Maternal Assessment of Physician Qualification to Give Advice on AAP-Recommended Infant Sleep Practices Related to SIDS

doi:10.1016/j.acap.2010.08.006

Academic Pediatrics

Volume 10, Issue 6, November–December 2010, Pages 383-388

https://doi.org/10.1016/j.acap.2010.08.006 Get rights and content

Abstract

Objective

The American Academy of Pediatrics (AAP) strongly recommends the supine-only sleep position for infants and issued 2 more sudden infant death syndrome (SIDS) reduction recommendations: avoid bed sharing and use pacifiers during sleep. In this study, we investigated the following: 1) if mothers from at risk populations rate physicians as qualified to give advice about sleep practices and 2) if these ratings were associated with reports of recommended practice.

Methods

A cross-sectional survey of mothers (N=2355) of infants aged <8 months was conducted at Women, Infants, and Children (WIC) Program centers in 6 cities from 2006 to 2008. The predictor measures were maternal rating of physician qualification to give advice about 3 recommended sleep practices and reported nature of physician advice. The dependent measures were maternal report of usage of recommended behavior: 1) “infant usually placed supine for sleep,” 2) “infant usually does not share a bed with an adult during sleep,” and 3) “infant usually uses a pacifier during sleep.”

Results

Physician qualification ratings varied by topic: sleep position (80%), bed sharing (69%), and pacifier use (60%). High ratings of physician qualification were associated with maternal reports of recommended behavior: supine sleep (adjusted odds ratio [AOR] 2.1, 95% confidence interval [CI], 1.6–2.6); usually no bed sharing (AOR 1.5, 95% CI, 1.2–1.9), and usually use a pacifier during sleep (AOR 1.2, 95% CI, 1.0–1.5).

Conclusions

High maternal ratings of physician qualification to give advice on 2 of the 3 recommended sleep practices targeted to reduce the risk of SIDS were significantly associated with maternal report of using these behaviors. Lower ratings of physician qualification to give advice about these sleep practices may undermine physician effectiveness in promoting the recommended behavior.

Section snippets

Study Population

We conducted in-person, semistructured interviews with mothers of infants aged less than 8 months enrolled at Women, Infants, and Children (WIC) Program centers. The WIC Supplemental Nutrition Program is a federally funded program for low-income women who are pregnant, breastfeeding, and/or postpartum and for low-income children aged under 5 years. Study participants were enrolled at 6 sites during the periods June to December 2006, June to September 2007, and July to November 2008. In 2006,

Results

Of the 2355 mothers, 74% were African American, 15% were Latino, and 8% were white (Table 1). The mothers had a mean age of 24 years and the majority, 61%, had a high school education or less.

Major Findings

A substantial majority of our study population of predominantly low-income African American mothers rate their infants’ physicians as highly qualified to give advice about sleep position. More moderate majorities rate physicians as qualified to give advice about bed sharing and pacifier use. The majority of mothers reported that they had received no advice about bed sharing or pacifier use, identifying an important gap in the receipt of physician advice in these 2 areas. Pacifier use was an

Conclusion

This study suggests that not all mothers believe their infants’ physicians are qualified to give advice about the 3 sleep practices associated with SIDS risk reduction: sleep position, bed sharing, and pacifier use. This may lead mothers to ignore or discount advice they believe is beyond the scope of physicians’ expertise, presenting a barrier to adoption of recommended sleep practices and the subsequent reduction in risk of SIDS. These findings suggest that physicians may not always be the

Acknowledgments

This study was supported by the National Institute of Child Health and Human Development grant U10 HD029067–14, awarded to Michael Corwin, MD. For their assistance in completing this project, we thank the following WIC center staff: Janet Bedsole and the staff at the Bessemer Health Center WIC center in Birmingham, Ala; Karen Newsome, Joyce Deveraux, and the staff at the Lancaster-Kiest and West Ledbetter WIC centers in Dallas, Tex; Constance Adair and the staff at the Herman Kiefer Health

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PreventionMaternal Assessment of Physician Qualification to Give Advice on AAP-Recommended Infant Sleep Practices Related to SIDS

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Study Population

Results

Major Findings

Conclusion

Acknowledgments

Quickstats: leading causes of neonatal and postnatal deaths–United States, 2002

MMWR

Infant, neonatal, postneonatal deaths, percent of total deaths, mortality rates for 15 leading cause of infant death by race and sex, United States, 2006

American Academy of Pediatrics AAP Task Force on Infant Positioning and SIDS: positioning and SIDS

Pediatrics

Infant sleep position and risk for sudden infant death syndrome: report of meeting held January 13 and 14, 1994, National Institutes of Health, Bethesda, MD

Pediatrics

Infant sleep position and sudden infant death syndrome (SIDS) in the United States: joint commentary from the American Academy of Pediatrics and selected agencies of the federal government

Pediatrics

Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study

JAMA

Infant sleep placement after the back to sleep campaign

Pediatrics

Infant sleep position: a telephone survey of inner-city parents of color

Pediatrics

Task Force on Sudden Infant Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk

Pediatrics

Trends and factors associated with infant sleeping position: the National Infant Sleep Position Study 1993–2007

Arch Pediatr Adolesc Med

Prevalence and predictors of the prone sleep position among inner-city infants

JAMA

Trends and predictors of infant sleep positions in Georgia, 1990 to 1995

Pediatrics

Widening social inequalities in risk for sudden infant death syndrome

Am J Public Health

The contribution of prone sleeping position to the racial disparity in sudden infant death syndrome: the Chicago Infant Mortality Study

Pediatrics

Secular changes in sleep position during infancy: 1995–1998

Pediatrics

Barriers to following the supine sleep recommendation among mothers at four centers for the Women, Infants, and Children Program

Pediatrics

Prevention
Maternal Assessment of Physician Qualification to Give Advice on AAP-Recommended Infant Sleep Practices Related to SIDS