Mothers’ knowledge and attitudes to sudden infant death syndrome risk reduction messages: results from a UK survey

Abstract

ObjectiveTo investigate mothers’ knowledge of reducing the risks for sudden infant death syndrome (SIDS) and attitudes towards safer sleep practices.Design and settingA cross-sectional survey was carried out in deprived areas of Bristol, UK. Recruitment took place in 2014 at local health visitor-led baby clinics.ParticipantsOf 432 mothers approached, 400 (93%) completed the face-to-face survey. Participants with infants at ‘higher’ risk of SIDS (using an algorithm based on a previous observational study) were compared with those at ‘lower’ risk.Main outcome measuresThe survey asked participants to recall three SIDS risk reduction strategies (unprompted), and scored responses to 14 SIDS risk-related infant sleep scenarios (prompted).ResultsOverall, 48/400 (12%) mothers were classified as higher risk. Mothers in the higher risk group were less likely to breast feed (multivariate OR=3.59(95% CI 1.46 to 8.86)), less likely to be able to cite two or more unprompted correct SIDS risk reduction strategies (multivariate OR=2.05(95% CI 1.02 to 4.13)) and scored lower on prompted safer sleep scenarios overall.Notably, only 206/400 (52%) of all mothers surveyed (33% in the higher risk group) from these deprived areas in Bristol identified infant sleep position as a risk reduction strategy for SIDS, despite 25 years of campaigns.ConclusionsMothers in the higher risk group were disadvantaged when it came to some aspects of knowledge of SIDS risk reduction and attitudes to safer sleep. The initial ‘Back-to Sleep’ message that dramatically reduced these deaths a generation ago needs more effective promotion for today’s generation of mothers.

Observed compliance with safe sleeping guidelines in licensed childcare services

“…A 19-item measure of educator knowledge, beliefs and confidence regarding infant sleep was developed (online supplementary table 1) modelled from that used by Pease 15. Seven items assessed educator knowledge, six items assessed educator beliefs and four items assessed educator confidence.…”

“…Other factors identified as risks (eg, hazardous cosleeping) or protections (eg, breastfeeding) are less salient in the childcare context, although it is noted that childcare services are significant sites for public health promotion and parent education 14. In home settings, there is evidence that many families do not follow safe sleeping guidelines, do not follow all guidelines or do not follow them all of the time 15–18. For example, placing a baby to sleep in a non-supine position (front or side placement) has been consistently shown as a significant risk factor for sleep-related infant death1 and, since the 1990s, a key focus of related public health campaigns 19.…”

“…For example, placing a baby to sleep in a non-supine position (front or side placement) has been consistently shown as a significant risk factor for sleep-related infant death1 and, since the 1990s, a key focus of related public health campaigns 19. Non-compliance is highest among families living in circumstances of disadvantage15 and from racially or culturally diverse backgrounds 16. However, recent studies report that some degree of non-compliance occurs regardless of family culture or socioeconomic status 5 15.…”

“…Non-compliance is highest among families living in circumstances of disadvantage15 and from racially or culturally diverse backgrounds 16. However, recent studies report that some degree of non-compliance occurs regardless of family culture or socioeconomic status 5 15. In licensed childcare services, the obligation to follow health guidelines is often formalised in regulations.…”

Conversations with families about reducing the risk of sudden infant death syndrome

“…A recent survey of higher-risk families found that as few as one third identified back sleeping as a risk reduction strategy for SIDS (Pease et al, 2018), and related qualitative work found a lack of understanding about why or how sleeping position is related to SIDS (Pease et al, 2017). Future interventions in this area should, therefore, consider effective ways to improve understanding as well as knowledge.…”