VANCOUVER, British Columbia — Adherence to safe sleep practices, such as placing an infant on his or her back and sleeping in a separate bed, varies by ethnic group and region of the United States, according to a survey of 32 maternity hospitals.

The numbers suggest that safe sleep practices might be plateauing, but there remains room for improvement. "It reinforces that we're kind of stuck where we are and we may need to think about moving forward in different ways," said investigator Eve Colson, MD, professor of pediatrics at the Yale School of Medicine in New Haven, Connecticut.

She presented the survey results here at the Pediatric Academic Societies and Asian Society for Pediatric Research Joint Meeting.

Current recommendations from the American Academy of Pediatrics call for putting an infant to sleep on his or her back and in a separate bed, ideally in the same room as the caretaker.

Overall, 18.5% of the mothers reported sharing a bed with their infants; among Hispanic mothers, this rose to 28.0%. Regionally, women in the West were more likely to cosleep.

In addition, 10.3% of mothers put their infants to sleep on their stomachs; among black mothers, this rose to 22.0%. Regionally, women in the South were more likely to put infants to sleep on their stomachs.

Previous studies have shown similar trends, but they were based on telephone interviews, not a representative sample of the overall population in the United States. By recruiting from maternity hospitals, we hoped "to get a broader representation, and we set out to target specific populations that we did not have a lot of data on," Dr. Colson reported.

The researchers recruited 1276 mothers from January, 2011 to February 2013; 1030 (81%) completed the online or telephone follow-up survey when the infant was 2 to 6 months of age.

In the study cohort, 61% of the women were white, 13% were black, and 26% Hispanic, which is similar to national breakdown, according to Dr. Colson. Maternal age was 14 to 19 years for 8% of the women, 20 to 24 years for 24%, 25 to 29 years for 29%, and 30 years and older for 36%. More than half of the women (57%) were married.

Infants in the South were more likely to sleep on their stomachs than in the West (14% vs 9%). Sharing a bed was more common in the West than in the overall population (26% vs 19%).

Table. Sleep Behaviors by Ethnic Group

Group Shared Bed Infant on Back Infant on Stomach
Overall 18.5 72.3 10.3
White 13.7 75.4 10.4
Black 18.4 58.0 21.6
Hispanic 28.0 69.9 7.1


Dr. Colson was asked whether breast-feeding mothers are more likely to share a bed with their infants. "I think they're inter-related, but I don't know that we understand it fully," she responded. "We'd like to find a way to put out recommendations that we know will be safer but not have an impact on something else that is very important, such as breast-feeding," she explained.

"There remain questions about how mothers can best follow safe sleeping recommendations when they're breast-feeding their infants, said Ardythe Morrow, PhD, professor of pediatrics, nutrition, and environmental health at the University of Cincinnati.

"Nationally, that needs to be much better developed as a strategy, and the needs and perspectives of breast-feeding mothers need to be better attended to. It's not simply about trying to convince the mother, we also need to enable her," she told Medscape Medical News.

In fact, it's possible that breast-feeding advocacy is working counter to the recommendation that infants not sleep in the same bed as the mother.

"There is a belief that breast-feeding is easier when cobedding," said Sunah Hwang, MD, a neonatologist at Boston Children's Hospital, who presented research during the same session.

"Many breast-feeding advocates actually support cobedding to increase breast-feeding rates. We're at a point where there is some tension between adhering to safe sleep practices and promotion of breast-feeding in some communities," she told Medscape Medical News.

A side car infant bed or cosleeper, which attaches to the adult bed but keeps the infant separate, is a convenient compromise for mothers who breast-feed, Dr. Morrow explained. The solution is promising, but has not been well studied: "I think very little has been done to help enable that," said Dr. Morrow.

In the research Dr. Hwang presented, black and Hispanic mothers were less likely to put infants on their backs, and preterm infants were less likely to sleep on their backs than term infants.

Dr. Colson, Dr. Morrow, and Dr. Hwang have disclosed no relevant financial relationships.

Pediatric Academic Societies (PAS) and Asian Society for Pediatric Research (ASPR) Joint Meeting: Abstract 1690.4. Presented May 3, 2014.


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