Find Established Evidence

NPM: 7-1: Child Safety/Injury (0-9 years) 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Training (Parent/Family), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Provision of Safe Sleep Item
Intervention Description: The purpose was to describe participants’ knowledge and intentions regarding safe sleep following a Community Baby Shower.
Conclusion: Our Baby Showers were attended by the target audience, who exhibited high levels of safe sleep knowledge, and stated intentions to utilize most safe sleep recommendations following the Shower. However, some participants were resistant to following at least some of the recommendations. Additional venues and other educational strategies may be needed to maximize the uptake of these recommendations.
Study Design: Survey following Baby Shower
Setting: Community Baby Showers
Target Audience: 60% AA women
Data Source: Survey
Sample Size: 364 participants
Age Range: Infant

NPM: 7-1: Child Safety/Injury (0-9 years) 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider)
Intervention Description: A Safe Sleep Toolkit was developed to improve consistency in safe sleep communication between health providers and parents. The toolkit was implemented at two resident physician clinics, obstetric and pediatric, and included: 1) parent checklist regarding sleep position, location, environment, and intentions to share information; 2) a brief health care provider script; and 3) nationally available resources.
Study Design: Completion of checklist at clinic visit
Setting: Obstetric and pediatric clinics
Target Audience: Expectant and new parents
Data Source: Checklist
Sample Size: 309 parents
Age Range: Infant

NPM: 7-1: Child Safety/Injury (0-9 years) 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Presentation/Meeting/Information Session/Event, CAREGIVER, Provision of Safe Sleep Item
Intervention Description: The purpose of this study was to test the effectiveness of a wearable blanket versus a control item to increase safe sleep practices among parents at a pediatric resident clinic.
Study Design: RCT
Setting: Pediatric continuity clinic that serves mostly state-insured patients.
Target Audience: Parents of infants
Data Source: Survey at baseline and 2-month clinic visit
Sample Size: 152 participants
Age Range: Infant

NPM: 7-1: Child Safety/Injury (0-9 years) 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Presentation/Meeting/Information Session/Event, Notification/Information Materials (Online Resources, Information Guide)
Intervention Description: To evaluate whether an educational video would impact infant sleep practices among new mothers.
Conclusion: Given the potentially fatal consequence of unsafe sleep, a brief video provided by nursing staff can be a prudent component of new parent education.
Study Design: Before-and-after study design (with historical and concurrent controls and a 2-month prospective intervention)
Setting: Maternity ward
Target Audience: Parents of newborns
Data Source: Self-administered survey
Sample Size: Intervention n=43 Control n=49
Age Range: Infant

NPM: 7-1: Child Safety/Injury (0-9 years) 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Training (Parent/Family), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Sleep Environment Modification, PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Nurse/Nurse Practitioner, Guideline Change and Implementation
Intervention Description: We evaluated a comprehensive hospital-based infant safe sleep education program on parental education and safe sleep behaviors in the home using a cross-sectional survey of new parents at hospital discharge (HD) and 4-month follow-up (F/U).
Conclusion: Reinforcing the infant sleep safety message through intensive hospital-based education improves parental compliance with sudden infant death syndrome risk reduction guidelines.
Study Design: Quasi-experimental nonequivalent control group design
Setting: Hospital, postpartum maternity units
Target Audience: Nurses + New parents
Data Source: Cross-sectional survey of parents at time of hospital discharge and at 4-month well-child visit
Sample Size: 1,092 in hospital sample 490 at 4-month follow-up
Age Range: Infant

NPM: 7-1: Child Safety/Injury (0-9 years) 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PROVIDER/PRACTICE, Nurse/Nurse Practitioner, Provider Training/Education, Educational Material (Provider)
Intervention Description: The purpose of this study was to improve sleep position and environment in the hospital.
Conclusion: Using a multifaceted approach significantly improved infant safe sleep practice in the hospital setting.
Study Design: Pre-post intervention
Setting: Wesley Medical Center postpartum units
Target Audience: Nursing staff and mothers of infants
Data Source: Observation of sleep environment in hospital; follow-up parent survey
Sample Size: Baseline in hospital n=144 Post-intervention in hospital n=249 Parent survey n=101
Age Range: Infant

NPM: 7-1: Child Safety/Injury (0-9 years) 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, CAREGIVER, Educational Material (caregiver), Provider Training/Education, Nurse/Nurse Practitioner, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital)
Intervention Description: The authors describe a 4-year demonstration project (2004-2007) to reduce infant deaths related to sleep environments by changing attitudes and practices among nurses who work with African American parents and caregivers in urban Michigan hospitals.
Conclusion: Following the policy change effort, nurses changed their behavior and placed infants on the back to sleep.
Study Design: QE: pretest-posttest
Setting: 7 maternity wards in urban hospitals in MI
Target Audience: Nursing staff and parents
Data Source: Crib audit; infant observation
Sample Size: Baseline: n=579 Follow-up: n=692
Age Range: Infant

NPM: 7-1: Child Safety/Injury (0-9 years) 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Policy/Guideline (Hospital), Quality Improvement, Continuing Education of Hospital Providers, Sleep Environment Modification, PROVIDER/PRACTICE, Nurse/Nurse Practitioner, Provider Training/Education, CAREGIVER, Educational Material (caregiver)
Intervention Description: The dual aims of this project were to develop a safe sleep educational model for our neonatal intensive care unit (NICU), and to increase the percentage of eligible infants in a safe sleep environment.
Conclusion: With formal staff and family education, optional wearable blanket, and data sharing, safe sleep compliance increased and patient safety improved.
Study Design: QE: pretest-posttest
Setting: NICU
Target Audience: Neonatal nurses; staff Parents of newborns
Data Source: Crib audit/infant observation
Sample Size: 28 families at baseline 26 families at follow-up
Age Range: Infant

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): Mini Grants, Policy/Guideline (State)
Intervention Description: The Maternal and Child Health Bureau of the Health Resources and Services Administration led a 21-month visioning process to engage input from MCH stakeholders and other national, state and local MCH leaders, families and other partners to improve, innovate, and transform the Title V MCH Services Block Grant. The process has helped inform the development of a new grant guidance for the next 5-year cycle beginning in fiscal year 2016. The triple aims of the transformation are to reduce burden, maintain flexibility, and increase accountability.
Primary Outcomes: N/A
Conclusion: Accountability is increased through the new three-tiered performance measurement framework, which will help States tell a more coherent and compelling story about the impact of Title V on the health of the Nation’s mothers, children, and families. The ultimate success of the transformation will be measured by how much the transformed Title V program moves the needle in MCH in the States and for the Nation.
Study Design: Visioning process
Significant Findings: N/A
Setting: N/A
Data Source: N/A
Sample Size: N/A
Age Range: N/A

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Sleep Environment Modification
Intervention Description: N/A
Primary Outcomes: Infant usually placed to sleep in the supine position.
Conclusion: Since 2001 supine sleep has reached a plateau, and there continue to be racial disparities in both sleep practice and death rates. There have been changes in factors associated with sleep position and maternal attitudes about issues such as comfort and choking concerns may account for much of the racial disparity in practice. To decrease SIDS, we must ensure that public health measures reach the populations at risk and include messages that address concerns about infant comfort or choking in the supine position.
Study Design: National Infant Sleep Position Study (NISP): Annual nationally representative telephone surveys.
Significant Findings: Yes
Setting: 48 contiguous states of the United States.
Data Source: Interviews
Sample Size: N/A
Age Range: N/A

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): Sleep Environment Modification
Intervention Description: N/A
Primary Outcomes: N/A
Conclusion: The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment," which is included in this issue.
Study Design: N/A
Significant Findings: N/A
Setting: N/A
Data Source: N/A
Sample Size: N/A
Age Range: N/A

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): Sleep Environment Modification
Intervention Description: N/A
Primary Outcomes: N/A
Conclusion: N/A
Study Design: N/A
Significant Findings: N/A
Setting: N/A
Data Source: searched PubMed for articles in English published between 1980 and January 2015 using the search terms “sudden infant death syndrome”, “SIDS”, and “cot death”.
Sample Size: N/A
Age Range: N/A

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Sleep Environment Modification
Intervention Description: The objective of this study was to examine the association between the perceptions of inner city parents about teaching and modeling during the postpartum period of infant sleeping position, and their choice of sleeping position for their infants.
Primary Outcomes: N/A
Conclusion: Perceptions by parents of instructions from a doctor or a nurse of the position in which the infants were placed in the nursery were associated with the position parents reported placing their infants to sleep at home. Efforts to promote the supine sleeping position in the inner-city setting should address both practices and education provided to parents in the nursery during the postpartum hospital stay and should be sufficiently powerful to align their perceptions of the postpartum experience with current American Academy of Pediatrics recommendations.
Study Design: Survey based on a convenience sample
Significant Findings: Yes
Setting: Urban Primary Care Center
Data Source: A convenience sample of parents of 100 healthy infants who came for the 2-week well-child visit at an urban primary care center were invited to complete a questionnaire and to report on the position in which infants were placed for sleep.
Sample Size: 100 healthy infants
Age Range: Infants 2 weeks old

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Quality Improvement/Practice-Wide Intervention, Sleep Environment Modification
Intervention Description: (1) Determine the prevalence of maternal trust in advice sources on infant care practices; (2) Investigate the association of maternal and infant characteristics with trust in advice sources on infant care practices. Using probability sampling methods, we recruited mothers from 32 U.S. maternity hospitals with oversampling of Black and Hispanic women resulting in a nationally representative sample of mothers of infants aged 2-6 months. Survey questions assessed maternal trust in advice sources (physicians, nurses, family, friends, and media) regarding infant care practices including infant sleep practices (sleep position, bed sharing, and pacifier use), feeding, and vaccination.
Primary Outcomes: N/A
Conclusion: for Practice Maternal trust in advice about infant care practices varied significantly by source. A better understanding of which advice sources are most trusted by mothers, as well as the factors associated with maternal trust, may guide the development of more effective strategies to improve adherence to health promoting infant care practices.
Study Design: Survey
Significant Findings: Yes
Setting: Maternity Hospitals
Data Source: Recruited Mothers from Maternity Hospitals
Sample Size: N/A
Age Range: N/A

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): Access, Sleep Environment Modification
Intervention Description: The risk for sudden infant death syndrome in black infants is twice that of white infants, and their parents are less likely to place them in the supine position for sleep. We previously identified barriers for parents to follow recommendations for sleep position. Our objective with this study was to quantify these barriers, particularly among low-income, primarily black mothers.
Primary Outcomes: N/A
Conclusion: We identified specific barriers to placing infants in the supine position for sleep (lack of or wrong advice, lack of trust in providers, knowledge and concerns about safety and comfort) in low-income, primarily black mothers that should be considered when designing interventions to get more infants onto their back for sleep.
Study Design: Survey
Significant Findings: Yes
Setting: Women, Infants, and Children Program centers in Boston, Massachusetts, Dallas, Texas, Los Angeles, California, and New Haven, Connecticut.
Data Source: Participant Testimony
Sample Size: 671 mothers
Age Range: N/A

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): Group Education, Access, Community-Based Group Education, Sleep Environment Modification
Intervention Description: To investigate, by using qualitative methods, beliefs among African-American and American Indian families about infant safe sleep practices, barriers to acceptance of prevention recommendations, and more effective messaging strategies.
Primary Outcomes: N/A
Conclusion: Adherence with safe sleep recommendations may be enhanced if health care providers and educational materials discussed rationale underlying recommendations and addressed common parental concerns. It may be beneficial to target educational interventions towards fathers, as they may be untapped sources in implementing safe sleep practices.
Study Design: N/A
Significant Findings: Yes
Setting: Focus Groups
Data Source: Mother and supporters participating in focus groups
Sample Size: 73 participants
Age Range: Mean age for the participants was 24.9 years for the mothers and 30.7 years for the supporters, and mean age for the children was 5.6 months for both groups.

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): Group Education, Sleep Environment Modification, Training (Parent/Family)
Intervention Description: Eighty-three mothers participated in focus groups or individual interviews. Questions probed reasons for infant sleep position decisions and influences on decision making.
Primary Outcomes: N/A
Conclusion: African American mothers are generally aware of the Back to Sleep recommendation. However, many may not believe that the supine position is the safest position. Other mothers may use the prone position because of infant comfort or parent's need for longer sleep. Trust in the pediatrician may not be sufficient reason for parents to use the supine position.
Study Design: N/A
Significant Findings: N/A
Setting: Washington, DC, and Maryland
Data Source: Mother interview
Sample Size: 83 mothers
Age Range: parents with infants 0 to 6 months of age

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): Family-Based Interventions, Access, Sleep Environment Modification
Intervention Description: This study was intended to better understand how low-income, African-American mothers understand and act upon safe sleep recommendations for newborns and how providers counsel these mothers. We conducted focus groups with 60 African-American, low-income, first-time mothers and telephone interviews with 20 providers serving these populations to explore provider counseling and patient decision making.
Primary Outcomes: N/A
Conclusion: We suggest that counseling strategies should be adapted to: (1) provide greater detailed rationale for SIDS prevention recommendations; and (2) incorporate or acknowledge familial and cultural preferences. Ignoring the reasons for sleep decisions by African-American parents may perpetuate ongoing racial/ethnic disparities in SIDS.
Study Design: N/A
Significant Findings: N/A
Setting: Georgia
Data Source: Mother interview
Sample Size: 80 mothers
Age Range: Parents of infants less than 6 months

NPM: 5: Safe Sleep
Intervention Description: N/A
Primary Outcomes: N/A
Conclusion: N/A
Study Design: N/A
Significant Findings: N/A
Setting: N/A
Data Source: N/A
Sample Size: N/A
Age Range: N/A

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): Sleep Environment Modification
Intervention Description: Healthy, term newborns were recruited for a parent study examining the role of parenting in the development of nighttime infant sleep patterns. For 1 night at ages 1, 3, and 6 months, video recordings were conducted within family homes. Videos were coded for sudden infant death syndrome risk factors in post hoc secondary analyses after the parent study was completed.
Primary Outcomes: N/A
Conclusion: Most parents, even when aware of being recorded, placed their infants in sleep environments with established risk factors. If infants were moved overnight, the second sleep environment generally had more hazards.
Study Design: Parent Study
Significant Findings: Yes
Setting: N/A
Data Source: Video of infants, recorded by families
Sample Size: 160 infants
Age Range: 1-6 months