Prevalence and Factors Associated With Safe Infant Sleep Practices

Abstract

OBJECTIVES: To examine prevalence of safe infant sleep practices and variation by sociodemographic, behavioral, and health care characteristics, including provider advice. METHODS: Using 2016 Pregnancy Risk Assessment Monitoring System data from 29 states, we examined maternal report of 4 safe sleep practices indicating how their infant usually slept: (1) back sleep position, (2) separate approved sleep surface, (3) room-sharing without bedsharing, and (4) no soft objects or loose bedding as well as receipt of health care provider advice corresponding to each sleep practice. RESULTS: Most mothers reported usually placing their infants to sleep on their backs (78.0%), followed by room-sharing without bed-sharing (57.1%). Fewer reported avoiding soft bedding (42.4%) and using a separate approved sleep surface (31.8%). Reported receipt of provider advice ranged from 48.8% (room-sharing without bed-sharing) to 92.6% (back sleep position). Differences by sociodemographic, behavioral, and health care characteristics were larger for safe sleep practices (∼10-20 percentage points) than receipt of advice (∼5-10 percentage points). Receipt of provider advice was associated with increased use of safe sleep practices, ranging from 12% for room-sharing without bed-sharing (adjusted prevalence ratio: 1.12; 95% confidence interval: 1.09-1.16) to 28% for back sleep position (adjusted prevalence ratio: 1.28; 95% confidence interval: 1.21-1.35). State-level differences in safe sleep practices spanned 20 to 25 percentage points and did not change substantially after adjustment for available characteristics. CONCLUSIONS: Safe infant sleep practices, especially those other than back sleep position, are suboptimal, with demographic and state-level differences indicating improvement opportunities. Receipt of provider advice is an important modifiable factor to improve infant sleep practices. WHAT'S KNOWN ON THIS SUBJECT: Approximately 3500 infants die annually in the United States from sleep-related sudden unexpected causes. Previous studies have indicated suboptimal adherence to safe infant sleep recommendations and highlighted various sociodemographic disparities and connections with provider advice. WHAT THIS STUDY ADDS: We update previous estimates of safe infant sleep and include a new composite measure assessing the use of separate approved sleep surfaces. We also explore state variation and examine associations between provider advice and each of 4 corresponding sleep-related practices.

Enhancing Safe Sleep Counseling by Pediatricians through a Quality Improvement Learning Collaborative

“…2 A 2017 study in Pediatrics showed that mothers were less likely to place their infant on their belly or side to sleep when they had received advice from a physician consistent with the AAP’s recommendations. 3 In a 2019 study, receiving advice from a physician was associated with a 12%–28% increase in prevalence in safe sleep practices; however, mothers reported that they did not receive consistent advice in aspects of safe sleep beyond “back to sleep.” 4 This finding is consistent with prior literature showing that families often report that they do not receive comprehensive safe sleep advice from their pediatric provider. 5 – 7 Also, there are demonstrated gaps in pediatrician knowledge about safe sleep practices.…”

Safe to sleep: Community‐based caregiver training

“…It is possible that the didactic training, the educational brochure, or both produced a rule that established or altered discriminative functions of the stimuli relevant to positioning the infant in the crib. Although the exact source of control for such responding is not clear, these collective outcomes are interesting in that they correspond with caregiver report of being more likely to include soft bedding and an unsafe sleep surface compared to unsafe sleep positioning (Hirai et al, 2019).…”

“…Although the exact source of control for such responding is not clear, these collective outcomes are interesting in that they correspond with caregiver report of being more likely to include soft bedding and an unsafe sleep surface compared to unsafe sleep positioning (Hirai et al, 2019). Second, all participants demonstrated perfect responding in the training context following BST, as did all participants from Carrow et al (2020).…”

“…( Soft bedding is a categorical description to capture any soft items in the infant sleep area including, but not limited to, pillows, blankets, and bumper pads.) Despite the AAP recommendation to eliminate soft bedding from the infant sleep area, a sizable percentage of caregivers report continued use of soft bedding (> 38% in Bombard et al, 2018; > 58% in Hirai et al, 2019), and this use has been directly linked to infant suffocation deaths (Cottengim et al, 2020; Erck Lambert et al, 2019).…”

Generations in Families Talking Safe Sleep (GIFTSS)

“…National surveys including the National Infant Sleep Position Study (National Institute of Child Health and Human Development, 2019) and the Pregnancy Risk Assessment Monitoring System (Shulman, D'Angelo, Harrison, Smith, & Warner, 2018) show that teen mothers are less likely to adhere to recommendations for supine sleeping, bed surfacing (including bed sharing on an adult bed) and other environmental precautions (Bombard et al, 2018;Colson, Geller, Heeren, & Corwin, 2017;Hirai et al, 2019;Phares et al, 2004;Shapiro-Mendoza et al, 2015;Willinger, Ko, Hoffman, Kessler, & Corwin, 2003). Data for US and Arkansas (AR), the site for this study, demonstrate substantial risk.…”