Safe infant sleep practices remain underutilized

1. A large number of new mothers surveyed in 2016 reported nonadherence to American Academy of Pediatrics safe infant sleep recommendations; three-quarters reported placing their infants to sleep on their backs, and a minority reported avoiding soft bedding for infant sleep.

2. The majority of mothers reported receiving some provider advice for safe infant sleep practices, and this was associated with increased use of practices.

Evidence Rating Level: 3 (Average)

Study Rundown: The American Academy of Pediatrics recommends using a firm sleep surface, room-sharing without bed sharing, and avoiding soft objects and loose bedding in order to reduce sudden infant death syndrome. Recent data on adherence to these recommendations have been limited. In this study, researchers used maternal self-report survey data from the Pregnancy Risk Assessment Monitoring System to examine prevalence of safe infant sleep practices. The majority of mothers surveyed reported placing their infants to sleep on their backs and room-sharing without bed-sharing, though less than half avoided using soft bedding for infant sleep. The majority of mothers reported receiving provider advice to place infants to sleep on their back, and half received advice for room-sharing without bed-sharing. Receipt of advice was associated with greater adherence to safe sleep practices.

The study was limited by its exclusion of 21 states that did not participate in the study or did not meet the response rate threshold, which resulted in a lack of representation from southeastern states. Nonetheless, the study is strengthened by its large sample and detailed analysis of multiple covariates. For physicians, these findings provide evidence that provider advice is an important, effective factor in improving safe infant sleep practices, and highlight the need to expand efforts to reach population groups at elevated risk.

Click to read the study, published today in Pediatrics

Relevant reading: SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment

In-Depth [survey]: Researchers used survey data from the 2016 Pregnancy Risk Assessment Monitoring System encompassing more than 30 000 mothers randomly sampled from birth certificate records 2 to 9 months postpartum assessing infant sleep practices through maternal report. Multivariate logistic regression models were used to examine the covariates contributing to variation in sleep practices.

Of the mothers surveyed, the majority (78.0%) reported placing their infants to sleep on their backs, and 57.1% reported room-sharing without bed-sharing. Less than half (42.4%) of mothers avoided using soft bedding for infant sleep, including blankets, crib bumper pads, and toys, cushions, or pillows. Mothers who were older, non-Hispanic white, more educated, and married were more likely to report following usual safe sleep practices than other mothers. The vast majority (92.6%) of mothers reported receiving provider advice to place their infant to sleep on their back, 48.8% received advice for room-sharing without bed-sharing, and receipt of advice was associated with greater odds for use of safe sleep practices, including back sleep position (adjusted prevalence ratio: 1.29; 95% confidence interval 1.21-1.35), after adjustment for demographic characteristics.

Image: PD

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