Table 3 Studies regarding infant sleep safety (Alphabetic ordered after first author)
Study | Aims & participants | Methods | Results | Comments and clinical implications | |
|---|---|---|---|---|---|
1. | Baddock et al. (2019) [46] New Zealand | Investigation of infant physiology and risks and benefits of parent-infant bedsharing. The review included 40 papers reporting on infants aged six month or younger. Studies were published between 1994 and 2017. | A systematic review. Some type of objective data was assessed in 27 papers and subjective data in 32 papers. | Sleep duration was reported in 19 studies. Compared to solitary sleeping, bed-sharing was associated with significantly shorter sleep among infants in six studies, no difference in four and longer sleep duration in two studies. Bed-sharing was associated with slightly higher axillary and skin-temperature and more frequent breastfeeding. Bed-sharing was associated with lower cortisol response to a mild stressor (bath) at five weeks but not later in infancy. | Bedsharing or not Different sleep-arrangements influence infants sensory and physical micro-environment in different ways. Differences related to sleep architecture, infant arousals, infant overnight temperature control, cardiorespiratory responses, breastfeeding duration, sleep position, mother-infant interactions and physiological responses to mild stress. |
2. | Canter et al. (2015) [32] USA | Assess the usefulness of an educational video about infant safe sleep that was tested by 43 new mothers, while 49 new mothers received standard care N = 92 | Prospective, pre- post intervention study. Maternal observations of infant sleep were collected on surveys. | Compared to the standard care-group, video-mothers reported more frequently that they had observed appropriate infant sleep positions in the nursery (67.4% vs. 46.9%,(p < .05). The study did not control for changes in sleep knowledge among health workers in the unit. | Safe infant sleep educational tools The 6 minutes long video focused on (a) avoiding smoke, alcohol, and drugs, (b) the importance of a comfortable sleeping temperature, (c) appropriate dressing and sleep position for babies and d) the ABCs of safe sleeping: alone, on the back and in a crib. |
3. | Cullen et al. (2016) [47] USA | Identify teaching strategies that nurses can use to increase families safe sleep practices. Among 100 studies, 24 papers were selected for intensively review and 14 studies included. | A systematic review and meta synthesis. | Analysis resulted in 14 findings that formed 4 themes. Meta-aggregation resulted in two synthesized outcomes: First, parents practice co-bedding with their infant despite knowledge about the risks and having received teaching. Next, families should receive co-bedding messages tailored to their specific circumstances and risks. | Personalization of safe infant sleep guidance For the first outcome the categories were” Keeping their babies close” and “My grandma says - family traditions”. The second outcome was obtained from two categories that covered seven findings. The categories were “Nurses influencing parenting behavior” and “Modeling ways to reduce risk”. Thus, healthcare workers should be context sensitive and personalize their information. |
4 | Hauck et al. (2015) [48] USA | Description of parental knowledge and practice before and after implementation of an educational program and free crib distribution. N = 3303 (antenatally), 1483 (postnatally) and 1729 at 3 months follow-up. | Prospective cohort study evaluating a program in a high-risk US area. Data collection by surveys developed for this study | Parental knowledge about safe infant sleep increased after receiving a crib (p < 0.001). Intended use of supine position for infant sleep increased from 80% (postnatally) to 87% after receiving a crib (p < 0.001). Unintended bedsharing decreased after participation in the program and 90% reported that the infant slept in the crib after the program compared to 51% before. | Safe infant sleep educational tools The authors state that programs like the BBB should be evaluated on a periodic basis to assure that they positively influence parental knowledge and practices about safe infant sleep. The program focused on sleep position, use of pacifier, bedsharing and feeding practices. |
5. | Kellams et al. (2017) [49] USA | A multisite quality improvement intervention was implemented in 8 US-maternity wards, aiming to improve health professionals’ knowledge and role modeling about infant safe sleep. | A knowledge-campaign lasting for a median of 160 days (range, 101–273) across the 8 units. New mothers answered a survey before discharge from hospital | Mothers who reported receiving information on 4 primary safe sleep topics raised from 72 to 95% of the time (a 24–57% increase over the baseline). Additionally, 93% of infants were observed in a supine sleep position, and 88% of infants were observed in a safe sleep environment (a 24 and 33% increase over baselines). These rates sustained until 12 months later. | Safe infant sleep educational tools The intervention included information on safe sleep positions, absence of objects in sleep environment, introduction of pacifier for sleep once breastfeeding is established and room-sharing without bed-sharing. Tool kit for hospitals: PP, Posters, pocket-sized cards for nurses to use when counseling parents and sample letters to inform hospital leaders. |
6. | Mathews et al. 2016) [50] USA | Can enhanced information reduce the use of soft bedding? Comparison of two groups of African American mothers receiving either standard or enhanced information N = 1194. | A randomized controlled study (RCT). All data are based on self-reports | Across 3 follow-ups (2–3 weeks, 2–3 months and 5–6 months) mothers in the enhanced information group used less soft bedding last night (adj OR = 0.74 (0.58–0.94), p = 0.013, used less soft bedding in the last week (adj OR = 0.70 (0.54–0.90), p = 0.006. More maternal self-efficacy was associated with more frequent inappropriate arrangements. | Soft bedding, personalization of safe infant sleep guidance The study focuses on a group of US-mothers that mostly were unmarried (80%) and in the lower range regarding socio-economic resources (SES). The results may be affected by high attrition rates, only 46% participated at 6 months. Mothers that left the study were younger and with lower SES. |
7. | Mileva-Seitz et al. (2017) [21] The Netherlands | The prevalence of parent-child bed sharing (P-CBS) is investigated across 659 research articles (peer-reviewed, editorial pieces and comments). | A systematic review. | P-CBS was reported in 98 studies. Prevalence ranged from 2.5% in an Australian study to 100% in many African countries. The relation between P-CBS and risks of sudden infant death is investigated and nuanced. The reviewers call for collaboration across different disciplines introducing a new term “psychoanthropediatrics”. | Intentional or reactive bedsharing Some studies focus on the difference between intentional and reactive bed-sharing. Results indicate that intentional bed-sharing parents were more likely to bed-share all night, to endorse and be more satisfied with bed-sharing, while parents of reactive bed-sharers had more often tried a ‘cry-it-out-method’ of sleep training and reported more night-time difficulties. |
8. | Patton et al. (2015) [30] USA | Investigation of whether nurses provide safe sleep environments for infants in a hospital setting Sample sizes ranged from 94 to 5911 nurses and/or other healthcare workers across included studies. Samples of parents ranged from 100 to 671. | An integrative review based on search in multiple databases (1999–2013) 16 studies included. | Four papers discussed nursing knowledge and compliance with safe sleep recommendations. In 12 of the 16 studies incorrect recommendations from nurses were detected. Most nurses are aware of the AAP recommendations but may choose not to follow them consequently due to fear of aspiration. Parental observations mirror these inconsistencies in health workers’ practice: 50% used the side-lying position, 37% the supine position, and 10% a combination of positions. | Safe infant sleep education and role modeling The choices nurses make regarding safe infant sleep practices can influence parental behavior at home. In the included studies some mothers were not even aware of sleep related risk factors. When nurses lack knowledge and their practice is inconsistent, parents may find themselves confused. If parents observe inconsistencies between nurses’ practice and teaching, they may use the positions they observed professionals performed. |
9. | Raines (2018) [31] USA | Investigates which factors that influence on parental behaviors related to newborn safe sleep positions and environments in the home. | Descriptive qualitative study. - qualitative interview conducted by telephone | Participants described three consistent factors that influenced how newborn sleep at home. The most frequently mentioned influence was Other People followed by Nobody/No One and Images from sources such as books, pictures, television, and the Internet. | Safe infant sleep and parental believes Parents need education about the rationale for the AAP safe sleep guidelines and nurses are important in helping them understand AAP recommendations for safe sleep. The images to which parents are exposed send mixed messages. Health care professionals should portray safe sleep for infants in media, marketing materials, and other graphic representations. |
10. | Salm-Ward et al. (2018) [51] USA | A comparison of parental knowledge and use of safe sleep practices after distribution of an educational program and baby cribs. Mothers that either were pregnant in the last trimester or mother of a child less than 3 months old were eligible, N = 132. | A prospective, matched pre- and post-test cohort study with follow-up. Surveys were answered by use of telephone interviews ten weeks after post-test survey. | Participants reported increased knowledge after the program: recommended back position (58.8% at pre-test vs. 96.2% at post-test, p < 0.001); recommended separate surface in parents’ room (53.4 vs. 74.8%, p < 0.001); no soft items (85.9% vs. 96.9%, p = 0.001); smoke exposure increases risk (57.1 vs. 93.7%, p < 0.001); breastfeeding reduces risk (55.8 vs. 82.2%, p < 0.001); back sleep does not increase risk of choking (48.8 vs. 85.6%, p < 0.001); pacifier use decreases risk (9.6 vs. 62.4%, p < .001); always back sleep (76.4% vs. 92.9%, p < 0.001); and infants should sleep on a flat, firm surface (89.1 vs. 98.4%, p = 0.003). | Safe infant sleep education At pre-test, 58.4% of participants reported receiving a health workers advice on sleep position and 40.2% on sleep location. The only informational item that were significantly less known the responders at follow-up compared to the post-test survey was that use of a pacifier decreases the risk of SUID. |
11. | Vilvens et al. (2020) [52] USA | Focus on why parents/ caregivers might fail to practice safe infant sleep arrangements. (N = 124) Parents of infants less than one year were interviewed. | A descriptive, qualitative study based on interviews. Use of ‘pulse interviewing’ -talking with parents at community events in a high-risk US area. | Six themes of underlying reasons why caregivers might not practice safe sleep behaviors were identified and included: (a) culture and family tradition; (b) knowledge about safe sleep practices; (c) resource access; (d) stressed out parents; (e) lack of support; and (f) fear for safety of baby. | Safe infant sleep and parental resources Based on the study information the authors formed five narratives (personas). These learning examples are introduced as resources that may strengthen health workers ability to be context sensitive and personalize their information in communication with new parents about infant sleep safety. |