Standardized Survey Promotes Disclosure of Unsafe Sleep Practices

By Anne Harding

July 05, 2019

NEW YORK (Reuters Health) - Asking more specific questions can increase new mothers' disclosure of sleep practices deemed unsafe, according to new research.

Mothers were more likely to disclose co-sleeping and other practices to a research assistant (RA) who used a structured 18-question survey than to their pediatricians, who did not use a standardized approach, Patricia Mahoney of the Johns Hopkins Center for Injury Research & Policy in Baltimore, Maryland, and colleagues found.

"Pediatric primary-care providers have so many demands on their time in the clinical setting. Our research shows that when they ask about infant sleep safety, their questions often aren't phrased in a way that promotes disclosure of unsafe sleep practices," Mahoney told Reuters Health in an email.

Sleep-related infant deaths have declined in the general population, but the risk is still high for African-American infants from low-income families, Mahoney and her team write in JAMA Pediatrics, online their July 1.

As part of a larger research study by the Johns Hopkins Bloomberg School of Public Health, the Center for Injury Research and Policy, and the Johns Hopkins School of Medicine/Department of Pediatrics, 46 African American mothers were asked about infant sleep practices during a visit with their pediatrician, by a RA using the structured survey, and by a health educator who delivered a safe-sleep intervention.

Mothers were most likely to disclose unsafe sleep practices to the RA, the authors found. Thirty percent reported co-sleeping during the structured survey, 13% disclosed co-sleeping to the health educator, but none disclosed co-sleeping to the pediatrician.

"We used a simple questionnaire (a standardized assessment) that revealed more details about unsafe sleep practices relative to the provider-parent interaction," Mahoney said. "We believe that currently available technology, like Electronic Medical Records (EMRs) and smartphone apps, holds the promise of improving provider knowledge about unsafe sleep practices and thus increasing appropriate safe-sleep guidance during office visits."

Parents could complete an assessment the night before an appointment using a smartphone, she added, or another option would be to provide a laptop or tablet to the parent when they check in.

"We would like to pilot test a digital self-administered safe-sleep assessment in a pediatric care setting to assess the impact of such an assessment on provider knowledge of parental unsafe sleep practices, safe-sleep guidance given during the office visit, and parental behaviors following safe-sleep guidance," Mahoney said.

"Pediatric primary-care providers play a crucial role in supporting parents' health and safety practices," she added. "It is important that providers - especially in newborn well child visits - stress the importance of safe sleep practices to parents and others who care for newborns. Our research team is committed to finding ways that make following safety behaviors easier for parents of infants and children."


JAMA Pediatr 2019.