Infant Safe Sleep Interventions, 1990–2015: A Review

Abstract

Sleep-related infant deaths remain a major public health issue. Multiple interventions have been implemented in efforts to increase adherence to safe sleep recommendations. We conducted a systematic review of the international research literature to synthesize research on interventions to reduce the risk of sleep-related deaths and their effectiveness in changing infant sleep practices. We searched PubMed, CINAHL, PsycINFO, and Google Scholar for peer-reviewed articles published between 1990 and 2015 which described an intervention and reported results. Twenty-nine articles were included for review. Studies focused on infant caregivers, health care professionals, peers, and child care professionals. Targeted behaviors included sleep position, location, removing items from the crib, breastfeeding, smoke exposure, clothing, pacifier use, and knowledge of Sudden Infant Death Syndrome. Most articles described multi-faceted interventions, including: one-on-one or group education, printed materials, visual displays, videos, and providing resources such as cribs, pacifiers, wearable blankets, and infant t-shirts. Two described public education campaigns, one used an educative questionnaire, and one encouraged maternal note taking. Health professional interventions included implementing safe sleep policies, in-service training, printed provider materials, eliciting agreement on a Declaration of Safe Sleep Practice, and sharing adherence data. Data collection methods included self-report via surveys and observational crib audits. Over half of the studies utilized comparison groups which helped determine effectiveness. Most articles reported some degree of success in changing some of the targeted behaviors; no studies reported complete adherence to recommendations. Future studies should incorporate rigorous evaluation plans, utilize comparison groups, and collect demographic and collect follow-up data.

Safe to sleep: Community‐based caregiver training

“…In a review of the literature focused on interventions to increase adherence with infant safe sleep recommendations, Ward and Balfour (2015) reported that the majority of studies utilized indirect measures of complianceself-report questionnaires that ask about intent to adhere to or retrospective use of safe sleep recommendations-to evaluate outcomes. For example, Moon et al (2017) conducted a randomized clinical trial in which 1,600 mothers were randomly assigned to one of four groups to evaluate the individual and combined effects of two interventions (nursing quality improvement and mobile health messaging) on adherence with infant safe sleep practices.…”

Barriers to and Interventions that Increase Nurses’ and Parents’ Compliance With Safe Sleep Recommendations for Preterm Infants

“…These include lack of consistent education, parental preference, infant comfort, and parents' fear of risk of infant choking. Parents of full-term newborns cited similar barriers including conflicting information, fear of choking, infant comfort, and parental exhaustion as reasons for not following safe sleep practices at home (Salm Ward & Balfour, 2016). Another area of concern was that parents thought the use of a home monitor would decrease the risk of SIDS.…”

“…Nursing education initiatives have also been shown to improve nursing compliance with safe sleep for premature infants. In a review of studies in the full-term newborn population with a bundled interventional approach including policy changes, nursing education, and continued yearly competencies for safe sleep, authors showed some degree of success in improving safe sleep compliance (Salm Ward & Balfour, 2016). A statewide safe sleep training program for nurses in Missouri behavioral organization in preterm infants (Sweeney & Gutierrez, 2002).…”

Behavioral interventions to promote adequate sleep among women: protocol for a systematic review and meta-analysis

“…Previous reviews of behavioral or non-pharmacological sleep interventions have either focused on underage populations, such as infants [40, 41] or children [42–44]; older people [45, 46]; populations with health problems, such as youth with chronic health conditions [47], children with autism spectrum disorders [48], hospitalized patients [49], oncology patients and family caregivers [50], adults in intensive care units [51]; or people with sleep disorders, such as apnea [52–54] or insomnia [55, 56]; or on specific interventions, such as stress reduction [57]. …”

“…These reviews included the following types of behavioral sleep interventions: educational interventions (e.g., providing parents information on safe sleep among infants [40] or on positive routines to favor sleep in their child [42, 44]), sleep education [43, 50] or sleep hygiene education [46, 49], cognitive behavioral therapy [43, 50, 55, 56] or cognitive therapy [46], environmental interventions (e.g., reducing environmental noise in aged care facilities [45]), relaxation [49, 51, 55, 56] or massage [51] or aromatherapy [51] or stress reduction [57], and exercise [50] or lifestyle, and dietary interventions [52, 53]. …”