A newborn fall in the hospital is an uncommon but distressing event for parents, staff, and clinicians. Yet, despite a growing body of literature on the frequency of newborn falls and multiple quality improvement initiatives with newborn safety bundles (NSB), newborn falls continue to occur as low frequency, high stress events. An underlying premise in most NSBs is that parent education is key in preventing newborn falls. One example of an intervention in many NSBs is an infant safety pledge, where new parents are asked for a signature to acknowledge the receipt of education about safe sleep practices.
In a special article in this month’s Hospital Pediatrics, investigators argue for a paradigm shift in how we think about newborn falls (10.1542/hpeds.2020-0112). Using what is known about sleep science, sleepiness in post-partum mothers, and high fall rates associated with nighttime feedings, the authors make a compelling argument that current fall prevention strategies rely on a flawed presumption that most mothers know that they are tired and sleepy and intend to fall asleep with their infant. According to the authors, the physiologic rapid onset of sleep especially in already sleep-deprived well-intentioned new mothers does not allow for the mother to recognize what is happening in time to alert staff and prevent a newborn fall. The authors also make an interesting case for a separate definition from “newborn falls” called “newborn slips” to distinguish the scenario in which an infant in a sleeping mother’s arms slips into the bed from other causes of newborn falls. The authors propose that a better understanding of the scenario in which a sleeping mother is holding a newborn may be the key to more successful targeted interventions to prevent newborn falls and slips. This includes data collection on how often mothers unintentionally fall asleep while holding their infant. We could potentially also learn a lot from these scenarios in which the newborn does not fall or slip.
There is no doubt that we need to continue messaging evidenced based safe sleep practices endorsed by the American Academy of Pediatrics to parents of newborns. Authors of this article suggest that there is more to the story when it comes to newborn fall prevention and we may need to rethink our current mitigation strategies.