Priority setting: Consensus for Australia's infant safe sleeping public health promotion programme

Evolutionary and empirical perspectives on 'demand' breastfeeding: The baby in the driver's seat or the back seat?

Background/Objectives

The concept of 'demand' breastfeeding is central in public health. A key feature of the concept is that the infant is the locus of control in the breastfeeding process; when the breast is demanded by the infant, it is given the opportunity to feed. This study questions this notion of the infant as the locus of control in demand breastfeeding for empirical and theoretical reasons. From an evolutionary perspective, infants are expected to seek maximal investment and, against this backdrop of maximal investment-seeking, parents decide how much investment to put into offspring.

Methodology

Focal follows were conducted among 113 mother-infant dyads in Papua New Guinea. During these follows, response times and types of responses, including breastfeeding to offspring fussing and crying, were recorded.

Results

Infants were breastfed an average of 3.6 times/hour for just over 2 min/feed. Fussing and crying were responded to quickly, with most response times under 1 min. When the mother responded, she breastfed the child approximately 52% of the time. The other 48% of the time, mothers responded to infants with other forms of pacification. Mothers were significantly less likely to respond to infants by breastfeeding if the child had been breastfed within the past 59-76 min.

Conclusion/Implications

As predicted by evolutionary parental investment theory, infants make frequent demands on their parents for investment, but mothers are ultimately the locus of control in the investment process. The mother decides whether and how frequently to breastfeed her offspring against this backdrop of near-continuous investment demands.

Awareness of infant safe sleep messages and associated care practices: findings from an Australian cohort of families with young infants

OBJECTIVE

To investigate primary infant caregiver awareness of the current national public health safe sleep messages and the associations of awareness with care practices.

DESIGN AND SETTING

A cross-sectional survey in Queensland, Australia. All families with live babies birthed during April-May 2017 were eligible. Questionnaires were distributed when infants were approximately 3 months old.

PARTICIPANTS

Of the 10 200 eligible families, 3341 (33%) primary caregivers participated.

MAIN OUTCOME MEASURES

Participants were asked: to recall key safe sleeping messages they were aware of (unprompted); questions about their infant care practices; and to select the current, national six safe sleeping messages (prompted multi-choice).

RESULTS

Overall, the majority of families are aware of sleep-related infant mortality and sudden infant death (3178/3317, 96%); however, approximately one in four caregivers (867/3292, 26%) could not identify the current six messages to promote safer infant sleep in a multi-choice question. Despite being aware of the six key messages, some caregiver practices did not always align with advice (336/2423, 14% were not smoke-free; 349/2423, 14% were not usually supine for sleep; 649/2339, 28% employed practices which may increase risk of head or face covering; 426/2423, 18% were not receiving breastmilk).

CONCLUSIONS

There is considerable scope for improvement in parent awareness and ability to recall key safe sleep messages. Awareness of advice does not always translate into safe infant care. Health promotion messaging to encourage safer infant sleep, ultimately aimed at reducing sudden unexpected infant deaths, needs more effective supportive strategies and dissemination if future campaigns are to be successful.