Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Understanding the barriers and facilitators to safe infant sleep for mothers of preterm infants

Journal of Perinatology volume 41, pages 1992–1999 (2021)Cite this article

Subjects

Abstract

Objective

To identify barriers and facilitators to adherence to safe sleep practices (SSP) among mothers of preterm infants using qualitative methodology.

Design

We conducted 23 in-depth interviews in English or Spanish with mothers of preterm infants who were recently discharged from four hospitals, utilizing a grounded-theory approach and framework of the Theory of Planned Behavior (attitudes, perceived control, social norms).

Results

For attitudes, mothers’ fear about their infants’ vulnerable preterm state related to suffocation, apnea of prematurity, and reflux influenced infant sleep practices. For social norms, education received in the NICU and advice from other health care providers, family, friends, and media impacted their choices. For perceived control, mothers adapted infant sleep practices to meet their own needs and address the perceived safety and comfort of infants.

Conclusion

Factors identified that influence maternal decision-making about infant sleep practices can inform interventions to address sudden unexpected infant death reduction in preterm infants.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final Data for 2018. Natl Vital- Stat Rep. 2019;68:1–47.

    PubMed  Google Scholar 

  2. Malloy MH. Prematurity and sudden infant death syndrome: United States 2005-2007. J Perinatol. 2013;33:470–5.

    Article  CAS  Google Scholar 

  3. Prevention CfDCa. Sudden Unexpected Infant Death and Sudden Infant Death Syndrome. https://www.cdc.gov/sids/about/index.htm. Accessed 1 June, 2020.

  4. Kochanek KD, Murphy SL, Xu J, Tejada-Vera B. Deaths: final Data for 2014. Natl Vital- Stat Rep. 2016;65:1–122.

    PubMed  Google Scholar 

  5. Moon RY. Task Force On Sudden Infant Death S. SIDS and Other Sleep-Related Infant Deaths: evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 2016;138:e20162940. https://doi.org/10.1542/peds.2016-2940.

  6. Colson ER, Rybin D, Smith LA, Colton T, Lister G, Corwin MJ. Trends and factors associated with infant sleeping position: the national infant sleep position study, 1993-2007. Arch Pediatr Adolesc Med. 2009;163:1122–8.

    Article  Google Scholar 

  7. Colson ER, Willinger M, Rybin D, Heeran T, Smith LA, Lister G, et al. Trends and factors associated with infant bed sharing, 1993-2010: the National Infant Sleep Position Study. JAMA Pediatr. 2013;167:1032–7.

    Article  Google Scholar 

  8. Hirai AH, Kortsmit K, Kaplan L, Reiney E, Warner L, Parks SE, et al. Prevalence and Factors Associated With Safe Infant Sleep Practices. Pediatrics. 2019;144:e20191286. https://doi.org/10.1542/peds.2019-1286.

  9. Hwang SS, Lu E, Cui X, Diop H, Barfield WD, Manning SE. Home care practices for preterm and term infants after hospital discharge in Massachusetts, 2007 to 2010. J Perinatol. 2015;35:880–4.

    Article  CAS  Google Scholar 

  10. Hwang SS, Smith RA, Barfield WD, Smith VC, McCormick MC, Williams MA. Supine sleep positioning in preterm and term infants after hospital discharge from 2000 to 2011. J Perinatol. 2016;36:787–93.

    Article  CAS  Google Scholar 

  11. Ajzen I. The Theory of Planned Behavior. In: Organizational Behavior and Human Decision Processes. 1991;50:179–211. https://doi.org/10.1016/0749-5978(91)90020-T.

  12. Smith LA, Geller NL, Kellams AL, Colson ER, Rybin DV, Heeren T, et al. Infant Sleep Location and Breastfeeding Practices in the United States, 2011-2014. Acad Pediatr. 2016;16:540–9.

    Article  Google Scholar 

  13. Colson ER, Geller NL, Heeren T, Corwin MJ. Factors Associated With Choice of Infant Sleep Position. Pediatrics. 2017;140:e20170596. https://doi.org/10.1542/peds.2017-0596.

  14. HR B. Research methods in anthropology: qualitative and quantitative approaches. 3rd edn. Walnut Creek, CA: Altamira; 2002.

  15. Denzin N, Kal YS. The sage handbook of qualitative research. 3rd edn. SAGE Publications, Thousand Oaks, CA; 2006.

  16. Colson ER, Levenson S, Rybin D, Calianos C, Margolis A, Colton T, et al. Barriers to following the supine sleep recommendation among mothers at four centers for the Women, Infants, and Children Program. Pediatrics. 2006;118:e243–50.

    Article  Google Scholar 

  17. Oden RP, Joyner BL, Ajao TI, Moon RY. Factors influencing African American mothers’ decisions about sleep position: a qualitative study. J Natl Med Assoc. 2010;102:870–2, 875–80.

    Article  Google Scholar 

  18. Pease A, Ingram J, Blair PS, Fleming PJ. Factors influencing maternal decision-making for the infant sleep environment in families at higher risk of SIDS: a qualitative study. BMJ Paediatr Open. 2017;1:e000133.

    Article  Google Scholar 

  19. Ajao TI, Oden RP, Joyner BL, Moon RY. Decisions of black parents about infant bedding and sleep surfaces: a qualitative study. Pediatrics. 2011;128:494–502.

    PubMed  PubMed Central  Google Scholar 

  20. Hwang SS, Rybin DV, Heeren TC, Colson ER, Corwin MJ. Trust in Sources of Advice about Infant Care Practices: the SAFE Study. Matern Child Health J. 2016;20:1956–64.

    Article  Google Scholar 

  21. Moon RY, Hauck FR, Colson ER, Kellams AL, Geller NL, Heeren T, et al. The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices: a Randomized Clinical Trial. JAMA. 2017;318:351–9.

    Article  Google Scholar 

  22. Gelfer P, Cameron R, Masters K, Kennedy KA. Integrating “Back to Sleep” recommendations into neonatal ICU practice. Pediatrics. 2013;131:e1264–70.

    Article  Google Scholar 

  23. Hwang SS, O’Sullivan A, Fitzgerald E, Melvin P, Gorman T, Fiascone JM. Implementation of safe sleep practices in the neonatal intensive care unit. J Perinatol. 2015;35:862–6.

    Article  CAS  Google Scholar 

  24. Hwang SS, Melvin P, Diop H, Settle M, Mourad J, Gupta M. Implementation of safe sleep practices in Massachusetts NICUs: a state-wide QI collaborative. J Perinatol. 2018;38:593–9.

    Article  Google Scholar 

  25. Allen EC, Manuel JC, Legault C, Naughton MJ, Pivor C, O’Shea TM. Perception of child vulnerability among mothers of former premature infants. Pediatrics. 2004;113:267–73.

    Article  Google Scholar 

  26. Culley BS, Perrin EC, Chaberski MJ. Parental perceptions of vulnerability of formerly premature infants. J Pediatr Health Care. 1989;3:237–45.

    Article  CAS  Google Scholar 

  27. McCormick MC, Shapiro S, Starfield B. Factors associated with maternal opinion of infant development-clues to the vulnerable child? Pediatrics. 1982;69:537–43.

    CAS  PubMed  Google Scholar 

  28. Aitken ME, Rose A, Mullins SH, Miller BK, Nick T, Rettiganti M, et al. Grandmothers’ Beliefs and Practices in Infant Safe Sleep. Matern Child Health J. 2016;20:1464–71.

    Article  Google Scholar 

  29. Gershon NB, Moon RY. Infant sleep position in licensed child care centers. Pediatrics. 1997;100:75–8.

    Article  CAS  Google Scholar 

  30. Lagon E, Moon RY, Colvin JD. Characteristics of Infant Deaths during Sleep While Under Nonparental Supervision. J Pediatr. 2018;197:57–62 e36.

    Article  Google Scholar 

Download references

Funding

National Institute of Child Health and Human Development (1R01HD095060-01; to MP and SH).

Author information

Authors and Affiliations

  1. Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA

    Sunah S. Hwang

  2. Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA

    Margaret G. Parker

  3. Slone Epidemiology Center, Boston University School of Medicine, Boston, MA, USA

    Margaret G. Parker & Emma S. Forbes

  4. Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, USA

    Bryanne N. Colvin & Eve R. Colson

  5. Graduate School of Social Work, Colorado School of Public Health, Aurora, CO, USA

    Kyria Brown

Authors
  1. Sunah S. Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Margaret G. Parker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bryanne N. Colvin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emma S. Forbes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kyria Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eve R. Colson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sunah S. Hwang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hwang, S.S., Parker, M.G., Colvin, B.N. et al. Understanding the barriers and facilitators to safe infant sleep for mothers of preterm infants. J Perinatol 41, 1992–1999 (2021). https://doi.org/10.1038/s41372-020-00896-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-020-00896-5

This article is cited by

Search

Advanced search

Quick links