Objective To determine whether an educational intervention to change nursery practice would result in more inner-city parents placing their infants in the supine position for sleep. Design We conducted semistructured interviews at the 2-week health supervision visit with 1 convenience sample of parents before and a different convenience sample of parents after an educational intervention was conducted to change nursery practice in positioning infants for sleep. Setting University hospital clinic located in an urban setting. Participants Parents of 2-week-old infants at their first health supervision visit in an urban, university-affiliated clinic. All parents who were approached agreed to participate. Intervention Nurses were instructed to place infants exclusively in the supine position in the nursery and to instruct parents to exclusively place infants in the supine sleeping position at home. Main Outcome Measure The usual sleeping position in which parents reported placing their 2-week old infants. Results Before the intervention, 41% of parents reported that a clinician had told them to place their infants to sleep in the supine position compared with 81% after the intervention (odds ratio [OR], 6.1; 95% confidence interval [CI], 3.1-12.3). Before the intervention, 37% of parents reported that the nursery staff placed their infants to sleep in the supine position, compared with 88% after the intervention (OR, 12.5; 95% CI, 5.7-27.7). Before the intervention, 42% of parents reported that they usually placed their infants to sleep in the supine position at home compared with 75% after the intervention (OR, 4.2; 95% CI, 2.1-7.9). Conclusion After an educational intervention to change practice in a well-newborn nursery, many more parents reported placing their infants in the supine position for sleep, which suggests that such an intervention may have an impact on the position in which parents place their children to sleep.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/203592/POA10405.pdf

Changing nursery practice gets inner-city infants in the supine position for sleep

" Background: Although advice from healthcare professionals may influence parental infant placement choice to reduce sudden infant death syndrome risk, literature on nursery staff infant placement behaviors and the degree to which they influence maternal infant sleep positioning is limited. " Objective: To assess newborn placement practices of the mother and nursery staff and their interrelationship in the hospital setting. " Methods: A cross-sectional survey-based study was conducted among hospital newborn nursery staff (n = 96) and mothers of newborns (n = 579) at eight perinatal hospitals in Orange County, California. " Results: Although a majority of sampled nursery staff (72%) identified the supine position as the placement that most lowers sudden infant death syndrome risk, only 30% reported most often placing infants to sleep in that position, with most staff (91%) citing fear of aspiration as the motivation for supine position avoidance. Only 34% of staff reported advising exclusive supine infant positioning to mothers. Approximately 36% of mothers reported using supine infant placement exclusively. Maternal infant placement choice varied by both the advice (p <.01) and the placement modeling (p <.01) provided by staff, with the highest proportion of usual supine infant placement found among mothers who reported receiving both. A mother's race/ethnicity also affected the reception of exclusive supine placement recommendations (p <.01). " Conclusions: Exclusive supine infant placement appears to be underused by both nursery staff and mothers of newborn infants. Culturally grounded educational intervention with nursery staff regarding infant positioning and placement in the hospital setting is indicated.

Infant sleep positioning by nursery staff and mothers in newborn hospital nurseries.

Modifiable infant sleep and care practices are recognised as the most important factors parents and health practitioners can influence to reduce the risk of sleep-related infant mortality. Understanding caregiver awareness of, and perceptions relating to, public health messages and identifying trends in contemporary infant care practices are essential to appropriately inform and refine future infant safe sleep advice. This scoping review sought to examine the extent and nature of empirical literature concerning infant caregiver engagement with, and implementation of, safe sleep risk-reduction advice relating to Sudden Unexpected Deaths in Infancy (SUDI). Databases including PubMed, CINAHL, Scopus, Medline, EMBASE and Ovid were searched for relevant peer reviewed publications with publication dates set between January 2000–May 2021. A total of 137 articles met eligibility criteria. Review results map current infant sleeping and care practices that families adopt, primary infant caregivers’ awareness of safe infant sleep advice and the challenges that families encounter implementing safe sleep recommendations when caring for their infant. Findings demonstrate a need for ongoing monitoring of infant sleep practices and family engagement with safe sleep advice so that potential disparities and population groups at greater risk can be identified, with focused support strategies applied.

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Infant Care Practices, Caregiver Awareness of Safe Sleep Advice and Barriers to Implementation: A Scoping Review

Objective To estimate the occurrence of prone sleep among a group of infants in two inner-city clinics and examine the factors associated with parents' choice of sleep position



Methods A convenience sample of 80 parents (76 mothers and 4 fathers) was interviewed between June and October 1997, during their healthy, term infant's 2-week health supervision visit. The interview included questions about sleep position practices, knowledge, and beliefs; knowledge about Sudden Infant Death Syndrome (SIDS); education about SIDS; and socio-demographic data. All participants received post-interview SIDS education.



Results Thirty-one percent of parents reported that they placed their infants to sleep in the prone position at least some of the time. Factors associated with prone sleeping included prior child-rearing experience (P = 0.005) and the opinion of other people that were regarded as important (P = 0.0001). Only 20% of parents usually had their child sleep on its back. The majority worried that the child would vomit and choke while lying on its back. Parents who chose to position their infant to sleep on its back were less likely to describe themselves as Hispanic (P = 0.025) and more likely to remember being told to have the infant sleep on its back by a health care provider (P = 0.001). Just over one-half of parents recall receiving sleep position instructions from a health care provider. More than 60% of these parents remember being told to place the infant on the side, 24% the back and none prone. Teen parents were more likely to remember being given sleep instructions (P = 0.033). Parents with older children were less likely to remember receiving sleep position instructions (P = 0.001).



Conclusions/implications for practice Many parents in our urban practice still put their children to sleep in the prone position at least some of the time. Family and friends, as well as prior child-rearing experience influence the choice. Parents are more likely to choose the supine position if they are instructed to do so by a health care provider. However, many parents do not recall such instruction being routinely given by their health care provider and have concerns for the safety of supine sleeping. Efforts to promote sleeping on the back should address parental concerns and health care provider practice.

Jessica Payton

Papers

Not yet ‘Back to Sleep’: sleep position for infants in two inner‐city clinics