Parental decision making about safer sleep practices: A qualitative study of the perspectives of families with additional health and social care needs

PLoS One. 2024 Mar 8;19(3):e0298383. doi: 10.1371/journal.pone.0298383. eCollection 2024.

Abstract

Introduction: Despite a decline in Sudden Unexpected Death in Infancy in the UK since 2004, inequalities have widened with higher rates among families from deprived backgrounds and those known to child protection services. Almost all cases involve parents who had engaged in unsafe sleeping practices despite awareness of safer sleeping advice.

Objective: To understand the perspectives surrounding safer sleep of families supported by statutory child protection agencies, and use behavior change theory to inform how approaches to providing safer sleep advice to these families may be modified.

Participants and setting: We interviewed 14 mothers, 2 fathers and one grandmother, who had recent contact with child protection services in northeast England.

Methods: In-depth, semi-structured interviews, with purposive sampling. The COM-B model (Capability, Opportunity, and Motivation) structured our analysis.

Results: Parents described how anxiety, sleep deprivation, settling infants, illness, and a desire to bond with infants influence their decision making about sleep. Parents valued credible, trusted sources and understanding how safer sleep practices protect infants. Responses to questions about 'out of routine' situations suggested social pressures surrounding routines and 'good parenting' may preclude parents from acknowledging risks and planning for these situations.

Conclusion: Open conversations tailored to the needs of families, focused upon understanding why and when parent(s) do or do not follow safer sleep guidance seem a promising way of promoting safer sleep practices. Safer sleep discussions with these families are likely to be best delivered as part of wider infant care by professionals who have an established and continuing trusting relationship with parents. While advice and information should be provided by any professional in contact with the family with the necessary expertise, sensitive conversations around sleeping practices, particularly co-sleeping, may be more easily facilitated by professionals where the statutory responsibility for safeguarding is less apparent.

MeSH terms

  • Child
  • Decision Making
  • Female
  • Humans
  • Infant
  • Mothers*
  • Parents*
  • Sleep
  • Social Support

Grants and funding

This study is funded by the National Institute for Health and Care Research (NIHR) through the Children and Families Policy Research Unit. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Hannah Cann is supported by a NIHR Local Authority Short Placement Award and NIHR Pre-doctoral Fellowship Award. Ruth McGovern is funded by multiple grants awarded by NIHR and MRC. She also holds a substantive role with North-East North Cumbria Clinical Research Network as the Associate Lead for Social Care Research. Anna Pease, Research Fellow, is funded via an NIHR Advanced Fellowship (NIHR300820). The funders or sponsors did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.