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Good Intentions but Low Adherence for Safe Sleep Guidelines

Good Intentions but Low Adherence for Safe Sleep Guidelines 1024 585 JoAnna Pendergrass, DVM

Although mothers are aware of the Safe Sleep Guidelines developed by the American Academy of Pediatrics, they frequently deviate from them to try to help their babies sleep better and longer.

Research recently published in Pediatrics and conducted by Lara B. McKenzie, MA, PhD, FAAHB, principal investigator in the Center for Injury Research and Policy at Nationwide Children’s Hospital, and her team revealed the tension mothers feel between following Safe Sleep guidelines established by the American Academy of Pediatrics (AAP) and getting their babies to sleep.

The guidelines, known as the ABCs (Alone, Back, Crib) of Safe Sleep, aim to reduce the risk of sudden and unexpected infant death (SUID).

Although guideline awareness is high, adherence remains stubbornly low.

From November 2022 to March 2023, the researchers interviewed 25 mothers via five 90-minute virtual focus groups (VFGs). Eligible mothers had infants younger than 6 months old and placed them in a non-recommended sleep position or location at least twice in the past week.

The mothers completed surveys on their demographics and infant’s sleep. VFG transcripts were analyzed to extract major themes. Most of the mothers were White and were married or living with a partner. The infants woke up approximately twice per night and napped about three times a day.

Five major themes arose from the VFGs:

  1. Universal knowledge of the AAP Safe Sleep guidelines. All mothers were aware of the guidelines via multiple sources.
  2. Challenges regarding infant sleep. One mother noted, “He doesn’t want to just lay down on his crib or bed or wherever I try to let him sleep. So, I have to hold him.”
  3. Deviations from the ABCs. “Moms deviate from the guidelines to help their infants sleep,” says Dr. McKenzie. Deviations included placing the infant in a non-recommended sleep location, such as the couch.
  4. Justifications for not following the ABCs. The mothers believed the guidelines were unrealistic. Some followed alternative sleep guidelines, while others prioritized minimizing lesser sleep-related injury risks.
  5. Low self-efficacy with getting the infant to sleep following the guidelines. “If I had to follow the [guidelines]…I don’t think she would get much sleep, nor would I, so I don’t feel confident in that,” noted one mother.

Mothers were generally unconcerned about SUID risk. “There may be some distance between recognizing what the guidelines are for and SUID’s relative rarity,” explains Dr. McKenzie.

“Our group wants to help parents bridge the gap between understanding the guidelines and implementing them to help their babies sleep soundly,” she says.

Dr. McKenzie explains that she and her team plan to combine safe sleep education with preventive sleep education, which is reportedly effective in improving infant sleep.

“We recognize the extreme challenge mothers face in helping their infants sleep,” says Dr. McKenzie. “Our ultimate goal is to help babies sleep safely and soundly, ensuring that babies and their families get adequate sleep.”

This article also appears in the Fall/Winter 2024 print issue. Download the full issue.

 

Reference:

Moon RY, Mindell JA, Honaker S, Keim S, Roberts KJ, McAdams RJ, McKenzie LB. The tension between AAP Safe Sleep Guidelines and infant sleep. Pediatrics. 2024:153(4).

Image credit: Adobe Stock

About the author

JoAnna Pendergrass

JoAnna Pendergrass, DVM, is a veterinarian and freelance medical writer in Atlanta, GA. She received her veterinary degree from the Virginia-Maryland College of Veterinary Medicine and completed a 2-year postdoctoral research fellowship at Emory University’s Yerkes Primate Research Center before beginning her career as a medical writer.

As a freelance medical writer, Dr. Pendergrass focuses on pet owner education and health journalism. She is a member of the American Medical Writers Association and has served as secretary and president of AMWA’s Southeast chapter.

In her spare time, Dr. Pendergrass enjoys baking, running, and playing the viola in a local community orchestra.

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