Original Article

Disparities in Sleep Position Awareness and Compliance

Authors: Anne H. Zachry, PhD, OTR/L, Katherine M. Kitzmann, PhD


Objectives: To identify demographic predictors of caregivers who are more likely to position their infants prone for sleep; to determine caregivers' primary information sources regarding sleep position recommendations; and to determine the primary influence on choice of infant sleep position among caregivers who still place their infants in an at-risk sleep position when informed of the recommendations.

Methods: Survey of caregivers of 205 infants from birth to 24 months at 2 rural and 2 urban private pediatric practices in Southwest Tennessee.

Results: Income was a significant predictor (P < 0.05) of caregivers' awareness of sleep position recommendations. Awareness rates were 74% among respondents with an income of less than $20,000 and 98% among those earning above $80,000. The primary source of sleep position recommendations for lower income and African American respondents was hospital staff; higher income and European Americans reported printed materials as the primary source. Among respondents who were aware of the recommendations but noncompliant, 60% reported infant preference as the primary influence on choice of sleep position.

Conclusions: Based on this study, particular emphasis needs to be placed on reaching out to lower income groups to disseminate the American Academy of Pediatrics (AAP) sleep positioning recommendations. The importance of positioning infants supine for sleep must be stressed before mother and baby are discharged from the hospital. Caregivers need to understand that many infants prefer to sleep on their stomachs, but there are ways to help babies adapt to supine sleeping.

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