Unsafe Infant Sleep Practices Common Among New Mothers

Megan Brooks

January 10, 2018

Many new mothers are not getting the message about recommended safe infant sleep practices, which contributes to roughly 3500 sleep-related deaths among US infants each year, federal health officials at the Centers for Disease Control and Prevention (CDC) said on Tuesday.

According to the January 9 Vital Signs report, about 1 in 5 mothers place their infant to sleep in a nonsupine position (on their side or stomach), more than half share a bed with their infant, and more than one third use soft bedding in the infant's sleep environment (such as pillows, blankets, stuffed toys, and bumper pads).  

"This new report shows unsafe sleep practices are common," CDC Director Brenda Fitzgerald, MD, said during a press briefing.  "It is clear that we all have more work to do and everyone has a role to play."

Sudden infant death syndrome (SIDS) and accidental infant suffocation decreased significantly in the 1990s after the national "Back to Sleep" safe sleep campaign. However, "our progress has slowed [and] we need to reinvigorate this important work," said Dr Fitzgerald.

"We must do more to ensure every family knows the American Academy of Pediatrics (AAP) recommendations — babies should sleep on their backs, without any toys or soft bedding, and in their own crib. Parents are encouraged to share a room with the baby, but not the same bed. These strategies will help reduce the risk and protect our babies from harm," she added in a news release.

"We Need to Do Better"

CDC researchers analyzed data from the national Pregnancy Risk Assessment Monitoring System (PRAMS), which monitors self-reported behaviors and experiences before, during, and 2 to 6 months after pregnancy.

In 2015, 21.6% of mothers reported placing their baby to sleep on their side or stomach, 61.4% reported sharing a bed with their baby, and 38.5% reported using any soft bedding in the baby's sleep area, most often bumper pads (19.1%) and plush or thick blankets (17.5%), followed by pillows (7.1%), infant positioners (6.2%), and stuffed toys (3.1%).

The percentage of mothers who reported placing their baby in a nonsupine position to sleep varied by state, ranging from 12.2% in Wisconsin to 33.8% in Louisiana. Placing babies in a nonsupine sleep position was more common among mothers who were non-Hispanic black, were younger than 25, or had 12 or fewer years of education and who were participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).

"The noted variation observed in nonsupine sleep positioning by maternal characteristics is similar to several disparities observed in sleep-related death rates.  Sleep-related infant deaths have been consistently highest among American Indian or Alaska Native followed by non-Hispanic black mothers and those who are aged <20 years and have less education," the authors, led by Jennifer Bombard, MSPH, from CDC's Division of Reproductive Health, note in their report.

Trend data from 15 states show that incorrectly placing infants in a nonsupine sleep position decreased significantly from 27.2% in 2009 to 19.4% in 2015, they say.

Nonetheless, this report shows that "we need to do better at promoting and following safe sleep recommendations," Bombard said in a news release. "This is particularly important for populations where data show infants may be at a higher risk of sleep-related deaths."

During the briefing, Wanda Barfield, MD, MPH, director of CDC's Division of Reproductive Health, suggested that healthcare providers "model safe sleep practices during office visits and after delivery."

Novel methods to boost adherence to safe sleep practices may also help. As reported by Medscape Medical News, a recent randomized controlled trial among postpartum mothers found a 60-day mobile health program significantly improved uptake of safe sleep practices. The mobile health program included sending frequent emails or text messages with short videos related to infant safe sleep practices.

The authors have disclosed no relevant financial relationships.

MMWR Morb Mortal Wkly Rep . Published online January 9, 2018. Full text

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