Factors Influencing Maternal Decision-making for the Infant Sleep Environment in Families at Higher Risk of SIDS: a Qualitative Study

Overview

Journal BMJ Paediatr Open

Publisher BMJ Publishing Group

Specialty Pediatrics

Date 2018 Apr 12

PMID 29637151

Citations 15

Authors

Anna Pease

Jenny Ingram

Peter S Blair

Peter J Fleming

Affiliations

Soon will be listed here.

Abstract

Objective: Qualitative interviews with mothers of babies at higher risk of sudden infant death syndrome (SIDS) were carried out to understand their views and decision-making process on the infant sleep environment and safe sleep messages.

Design And Setting: Twenty semi-structured interviews were conducted between February and November 2014 in deprived areas of Bristol, UK. Mothers were asked about their decision-making for the infant sleep environment and safe sleep messages including infant sleep position, co-sleeping, smoking, dummy use, feeding and disrupted routines. The interviews were transcribed, coded and thematic analysis carried out.

Participants: Participants were invited based on an algorithm developed in a previous SIDS case control study that identified an increased risk of SIDS from four demographic characteristics: young maternal age, smoking during pregnancy, three or more children, and a measure of deprivation. The presence of three, or more characteristics led to being invited to take part in the qualitative study.

Results: Factors influencing mothers' adherence to the safe sleep messages included previous experience and the credibility of the advice given. They described disrupted routines that led to risky scenarios with a belief that occasional risks were acceptable. Where circumstances made following the advice more difficult they found alternative strategies to reduce the risk, including the use of movement monitors, regular checking and a belief that lighter maternal sleep in the presence of a baby was protective.

Conclusions: Safer sleep messages should be tailored to fit with the lived realities of mothers, especially those at higher risk. The traditional list of 'do's' and 'don'ts' was not well accepted by this group. Interventions that seek to influence this higher-risk group should acknowledge mothers' own protective instincts and consider their beliefs and understanding behind the safer sleep messages if they are to be effective and encourage this group to change.

Citing Articles

Baby Sleep Project Protocol: a realist evaluation of an intervention to reduce preventable infant mortality.

Pease A, Lambert B, Ingram J, Bradley N, Fleming P, Blair P BMJ Open. 2025; 15(2):e091414.

PMID: 39947829 PMC: 11831312. DOI: 10.1136/bmjopen-2024-091414.

Safe sleep crib clinics: Promoting risk reduction strategies for sudden unexpected infant death.

Ahlers-Schmidt C, Schunn C, Hervey A, Torres M PEC Innov. 2025; 6():100370.

PMID: 39845574 PMC: 11750555. DOI: 10.1016/j.pecinn.2024.100370.

Parental decision making about safer sleep practices: A qualitative study of the perspectives of families with additional health and social care needs.

Barrett S, Barlow J, Cann H, Pease A, Shiells K, Woodman J PLoS One. 2024; 19(3):e0298383.

PMID: 38457404 PMC: 10923434. DOI: 10.1371/journal.pone.0298383.

A Risk Assessment and Planning Tool to Prevent Sudden Unexpected Death in Infancy: Development and Evaluation of The Baby Sleep Planner.

Pease A, Ingram J, Lambert B, Patrick K, Pitts K, Fleming P JMIR Pediatr Parent. 2024; 7:e49952.

PMID: 38386377 PMC: 10921318. DOI: 10.2196/49952.

Changes in background characteristics and risk factors among SIDS infants in England: cohort comparisons from 1993 to 2020.

Pease A, Turner N, Ingram J, Fleming P, Patrick K, Williams T BMJ Open. 2023; 13(10):e076751.

PMID: 37832988 PMC: 10582842. DOI: 10.1136/bmjopen-2023-076751.

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