The main finding of our study is that the majority of the 1,400 families surveyed in our birth cohort followed the pivotal recommendations for SIDS prevention during the first year of life of their infants. This was especially true of recommendations to let infants sleep in their parents’ bedrooms and use sleeping bags instead of blankets. However, we also observed a significant proportion of infants placed in a regular or preferably prone position for sleep. Bed-sharing with an adult was practiced in a significant part of the family.
The majority of parents are well-informed about measures to prevent SIDS and, as a result, will most likely follow these recommendations.8The current study was able to show that parents not only know the recommendations until the first year of life, but also seem to follow them largely. Notably, most infants initially slept in their parents’ bedroom, but slowly moved to their own room during her first year. Also note that most infants were provided with sleeping bags instead of loose blankets. This finding is consistent with her Shapiro-Mendoza who reported a marked tendency towards blanket use.13Regarding other loose items for infants’ beds, the most frequent items were the baby’s bed and nursing pillow (U-shaped pillow), and approximately 20% of the infants put them to sleep. Although the exact risks posed by such pillows are still unknown, there have been several reported cases of sudden infant death of unknown cause in this connection.14 Guidelines do not recommend its use1In general, don’t put loose objects on the bed that risk impeding the baby’s breathing.
To our knowledge, no studies have ever determined an association between bedside sleepers and SIDS risk.Therefore, there is no evidence of a clear recommendation, and therefore the SIDS Task Force American Academy of Pediatrics Neither for nor against the use of bedside sleepers1German national guidelines on SIDS prevention do not mention bedside sleepers4,5An update to the corresponding German SIDS guidelines was published during the birth cohort recruitment periodFourHowever, there are no relevant changes compared to previous versions with respect to the parameters evaluated in the current paperFiveAt least in the United States Consumer Product Safety Commission Issue safety standards for bedside sleepers15As bedside sleepers appear to become the most common bedroom furniture for infants (at least in our study area), further epidemiological studies of their impact on SIDS are urgently needed.
Unlike bedside sleepers, data on bed-sharing and SIDS are available, and some studies have shown an increased risk of SIDS in infants who share beds with adults.16,17especially in the context of alcohol or drug use, or in special situations such as sleeping on the couch18As a result, most (but not all) current guidelines in Western countries discourage sharing a bed with an adult. In particular, German guidelines state thatFour, which is relevant to our research population.However, the topic is the subject of ongoing scientific debate, with other authors highlighting even more important aspects of bed-sharing.19For example, promoting breastfeeding, bonding aspects, and improving infant-parent triad sleep quality. Some authors do not view bed-sharing as a modifiable risk factor in the proper sense that could be affected by simple recommendations.20 Suggest a balanced approach through parental counselingtwenty one. However, the purpose of our present study was not to question the content of guidelines currently applicable to the study population, but to determine actual implementation by families.
Previous studies have shown that most parents are well aware that current SIDS guidelines discourage bed-sharing with adults, and intend to follow the corresponding recommendation of not bed-sharing with infants. It turns out there is.8Shortly before their first discharge from the maternity ward, only 2% of mothers interviewed said their child was allowed to sleep in the parent’s bed on a regular basis. However, current analysis of actual practice indicates a substantial gap between intentions and actual behavior, with only about one-third of families surveyed sharing a bed with an infant. are not practiced at all. These observations are consistent with Stromberg et al.Bed-sharing was common, with up to 25% of infants under 3 months of age reporting sleeping almost exclusively in their parent’s bed.twenty twoIn our current study, two-thirds of all infants slept with their parents’ bed for at least some time. Considering potential social desirability biases, this rate could be even higher. A sub-analysis of migration balances sheds light on aspects of interest in this context. Bed-sharing was the only sleeping furniture with a positive net balance for all other items, but in summary, we observed a particularly pronounced net transfer from ‘own baby’s bed’. I was. From birth to 4 weeks of age, “co-sleeping”. Although an investigation of parents’ motivations for this behavior was not part of the current study, other authors analyzed the reasons for bed-sharing.19 It turns out that the ease of nighttime childcare and breastfeeding is a big point. Whether the use of bedside sleepers makes a difference in this respect, leading to more stable avoidance of bed sharing, can only be speculated and should be addressed in future research.
In summary, we must admit that the majority of parents in our sample (and many others) are unwilling to follow current guidelines regarding bed sharing. Evaluation of possible reasons for this deviation from official advice was not part of our study, but at least a significant association between bed sharing and breastfeeding provides an important partial explanation. In general, when considering bed-sharing data, it is important to recognize that the survey sample does not represent populations at high risk for SIDS, such as low birth weight infants or premature infants. . Whether future recommendations for parents of such aggregations should be revised toward risk-based recommendations rather than more decisive ones for bed-sharing is a subject of scientific debate. Given that two-thirds of the families participating in our survey apparently did not follow the blanket recommendation not to share beds, it seems unlikely that current counseling practices are working. am. Future research will need to clarify whether more targeted approaches, focusing on specific high-risk infants, are more effective overall. Regardless, all parents should be educated about the potential benefits and risks of bed-sharing from a medical professional.
in the Nationwide Infant Sleep Position SurveyColson et al. showed that between 1993 and 2000 there was a continuous increase in the proportion of parents who exclusively put their children to sleep on their backs.twenty threeHowever, since 2001, this trend has plateaued. Although the majority of mothers in our study did not intend to actively put their infants to sleep on their stomachs, the number of infants who actually did sleep on their stomachs increased in the first year of life. At 4 weeks of age, approximately one-third of the infants studied were placed in the prone position occasionally or more frequently. However, occasional prone positioning is of particular concern, as an infant unaccustomed to this position is at particular risk for her SIDS.twenty fourBecause most parents knew SIDS precautions after birth8but their good intentions were not consistently implemented in the first years of their lives.
Among environmental factors for SIDS, exposure to tobacco smoke is an important modifiable risk factor25,26,27A 2012 analysis of a large longitudinal cohort found that 43% of German children under the age of 17 had at least one parent who smoked.28Nearly a quarter of the children in our cohort were born into households with smokers. This reflects that a significant number of infants are still exposed to avoidable risk factors for SIDS. Furthermore, it should be recognized that questions about parental smoking behavior are particularly prone to social desirability bias. Therefore, the actual numbers are likely higher than those reported by parents in this study.
Our study has some limitations. Firstly, parents must have sufficient German language proficiency, which can lead to selection bias.Because ethnic differences can affect family sleep habits29,30,31, studies in different cultural populations may yield different results. Additionally, the KUNO-Kids birth cohort has a majority of highly educated parents.9This situation led to differences in some socioeconomic characteristics between those who dropped out and those who remained in the cohort. Mothers with higher educational attainment, mothers who worked full-time before their children were born, and mothers with no immigration history were more likely to continue participating. Studies (for details see Brandstetter et al.9). Therefore, when interpreting our data, it is important to note that, conversely, families with low socioeconomic status and/or a migrant background are significantly underrepresented. and low socioeconomic status, this aspect should be considered in the context of SIDS prevention.16,32Another limitation of our analysis is the inclusion of primiparous and multiparous women. However, for mothers who already have one older child (or multiple older children), previous exposure to and experience implementing SIDS recommendations may be a significant factor, especially if the mother attempts to follow the guidance. , which may affect its implementation in current children. I’ve found it difficult to do so before. Another point that must be taken into account when interpreting our data is that it is very likely that infants moved from one place to another during the night. In order to be as simple as possible for patients and achieve better quality of responses, this survey focused on asking about the default primary sleeping location where babies sleep most of the time. We may have underestimated the role of some secondary sleep locations (especially during the day), such as Furthermore, the KUNO-Kids birth cohort is a multidisciplinary study covering multiple areas of pediatric health and development, which forced us to limit data collection in the substudy to an appropriate number of items. . Therefore, we focused on important aspects of SIDS prevention, including differences in nighttime and daytime sleep, bed sharing versus smoking, or alcohol consumption. Finally, there was significant family dropout from the postnatal baseline interview to the 1-year questionnaire. This may have further selected the most conscientious families who tended to follow the recommendations. In summary, her actual situation regarding adherence to SIDS prevention recommendations in the first year of life may be even worse than reported in this study.