Decision-making for the infant sleep environment among families with children considered to be at risk of sudden unexpected death in infancy: a systematic review and qualitative metasynthesis

Abstract

BackgroundAdvice to families to sleep infants on their backs, avoid smoke exposure, reduce excess bedcovering and avoid specific risks associated with cosleeping has greatly reduced sudden unexpected death in infancy (SUDI) rates worldwide. The fall in rates has not been equal across all groups, and this advice has been less effective for more socially deprived families. Understanding decision-making processes of families with infants at risk would support the development of more effective interventions.AimTo synthesise the qualitative evidence on parental decision-making for the infant sleep environment among families with children considered to be at increased risk of SUDI.MethodsThis study was one of three related reviews of the literature for the Child Safeguarding Practice Review Panel’s National Review in England into SUDI in families where the children are considered at risk of harm. A systematic search of eight online databases was carried out in December 2019. Metasynthesis was conducted, with themes extracted from each paper, starting with the earliest publication first.ResultsThe wider review returned 3367 papers, with 16 papers (across 13 studies) specifically referring to parental decision-making. Six overall themes were identified from the synthesis: (1) knowledge as different from action; (2) external advice must be credible; (3) comfort, convenience and disruption to the routine; (4) plausibility and mechanisms of protection; (5) meanings of safety and risk mitigation using alternative strategies; and (6) parents’ own expertise, experience and instincts.ConclusionInterventions that are intended to improve the uptake of safer sleep advice in families with infants at risk of sleep-related SUDI need to be based on credible advice with mechanisms of protection that are understandable, consistent with other sources, widened to all carers of the infant and fit within the complex practice of caring for infants.

Pēpē‐infant sleep practices and sudden unexpected death in infancy in Aotearoa New Zealand

“…As bed sharing is not a simple pēpē care practice, advice to avoid bed sharing is ineffective, and may be dismissed by parents as being culturally irrelevant 3 . Advice must come from a trusted source to be credible to parents, and when parents understand the mechanisms by which safe sleep is protective, they are more likely to adopt new practices 22 …”

Material Appropriation for Infant Mortality Reduction: Troubling the discourse

“…The use of baby boxes in England could be critiqued as one of many ‘quick fixes’ in a National Health Service looking to avoid financial distress (Kmietowicz, 2014) whilst still delivering health improvements (reduced infant mortality, increased safer sleep practices, better parenting) that it alone cannot possibly achieve, and this negates the possibilities for incorporation and transformation . Whilst incorporation of public health messages into parenting practices may occur through this vehicle, our concern is that in the absence of embedded cultural context this becomes a set of technocratic professionalized rules by which to parent that promotes professional allegiances (Davis-Floyd et al, 2009) with little investment from families in any form of transformation in parenting practices which may seem inappropriate to their cultural context and easily ignored when routines suddenly change- a key factor noted in SUDI deaths (Pease et al, 2021).…”

“…The systematic literature review (Pease et al, 2020) accompanying the DfE Review and subsequent papers (Garstang et al, 2021) focused on three areas of literature: parental decision-making (Pease et al, 2021), interventions and service engagement strategies (Garstang et al, 2021). The review concluded that whilst information about safe sleep is widely available to families, an approach to engagement needs to acknowledge the ecological contexts and constraints within which family life occurs.…”

Bed-sharing and SIDS: an evidence-based approach

“…In 2014, NICE conducted a thorough review of the relationship between SIDS and co-sleeping and issued recommendations that moved SIDS messaging in the UK towards informed parental choice, the 2014 guidance was superseded in 2021 5. A systematic review of the qualitative evidence has shown, for a variety of reasons, many parents felt the previous long-standing SIDS guidance issued by Department of Health ( Reduce the Risk ) was intended for other families, but not them, and parents objected to the authoritative tone of SIDS reduction guidance that advised what to do—but did not offer parents’ explanations as to why 6…”