Approximately 3,500 infants die unexpectedly in the United States each year due to Sudden Unexpected Infant Death (SUID). Research suggests that SUID can be prevented by following infant safe sleep practices, which include supine sleeping position, room sharing but no bed sharing, and avoidance of soft and loose bedding in a crib. Nationwide prevention efforts, such as the Back to Sleep campaign, led to a significant decrease in SUID rates in the U.S. during the 1990s. The decrease has, however, stagnated in recent years. One of the strategies to decrease the SUID rates further is to focus on the use of unsafe items in an infant’s sleep area. Items such as loose blankets, pillows, stuffed animals, and crib bumpers were found to increase the risk of accidental suffocation and SUID. However, the risks associated with the use of these items have not been emphasized in previous prevention efforts. Indeed, studies have found that over 50% of caregivers report placing these items in their infants’ cribs. The present study examined if a comprehensive, multi-level, SUID preventive intervention is effective in promoting the use of firm sleep surface and removing unsafe items from a sleeping environment.
Using a prospective longitudinal design, the Longitudinal Infant and Family Environment (LIFE) Study interviewed a sample of 497 participants (56.5% African American) recruited at the mother-infant unit of an urban university medical center. The present study evaluated the effectiveness of LIFE intervention, which was designed to decrease SUID in urban low-income communities. The LIFE intervention includes: (a) online psychoeducation focused on infant safe sleep and safe home environments, (b) distribution of baby boxes to families, and (c) postpartum home visits by pediatric nurses. Surveys focused on safe sleep practices, and knowledge of SUID risk factors were collected before (baseline) and after the preventive intervention (7-day follow-up).
At baseline, 67% of participants intended to use potentially dangerous items, including blankets, pillows/cushions/toys, and crib bumpers, in their infant’s sleep area. The number of participants who reported using these items significantly decreased to 57% after the intervention (7-day follow-up). Results of the McNemar's test showed statistically significant decreases in the use of blankets (p < .001), pillows/cushions/toys (p < .001), and crib bumpers (p = .001), as well as all observed items (p < .001). The changes in the use of unsafe items were more pronounced among African Americans (N = 279) than Whites (N = 150).
Discussion and implications
The current study revealed a need to promote recommendations to remove unsafe items from an infant’s sleep area. This recommendation has not been emphasized in SUID prevention programs as much as safe sleep positions and locations. Therefore, caregivers may not be aware that these items present a suffocation risk for infants. The LIFE intervention led to a significant reduction in the use of unsafe items. Thus, the comprehensive, multi-level, SUID preventive intervention can be effective in decreasing the use of unsafe items in an infant’s sleep environment and potentially preventing SUID cases.