Rosalind P. Oden

Decisions of Black Parents About Infant Bedding and Sleep Surfaces: A Qualitative Study

OBJECTIVE: The goal of this qualitative study was to examine factors influencing decisions by black parents regarding use of soft bedding and sleep surfaces for their infants. METHODS: We conducted focus groups and individual interviews with black mothers of lower and higher socioeconomic status (SES). Mothers were asked about many infant care practices, including sleep surface and bedding. RESULTS: Eighty-three mothers were interviewed, 73 (47 lower and 26 higher SES) in focus groups and 10 (7 lower and 3 higher SES) in individual interviews. The primary reason for using soft surfaces was infant comfort. Parents perceived that infants were uncomfortable if the surface was not soft. Many parents also interpreted “firm sleep surface” to mean taut; they were comfortable with and believed that they were following recommendations for a firm sleep surface when they placed pillows/blankets on the mattress as long as a sheet was pulled tautly over the pillows/blankets. The primary reasons for using soft bedding (including bumper pads) were comfort, safety, and aesthetics. In addition to using bedding to soften sleep surfaces, bedding was used to prevent infant rollover and falls, particularly for infants sleeping on a bed or sofa. Some parents used soft bedding to create an attractive space for the infant. CONCLUSIONS: Many black parents believe that soft bedding will keep their infant safe and comfortable. There is much misunderstanding about the meaning of a “firm” sleep surface. Additional educational messages apparently are needed to change parental perceptions and practices.

Physician Recommendations Regarding SIDS Risk Reduction: A National Survey of Pediatricians and Family Physicians

Background: Sudden infant death syndrome (SIDS) is a leading cause of death among infants. Recently, new SIDS risk factors have emerged. Objective: To determine knowledge and recommendations of pediatricians and family physicians regarding SIDS-relevant practices. Methods: Cross-sectional survey of 3005 pediatricians and family physicians. Results: Of the 783 respondents, pediatricians comprised 64% and females 52%; 78% recognized supine as the recommended sleep position; 69% recommended supine. Almost all physicians recommended a firm mattress, 82% recommended a crib or bassinet, and 42% recommended a separate room for infants; 63% had no preference about or did not recommend restricting pacifier use. Pediatricians were more likely to discuss infant sleep position and room sharing at every well-child visit. Conclusions: Knowledge about recommended infant sleep position is relatively high, but there are gaps in physician knowledge regarding safe sleep recommendations. Greater dissemination of information is required, and barriers to implementation need to be identified and addressed.

Swaddling Will It Get Babies Onto Their Backs for Sleep

INTRODUCTION The supine sleep position is recommended to reduce sudden infant death syndrome risk. Swaddling may improve adherence with supine placement. AIM To assess knowledge, attitudes, and practice regarding swaddling among adult caregivers of 0- to 3-month-old infants. METHODS Cross-sectional descriptive survey. RESULTS All 103 adults interviewed had swaddled their infant. Common reasons for swaddling included infant comfort and warmth. Almost 80% of those who swaddled their infant found it effective, 80% believed it to be comfortable, and ~90% believed swaddling to be safe. Parents who routinely used swaddling were more likely to find it effective and to place their infant supine when swaddled (P < .01). CONCLUSIONS Parents often use swaddling to comfort the infant, and most find it effective. Parents who routinely use swaddling are more likely to place their infant supine if swaddled. Swaddling may be a strategy for parents of infants who have difficulty sleeping in the supine position.Introduction. The supine sleep position is recommended to reduce sudden infant death syndrome risk. Swaddling may improve adherence with supine placement. Aim. To assess knowledge, attitudes, and practice regarding swaddling among adult caregivers of 0- to 3-month-old infants. Methods. Cross-sectional descriptive survey. Results. All 103 adults interviewed had swaddled their infant. Common reasons for swaddling included infant comfort and warmth. Almost 80% of those who swaddled their infant found it effective, 80% believed it to be comfortable, and ~90% believed swaddling to be safe. Parents who routinely used swaddling were more likely to find it effective and to place their infant supine when swaddled (P < .01). Conclusions. Parents often use swaddling to comfort the infant, and most find it effective. Parents who routinely use swaddling are more likely to place their infant supine if swaddled. Swaddling may be a strategy for parents of infants who have difficulty sleeping in the supine position.

Breastfeeding in African Americans May Not Depend on Sleep Arrangement A Mixed-Methods Study

Background. Despite high bedsharing rates, breastfeeding rates are low among African Americans. Objective. Describe the association between breastfeeding and bedsharing; elucidate barriers to breastfeeding in African Americans. Methods. African American mothers with infants <6 months were recruited for this cross-sectional, mixed-methods study and completed an infant care practices survey. A subgroup participated in focus groups or individual interviews. Results. A total of 412 completed the survey; 83 participated in a focus group or interview. Lower socioeconomic status mothers were more likely to breastfeed exclusively or at all if they bedshared (P = .02 and P = .01, respectively). Bedsharing was not associated with breastfeeding among higher socioeconomic status mothers. Breast pain, lack of support, and maternal skepticism about breastfeeding benefits were barriers; the latter was a recurrent theme among nonbreastfeeding mothers. Conclusions. While bedsharing is associated with breastfeeding in lower socioeconomic groups, it is not in higher socioeconomic African American groups. Skepticism about breastfeeding benefits may contribute to low breastfeeding rates in African Americans.

The Impact of Health Messages on Maternal Decisions About Infant Sleep Position: A Randomized Controlled Trial

Sudden infant death syndrome (SIDS) rates in African-Americans are more than twice national rates, and historically, African-American parents are more likely than other groups to place infants prone, even when they are aware of supine sleep recommendations. Prior studies have shown African-Americans have low self-efficacy against SIDS but high self-efficacy against suffocation. This study aimed to determine the impact of a specific health message about suffocation prevention on African-American parental decisions regarding infant sleep position. We conducted a randomized controlled trial of 1194 African-American mothers, who were randomized to receive standard messages about safe sleep practices to reduce the risk of SIDS, or enhanced messages about safe sleep practices to prevent SIDS and suffocation. Mothers were interviewed about knowledge and attitude, self-efficacy and current infant care practices when infants were 2–3 weeks, 2–3 months and 5–6 months old. Analyses of covariance were conducted to estimate the change in knowledge, attitudes and practice in each group, and chi square tests were used to compare sleep position with each variable. Over the first 6 months, the proportion of African-American infants placed supine gradually decreased and was unchanged by enhanced education about SIDS, suffocation risk and sleep safety. While initially high self-efficacy against SIDS and suffocation correlated with supine positioning, by 5–6 months self-efficacy did not correspond to sleep position in either group.