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. 2019 Nov;144(5):e20191286.
doi: 10.1542/peds.2019-1286. Epub 2019 Oct 21.

Prevalence and Factors Associated With Safe Infant Sleep Practices

Ashley H Hirai  1 , Katherine Kortsmit  2   3 , Lorena Kaplan  4 , Erin Reiney  5 , Lee Warner  2 , Sharyn E Parks  2 , Maureen Perkins  5 , Marion Koso-Thomas  4 , Denise V D'Angelo  2 , Carrie K Shapiro-Mendoza  2
Affiliations

Prevalence and Factors Associated With Safe Infant Sleep Practices

Ashley H Hirai et al. Pediatrics. 2019 Nov.

Abstract

Objectives: To examine prevalence of safe infant sleep practices and variation by sociodemographic, behavioral, and health care characteristics, including provider advice.

Methods: Using 2016 Pregnancy Risk Assessment Monitoring System data from 29 states, we examined maternal report of 4 safe sleep practices indicating how their infant usually slept: (1) back sleep position, (2) separate approved sleep surface, (3) room-sharing without bed-sharing, and (4) no soft objects or loose bedding as well as receipt of health care provider advice corresponding to each sleep practice.

Results: Most mothers reported usually placing their infants to sleep on their backs (78.0%), followed by room-sharing without bed-sharing (57.1%). Fewer reported avoiding soft bedding (42.4%) and using a separate approved sleep surface (31.8%). Reported receipt of provider advice ranged from 48.8% (room-sharing without bed-sharing) to 92.6% (back sleep position). Differences by sociodemographic, behavioral, and health care characteristics were larger for safe sleep practices (∼10-20 percentage points) than receipt of advice (∼5-10 percentage points). Receipt of provider advice was associated with increased use of safe sleep practices, ranging from 12% for room-sharing without bed-sharing (adjusted prevalence ratio: 1.12; 95% confidence interval: 1.09-1.16) to 28% for back sleep position (adjusted prevalence ratio: 1.28; 95% confidence interval: 1.21-1.35). State-level differences in safe sleep practices spanned 20 to 25 percentage points and did not change substantially after adjustment for available characteristics.

Conclusions: Safe infant sleep practices, especially those other than back sleep position, are suboptimal, with demographic and state-level differences indicating improvement opportunities. Receipt of provider advice is an important modifiable factor to improve infant sleep practices.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Usual safe infant sleep practice prevalence by state, PRAMS, 2016. A, Back sleep position. B, Separate approved sleep surface. C, Room-sharing without bed-sharing. D, No soft objects or loose bedding.
See this image and copyright information in PMC

Comment in

References

    1. US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Child Health USA, 2014. Rockville, MD: U.S. Department of Health and Human Services; 2014
    1. Matthews TJ, MacDorman MF, Thoma ME. Infant mortality statistics from the 2013 period linked birth/infant death data set. Natl Vital Stat Rep. 2015;64(9):1–30 - PubMed
    1. Moon RY; Task Force On Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162940. - PubMed
    1. Erck Lambert AB, Parks SE, Shapiro-Mendoza CK. National and state trends in sudden unexpected infant death: 1990–2015. Pediatrics. 2018;141(3):e20173519. - PMC - PubMed
    1. American Academy of Pediatrics AAP task force on infant positioning and SIDS: positioning and SIDS [published correction for Pediatrics. 1992;90(2 pt 1):264]. Pediatrics. 1992;89(6, pt 1):1120–1126 - PubMed