Decisions of Black Parents About Infant Bedding and Sleep Surfaces: A Qualitative Study

Abstract

OBJECTIVE: The goal of this qualitative study was to examine factors influencing decisions by black parents regarding use of soft bedding and sleep surfaces for their infants. METHODS: We conducted focus groups and individual interviews with black mothers of lower and higher socioeconomic status (SES). Mothers were asked about many infant care practices, including sleep surface and bedding. RESULTS: Eighty-three mothers were interviewed, 73 (47 lower and 26 higher SES) in focus groups and 10 (7 lower and 3 higher SES) in individual interviews. The primary reason for using soft surfaces was infant comfort. Parents perceived that infants were uncomfortable if the surface was not soft. Many parents also interpreted “firm sleep surface” to mean taut; they were comfortable with and believed that they were following recommendations for a firm sleep surface when they placed pillows/blankets on the mattress as long as a sheet was pulled tautly over the pillows/blankets. The primary reasons for using soft bedding (including bumper pads) were comfort, safety, and aesthetics. In addition to using bedding to soften sleep surfaces, bedding was used to prevent infant rollover and falls, particularly for infants sleeping on a bed or sofa. Some parents used soft bedding to create an attractive space for the infant. CONCLUSIONS: Many black parents believe that soft bedding will keep their infant safe and comfortable. There is much misunderstanding about the meaning of a “firm” sleep surface. Additional educational messages apparently are needed to change parental perceptions and practices.

Nocturnal Video Assessment of Infant Sleep Environments

“…Adult beds frequently have parental bedding (eg, blankets, pillows); in addition, many parents who sleep with their infant use bedding to build a barrier in the belief that the bedding will protect the infant from falling off the bed or from rollover accidents. 16 We also found that the majority of cribs contained soft or loose bedding. Many parents use soft bedding because of concerns about infant warmth and comfort, and to prevent infants from hurting themselves, and they may not be aware that soft bedding in the infant sleep environment creates a hazard.…”

SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment

“…Qualitative studies show that parents who use bedding want to provide a comfortable and safe environment for their infant. 236 For comfort, parents may use blankets to provide warmth or to soften the sleep surface. For safety, parents may use pillows as barriers to prevent falls from adult beds or sofas or as a prop to keep their infant on the side.…”

“…For safety, parents may use pillows as barriers to prevent falls from adult beds or sofas or as a prop to keep their infant on the side. 236 Images of infants sleeping with blankets, pillows, and other soft objects are widespread in popular magazines targeted to families with newborn infants. 237 Parents and caregivers who see these images may perceive the use of these items as the norm, both favorable and the ideal, for infant sleep.…”

Hazardous Bedding in Infants’ Sleep Environment Is Still Common and a Cause for Concern

“…Why do parents feel the need to use soft bedding? Qualitative studies 13 are helpful in this regard. The major reasons for using soft bedding are comfort/warmth and safety.…”

“…If they cover the bedding tightly, so that the covering sheet is taut, they believe that they are following the "firm sleep surface" recommendation, while also making it more comfortable. 13 In addition, parents may be incorrectly interpreting the recommendation against using thick blankets or comforters as meaning only over the infant, rather than under as well.…”