) has reduced by 50%-85% globally. Despite improvements from 1990 to 2009, the Irish SIDS rate has plateaued. Reasons for this are unclear, but may be related to a reduced parental SIDS awareness. Our study aimed to assess intentions regarding infant sleeping practices in mothers in Ireland. METHODS A cross-sectional survey of post-partum mothers was performed in the Rotunda Hospital over a four month period. Mothers with a history of SIDS, miscarriage or neonatal admissions were excluded. RESULTS Of 451 participants, unsafe sleeping positions were intended by 15.4%, reduced by Irish ethnicity [AOR = 0.52, 95% CI = 0.277-0.959, P = .036]. Safe sleep locations were intended by 66%, increased by Irish ethnicity [AOR = 2.6, 95% CI = 1.617-4.191, P < .001], and reduced by young maternal age [AOR = 0.15, 95% CI = 0.03-0.713, P = .02]. Maternal smoking was more likely in mothers with lower educational level [AOR = 3.51, 95% CI = 1.169-10.56, P = .03]. Soft bedding use was intended by 34.8%, increased in younger mothers [AOR = 2.28, 95% CI = 1.04-4.98, P = .04]. Breastfeeding was intended by 72.2%, decreased by Irish ethnicity [AOR = 0.14, 95% CI = 0.067-0.271, P < .001], and low maternal education [AOR = 0.22, 95% CI = 0.117-0.406, P < .001]. CONCLUSION Educational campaigns on safe sleep for infants in Ireland need to address modifiable SIDS risks factors, focusing on younger, non-Irish mothers, with lower educational attainment.
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Affiliation(s)
- Niamh O’ Brien
- Department of Neonatology Rotunda Hospital Dublin 1 Ireland
| | - Cliona McGarvey
- Children’s Health Ireland (CHI) at Temple St National Paediatric Mortality Register Dublin 1 Ireland
| | - Karina Hamilton
- Children’s Health Ireland (CHI) at Temple St National Paediatric Mortality Register Dublin 1 Ireland
| | - Breda Hayes
- Department of Neonatology Rotunda Hospital Dublin 1 Ireland
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22
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Moberg KU, Handlin L, Petersson M. Neuroendocrine mechanisms involved in the physiological effects caused by skin-to-skin contact – With a particular focus on the oxytocinergic system. Infant Behav Dev 2020; 61:101482. [DOI: 10.1016/j.infbeh.2020.101482] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
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Shipstone RA, Young J, Kearney L, Thompson JMD. Applying a Social Exclusion Framework to Explore the Relationship Between Sudden Unexpected Deaths in Infancy (SUDI) and Social Vulnerability. Front Public Health 2020; 8:563573. [PMID: 33194965 PMCID: PMC7606531 DOI: 10.3389/fpubh.2020.563573] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Sudden Unexpected Death in Infancy (SUDI) is a leading cause of preventable infant mortality and strongly associated with social adversity. While this has been noted over many decades, most previous studies have used single economic markers in social disadvantage analyses. To date there have been no previous attempts to analyze the cumulative effect of multiple adversities in combination on SUDI risk. Methods: Based on sociological theories of social exclusion, a multidimensional framework capable of producing an overall measure of family-level social vulnerability was developed, accounting for both increasing disadvantage with increasing prevalence among family members and effect of family structures. This framework was applied retrospectively to all cases of SUDI that occurred in Queensland between 2010 and 2014. Additionally, an exploratory factor analysis was performed to investigate whether differing “types” of vulnerability could be identified. Results: Increased family vulnerability was associated with four major known risk factors for sudden infant death: smoking, surface sharing, not-breastfeeding and use of excess bedding. However, families with lower levels of social vulnerability were more likely to display two major risk factors: prone infant sleep position and not room-sharing. There was a significant positive relationship between family vulnerability and the cumulative total of risk factors. Exploratory factor analysis identified three distinct vulnerability types (chaotic lifestyle, socioeconomic and psychosocial); the first two were associated with presence of major SUDI risk factors. Indigenous infants had significantly higher family vulnerability scores than non-Indigenous families. Conclusion: A multidimensional measure that captures adversity across a range of indicators highlights the need for proportionate universalism to reduce the stalled rates of sudden infant death. In addition to information campaigns continuing to promote the importance of the back-sleeping position and close infant-caregiver proximity, socially vulnerable families should be a priority population for individually tailored or community based multi-model approaches.
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Affiliation(s)
- Rebecca A Shipstone
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Jeanine Young
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Lauren Kearney
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - John M D Thompson
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia.,Departments of Paediatrics, Child and Youth Health, and Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
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24
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Bailey C, Tawia S, McGuire E. Breastfeeding Duration and Infant Sleep Location in a Cohort of Volunteer Breastfeeding Counselors. J Hum Lact 2020; 36:354-364. [PMID: 31237801 DOI: 10.1177/0890334419851801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Debate about mother and infant bed sharing has been polarized between supporters of bed sharing and public health policies that attempt to mitigate the risk of Sudden Infant Death Syndrome. Differences in group demographics may be an important aspect in co-sleeping acceptability. RESEARCH AIMS The first aim of this study was to investigate infant sleeping location in a dataset of mothers with strong breastfeeding outcomes. The second aim was to investigate the association between infant sleeping location and breastfeeding (exclusive breastfeeding to 6 months and total breastfeeding duration). Finally, we aimed to investigate predictors of breastfeeding duration. METHODS Participants comprised 174 women who had applied to train as counselors with the Australian Breastfeeding Association. Data were compiled from a survey of the participants' lactation histories, including questions related to the exclusivity and duration of breastfeeding, concerns about and problems encountered during breastfeeding, type of birth, medications during birth, demographics, and infant sleeping location. The study design was a cross-sectional, one-group survey design. RESULTS A high proportion of participants in this study bed shared and room shared: At 0-1 month (n = 58), 33% of participants bed-shared, which increased to 58% by 6-12 months (n = 80). Infants who co-slept were more likely to be exclusively breastfed at 6 months (χ2 (2, n = 116) = 4.83, p = .03) and had longer breastfeeding duration (t (62.61) = 3.81, p < .001). CONCLUSIONS Breastfeeding targets have been difficult to achieve globally, and innovative ideas are required to improve breastfeeding outcomes through public health messaging. There was a strong association in the current study between breastfeeding outcomes and degree of closeness of the infant to the mother at night. This finding should be brought into the discourse on breastfeeding and infant sleep arrangements, accompanied by evidence-based advice about safe sleeping and the promotion of breastfeeding.
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Affiliation(s)
- Cate Bailey
- 2541 Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Susan Tawia
- 110651 Australian Breastfeeding Association, Victoria, Australia
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25
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Kellams A, Hauck FR, Moon RY, Kerr SM, Heeren T, Corwin MJ, Colson E. Factors Associated With Choice of Infant Sleep Location. Pediatrics 2020; 145:peds.2019-1523. [PMID: 32034081 PMCID: PMC7049941 DOI: 10.1542/peds.2019-1523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the prevalence of and factors associated with actual recent practice and near-future intention for infant sleep location in a national sample. METHODS There were 3260 mothers from 32 US hospitals who responded to a survey at infant age 2 to 6 months regarding care practices, including usual and all infant sleep locations in the previous 2 weeks and intended location for the next 2 weeks. Mothers were categorized as (1) having practiced and/or intending to practice exclusive room-sharing without bed-sharing, (2) having practiced anything other than exclusive room-sharing but intending to practice exclusive room-sharing, (3) intending to have the infant sleep in another room; and (4) intending to practice bed-sharing all night or part of the night. Multivariable multinomial logistic regression examined associations between sleep-location category, demographics, feeding method, doctor advice, and theory of planned behavior domains (attitudes, social norms, and perceived control). RESULTS Fewer than half (45.4%) of the mothers practiced and also intended to practice room-sharing without bed-sharing, and 24.2% intended to practice some bed-sharing. Factors associated with intended bed-sharing included African American race and exclusive breastfeeding; however, the highest likelihood of bed-sharing intent was associated with perceived social norms favoring bed-sharing (adjusted odds ratio [aOR] 5.84; 95% confidence interval [CI] 4.14-8.22) and positive attitudes toward bed-sharing (aOR 190.1; 95% CI 62.4-579.0). Women with a doctor's advice to room-share without bed-sharing intended to practice bed-sharing less (aOR 0.56; 95% CI 0.36-0.85). CONCLUSIONS Sleep-location practices do not always align with the recommendation to room-share without bed-sharing, and intention does not always correspond with previous practice. Attitudes, perceived social norms, and doctor advice are factors that are amenable to change and should be considered in educational interventions.
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Affiliation(s)
| | - Fern R. Hauck
- Family Medicine, University of Virginia,
Charlottesville, Virginia
| | | | - Stephen M. Kerr
- Slone Epidemiology Center, Boston University, Boston,
Massachusetts; and
| | - Timothy Heeren
- Department of Biostatistics, School of Public Health
and
| | - Michael J. Corwin
- Slone Epidemiology Center, Boston University, Boston,
Massachusetts; and
| | - Eve Colson
- Department of Pediatrics, School of Medicine,
Washington University in St Louis, St Louis, Missouri
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26
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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: 32] [Impact Index Per Article: 8.0] [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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27
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Abstract
The aim of this study was to psychometrically test the Adaptation to the Late Preterm Infant when Breastfeeding Scale (ALPIBS) and also to test how a mother's self-efficacy predicts adaptation to a late preterm infant when breastfeeding. This study had a longitudinal and prospective design, and data collection was consecutive. Mothers (n = 105) with infants born between 340/7 and 366/7 weeks were recruited from a neonatal intensive care unit or a maternity unit. The ALPIBS was developed using exploratory factor analysis, and the association between breastfeeding self-efficacy and ALPIBS score was examined using linear regression analysis. The Breastfeeding Self-Efficacy Scale-Short Form instrument was used to measure self-efficacy in breastfeeding. A higher degree of self-efficacy was significantly associated with a higher degree of adaptation to the late preterm infant's breastfeeding behavior (P < .001). We identified 4 separate underlying factors measured by 11 items in the ALPIBS: (A) breastfeeding is a stressful event; (B) the infant should breastfeed as often as he or she wants; (C) a mother has to breastfeed to be a good mother; and (D) it is important to ensure control over the infant's feeding behavior. There is a link between self-efficacy and ALPIBS score, and self-efficacy is a modifiable factor that influences breastfeeding.
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28
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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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29
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Ball HL, Tomori C, McKenna JJ. Toward an Integrated Anthropology of Infant Sleep. AMERICAN ANTHROPOLOGIST 2019. [DOI: 10.1111/aman.13284] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Helen L. Ball
- Director, Parent–Infant Sleep LabDepartment of Anthropology, Durham University Durham DH1 3LE UK
| | - Cecilia Tomori
- Assistant Professor, Parent–Infant Sleep LabDepartment of Anthropology, Durham University Durham DH1 3LE UK
| | - James J. McKenna
- Director, Mother–Baby Sleep Lab, Department of AnthropologyUniversity of Notre Dame South Bend Indiana USA
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30
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Harries V, Brown A. The association between baby care books that promote strict care routines and infant feeding, night-time care, and maternal-infant interactions. MATERNAL AND CHILD NUTRITION 2019; 15:e12858. [PMID: 31216386 DOI: 10.1111/mcn.12858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/22/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022]
Abstract
Baby care books that promote strict infant care routines are popular, but little research has considered their impact upon maternal infant care behaviours. We explored whether mothers who have read these books guide their infant care behaviours based on their concepts and how this is associated with infant feeding, night-time care, and response to infant's needs. Three hundred and fifty-four U.K. mothers with a baby aged 0-12 months completed an online questionnaire exploring use of baby care books, motivations for use, whether guidance was followed, and infant care behaviours. Mothers who read the books were drawn to them for information about how to settle their infant, infant sleep, and infant feeding behaviour. Those who read the books were less likely to breastfeed, feed responsively, have their infant sleep in the same room, cuddle their infant to sleep, or respond promptly to infant cries. Although the causality between reading these books and care cannot be determined through this study design, and is likely bidirectional with some reading the books to confirm existing preferences, around 25-40% of mothers noted the information determined their care decisions. Regardless of specific causal pathways, there is an association between these books and behaviours that go against infant feeding and responsive care recommendations. Understanding what drives mothers to follow these books and increasing support for new mothers in these areas is important. The findings will be important for those supporting mothers in the perinatal period in starting conversations around responsive infant care.
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Affiliation(s)
- Victoria Harries
- Department of Biological Anthropology, Yale University, New Haven, Connecticut.,Department of Public Health, Policy and Social Sciences, Swansea University, Swansea, UK.,Centre for Lactation, Infant Feeding and Translation research (LIFT), Swansea University, Swansea, UK
| | - Amy Brown
- Department of Public Health, Policy and Social Sciences, Swansea University, Swansea, UK.,Centre for Lactation, Infant Feeding and Translation research (LIFT), Swansea University, Swansea, UK
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31
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Ng CA, Ho JJ, Lee ZH. The effect of rooming-in on duration of breastfeeding: A systematic review of randomised and non-randomised prospective controlled studies. PLoS One 2019; 14:e0215869. [PMID: 31022227 PMCID: PMC6483355 DOI: 10.1371/journal.pone.0215869] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/05/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The benefits of six months exclusive breastfeeding are well established for both mother and infant. One of the 10 steps of the Baby Friendly Hospital Initiative is rooming-in (mother and baby together in the same room throughout hospitalisation). A Cochrane review found only one randomised controlled trial (RCT) examining the effects of continuous rooming-in versus nursery care on breastfeeding duration, and concluded there was insufficient evidence to support or refute either practice. We aimed to examine the effect of continuous or intermittent rooming-in on breastfeeding duration. METHODS AND FINDINGS We included all prospective controlled studies (randomised and non-randomised) comparing rooming-in to nursery care that reported full or partial breastfeeding up to six months. We used the 2016 search results of the Cochrane review and updated the search to August 2018 using OVID MEDLINE. Duplicate data extraction and assessment of risk of bias were performed. Meta-analyses were performed using REVMAN 5. The GRADE approach was used to assess quality of evidence. Seven studies were included, five had 24-hour-per-day, one daytime only and one 8-hours-per-day rooming-in. Four studies had at least one additional co-intervention: Differences in delivery room management, and educational packages. All studies contributing to meta-analyses had 24-hour rooming-in. There was no difference in the proportion of infants on full breastfeeding at 3 months (RR 1.14; 95% CI 0.84 to 1.54; very-low-quality evidence), 4 months (RR 0.99; 95% CI 0.73 to 1.33; very-low-quality evidence) and 6 months (RR 0.95; 95% CI 0.57 to 1.58; low-quality evidence). The proportion of infants on partial breastfeeding at 3-4 months was higher with rooming-in (RR 1.31; 95% CI 1.06 to 1.61; very-low-quality evidence). CONCLUSION The addition of non-randomised prospective controlled studies to existing evidence did not add further information on the effects of rooming-in on breastfeeding duration but resulted in lower quality of evidence. Uncertainty about the effects of rooming-in on breastfeeding duration remains.
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Affiliation(s)
- Chin Ang Ng
- C/O Department of Paediatrics, RSCI & UCD Malaysia Campus, George Town, Penang, Malaysia
| | - Jacqueline J. Ho
- Department of Paediatrics, RSCI & UCD Malaysia Campus, George Town, Penang, Malaysia
- * E-mail:
| | - Zcho Huey Lee
- C/O Department of Paediatrics, RSCI & UCD Malaysia Campus, George Town, Penang, Malaysia
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32
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Bartick M, Tomori C. Sudden infant death and social justice: A syndemics approach. MATERNAL & CHILD NUTRITION 2019; 15:e12652. [PMID: 30136404 PMCID: PMC7198924 DOI: 10.1111/mcn.12652] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/01/2018] [Accepted: 06/21/2018] [Indexed: 01/31/2023]
Abstract
Sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS) prevention has focused on modifying individual behavioural risk factors, especially bedsharing. Yet these deaths are most common among poor and marginalized people in wealthy countries, including U.S. Blacks, American Indians/Alaskan Natives, New Zealand Māori, Australian Aborigines, indigenous Canadians, and low-income British people. The United States now has the world's highest prevalence of SUID/SIDS, where even Whites' SIDS prevalence now approaches that of the Māori. Using public databases and the literature, we examine SUID/SIDS prevalence and the following risk factors in selected world populations: maternal smoking, preterm birth, alcohol use, poor prenatal care, sleep position, bedsharing, and formula feeding. Our findings suggest that risk factors cluster in high-prevalence populations, many are linked to poverty and discrimination and have independent effects on perinatal outcomes. Moreover, populations with the world's lowest rates of SUID/SIDS have low income-inequality or high relative wealth, yet have high to moderate rates of bedsharing. Employing syndemics theory, we suggest that disproportionately high prevalence of SUID/SIDS is primarily the result of socially driven, co-occurring epidemics that may act synergistically to amplify risk. SUID must be examined through the lens of structural inequity and the legacy of historical trauma. Emphasis on bedsharing may divert attention from risk reduction from structural interventions, breastfeeding, prenatal care, and tobacco cessation. Medical organizations play an important role in advocating for policies that address the root causes of infant mortality via poverty and discrimination interventions, tobacco control, and culturally appropriate support to families.
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Affiliation(s)
- Melissa Bartick
- Department of MedicineCambridge Health Alliance and Harvard Medical SchoolCambridgeMassachusetts
| | - Cecília Tomori
- Department of Anthropology, Parent–Infant Sleep LabDurham UniversityDurhamUK
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33
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Baddock SA, Purnell MT, Blair PS, Pease AS, Elder DE, Galland BC. The influence of bed-sharing on infant physiology, breastfeeding and behaviour: A systematic review. Sleep Med Rev 2018; 43:106-117. [PMID: 30553183 DOI: 10.1016/j.smrv.2018.10.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 11/18/2022]
Abstract
This review aimed to better understand the underlying physiology of the risks and benefits of bed-sharing. Eight databases were searched using terms relating to adult-infant/baby, bed-sharing/co-sleeping combined with outcome terms for physiology, sleep, cardiovascular, respiratory, temperature and behaviour. Of 836 papers identified, 59 papers representing 48 cohorts met inclusion criteria. Objective data using various methodologies were available in 27 papers and subjective data in 32 papers. Diverse measures were reported using variable definitions of bed-sharing. Identified physiological and behavioural differences between bed-sharing and cot-sleeping included increased behavioural arousals, warmer in-bed temperatures and increased breastfeeding duration in bedshare infants as well as differences in infant overnight sleep architecture, cardiorespiratory control and cortisol responses to stress. We concluded that many differences are context-specific, and dependent on the subjective view of the parents and their cultural values. Objective risk arises if the infant is unable to mount an appropriate physiological or behavioural response to their micro-environment. More studies in the bed-sharing setting are needed to identify infant risk, the potential benefits of a safer environment, and how bed-sharing interacts with infant care practices other than sleep.
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Affiliation(s)
| | | | - Peter S Blair
- Bristol Medical School, University of Bristol, United Kingdom
| | - Anna S Pease
- Bristol Medical School, University of Bristol, United Kingdom
| | - Dawn E Elder
- Department of Paediatrics & Child Health, University of Otago, Wellington, New Zealand
| | - Barbara C Galland
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, New Zealand.
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34
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Hernández-Aguilar MT, Bartick M, Schreck P, Harrel C, Noble L, Calhoun S, Dodd S, Elliott-Rudder M, Lappin S, Larson I, Lawrence RA, Marinelli KA, Marshall N, Mitchell K, Reece-Stremtan S, Rosen-Carole C, Rothenberg S, Seo T, Wonodi A. ABM Clinical Protocol #7: Model Maternity Policy Supportive of Breastfeeding. Breastfeed Med 2018; 13:559-574. [PMID: 30457366 DOI: 10.1089/bfm.2018.29110.mha] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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)
- Maria-Teresa Hernández-Aguilar
- 1 Breastfeeding Clinical Unit Dr. Peset, University Hospital Dr. Peset, National Health Service, Valencia, Spain .,2 National Coordinator of Spain Baby-Friendly Initiative (IHAN-España Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia), Madrid, Spain
| | - Melissa Bartick
- 3 Department of Medicine, Cambridge Health Alliance , Cambridge, Massachusetts.,4 Harvard Medical School, Boston, Massachusetts
| | - Paula Schreck
- 5 Department of Pediatrics, Ascension St. John , Detroit, Michigan
| | - Cadey Harrel
- 6 Department of Family Medicine, University of Arizona , Tucson, Arizona
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35
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Gürarslan Baş N, Karatay G, Arikan D. Weaning practices of mothers in eastern Turkey. J Pediatr (Rio J) 2018; 94:498-503. [PMID: 28893515 DOI: 10.1016/j.jped.2017.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/30/2017] [Accepted: 06/14/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The study aimed to determine the practices used by breastfeeding mothers to wean their children from the breast. METHOD This qualitative-quantitative research was conducted with mothers whose children were registered the pediatric clinics of a state hospital between June and September 2016. In accordance with a purposeful sampling method, 232 mothers of children between the ages of 2 and 5 years were included in the study. Data were collected through face-to-face interviews using a questionnaire with demographic characteristics of mothers as well as their weaning practices. The data obtained were analyzed with a computer-assisted program using number and percentage distributions. RESULTS The mean breastfeeding duration was 19.00±7.11 months. It was determined that the majority of mothers (56.5%) used traditional methods for weaning their children. These included applying substances with a bad taste (58.1%) to their breasts, covering their breasts with various materials (26.2%) to make the child not want to nurse anymore, and using a pacifier or feeding bottle (9.2%) to substitute for the mother's breast. CONCLUSIONS It was observed that more than half of the mothers were used some traditional practices that could cause trauma in their children, instead of natural weaning.
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Affiliation(s)
| | - Gülnaz Karatay
- Munzur University, School of Health Science, Tunceli, Turkey
| | - Duygu Arikan
- Atatürk University, Nursing Faculty, Erzurum, Turkey
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36
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Weaning practices of mothers in eastern Turkey. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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37
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Howson S. “I See No Other Option:” Maternal Practices of Sleep-Training and Co-Sleeping as the Management of Vulnerability. STUDIES IN THE MATERNAL 2018. [DOI: 10.16995/sim.246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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38
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Rudzik AEF, Robinson-Smith L, Ball HL. Discrepancies in maternal reports of infant sleep vs. actigraphy by mode of feeding. Sleep Med 2018; 49:90-98. [PMID: 30097331 DOI: 10.1016/j.sleep.2018.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/14/2018] [Accepted: 06/20/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Many studies of infant sleep rely solely on parentally-reported data, assuming that parents accurately report their infant's sleep parameters. The objective of this paper is to examine whether night-time sleep parameters of exclusively breastfed or exclusively formula-fed infants differ, and whether correspondence between parental reports and objective measures varies by feeding type. METHODS Mother-infant dyads intending to breastfeed or formula-feed exclusively for 18 weeks were recruited. Mothers were multiparas and primiparas, aged between 18 and 45 years. Infants were full-term, normal birthweight singletons. Maternal report and actigraphic data on infant sleep were collected fortnightly, from four to 18 weeks postpartum. Data were analysed cross-sectionally using t-tests and GLM analysis to control for interaction between feed-type and sleep location. RESULTS Actigraphy-assessed infant sleep parameters did not vary by feed-type but parentally reported sleep parameters did. Maternal report and actigraphy data diverged at 10 weeks postpartum and discrepancies were associated with infant feeding type. Compared to actigraphy, maternal reports by formula-feeding mothers (controlling for infant sleep location) over-estimated infant's Total Sleep Time (TST) at 10 weeks and Longest Sleep Period (LSP) at 10, 12 and 18 weeks. CONCLUSIONS These results raise questions about the outcomes of previous infant sleep studies where accuracy of parentally-reported infant sleep data is assumed. That parental reports of infant sleep vary by feeding type is particularly important for reconsidering previous studies of infant sleep development and intervention studies designed to influence sleep outcomes, especially where feed-type was heterogeneous, but was not considered as an independent variable.
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Affiliation(s)
- Alanna E F Rudzik
- Department of Anthropology, Durham University, Durham, UK; Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton-on-Tees, UK.
| | - Lyn Robinson-Smith
- Department of Anthropology, Durham University, Durham, UK; Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton-on-Tees, UK
| | - Helen L Ball
- Department of Anthropology, Durham University, Durham, UK; Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton-on-Tees, UK
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39
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Gerhardsson E, Hildingsson I, Mattsson E, Funkquist EL. Prospective questionnaire study showed that higher self-efficacy predicted longer exclusive breastfeeding by the mothers of late preterm infants. Acta Paediatr 2018; 107:799-805. [PMID: 29352489 DOI: 10.1111/apa.14229] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 11/20/2017] [Accepted: 01/15/2018] [Indexed: 11/27/2022]
Abstract
AIM An important variable that influences breastfeeding outcomes is how confident a woman feels about her ability to breastfeed successfully at an early stage. We investigated breastfeeding self-efficacy in the mothers of late preterm infants. METHODS This was a prospective, comparative study that focused on mothers who had delivered babies at 34 + 0 to 36 + 6 weeks and were recruited in 2012-2015 from a neonatal intensive care unit and a postnatal ward at a Swedish university hospital. The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) was used to psychometrically assess the mothers at 40 weeks of postmenstrual age (n = 148) and at three months of corrected age (n = 114). RESULTS The BSES-SF scores were higher in the 87% of mothers that exclusively breastfed when their babies reached 40 weeks (57.1 out of 70) than those who did not (41.4, p < 0.001), indicating better self-efficacy. The figures remained higher in the 68% of exclusive breastfeeding mothers at three months of corrected age (60.9 versus 51.7). CONCLUSION Self-efficacy was an important predictor of the length of breastfeeding in mothers of late preterm infants, and the BSES-SF can be used to detect low self-efficacy that could lead to early breastfeeding cessation.
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Affiliation(s)
- Emma Gerhardsson
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | | | - Elisabet Mattsson
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Eva-Lotta Funkquist
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
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40
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Boyden SD, Pott M, Starks PT. An evolutionary perspective on night terrors. Evol Med Public Health 2018; 2018:100-105. [PMID: 29765596 PMCID: PMC5941156 DOI: 10.1093/emph/eoy010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/07/2018] [Indexed: 12/21/2022] Open
Abstract
Night terrors, also known as sleep terrors, are an early childhood parasomnia characterized by screams or cries, behavioral manifestations of extreme fear, difficulty waking and inconsolability upon awakening. The mechanism causing night terrors is unknown, and a consistently successful treatment has yet to be documented. Here, we argue that cultural practices have moved us away from an ultimate solution: cosleeping. Cosleeping is the norm for closely related primates and for humans in non-Western cultures. In recent years, however, cosleeping has been discouraged by the Western medical community. From an evolutionary perspective, cosleeping provides health and safety benefits for developing children. We discuss night terrors, and immediate and long-term health features, with respect to cosleeping, room-sharing and solitary sleeping. We suggest that cosleeping with children (≥1-year-old) may prevent night terrors and that, under certain circumstances, cosleeping with infants (≤11-months-old) is preferable to room-sharing, and both are preferable to solitary sleeping.
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Affiliation(s)
- Sean D Boyden
- Department of Biology, Tufts University, Medford, MA 02155, USA
| | - Martha Pott
- Eliot-Pearson Department of Child Study and Human Development, Tufts University, Medford, MA 02155, USA
| | - Philip T Starks
- Department of Biology, Tufts University, Medford, MA 02155, USA
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Hatton REM, Gardani M. Maternal perceptions of advice on sleep in young children: How, what, and when? Br J Health Psychol 2018; 23:476-495. [DOI: 10.1111/bjhp.12300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/21/2018] [Indexed: 11/29/2022]
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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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Strömberg Celind F, Wennergren G, Möllborg P, Goksör E, Alm B. Area-based study shows most parents follow advice to reduce risk of sudden infant death syndrome. Acta Paediatr 2017; 106:579-585. [PMID: 27992061 PMCID: PMC5363386 DOI: 10.1111/apa.13711] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/31/2016] [Accepted: 12/12/2016] [Indexed: 12/31/2022]
Abstract
Aim Guidance on reducing the risk of sudden infant death syndrome (SIDS) was successfully introduced to a number of countries in the early 1990s. The most important recommendations were supine sleeping for infants and non‐smoking for mothers. This 2012–2014 study examined adherence to the national Swedish SIDS advice. Methods We asked 1000 parents with infants registered at child healthcare centres in western Sweden to complete a questionnaire on infant care from birth to 12 months of age. Results We analysed 710 responses and found that, in the first three months, 1.3% of the infants were placed in the prone sleeping position and 14.3% were placed on their side. By three to five months, this had risen to 5.6% and 23.6%. In the first three months, 83.1% were breastfed, 84.1% used a pacifier and 44.2% shared their parents' bed, while 5.8% slept in another room. Bed sharing was more likely if infants were breastfed and less likely if they used pacifiers. During pregnancy, 2.8% of the mothers smoked and the mothers who had smoked during pregnancy were less likely to bed share. Conclusion Overall adherence to the SIDS advice was good, but both prone and side sleeping practices should be targeted.
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Affiliation(s)
- Frida Strömberg Celind
- Department of Paediatrics; University of Gothenburg; Queen Silvia Children's Hospital; Gothenburg Sweden
| | - Göran Wennergren
- Department of Paediatrics; University of Gothenburg; Queen Silvia Children's Hospital; Gothenburg Sweden
| | - Per Möllborg
- Department of Paediatrics; University of Gothenburg; Queen Silvia Children's Hospital; Gothenburg Sweden
| | - Emma Goksör
- Department of Paediatrics; University of Gothenburg; Queen Silvia Children's Hospital; Gothenburg Sweden
| | - Bernt Alm
- Department of Paediatrics; University of Gothenburg; Queen Silvia Children's Hospital; Gothenburg Sweden
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Moon RY. SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment. Pediatrics 2016; 138:peds.2016-2940. [PMID: 27940805 DOI: 10.1542/peds.2016-2940] [Citation(s) in RCA: 350] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS), ill-defined deaths, and accidental suffocation and strangulation in bed. After an initial decrease in the 1990s, the overall sleep-related infant death rate has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, use of a firm sleep surface, room-sharing without bed-sharing, and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence and rationale for recommendations are presented for skin-to-skin care for newborn infants, bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. In addition, expanded recommendations for infant sleep location are included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment," which is included in this issue.
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Affiliation(s)
- Göran Wennergren
- Department of Paediatrics; University of Gothenburg; Queen Silvia Children's Hospital; Gothenburg Sweden
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Affiliation(s)
- Peter S Blair
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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