The American Academy of Pediatrics recommends infants be placed supine for sleep. Our objectives in this study were to, in a nationally representative sample, examine (1) prevalence of maternal intention regarding infant sleeping position and of actual practice and (2) factors associated with their choices.
We recruited mothers from 32 US hospitals, oversampling African American and Hispanic mothers, in a nationally representative sample of mothers of infants aged 2 to 6 months. Survey questions assessed choice of usual infant sleeping position, all sleeping positions, intention for sleep position, as well as actual practice. Multivariable logistic regression analyses controlled for demographic, receipt of doctor advice, and theory of planned behavior variables (attitudes, subjective norms, and perceived control).
Of the 3297 mothers, 77.3% reported they usually placed their infants in the supine position for sleep, but fewer than half reported that they exclusively did so. Only 43.7% of mothers reported that they both intended to and then actually placed their infants exclusively supine. African American mothers and those who did not complete high school were more likely to intend to use the prone position. Theory of planned behavior factors (attitudes, subjective norms, and perceived control) and doctor advice were associated with maternal choice.
Not all mothers place their infants exclusively supine for sleep. Many mothers intend to place their infants supine yet often do not do so in actual practice. Factors potentially amenable to intervention including attitudes, subjective norms, and doctor advice are associated with intention and practice.
Comments
RE: Comment on: Factors Associated With Choice of Infant Sleep Position
Factors Associated With Choice of Infant Sleep Position
Crystal Bent-Taylor
Affiliations: Utica College, Utica, New York
Address correspondence to: Crystal Bent-Taylor, Utica College, School of Health Professions and Education, 1600 Burrstone Road, Utica, NY, 13502, [[email protected]], 315-792-3059
Short title: Factors affecting infant sleep position
Funding Source: No funding was secured for this study.
Financial Disclosure: The author has no financial relationships relevant to this article to disclose.
Potential Conflict of Interest: The author has no conflict of interest to disclose.
Abbreviations: SIDS: Sudden Infant Death Syndrome, AAP: American Academy of Pediatrics
Sudden infant death syndrome is one of the leading causes of death for infants in the United States. To continuously decrease the prevalence of SIDS, in 2005, the American Academy of Pediatrics (AAP) began to advise that infants be solely positioned supine to sleep. Due to the alarmingly frequent rates of SIDS, it is important to find out whether parents and/or caregivers are ensuring that their infant(s) are placed in the safest sleeping position that is recommended.
In this issue of Pediatrics, “Factors Associated With Choice of Infant Sleep Position” by Colson, Geller, Heeren, and Corwin was profoundly interesting. The study reflected the alarming trend of infant mortality caused by sudden infant death syndrome (SIDS). Colson et al. questioned the factors that helped to influence the sleep position the 3,297 participating mothers chose to place their infants (aged two to six months old) in. The factors that were analyzed in the authors study were: maternal race, age, and education, the theory of planned behavior and advice given by a healthcare provider. The sleeping positions examined were: supine, prone, or side lying. In analyzing the factors and choices, the research concluded that “fewer than half [of mothers] chose the supine position exclusively”1.
In 2005, the American Academy of Pediatrics published a clinical report relevant to newly discovered evidence that advised and preferred that infants be placed on their backfor sleep because it significantly lowered the risk of SIDS. In 2013, sudden infant death syndrome was accountable for seven percent of post neonatal deaths becoming the fourth leading cause of infant death . Previously, in 2012, it was the third leading cause2. Despite the AAP’s recommendation and continued awareness by healthcare professionals for infants to be placed only in supine for sleep, sudden infant death syndrome is still an unceasing cause of death and validates that the AAP recommendations are not being adhered to and infants are still being placed prone or on their side.
Rollins (2017) identified the significance of suitable infant sleep concepts such as room sharing. Room sharing allows for infants to sleep within close proximity of their parent(s). Compared to bed sharing, room sharing reduces the likelihood of infant asphyxiation or entanglement within the bedding. As a result of room sharing, the risk for SIDS decreases nearly 50% . In Pediatrics, the authors only examined the positions neonates were placed in for sleep by the mother and/or caregiver(s) and the reasons that influenced the choice of position placement, whereas, an infant’s sleeping environment is an equally integral factor in the prevention and reduction of SIDS-related infant deaths. Furthermore, whether an infant shares a room and/or bed with their parent(s) is too a decision that is influenced by maternal factors, beliefs, norms, and advice from experts in the healthcare field. Another limitation was that the concluding data resulted much from self-reports provided by the participating mothers. The authors of the study reported that 43.7%1 of the mothers positioned their infant in supine to sleep, but there is no indication of verification whether the 43.7%1 of mothers truly placed their child in supine.
It is evident that a vast amount of research exists on infant deaths resulting from SIDS, but this research can be extended. It is significant that doctors and other healthcare professionals educate parent(s)/caregiver(s) on practicing safe sleeping positions with their infant. It is equally significant to examine whether or not parent(s)/caregiver(s) are being informed and conditioned to safely position their child and for the percentage of parent(s)/caregiver(s) that were educated to be reported.
In the near-future, it is important for healthcare providers to inform and discuss the safe sleeping positions for infants should be placed in with parents, so that children will be kept out of harm’s way. The research completed by the authors is proof that the healthcare field needs to constantly create and implement further innovative methods of educating parents, in order to protect children from SIDS.
Colson, ER, Geller, NL, Heeren, T, et al. Factors Associated With Choice of Infant Sleep Position. Pediatrics. 2017;140(3):1-10
Matthews, T, MacDorman, MF, Thoma, ME. Infant Mortality Statistics From the 2013 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports. 2015;54(9):9
Rollins, JA. Sharing a Room: Updated Recommendations for a Safe Infant Sleeping Environment. Pediatric Nursing. 2017;43(1):7