Nighttime parenting strategies and sleep-related risks to infants.

A large social science and public health literature addresses infant sleep safety, with implications for infant mortality in the context of accidental deaths and Sudden Infant Death Syndrome (SIDS). As part of risk reduction campaigns in the USA, parents are encouraged to place infants supine and to alter infant bedding and elements of the sleep environment, and are discouraged from allowing infants to sleep unsupervised, from bed-sharing either at all or under specific circumstances, or from sofa-sharing. These recommendations are based on findings from large-scale epidemiological studies that generate odds ratios or relative risk statistics for various practices; however, detailed behavioural data on nighttime parenting and infant sleep environments are limited. To address this issue, this paper presents and discusses the implications of four case studies based on overnight observations conducted with first-time mothers and their four-month old infants. These case studies were collected at the Mother-Baby Behavioral Sleep Lab at the University of Notre Dame USA between September 2002 and June 2004. Each case study provides a detailed description based on video analysis of sleep-related risks observed while mother-infant dyads spent the night in a sleep lab. The case studies provide examples of mothers engaged in the strategic management of nighttime parenting for whom sleep-related risks to infants arose as a result of these strategies. Although risk reduction guidelines focus on eliminating potentially risky infant sleep practices as if the probability of death from each were equal, the majority of instances in which these occur are unlikely to result in infant mortality. Therefore, we hypothesise that mothers assess potential costs and benefits within margins of risk which are not acknowledged by risk-reduction campaigns. Exploring why mothers might choose to manage sleep and nighttime parenting in ways that appear to increase potential risks to infants may help illuminate how risks occur for individual infants.

Sudden Infant Death Syndrome (SIDS) risk reduction and infant sleep location - moving the discussion forward.

The notion that infant sleep environments are 'good' or 'bad' and that parents who receive appropriate instruction will modify their infant-care habits has been fundamental to SIDS reduction campaigns. However infant sleep location recommendations have failed to emulate the previously successful infant sleep position campaigns that dramatically reduced infant deaths. In this paper we discuss the conflict between 'safeguarding' and 'well-being', contradictory messages, and rejected advice regarding infant sleep location. Following a summary of the relevant background literature we argue that bed-sharing is not a modifiable infant-care practice that can be influenced by risk-education and simple recommendations. We propose that differentiation between infant-care practices, parental behaviors, and cultural beliefs would assist in the development of risk-reduction interventions. Failure to recognize the importance of infant sleep location to ethnic and sub-cultural identity, has led to inappropriate and ineffective risk-reduction messages that are rejected by their target populations. Furthermore transfer of recommendations from one geographic or cultural setting to another without evaluation of variation within and between the origin and destination populations has led to inappropriate targeting of groups or behaviors. We present examples of how more detailed research and culturally-embedded interventions could reorient discussion around infant sleep location.