Last September I was hiking in Robert Frost country in Vermont, hardly close to a snowy evening at that time, but reading this new study reminded me of one of his best-known poems. The study shows us once again the gaps that arise when trying to implement results of research studies.
Source: Batra EK, Teti DM, Schaefer EW, et al. Nocturnal video assessment of infant sleep environments. Pediatrics. 2016;138(3):e20161533; doi:10.1542/peds.2016-1533. See AAP Grand Rounds commentary by Dr. Carrie Phillipi (subscription required).
For this study, the investigators signed up families with newborns within 48 hours of delivery. Parents of 167 newborn infants agreed to have video recordings of their infants' home sleeping environments at 1, 3, and 6 months of age, in order to assess adherence to recommended sleep practices for infants. The families were predominantly white and highly educated, and one would think that just knowing your infant was being videotaped to assess sleep practices would be quite an incentive for parents to follow best practices in this regard. This makes the study's findings all the more discouraging.
In a nutshell, here are the findings:
At the 1 month recording of 160 infants, 36% were placed nonsupine and 28% shared a sleep surface with another individual at some point in the night.
At the 3 month recording (n=151), 35% were placed nonsupine, 22% shared a sleep surface, and 89% slept with loose and/or nonapproved items.
At the 6 month recording (n=147), 44% were placed nonsupine, 16% shared a sleep surface, and 93% slept with loose and/or nonapproved items.
Another interesting finding was that many infants were being moved in the middle of the night, and it was often the second environment that was less safe.
It's worth remembering that the "Back to Sleep" principles originated from case-control studies, a relatively low level of evidence in the hierarchy of study design. However, this evidence ultimately led to a change in recommended infant sleep practices, and subsequently a marked decline in SIDS in the US. This suggests a true cause and effect mechanism and is similar to the circumstances surrounding Reye Syndrome, suspected to be associated with the use of aspirin in children and now almost nonexistent as aspirin use has trickled to nothing.
While some have interpreted Frost's poem as a death wish expression, I side with those who feel that it points out the time we all have to fulfill obligations. Helping our families implement effective preventive health measures is perhaps the highest professional obligation of any child healthcare provider. Now would be a good time to check the new AAP recommendations for safe infant sleeping environments, published after this study appeared, and then renew our efforts to educate our families with newborn infants.
As we celebrate Thanksgiving in the US this week, let's give thanks that we have the privilege and means to improve the lives of children.