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This study investigated the relationship between marital satisfaction and time spent bed sharing with infants in a community sample of 81 bed sharing mothers. Time spent bed sharing did not significantly predict variance in marital satisfaction when considering bed sharers as a whole. Moderation analysis, however, showed the interaction between time spent bed sharing and group classification either as "intentional," defined as parents who endorse the ideology of bed sharing, or "reactive," defined as parents who do not plan to bed share but bed share as a reaction to infant nighttime problems, explained a significant increase in variance in marital satisfaction, ΔR^sup 2^ = .075, F(1, 75) = 7.31, p = .008. None of the intended mediator variables (satisfaction with bed sharing, fatigue, and sexual satisfaction) were significantly correlated with time spent bed sharing. Results highlight the importance of recognizing the differences between intentional bed sharers and reactive bed sharers.Key Words: mothers, satisfaction with marriage and close relationships, transition to parenthood.The arrival of a new baby marks a period of change for first-time parents, as they negotiate the transition from a couple to a family (Belsky & Kelly, 1994). The family engages in the family stress process (Hill, 1958) as the family's equilibrium is disrupted and the couple is forced to make major adaptations and adjustments to their new life, moving from the spousal role to the parental role. Each couple may manage these changes differently, resulting in different levels of family satisfaction and functioning.The ABC-X model of family stress developed by Hill (1958) serves as the framework for current theories of family stress (for a review, see Malia, 2006). Variable A is the stressor event, which causes change to the family's current state. The family's resources at the time of the event (variable B) and parental perceptions or meanings attached to the event (variable C) influence variable X, the level of stress the family experiences. Boss (2002) refined the ABC-X model to include both internal (e.g., structural) and external (e.g., developmental) contextual considerations. The birth of a baby is a normal developmental stressor event (Boss, 1 987). The changes in the family structure that an addition of a new baby brings can influence the quality of the marital relationship (LeMasters, 1957), thereby contributing to family stress. Changing the family's current sleeping routine and arrangement by bringing the infant to sleep in bed with the parents may cause varying levels of stress in the marital relationship, depending on the parents' perceptions of bed sharing.Although some couples experience an increase in marital satisfaction during the transition to parenthood (Cowan & Cowan, 2000; Shapiro, Gottman, & Carrere, 2000), the majority (67%) experience a precipitous decline in marital quality within the first year after their infant's birth (Shapiro et al., 2000). Although many stressor events considered to contribute to changes in the marital relationship over the transition to parenthood have been explored, little research has addressed the link between marital satisfaction and parent-infant sleeping arrangements. The main purpose of this study is to describe the relationship between time spent parent-infant bed sharing and the mother's marital satisfaction at a point during the transition to parenthood.Bed Sharing PracticesWhen distinguishing between the terms bed sharing and cosleeping, cosleeping is increasingly being used to refer to the parent(s) sleeping in close proximity to the infant on either the same sleeping surface (bed sharing) or different sleeping surfaces (room sharing; McKenna, Ball, & Gettler, 2007). Previous literature does not often distinguish between bed sharing and room sharing when cosleeping is being studied . Whenever possible, this article will note if the researchers specifically studied bed sharing or room sharing; otherwise the general term cosleeping will be used. …

Neonatal intensive care units (NICUs) provide a setting for the care of some of the most vulnerable and fragile of patient populations: newborn infants. Some of these infants were born too soon or too small, whereas others may have had a difficult birth process or transition into life. The parents and families of these little ones are also vulnerable and fragile as they try to make sense of how their anticipated joy turned into a stark new reality. They often enter a scene unlike any other.They see little Plexiglas boxes or other strange pieces of equipment containing babies-some no bigger than your hand, others normal-sized-with tubes inserted in their noses, mouths, and many different parts of the body. The hum and whir of equipment and alarms overwhelm their senses and add to their anxiety. They are filled with fear-sometimes for the health of the mother, and always for the infant-and other emotions, part joy, part loss and grief. But fear-of the unknown present and future-governs. They are also full of questions, trying to make sense of it all: "Will my baby live through this experience? Will the baby be 'normal'? What did I/we do to make this happen? I feel helpless; what can I do to help?"NICUs can be frightful places, but they are also sacred places filled with the hopes and dreams of families and the healing hearts, hands, and minds of providers. NICUs are sacred places because they are where the transition to life occurs for most infants who enter, and sadly a transition to death for others. During these transitions, babies are nurtured, loved, and cared for by some of the most competent and compassionate of caregivers, parents, and providers working in partnership to make the transition as easy as possible. This issue of HERD features articles on NICU design and its effect on the patient/family and provider experience. As in other areas of healthcare design, evidence about the design of NICUs is emerging, but the goal is to create a healing environment for both families and providers to work together to facilitate the growth, development, and healing of fragile neonates.Transitions in CareThe immediate care environment for the neonate is the radiant warmer, isolette, or small crib, but the larger context of care is either an open ward, a cluster of several infant beds in one space, or a single-family-room (SFR) design. Previously, the open-ward design was considered state-of-the-art design for NICUs because it was the most costefficient model with less square footage required per bed, and it allowed for maximum observation of the infant, the sharing of nursing resources, and parent-to-parent interaction. Open-ward design continues to be the predominant design of NICUs across the United States and in other countries.In the last decade, more evidence and opinion have emerged about the challenges of caring for growing premature infants (preemies) and sick infants in an open ward. Some have been concerned about patient safety issues in the openward design, including noise and light levels that could be detrimental to neurological and brain development in the growing preemie (Chen et al., 2009; Krueger, Schue, & Parker, 2007; Shepley, 2004; White, 2004, 2011) and the potential for the transmission of infection from one infant to others in an open-ward design (Mesman, 2009; Walsh, McCullough, & White, 2006). Lack of privacy for the family to interact skin to skin with an infant (placing the infant on the mother's or father's bare chest) or for the mother to breastfeed the infant has also been a challenge in the open ward.Some nurses perceive that it is easier to observe multiple infants in an open-ward design because they often care for more than one infant at a time. Other providers have commented that parent-to-parent interaction is helpful and facilitated by open wards (Domanico, Davis, Coleman, & Davis, 2010). Still, some healthcare decision makers voice concerns that the SFR NICU is more costly than the open-ward design because of the increased square footage associated with the SFR design and increased operational costs related to greater staffing needs, although no published evidence validates these concerns. …

Bed sharing has been promoted as facilitating breastfeeding but also may increase risks for sudden, unexpected infant deaths. This prospective cohort study was performed to determine the prevalence of adult and infant bed sharing and its association with maternal and infant characteristics. Demographic data were collected from 10,355 infant-mother pairs at birth hospitals in Eastern Massachusetts and Northwest Ohio, and follow-up data were collected at 1, 3, and 6 months by questionnaire. Associations with bed sharing were estimated using odds ratios and 95% confidence intervals from multiple logistic regression models while adjusting for confounding variables. At 1, 3, and 6 months, 22%, 14%, and 13% of infant-mother pairs shared a bed, respectively. On multivariate analysis, race/ethnicity and breastfeeding seemed to have the strongest association with bed sharing. These factors need to be considered in any comprehensive risk to benefit analysis of bed sharing.

The NACManchester Asthma and Allergy Study is a prospective study of the development of asthma and allergies in childhood. The subjects (995 children at age 3 years) were recruited in utero by screening parents in the antenatal clinic using skin prick testing and a questionnaire regarding allergic diseases. Children were assigned to risk groups according to parental atopic status (high risk, both parents atopic; medium risk, one parent atopic; low risk, neither parent atopic). A subgroup of those at high risk (with no pets in the home) was randomized to stringent environmental control (allergen impermeable covers for the parental and infant bed, hot washing of bedding weekly, HEPA vacuum cleaner, hard floor for the nursery), and the remainder followed a normal regime. The children have been followed prospectively. The environmental influences are very clearly defined. Measurements of environmental exposures include levels of house dust mite; cat and dog allergens during pregnancy and early life; pet ownership and exposure; childcare arrangements; number of siblings; vaccination uptake; thorough dietary questionnaire; and endotoxin exposure. Further unique objective outcome in the cohort is the assessment of lung function in preschool children using specific airways resistance, which at age 3 years clearly reflects both genetic and environmental influences.

Summary Background To avoid allergen exposure of newborn babies, the use of a new mattress for the baby bed may be recommended. However, it is not certain that new mattresses are always free of allergens. Objective In the present study the allergen content of new infant mattresses was investigated. Methods Dust samples were vacuumed from 90 new mattresses for infant beds bought in 50 different Dutch shops, and the concentrations of Der p 1, Der f 1, Fel d 1 and Can f 1 were determined by radioimmunoassays. Results Most mattresses contained some allergen and often the allergen concentrations were surprisingly high. Only 15 of the 90 mattresses contained no detectable amounts of any of the four allergens. The highest concentration found for each allergen was 3.1, 46.5, 20.2 and 95.7 µg/g of dust, respectively. However, the total amount of allergen in a mattress was still rather low because the new mattresses contained only modest amounts of dust. Baby mattresses more often contained an increased allergen load than the larger, standard-sized, infant mattresses. This may be caused by differences in manufacturing procedure. Also, mattresses that were sold without a plastic encasement more often contained an increased allergen load. Conclusions It is advisable to buy a mattress that is wrapped in plastic, but it may still contain a substantial amount of allergen. Thorough vacuuming of a newly bought mattress before it is installed on a child's bed, is also advisable. After instalment, regular vacuuming of the mattress and washing of the bed linen as well as measures to eliminate allergen reservoirs in other parts of the house are important, because our observations indicate that mattresses easily pick up allergens from the environment.

This research provides data on behavioral issues associated with the design of neonatal intensive care units (NICUs). Behavior was examined utilizing both predesign research (PDR) and postoccupancy evaluation (POE) techniques; data were collected prior to the remodeling of a NICU and after the remodeling was completed. Infants in the original unit were located in closed bays. Infant beds in the new unit were distributed in an open floor plan with 60% more area. Behavioral mapping, interview, and questionnaire methods were used to examine medical staff activity patterns and perceptions of the modified environment. One hundred twenty-four hours of predesign and postconstruction mapping data were gathered. The hypothesis that the total amount of time staff spent walking from activity to activity would be reduced was not supported, although when the data were weighted to reflect the impact of the size of the large unit, the ratio of time spent traveling to a total unit area was found to be less in the open-ba...

The study aimed to evaluate possible association between parent‐infant bed sharing and behavioural features of 2‐4‐month‐old infants using Early Infancy Temperament Questionnaire (EITQ) as a tool. It covered the period from 1997 to 1996 and comprised 204 randomly selected clinically healthy infants aged 2‐4 months who were singletons and born in St. Petersburg within the period in consideration. The mothers were asked to complete the questionnaires addressing infant, maternal, and demographic major characteristics as well as some infant care practices with particular emphasis on sleep routine and parent‐infant bed sharing. As a part of the interview, the mothers filled in the EITQ consisting of 76 items which describe different aspects of infant behaviour. Groups of questions were added according to scoring sheet to produce total scores to describe nine different aspects of infant temperament: activity, rhythmicity, approach, adaptability, intensity, mood, persistence, distractibility and threshold. 175 i...

Importance A strong association between infant bed sharing and sudden infant death syndrome or unintentional sleep-related death in infants has been established. Occurrences of unintentional sleep-related deaths among infants appear to be increasing. Objectives To determine the trends and factors associated with infant bed sharing from 1993 through 2010, including the association of physician advice on bed sharing. Design National Infant Sleep Position study conducted with annual telephone surveys. Setting The 48 contiguous states. Participants Nighttime caregivers of infants born within 7 months of each survey administration. Approximately 1000 interviews were completed annually. Main Outcomes and Measures Infant bed sharing as a usual practice. Results Of 18 986 participants, 11.2% reported an infant sharing a bed as a usual practice. Bed sharing increased from 1993 (6.5%) to 2010 (13.5%). Although bed sharing increased significantly among white respondents from 1993 to 2000 ( P P = .48). Black and Hispanic respondents reported an increase in bed sharing throughout the study period, with no difference between the earlier and later periods ( P = .63 and P = .77, respectively). After accounting for the study year, factors associated with increase in infant bed sharing as a usual practice included maternal educational level of less than high school compared with college or greater (adjusted odds ratio, 1.42 [95% CI, 1.12-1.79]); black (3.47 [2.97-4.05]), Hispanic (1.33 [1.10-1.61]), and other (2.46 [2.03-2.97]) maternal race or ethnicity compared with white race; household income of less than $20 000 (1.69 [1.44-1.99]) and $20 000 to $50 000 (1.29 [1.14-1.45]) compared with greater than $50 000; living in the West (1.61 [1.38-1.88]) or the South (1.47 [1.30-1.66]) compared with the Midwest; infants younger than 8 weeks (1.45 [1.21-1.73]) or ages 8 to 15 weeks (1.31 [1.17-1.45]) compared with 16 weeks or older; and being born prematurely compared with full-term (1.41 [1.22-1.62]). Almost 46% of the participants reported talking to a physician about bed sharing. Compared with those who did not receive advice from a physician, those who reported their physicians had a negative attitude were less likely to have the infant share a bed (adjusted odds ratio, 0.66 [95% CI, 0.53-0.82]), whereas a neutral attitude was associated with increased bed sharing (1.38 [1.05-1.80]). Conclusions and Relevance Our finding of a continual increase in bed sharing throughout the study period among black and Hispanic infants suggests that the current American Academy of Pediatrics recommendation about bed sharing is not universally followed. The factors associated with infant bed sharing may be useful in evaluating the impact of a broad intervention to change behavior.

Summary Background Allergen exposure in early childhood is thought to be important for sensitization and subsequent development of asthma. Not much is known, however, about exposure of young children to allergens in the home. Objectives This study was designed to document dust mite allergen exposure in young children, and to determine wheither infants from atopic mothers (=‘high-risk’ infants) are exposed to lower concentrations of house dust mite alkrgen than infants from non-atopic parents (=‘low-risk’ infants). Methods Dust samples were taken in the homes of 104 infants (48 ‘high-risk’ and 56 ‘low-risk’ infants, selected by questionnaire) aged 3–15 months, from floors in different rooms and from the child's mattress surface. Results The majority of the infants were found to be exposed to Der p I concentrations of more than 2000 ng/g in dust collected from the surface of their mattresses. Lower Der p I concentrations were found in mattress surface dust from the beds of infants from atopic mothers than of infants from non-atopic parents. Also, lower Der p I concentrations were found in floor dust from the homes of infants from atopic mothers, Infant beds equipped with new mattresses, new blankets and top plastic sheeting had significantly lower Der p I concentrations than beds equipped with used mattresses and blankets, without top plastic sheeting. Conclusions Young children in the Netherlands are exposed to significant concentrations of Der p I in mattress surface dust. Allergic parents appear to provide their children with environments somewhat less rich in mite allergen than non-allergic parents.

Objective.The Alaska Division of Public Health has stated that infants may safely share a bed for sleeping if this occurs with a nonsmoking, unimpaired caregiver on a standard, adult, non-water mattress. Because this policy is contrary to recent national recommendations that discourage any bed sharing, we examined 13 years of Alaskan infant deaths that occurred while bed sharing to assess the contribution of known risk factors.Methods.We examined vital records, medical records, autopsy reports, and first responder reports for 93% of Alaskan infant deaths that occurred between 1992 and 2004. We examined deaths while bed sharing for risk factors including sleeping with a non-caregiver, prone position, maternal tobacco use, impairment of a bed-sharing partner, and an unsafe sleep surface. We used Pregnancy Risk Assessment Monitoring System data to describe bed-sharing practices among all live births in Alaska during 1996–2003.Results.Thirteen percent ( n=126) of deaths occurred while bed sharing; 99% of these had at least one associated risk factor, including maternal tobacco use (75%) and sleeping with an impaired person (43%). Frequent bed sharing was reported for 38% of Alaskan infants. Among these, 60% of mothers reported no risk factors; the remaining 40% reported substance use, smoking, high levels of alcohol use, or most often placing their infant prone for sleeping.Conclusions.Almost all bed-sharing deaths occurred in association with other risk factors despite the finding that most women reporting frequent bed sharing had no risk factors; this suggests that bed sharing alone does not increase the risk of infant death.

Aims: To investigate the characteristics of parent–infant bed-sharing prevalence in England. Methods: Data on night-time sleeping practices from a two year, local, longitudinal study and a three-year, national, cross-sectional study were obtained. A total of 261 infants in North Tees were followed up at 1 and 3 months of age, as were 1095 infants aged 1 week to 1 year from five English health regions. Results: Data from both studies found that almost half of all neonates bed-shared at some time with their parents (local = 47%, 95% CI 41 to 54; national = 46%, 95% CI 34 to 58), and on any one night in the first month over a quarter of parents slept with their baby (local = 27%, 95% CI 22 to 33; national = 30%, 95% CI 20 to 42). Bed-sharing was not related to younger mothers, single mothers, or larger families, and was not more common in the colder months, at weekends, or among the more socially deprived families; in fact bed-sharing was more common among the least deprived in the first months of life. Breast feeding was strongly associated with bed-sharing, both at birth and at 3 months. Bed-sharing prevalence was uniform with infant age from 3 to 12 months; on any one night over a fifth of parents (national = 21%, 95% CI 18 to 24) slept with their infants. Conclusion: Bed-sharing is a relatively common practice in England, not specific to class, but strongly related to breast feeding.

Sixteen accidental deaths of infants occurred in Wayne County (Detroit) during 1974-1975 as a result of unsafe sleeping environments. Thirteen of these deaths resulted from different modes of asphyxia, two were due to falls, and one drowned. Differential diagnoses are pointed out. It is estimated that over 600 infants die each year in the United States due to unsafe sleeping conditions. Despite the magnitude and importance of this problem, little has been provided to the public in the form of preventive education. Federal regulations, passed in 1974, control the manufacture of new cribs but do not affect the existing unsafe cribs. Suggestions for the prevention of such fatal accidents are outlined, in cluding a safety check list for infant beds. The cooperation of all health professionals is required to educate the public of these dangers to their infants.