The role that safe sleep practice plays in the prevention of sudden unexpected infant death due is well known to all of us, but just how good is our counseling of families about it? To answer that question, Hirai et al. (10.1542/peds.2019-1286) analyzed data gathered from 29 states in the Pregnancy Risk Assessment Monitoring System (PRAMS) to see if in 2016 mothers reported adherence to 4 safe sleep practices—(1) putting their infants on their backs to sleep, (2) using an approved sleep surface, (3) room-sharing without bed sharing, and (4) having no soft objects or loose bedding in the crib, bassinet, or portable crib. While the good news is that most (78%) mothers are placing their infants on their backs, only a little over half (57.1%) room share without bed sharing, 40% avoid soft bedding, and only 30% use a separate approved sleep surface. Why is adherence to these recommended sleep practices worse than we might expect? We might think that parents learn sleep practice during their babies’ health maintenance visits in the first few months of life—but the mothers report otherwise. While those who did get sleep education guidance from their clinician had higher rates of complying with recommended sleep practices, more than half of mothers surveyed stated they did not get information on room-sharing without bed sharing and 15% noted they had never been told about where their baby should be put down to sleep or to remove soft objects from the crib or other sleep environment. The authors point out racial and ethnic differences as well as differences across states. Why is this?
We asked sleep safety specialists Drs. Jeffrey Colvin and Rachel Moon to weigh in with an accompanying commentary (10.1542/peds.2019-2310). They are not shy to point out that a big part of the solution hinges on our needing to do a better job educating families about safe sleep during routine health maintenance visits. The Hirai study showed that when mothers recalled being taught about safe sleep, they also were more apt to report using safe sleep behaviors. Drs. Colvin and Moon remind us of the possible consequences of not talking to families about the safe sleep environment—an unintended and tragic sleep-related death. Hopefully this study will be a wake-up call for all of us to make sure that safe sleep messaging becomes a key part of anticipatory guidance to families, beginning at time of birth, and then being reinforced and monitored throughout infancy during well-childcare visits. If you need a reminder of what the AAP recommends for safe sleep, don’t forget the policy statement on this important topic (10.1542/peds.2016-2938) that provides what you need to know to educate infant caregivers about what they need to do to keep their babies safe when they sleep.
