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Barrett S, Barlow J, Cann H, Pease A, Shiells K, Woodman J, McGovern R. 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; 19:e0298383. [PMID: 38457404 PMCID: PMC10923434 DOI: 10.1371/journal.pone.0298383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/23/2024] [Indexed: 03/10/2024] Open
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.
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Affiliation(s)
- Simon Barrett
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Hannah Cann
- Southampton City Council, Civic Centre, Southampton, Hampshire, United Kingdom
| | - Anna Pease
- Bristol Population Health Science Institute, University of Bristol, Bristol, United Kingdom
| | - Kate Shiells
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Jenny Woodman
- Thomas Coram Research Unit, University College London, London, United Kingdom
| | - Ruth McGovern
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
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Al Hariri A. A new technology for pacifier weaning: a thematic analysis. Front Pediatr 2023; 11:1161886. [PMID: 37292379 PMCID: PMC10244660 DOI: 10.3389/fped.2023.1161886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction Babies and toddlers often become accustomed to using baby pacifiers. However, pacifiers may harm children's health and lead to various problems, such as less frequent breastfeeding, shorter breastfeeding duration, dental deformities, tooth decay, recurrent acute otitis media, sleep disorders, and the potential for accidents. This study aims to introduce new technology that may prevent babies from becoming used to a pacifier (patent titled "Prevents Getting Used to Pacifier Baby, Number SA10609, Saudi Authority for Intellectual Property"). This study used a descriptive qualitative design. Methods The participants included three pediatricians, three psychologists, three dentists, three family doctors, and three mothers of babies and toddlers, with a mean age of 42.6 years old (SD = 9.51). Semi-structured interviews were used, and thematic analysis was conducted to generate a thematic tree. Results and Discussion The thematic analysis resulted in three themes: (1) the disadvantages of pacifier use, (2) the introduction of new technology for the patent, and (3) the expectations for this technology. The results showed that a pacifier might negatively affect the health of babies and toddlers. However, the new technology may prevent children from becoming used to pacifiers and protect them from any possible physical or mental issues.
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Infant Care Practices, Caregiver Awareness of Safe Sleep Advice and Barriers to Implementation: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137712. [PMID: 35805369 PMCID: PMC9265757 DOI: 10.3390/ijerph19137712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
Modifiable infant sleep and care practices are recognised as the most important factors parents and health practitioners can influence to reduce the risk of sleep-related infant mortality. Understanding caregiver awareness of, and perceptions relating to, public health messages and identifying trends in contemporary infant care practices are essential to appropriately inform and refine future infant safe sleep advice. This scoping review sought to examine the extent and nature of empirical literature concerning infant caregiver engagement with, and implementation of, safe sleep risk-reduction advice relating to Sudden Unexpected Deaths in Infancy (SUDI). Databases including PubMed, CINAHL, Scopus, Medline, EMBASE and Ovid were searched for relevant peer reviewed publications with publication dates set between January 2000–May 2021. A total of 137 articles met eligibility criteria. Review results map current infant sleeping and care practices that families adopt, primary infant caregivers’ awareness of safe infant sleep advice and the challenges that families encounter implementing safe sleep recommendations when caring for their infant. Findings demonstrate a need for ongoing monitoring of infant sleep practices and family engagement with safe sleep advice so that potential disparities and population groups at greater risk can be identified, with focused support strategies applied.
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Chin S, Carlin R, Mathews A, Moon R. Infant Safe Sleep Practices as Portrayed on Instagram: Observational Study. JMIR Pediatr Parent 2021; 4:e27297. [PMID: 34779783 PMCID: PMC8663591 DOI: 10.2196/27297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Parenting practices are highly influenced by perceived social norms. Social norms and American Academy of Pediatrics (AAP) guidelines for infant safe sleep practices are often inconsistent. Instagram has become one of the most popular social media websites among young adults (including many expectant and new parents). We hypothesized that the majority of Instagram images of infant sleep and sleep environments are inconsistent with AAP guidelines, and that the number of "likes" for each image would not correlate with adherence of the image to these guidelines. OBJECTIVE The objective of this study was to determine the extent of adherence of Instagram images of infant sleep and sleep environments to safe infant sleep guidelines. METHODS We searched Instagram using hashtags that were relevant to infant sleeping practices and environments. We then used an open-source web scraper to collect images and the number of "likes" for each image from 27 hashtags. Images were analyzed for adherence to AAP safe sleep guidelines. RESULTS A total of 1563 images (1134 of sleeping infant; 429 of infant sleep environment without sleeping infant) met inclusion criteria and were analyzed. Only 117 (7.49%) of the 1563 images were consistent with AAP guidelines. The most common reasons for inconsistency with AAP guidelines were presence of bedding (1173/1563, 75.05%) and nonrecommended sleep position (479/1134, 42.24%). The number of "likes" was not correlated with adherence of the image to AAP guidelines. CONCLUSIONS Although individuals who use Instagram and post pictures of sleeping infants or infant sleep environments may not actually use these practices regularly, the consistent portrayal of images inconsistent with AAP guidelines reinforces that these practices are normative and may influence the practice of young parents.
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Affiliation(s)
- Samuel Chin
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Rebecca Carlin
- Department of Pediatrics, Columbia University School of Medicine, New York, NY, United States
| | - Anita Mathews
- Children's National Medical Center, Washington, DC, United States
| | - Rachel Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States
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Pease A, Garstang JJ, Ellis C, Watson D, Ingram J, Cabral C, Blair PS, Fleming PJ. Decision-making for the infant sleep environment among families with children considered to be at risk of sudden unexpected death in infancy: a systematic review and qualitative metasynthesis. BMJ Paediatr Open 2021; 5:e000983. [PMID: 33754131 PMCID: PMC7938979 DOI: 10.1136/bmjpo-2020-000983] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Advice to families to sleep infants on their backs, avoid smoke exposure, reduce excess bedcovering and avoid specific risks associated with cosleeping has greatly reduced sudden unexpected death in infancy (SUDI) rates worldwide. The fall in rates has not been equal across all groups, and this advice has been less effective for more socially deprived families. Understanding decision-making processes of families with infants at risk would support the development of more effective interventions. AIM To synthesise the qualitative evidence on parental decision-making for the infant sleep environment among families with children considered to be at increased risk of SUDI. METHODS This study was one of three related reviews of the literature for the Child Safeguarding Practice Review Panel's National Review in England into SUDI in families where the children are considered at risk of harm. A systematic search of eight online databases was carried out in December 2019. Metasynthesis was conducted, with themes extracted from each paper, starting with the earliest publication first. RESULTS The wider review returned 3367 papers, with 16 papers (across 13 studies) specifically referring to parental decision-making. Six overall themes were identified from the synthesis: (1) knowledge as different from action; (2) external advice must be credible; (3) comfort, convenience and disruption to the routine; (4) plausibility and mechanisms of protection; (5) meanings of safety and risk mitigation using alternative strategies; and (6) parents' own expertise, experience and instincts. CONCLUSION Interventions that are intended to improve the uptake of safer sleep advice in families with infants at risk of sleep-related SUDI need to be based on credible advice with mechanisms of protection that are understandable, consistent with other sources, widened to all carers of the infant and fit within the complex practice of caring for infants.
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Affiliation(s)
- Anna Pease
- Centre for Academic Child Health, University of Bristol Medical School, Bristol, UK
| | - Joanna J Garstang
- Children and Family Services, Birmingham Community Healthcare NHS Trust, Aston, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Catherine Ellis
- Department of Nursing, Midwifery and Health, University of Northumbria at Newcastle, Newcastle upon Tyne, Tyne and Wear, UK
| | - Debbie Watson
- Children and Families Research Centre, School for Policy Studies, University of Bristol, Bristol, UK
| | - Jenny Ingram
- Centre for Academic Child Health, University of Bristol Medical School, Bristol, UK
| | - Christie Cabral
- Centre for Academic Primary Care, University of Bristol Medical School, Bristol, UK
| | - Peter S Blair
- Centre for Academic Child Health, University of Bristol Medical School, Bristol, UK
| | - Peter J Fleming
- Centre for Academic Child Health, University of Bristol Medical School, Bristol, UK
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Riaz R, Ahmed M, Baloch M, Rizvi SAH, Shahid N, Siddiqui FQ, Haq MS, Saleem S. Frequency and Predictors of Pacifier Use in the Low Socioeconomic Group of Karachi, Pakistan: A Cross-Sectional Study. Cureus 2020; 12:e12324. [PMID: 33520522 PMCID: PMC7837666 DOI: 10.7759/cureus.12324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2020] [Indexed: 12/02/2022] Open
Abstract
Background Pacifier use has been popular for ages. They are prevalent all over the world because of their various perceived benefits. On the other hand, there is a common belief that they do carry health risks as well. Due to these contradicting belief systems, the frequency of their use, and the factors that determine them, need to be thoroughly evaluated. Since Pakistan is a developing country with a low literacy rate, it can be implied that a vast majority of the country's population may lack awareness regarding the advantages and disadvantages of pacifier use, making them incapable of weighing associated risks versus benefits. The data evaluating these factors in this region are however scarce in the published literature. We, therefore, aimed to highlight the frequency and predictors of pacifier use in the low socioeconomic group of Karachi, Pakistan. Materials and methods A descriptive, cross-sectional study was conducted on a sample of 300 mothers visiting a tertiary care hospital in Karachi, Pakistan. We included mothers who had at least one child under the age of two years, and whose child did not have any oro-nasal anomaly that could prevent them from sucking a pacifier. Data were collected using pre-tested questionnaires and analyzed using the Statistical Package for Social Sciences (SPSS version 23.0, IBM Corp., Armonk, NY, US). Frequencies were calculated and presented in the form of tables. The chi-square test was used to determine the significance of all categorical variables. A P-value of <0.05 was considered to be statistically significant. Results Almost half of our respondents (49%) gave pacifiers to their children. A significant number (59%) of these mothers were uneducated. Almost all (97%) of the users had annual household income less than 15,000 Pakistani rupees (PKR); 34% were primiparous and more than two-thirds (71%) had a normal vaginal delivery. Out of all the factors, maternal age less than 20, annual household income less than 15,000 PKR, and primiparity were significantly associated with pacifier use in mothers (P<0.05). Only a half of the users (51%) cleaned the pacifiers by boiling; one-fourth (25%) washed it with water only; while 18% washed it with soap and water. The majority (84%) of the mothers used the pacifier to soothe the baby when upset. Among mothers who did not use a pacifier, about a third (30%) did not do so as they believed it's a bad practice. About one-fourth (27%) believed it was unhygienic. Conclusions Our study highlights the gap in the awareness of mothers regarding pacifier use. Using this data, we can target to disseminate specific information to this population to integrate safe and healthy child care habits in society.
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Affiliation(s)
- Ramsha Riaz
- Internal Medicine, Dr Ruth KM Pfau Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Madiha Ahmed
- Medicine, Dr Ruth KM Pfau Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Mariam Baloch
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Syed Asad Hasan Rizvi
- Internal Medicine, Dr Ruth KM Pfau Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Naureen Shahid
- Internal Medicine, Dr Ruth KM Pfau Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Fatima Qadir Siddiqui
- Internal Hospital, Dr Ruth KM Pfau Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Muhammad S Haq
- Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Sania Saleem
- Research and Development, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, King Edward Medical University, Mayo Hospital, Lahore, PAK
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Zavala Abed B, Oneto S, Abreu AR, Chediak AD. How might non nutritional sucking protect from sudden infant death syndrome. Med Hypotheses 2020; 143:109868. [PMID: 32480251 DOI: 10.1016/j.mehy.2020.109868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022]
Abstract
Epidemiology has identified an association between the use of pacifiers and protection from sudden infant death syndrome (SIDS). The use of pacifiers for SIDS prevention fails to gain adoption partly because there is no widely accepted physiologic mechanism to explain the epidemiologic association. Additionally, the scientific literature available on pacifier use focuses largely on the probable adverse effects. We hypothesize that pacifier use and all other forms of non-nutritional sucking (specifically digit sucking, also known as thumb sucking) is a life saving defense mechanism meant to splint open and stabilize the collapsible portion of the upper airway in infants.The main objective of this review article is to propose a mechanism to explain how pacifiers might help prevent SIDS. If the medical community accepts this mechanism, it can help promote pacifier use by the public and potentially reduce the incidence of SIDS.
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Affiliation(s)
- Bruno Zavala Abed
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA; School of Medicine, Health Sciences Faculty, Universidad Catolica "Nuestra Senora de la Asuncion", Asuncion, Paraguay.
| | - Sabrina Oneto
- A.M. Rywlin, M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami, FL, USA; School of Medicine, Health Sciences Faculty, Universidad Catolica "Nuestra Senora de la Asuncion", Asuncion, Paraguay
| | - Alexandre R Abreu
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Alejandro D Chediak
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
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Ekambaram M, Irigoyen MM, Paoletti A, Siddiqui I. Impact of a Baby-Friendly-Aligned Pacifier Policy on Pacifier Use at 1 Month of Age. Acad Pediatr 2019; 19:808-814. [PMID: 30772504 DOI: 10.1016/j.acap.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Pacifier use decreases the risk of sudden infant death syndrome, but its impact on breastfeeding remains controversial. We evaluated the impact of a pacifier policy aligned with the World Health Organization and United Nations Children's Fund Baby-Friendly Hospital Initiative on subsequent pacifier use and breastfeeding at 1 month of age. METHODS We conducted a prospective 2-stage (pre- and post-implementation) cohort study of newborns at a birth hospital before and after implementation of a Baby-Friendly-aligned pacifier policy. Consecutive mothers of newborns admitted to the nursery participated in a telephone survey when the infants were 1 month of age. RESULTS In total, 342 mothers participated (190 before and 152 after implementation of the policy). Pacifier adoption was delayed in the post-implementation group, but pacifier use by 1 month of age was comparable (78.9% pre-implementation vs 77.6% post-implementation; P = .793). In the pre-implementation group, female and male infants used pacifiers at comparable rates; however, in the post-implementation group, females were significantly less likely to use a pacifier compared to males after controlling for insurance, race, parity, and delivery mode (adjusted odds ratio, 0.35; 95% confidence interval, 0.15-0.83; P = .02). In the post-implementation group, exclusive breastfeeding rates at discharge increased significantly (from 40% to 51.3%; P = .04), but rates were not different at 1 month (23.7% pre-implementation vs 24.3% post-implementation; P = .89). CONCLUSION A Baby-Friendly-aligned pacifier policy delayed pacifier adoption but did not impact overall pacifier use or breastfeeding rates at 1 month of age. The finding of lower pacifier use rates among female infants post-intervention requires verification in other populations before evaluating public heath relevance.
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Affiliation(s)
- Maheswari Ekambaram
- Department of Pediatric and Adolescent Medicine, Einstein Medical Center Philadelphia, Philadelphia, Penn Dr. Ekambaram is now with Baylor Scott & White Medical Center, Round Rock, Tex
| | - Matilde M Irigoyen
- Department of Pediatric and Adolescent Medicine, Einstein Medical Center Philadelphia, Philadelphia, Penn Dr. Ekambaram is now with Baylor Scott & White Medical Center, Round Rock, Tex.
| | - Andrew Paoletti
- Department of Pediatric and Adolescent Medicine, Einstein Medical Center Philadelphia, Philadelphia, Penn Dr. Ekambaram is now with Baylor Scott & White Medical Center, Round Rock, Tex
| | - Iqra Siddiqui
- Department of Pediatric and Adolescent Medicine, Einstein Medical Center Philadelphia, Philadelphia, Penn Dr. Ekambaram is now with Baylor Scott & White Medical Center, Round Rock, Tex
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Goodstein MH, Lagon E, Bell T, Joyner BL, Moon RY. Stock Photographs Do Not Comply With Infant Safe Sleep Guidelines. Clin Pediatr (Phila) 2018; 57:403-409. [PMID: 28868896 DOI: 10.1177/0009922817728698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated images in popular stock photography websites for adherence with American Academy of Pediatrics (AAP) guidelines for safe infant sleep practices. Three top stock photo websites were used to collect photographs generated from key phrases. All images depicting an infant sleep environment were analyzed for consistency with AAP guidelines. Descriptive statistics, chi-square and z test of proportions, were conducted. A total of 1233 of 1947 stock photographs showed sleeping infants on a flat surface. In all, 627 (50.8%) photographs showed the infant in the supine position and 79 (5%) of all infant sleep environments were adherent with AAP recommendations. Bedding inconsistent with safe sleep recommendations was identified in 1133 images (71.3%), with blankets noted in 49.5%. Images depicting sleeping infants on stock photography sites do not routinely adhere to AAP recommendations. Media messages inconsistent with health care messages create confusion and misinformation about infant sleep safety and may lead inadvertently to unsafe practices.
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Affiliation(s)
| | - Elena Lagon
- 2 University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Brandi L Joyner
- 3 Goldberg Center for Community Pediatric Health, Washington, DC, USA
| | - Rachel Y Moon
- 2 University of Virginia School of Medicine, Charlottesville, VA, USA
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Hohman EE, Savage JS, Birch LL, Beiler JS, Paul IM. Pacifier Use and Early Life Weight Outcomes in the Intervention Nurses Start Infants Growing on Healthy Trajectories Study. Child Obes 2018; 14:58-66. [PMID: 28976781 PMCID: PMC5743033 DOI: 10.1089/chi.2017.0177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although widely used by infants, little is known about the long-term effects of pacifiers. We investigated relationships between pacifier use in infancy and appetite, temperament, feeding, and weight outcomes through age 2 years using data from the Intervention Nurses Start Infants Growing on Healthy Trajectories study. METHODS Mother-newborn dyads were randomized to a responsive parenting intervention for obesity prevention or a control group. Infants with data on pacifier use (n = 250) were categorized as using a pacifier beyond early infancy (≥4 months of age) or not. Anthropometrics were measured at 6 months, 1, and 2 years with overweight defined as weight-for-length ≥95th percentile at 1 year and BMI ≥85th percentile at 2 years. Mothers completed questionnaires on temperament, appetite, and feeding. RESULTS Infants who used a pacifier at 4 months or later (68%) had greater conditional weight gain from birth to 6 months (p = 0.01), weight-for-length z-score at 1 year (p < 0.001), and BMI z-score at 2 years (p < 0.001) than infants who did not. Infants using a pacifier at ≥4 months were more likely to be overweight at ages 1 year (11.7% vs. 1.3%, p = 0.03) and 2 years (20.1% vs. 7.9%, p = 0.03). Pacifier use was associated with shorter breastfeeding duration and less responsive parent feeding styles, but these variables did not mediate the relationship between pacifiers and weight. Parent-reported temperament and appetite were unrelated to pacifier use. CONCLUSIONS Pacifier use beyond early infancy is associated with accelerated infant growth and toddler overweight, although the reasons for this relationship are unclear.
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Affiliation(s)
- Emily E. Hohman
- Center for Childhood Obesity Research, Penn State University, University Park, PA
| | - Jennifer S. Savage
- Center for Childhood Obesity Research, Penn State University, University Park, PA.,Department of Nutrition Science, Penn State University, University Park, PA
| | - Leann L. Birch
- Department of Foods and Nutrition, University of Georgia, Athens, GA
| | - Jessica S. Beiler
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Ian M. Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA
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Kellams A, Parker MG, Geller NL, Moon RY, Colson ER, Drake E, Corwin MJ, McClain M, Golden WC, Hauck FR. TodaysBaby Quality Improvement: Safe Sleep Teaching and Role Modeling in 8 US Maternity Units. Pediatrics 2017; 140:peds.2017-1816. [PMID: 29030524 PMCID: PMC5654395 DOI: 10.1542/peds.2017-1816] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nursing education and role modeling can increase adherence to safe sleep practices. Eight US hospital maternity units with variable baseline approaches to education participated in a national multicenter nursing quality improvement (QI) intervention to promote safe sleep practices. The goals at participating maternity units were to (1) increase the rate of mothers who reported receiving safe sleep information from nurses to ≥90% and (2) increase the rates of infants observed sleeping supine in a safe environment to ≥90%. METHODS A safe sleep QI toolkit, designed for and provided to all sites, included an educational curriculum and tools to use for staff and parent education. Local teams implemented safe sleep education using the tools as plan-do-study-act cycles. After each cycle, audits assessing maternal report of nursing education on safe sleep and inpatient infant sleep position and environment were performed. RESULTS The QI interventions lasted a median of 160 days (range, 101-273). Mothers reported receiving information on 4 primary safe sleep topics 72% to 95% of the time (a 24%-57% increase over the baseline). Additionally, 93% of infants were observed in a supine sleep position, and 88% of infants were observed in a safe sleep environment (a 24% and 33% increase over baseline, respectively). These rates were sustained up to 12 months later. CONCLUSIONS Implementation of a multisite QI intervention for safe sleep parenting education and role modeling led to increased knowledge of and compliance with safe sleep practices during postpartum hospitalization.
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Affiliation(s)
| | | | - Nicole L. Geller
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | | | - Eve R. Colson
- Department of Pediatrics, Yale University, New Haven, Connecticut; and
| | - Emily Drake
- Department of Family, Community and Mental Health Systems, School of Nursing, University of Virginia, Charlottesville, Virginia
| | | | - Mary McClain
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - W. Christopher Golden
- Department of Pediatrics, School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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12
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Moon RY, Hauck FR, Colson ER, Kellams AL, Geller NL, Heeren T, Kerr SM, Drake EE, Tanabe K, McClain M, Corwin MJ. The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices: A Randomized Clinical Trial. JAMA 2017; 318:351-359. [PMID: 28742913 PMCID: PMC5593130 DOI: 10.1001/jama.2017.8982] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Inadequate adherence to recommendations known to reduce the risk of sudden unexpected infant death has contributed to a slowing in the decline of these deaths. OBJECTIVE To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions. DESIGN, SETTING, AND PARTICIPANTS Four-group cluster randomized clinical trial of mothers of healthy term newborns who were recruited between March 2015 and May 2016 at 16 US hospitals with more than 100 births annually. Data collection ended in October 2016. INTERVENTIONS All participants were beneficiaries of a nursing quality improvement campaign in infant safe sleep practices (intervention) or breastfeeding (control), and then received a 60-day mobile health program, in which mothers received frequent emails or text messages containing short videos with educational content about infant safe sleep practices (intervention) or breastfeeding (control) and queries about infant care practices. MAIN OUTCOMES AND MEASURES The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days. RESULTS Of the 1600 mothers who were randomized to 1 of 4 groups (400 per group), 1263 completed the survey (78.9%). The mean (SD) maternal age was 28.1 years (5.8 years) and 32.8% of respondents were non-Hispanic white, 32.3% Hispanic, 27.2% non-Hispanic black, and 7.7% other race/ethnicity. The mean (SD) infant age was 11.2 weeks (4.4 weeks) and 51.2% were female. In the adjusted analyses, mothers receiving the safe sleep mobile health intervention had higher prevalence of placing their infants supine compared with mothers receiving the control mobile health intervention (89.1% vs 80.2%, respectively; adjusted risk difference, 8.9% [95% CI, 5.3%-11.7%]), room sharing without bed sharing (82.8% vs 70.4%; adjusted risk difference, 12.4% [95% CI, 9.3%-15.1%]), no soft bedding use (79.4% vs 67.6%; adjusted risk difference, 11.8% [95% CI, 8.1%-15.2%]), and any pacifier use (68.5% vs 59.8%; adjusted risk difference, 8.7% [95% CI, 3.9%-13.1%]). The independent effect of the nursing quality improvement intervention was not significant for all outcomes. Interactions between the 2 interventions were only significant for the supine sleep position. CONCLUSIONS AND RELEVANCE Among mothers of healthy term newborns, a mobile health intervention, but not a nursing quality improvement intervention, improved adherence to infant safe sleep practices compared with control interventions. Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01713868.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville
| | - Fern R Hauck
- Department of Family Medicine, School of Medicine, University of Virginia, Charlottesville
| | - Eve R Colson
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Ann L Kellams
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville
| | - Nicole L Geller
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Timothy Heeren
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | - Stephen M Kerr
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Emily E Drake
- Department of Family, Community, and Mental Health Systems, School of Nursing, University of Virginia, Charlottesville
| | - Kawai Tanabe
- Department of Family Medicine, School of Medicine, University of Virginia, Charlottesville
| | - Mary McClain
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Michael J Corwin
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
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Comparison of Text Messages Versus E-mail When Communicating and Querying With Mothers About Safe Infant Sleep. Acad Pediatr 2017; 17:871-878. [PMID: 28606858 PMCID: PMC5673525 DOI: 10.1016/j.acap.2017.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/23/2017] [Accepted: 06/03/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess how mothers' choice of e-mail or text messages (SMS) to receive safe sleep communications is associated with educational video viewing and responses to care practice queries. METHODS Seven hundred ninety-two new mothers received safe sleep-related communications for 60 days after newborn hospital discharge as part of a trial of health education interventions on infant care practices. Mothers chose e-mail or SMS for study communications and were sent 22 short safe sleep videos and 41 queries regarding infant care practices. RESULTS Study communications via e-mail were elected by 55.7% of participants. The SMS group had a modestly higher overall view rate of videos (59.1% vs 54.4%; adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.07-1.81) and a substantially higher response rate to queries (70.0% vs 45.2%; aOR, 3.48; 95% CI, 2.74-4.43). CONCLUSIONS Participants more commonly opted to receive infant care practice videos and queries via e-mail. SMS was associated with higher viewing and response rates, especially for query responses. These results highlight the importance of understanding how specific modalities of communication might vary in reach.
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Chung M, Oden RP, Joyner BL, Sims A, Moon RY. Safe infant sleep recommendations on the Internet: let's Google it. J Pediatr 2012; 161:1080-4. [PMID: 22863258 PMCID: PMC3504635 DOI: 10.1016/j.jpeds.2012.06.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/14/2012] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To determine the accuracy of information on infant sleep safety on the Internet using Google. We hypothesized that the majority of Web sites would accurately reflect the American Academy of Pediatrics (AAP) recommendations for infant sleep safety. STUDY DESIGN We searched for advice using 13 key phrases and analyzed the first 100 Web sites for each phrase. Web sites were categorized by type and assessed for accuracy of information provided, based on AAP recommendations. The accuracy of information was classified as "accurate," "inaccurate," or "not relevant." RESULTS Overall, 43.5% of the 1300 Web sites provided accurate information, 28.1% provided inaccurate information, and 28.4% were not relevant. The search terms "infant cigarette smoking," "infant sleep position," and "infant sleep surface" yielded the highest percentage of Web sites with accurate information. "Pacifier infant," "infant home monitors," and "infant co-sleeping" produced the lowest percentage of Web sites with accurate information. Government Web sites had the highest rate of accuracy; blogs, the lowest. CONCLUSION The Internet contains much information about infant sleep safety that is inconsistent with AAP recommendations. Health care providers should realize the extent to which parents may turn to the Internet for information about infant sleep safety.
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Affiliation(s)
- Matthew Chung
- Department of Pediatrics, University of South Carolina School of Medicine, Columbia, SC
| | - Rosalind P. Oden
- Division of General Pediatrics and Community Health, Children’s National Medical Center, Washington, DC
| | - Brandi L. Joyner
- Division of General Pediatrics and Community Health, Children’s National Medical Center, Washington, DC
| | - Alexandra Sims
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington DC
| | - Rachel Y. Moon
- Division of General Pediatrics and Community Health, Children’s National Medical Center, Washington, DC,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington DC
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