Physicians at Monroe Carell Jr. Children’s Hospital at Vanderbilt are seeking ways to prevent sudden unexpected infant death (SUID), which remains a leading cause of mortality for U.S. infants under one year of age.
“Working in the emergency department, we end up seeing a decent number of SUID cases, with children brought in after having been found passed away in the crib,” said Tom Gilmartin, M.D., a pediatric emergency medicine fellow at Vanderbilt. “I felt drawn to take a look at how we could potentially prevent some of these cases. We typically just see it on the back end, when it’s too late.”
Gilmartin began by assessing safe-sleep knowledge and practices among parents of young infants in the emergency department to understand why gaps were occurring between parents’ understanding of infant sleep precautions and what happens in the crib or bassinet.
Approximately 3,500 U.S. infants die of sleep-related deaths annually – a number that’s remained relatively stagnant since the turn of the century. This follows a steep decline in cases throughout the 1990s that is largely attributed to the national “Back to Sleep” campaign, which has since been revised as “Safe to Sleep” to accommodate evolving recommendations, such as bedding type and room temperature in addition to preferred back-sleeping position.
Given the success of the original campaign, Gilmartin expected parents would retain some knowledge of safe-sleep guidelines, which include additional precautions.
“We kind of expected that families in general knew more about safe sleep than they have in the past, given the creative push over the past decades to get this information out,” he said.
All Call Survey
Together with his mentor at Vanderbilt, Donald Arnold, M.D., and co-fellow researcher Jessica Hayes, M.D., Gilmartin designed a simple, quantitative survey to measure parental knowledge of the latest safe-sleep recommendations from the American Academy of Pediatrics. The survey also included questions about sleep practices in the home.
Gilmartin administered the oral survey to 200 parents who had brought a young infant along to the emergency department for reasons unrelated to sleep.
“The biggest surprise what just how much of a gap there was between a parent’s knowledge versus what they were actually doing.”
“The biggest surprise was just how much of a gap exists between a parent’s knowledge versus what they were actually doing,” Gilmartin said.
For five out of six safe-sleep recommendations assessed, parental knowledge ranked higher than compliance ratings. When asked if they should avoid soft or loose objects in the infant bed, as one example, nearly 90 percent of parents agreed – yet only 65 percent said that they comply with this admonition.
Open Discussion Key
The researchers provided a handout to parents after completing the survey that provided additional information about safe-sleep practices. They also discussed safe-sleep recommendations with parents, which Gilmartin believes is an important step.
“Some families were pretty open and honest, saying things like, ‘I’m aware of these recommendations, but for my child, I feel they don’t sleep very well when placed on their back,’” Gilmartin said. “So, in that moment, we were able to provide a little information and talk about why we were so concerned about it.
“For some of those families, they’d say ‘I didn’t realize it was that big of a deal, or that this big of an issue was still going on.”
Opportunities in Primary Care
Gilmartin said the next step is to better engage parents in the primary-care setting and the newborn nursery, the main locations where parents said they received information about safe sleep.
The researchers suggest motivational interviewing in those settings might clarify why a parent isn’t following a particular recommendation.
“We haven’t budged on SUID rates in 20 years,” he said.
“We were wondering, is that because families aren’t practicing this, or because they don’t know? Finding out there was a significant gap there is pretty helpful as far as moving forward to where we can maybe cut into those rates and make improvements.
“Now, we need to figure out where this gap is coming from, and if there is more specific education we can offer that family to fill it in.”
The researchers presented their findings at the VUMC Department of Pediatrics 2024 Research Retreat.
