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Sleep-related deaths are a leading cause of infant mortality in Florida. The American Academy of Pediatrics recommends placing infants to sleep on their back, alone, and without soft bedding. Compliance with these guidelines varies among parents. This evaluation examined the rates of safe infant sleep practices and associated factors among 1985 participants enrolled in Florida Maternal, Infant, and Early Childhood Home Visiting (FL MIECHV) programs during 2017–2019. Participant- and program-level variables were examined in relation to three sleep practices: infant position, bedding, and bed-sharing at 2–3 months to determine which factors were associated with high rates of safe sleep outcomes. Analyses included univariate descriptive statistics, bivariate statistics, and multivariable logistic regression. Most caregivers (70%) reported always placing their babies to sleep on their back, alone, and without soft bedding. Factors such as primary language, race, education, housing situation, and year the Safe Baby™ curriculum implemented were significantly associated with safe infant sleep practices. Bearing this in mind, FL MIECHV can tailor safe sleep education, messaging, and strategies to support participants at highest risk. Recent adoption of the Safe Baby™ curriculum, and associated staff training, was an important factor influencing parents’ infant sleep practices.

Objective The COVID-19 pandemic has profoundly impacted families, yet studies on its effects on infants and their parents have thus far been sparse and based mostly on retrospective parent reporting. This study aimed to prospectively evaluate the impact of COVID-19 living conditions on infant and parent sleep, as well as infant screen exposure, parent daytime sleepiness, and parent depression levels, using multi-method assessment. Methods Infant and parent data collected in 2020 were compared with a matched cohort collected in 2019. The total sample included 1518 US infants aged 1–18 months (M = 8.5, SD = 4.6; 54% boys). Auto-videosomnography metrics were obtained from the 14-day period prior to survey completion (number of analyzed nights: M = 12.11 SD = 2.66 in the 2019 cohort; and M = 11.91 SD = 2.41 in the 2020 cohort). Parents completed online questionnaires regarding their infant's sleep and screen exposure, as well as their own sleep quality, daytime sleepiness, and depression levels. Results Compared to 2019, infants in 2020 slept ∼40 min more per night on average, as indicated by auto-videosomnography. Infants additionally had earlier sleep timing, and increased parent-reported sleep-onset latency and nocturnal wakefulness. Infant screen time rose by 18.3 min per day for older infants, but remained stable for younger infants. Parents reported lower daytime sleepiness and higher depression symptomology during 2020, whereas no change was apparent in their sleep quality ratings. Conclusions Restricted living conditions during COVID-19 in the USA led to increased infant screen exposure and parental depression, but also to increased infant sleep duration and reduced parent sleepiness. Future research is needed to examine the mechanistic pathways through which COVID-19 impacted on infant and parent well-being.

cited By 0 Aim To describe and test the accuracy of respiratory rate assessment in long-term surveillance using an open-source infant wearable, NAPping PAnts (NAPPA). Methods We recorded 24 infants aged 1-9 months using our newly developed infant wearable that is a diaper cover with an integrated programmable electronics with accelerometer and gyroscope sensors. The sensor collects child's respiration rate (RR), activity and body posture in 30-s epochs, to be downloaded afterwards into a mobile phone application. An automated RR quality measure was also implemented using autocorrelation function, and the accuracy of RR estimate was compared with a reference obtained from the simultaneously recorded capnography signal that was part of polysomnography recordings. Results Altogether 88 h 27 min of data were recorded, and 4147 epochs (39% of all data) were accepted after quality detection. The median of patient wise mean absolute errors in RR estimates was 1.5 breaths per minute (interquartile range 1.1-2.6 bpm), and the Blandt-Altman analysis indicated an RR bias of 0.0 bpm with the 95% limits of agreement of -5.7-5.7 bpm. Conclusion Long-term monitoring of RR and posture can be done with reasonable accuracy in out-of-hospital settings using NAPPA, an openly available infant wearable.

Background: Sleep is one of the essential and vital needs of human and a factor that affects the growth and development of children. The basic learning of sleep habit is formed in childhood and the person tries to maintain it throughout life. Therefore, considering the importance of childhood in the formation of appropriate sleep habit, this study was conducted to investigate the effect of continuous care model on infant sleep habits in Bint Al-Huda medical center in Bojnourd. Methods: This interventional study was performed on 66 mothers attending the Bint Al-Huda Hospital in Bojnourd in 2019. Sampling was done by available method and the samples were randomly assigned to the intervention and control groups. The intervention group received a continuous care model program in 4 sessions. Each session lasted for of 45-60 minutes. Data collection tools included the demographic characteristics questionnaire and the Infant Sleep Habit Scale (ISQ). The collected data were analyzed by SPSS software version 16 using Fisher and Rapid Major statistical tests at the significance level of p

Introduction: Most babies (44.2%) had sleep disturbances, and 72% of parents thought that this was not a significant problem. Sleep problems in babies are generally due to insufficient sleep in the baby. One of the efforts to improve baby sleep uration is by offering baby massage accompanied by the chanting of the Al-Qur'an murottal. Methods: International literature searched using electronic media by using several databases such as Google Scholar, Link Spinger and PubMed. The article used is 8 articles that discuss the effect of baby massage on baby sleep and the effect of listening to the Murottal Al-Quran on the duration of baby sleep. Results: There was a significant effect between infant massage and murottal Al-Qur'an on the increase in infant sleep duration. Discussion: One way to meet the sleep needs of babies is by increasing the duration of the baby's sleep. Efforts to increase sleep duration in babies can be done by giving baby massage accompanied by Al-Qur'an murottals. Baby massage can increase serotonin neurotansmiter levels, and listening to the murottal Al-Qur'an, the brain can produce neuropeptide substances so that it provides feedback in the form of a sense of comfort, safety, after that the baby's sleep will be more soundly. Conclusion: Baby massage with murottal Al-Qur'an is effective for increasing sleep duration in babies. Keywords: Baby massage; Murottal; length of sleep for babies

Cardiorespiratory interaction (CRI) has been intensively studied in adult sleep, yet not in preterm infants, in particular across different sleep states including wake (W), active sleep (AS), and quiet sleep (QS). The aim of this study was to quantify the interaction between cardiac and respiratory activities in different sleep states of preterm infants. The postmenstrual age (PMA) of preterm infants was also taken into consideration. The CRI during sleep was analyzed using a visibility graph (VG) method, enabling the nonlinear analysis of CRI in a complex network. For each sleep state, parameters quantifying various aspects of the CRI characteristics from constructed VG network including mean degree (Dm) and its variability (Dsd), clustering coefficient (CCm) and its variability (CCsd), assortativity coefficient (AC) and complexity (DSE) were extracted from the CRI networks. The interaction effect of sleep state and PMA was found to be statistically significant on all CRI parameters but AC and DSE. The main effect between sleep state and CRI parameters was statistically significant except for CCm, and that between PMA and CRI parameters was statistically significant but DSE. In conclusion, the CRI of preterm infants is associated with sleep states and PMA in general. For preterm infants with a larger PMA, CRI has a more clustered pattern during different sleep states, where QS shows a more regular, stratified, and stronger CRI than other states. In the future, these parameters can be potentially used to separate sleep states in preterm infants.

Health visitors play a central role in assessing and supporting families to manage sleep concerns; but with little evidence-based guidance on managing infant sleep difficulties this can be challenging, says Bethany Boddy

OBJECTIVE To assess propranolol's impact on sleep when used in infants and toddlers with infantile hemangioma (80% under 6 months old). METHODS Parents and caregivers of infants and toddlers with infantile hemangioma presenting to a tertiary pediatric hospital's dermatology clinic and assessed by their dermatologist as requiring propranolol treatment were invited to participate. All participants completed an extended version of the Brief Infant Sleep Questionnaire (BISQ) prior to propranolol treatment initiation, which acted as the control, and 5 weeks after treatment commencement. Objective data were gathered through actigraphy, which utilizes a small wristwatch-like device that measures sleep-wake patterns, for 1 week prior to initiation and again 5 weeks after commencement. BISQ responses and actigraphy values from the two time points were compared. RESULTS 55 infants and toddlers (aged 0-2.8 years, 80% under 6 months) were included. Sleep was reported as only a minor problem by most parents 5 weeks after starting propranolol (P = .049). Subgroup analysis of 45 infants

Objective There are substantial inter-individual differences in infants’ longest consecutive sleep duration. However, intra-individual differences are rarely considered. The present study aimed to describe night-to-night variability in achieving 6 or 8 h of consolidated sleep over a 13-night period in 6-month-old infants. Methods Forty-four typically developing infants were part of the study (22 girls). When infants were 6 months old, mothers were asked to complete an infant sleep diary over 13 nights to measure the longest period of uninterrupted sleep each night. Two criteria were used to determine if infants were sleeping through the night: 6 and 8 h of uninterrupted sleep. Results On average, mothers reported that their infant slept 6 h consecutively for about 5 nights out of 13. Nine infants (20.5%) never slept 6 h consecutively, three (6.8%) met the criterion every night, but most infants (n = 32; 72.7%) showed high variability between the nights. Mothers reported that their infant slept 8 h consecutively for about 3 nights out of 13. Half of the infants (50.0%) never slept 8 h consecutively, one infant (2.3%) slept 8 h consecutively every night, and twenty-one infants (47.7%) showed high variability. Conclusions These findings expand current knowledge by showing that there is not only high inter-individual variability, but also high intra-individual variability in infant sleep consolidation. Parents and clinicians should be aware that occasional sleeping through the night does not necessarily indicate a consolidation of this behavior.

Background Sleep disturbances are quite common in infancy and have negative consequences for both child and parents. While the use of strategies to settle infants to sleep and their relationship to infantile sleep problems has already been proven, modern strategies such as apps have not yet been investigated. The aim of this study was to investigate the use of electronic devices, apps, and other strategies to settle infants to sleep in two different groups: parents of infants with sleep problems and parents of infants without sleep problems. Methods The study included 182 parents of infants aged 12 to 18 months, whereby 91 of the children suffered from sleep problems (SP) and 91 were healthy sleepers and had no sleep problem (NoSP). They filled in various questionnaires regarding infant sleep problems (Infant Sleep Questionnaire, ISQ), and strategies they use to settle their infant to sleep at bedtime and at night were assessed by the revised version of the Parental Interactive Bedtime Behavior Scale (PIBBS-R). Furthermore, sleep help-seeking behavior was evaluated. Results Parents of children with SP used more active physical comforting, whereas parents of NoSP children encouraged the child's autonomy. Social comforting at bedtime was the most used strategy, followed by using sounds at bedtime and at night. Parents of SP infants used fewer apps at bedtime than parents with NoSP infants. The groups did not differ regarding sleep-related digital or printed media advices. However, parents of SP children used more institutional support. Conclusion These results highlight the importance of parental sleep-related behavior. For prevention and early intervention, parents should be trained regarding sleep-related supportive behavior without suppressing the child's autonomy-related development.

Background An important developmental task for infants over their first few years of life is to learn to settle to sleep with a reasonably short latency, maintain sleep through the night and coordinate with family sleeping and waking schedules. A child who can reliably do this is exhibiting self-regulated sleep. Otherwise, children's sleep may have to be other (non-self) regulated to some degree and they may exhibit pediatric sleep disturbances (e.g., extended sleep latency, and/or frequent nightwaking); these are reported by 36-45% of parents of infants between ages four to 12 months. Purpose To answer the question: Can infant and parent factors observed at 1 month of infant age predict which infants will have regulated sleep at 6- and 12-months of age? Prediction from 1 month has not previously been investigated. Methods In a prospective longitudinal study, the mothers of 52 typically developing infants completed 6-day sleep diaries at 1, 3, 6, 9 and 12 months from which a composite sleep score (CSS) was derived for each child at each month. Diary reliability was assessed once (for 54% of families) using all-night videosomnography. Results At 6 months, CSS scores were distributed bi-modally and thus differentiated into two groups by an empirically observed CSS cutoff score, with a majority (56%) of infants classified as self-sleep regulated (S-R) and the rest as non-self sleep-regulated (NS-R). At 12 months, 72% could similarly be classified as S-R, while 28% exhibited some continuing sleep disturbance. Discriminant function analysis investigated the predictors of S-R vs NS-R group membership at 6 and 12 months from parent and child variables recorded at 1 month. Parent presence at sleep onset and less total infant sleep time predicted group membership at 6 months with 94% classification accuracy, and parental presence at sleep onset and frequency of infant night wakings predicted group membership at 12 months with 85% accuracy. At 1 month, parents of infants later classified as NS-R at 6 and 12 months had higher frequencies of all settling activities than parents of those later classified as S-R. Conclusion Variables measured at 1 month that predicted sleep status at 6 and 12 months were parental presence at sleep onset, frequency of infant night waking and total infant sleep time. The overall frequency of parent settling activities at 1 month also clearly differentiated the two sleep groups at the older ages. Parenting behaviours are modifiable factors and thus may have the potential for preventing pediatric sleep disturbances in children.

Background: Infancy was a golden period for children's growth and development, so it needs special attention. One of the factors that influence a baby's growth and development was sleep and rest. If the baby's sleep was disrupted then the child's physical growth will be disrupted, the cognitive and emotional development of the baby will be disrupted and this will affect the development of the brain and the potential that should develop will be lost. Baby spa was one of the useful non-pharmacological therapies which was to increase the concentration of the baby and make the baby sleep well. The aim of this study was to determine the effect of Baby Spa on sleep quality of infants 3-6 months. Methods: The design of this research was pre-experimental, one group pretest-post use a brief infant sleep questionnaire (BISQ). The sampling technique was purposive sampling with a sample of 31 infants. Statistical analysis used wilcoxon signed rank test. Results: Results of studies that had been carried out obtained frequency of sleep quality is p=0,001. That suggests baby spa were effective for improving sleep quality. Conclusion: Baby SPA was effective for improving the quality of sleep for infants 3-6 months. for mothers who had babies to add insight about the Baby Spa, because Baby Spa had many benefits, including regular sleep patterns

Clinical recommendations include putting infants to bed using a consistent bedtime routine at an appropriate hour to promote longer nighttime sleep. Actigraphy was used in this exploratory study to examine how bedtime routines and nighttime sleep onset were associated with nighttime total sleep time (TST) and efficiency from 6 to 24 weeks of age.Infants (n = 24) wore sleep actigraphs for three, one-week periods at 6, 15, and 24 weeks of age. Nighttime TST, sleep efficiency, sleep onset and offset were quantified. Mothers reported on infant bedtime routines using the Brief Infant Sleep Questionnaire at each age. Multilevel models examined between- and within-person associations.As infants aged, sleep onset was earlier, and bedtime routines became shorter (p's 0.05). Infants fell asleep between 7 and 8:00PM on 24% of the nights. Most mothers (70%) reported that they often fed infants to sleep for the night. For every 1 h earlier in infants' usual sleep onset, nighttime TST was 34.4 min longer that night (p 0.01). Infants with earlier than usual sleep onset had slightly earlier sleep offset the next morning (8.4 min for every 1 h earlier in onset; p = 0.02). Between-person analyses showed similar patterns. Infants with a more consistent bedtime routine and who were not typically fed to sleep at bedtime had longer nighttime TST at 6 weeks, with a trend or no association at later ages.Infants who fell asleep earlier also slept longer at night. Keeping infants up later in hopes of them sleeping in longer may be counterproductive.

Bedtime problems and night wakings are highly prevalent in infants. This study assessed the real-world effectiveness of an mHealth behavioral sleep intervention (Customized Sleep Profile; CSP). Caregivers (83.9% mothers) of 404 infants (age 6 to 11.9 m, M = 8.32 m, 51.2% male) used the CSP (free and publicly available behavioral sleep intervention delivered via smartphone application, Johnson's® Bedtime® Baby Sleep App). Caregivers completed the Brief Infant Sleep Questionnaire-Revised (BISQ-R) at baseline and again 4 to 28 days later. Changes in sleep patterns were analyzed, based on sleep problem status (problem versus no problem sleepers; PS; NPS). Sleep onset latency improved in both groups. Earlier bedtimes, longer continuous stretches of sleep, as well as decreased number and duration of night wakings, were evident in the PS group only. The BISQ-R Total score, total nighttime sleep, and total 24-hour sleep time improved for both groups, with a greater change for the PS group. Further, caregivers of infants in the PS group decreased feeding (bedtime and overnight) and picking up overnight, and perceived better sleep. Bedtime routine regularity, bedtime difficulty, sleep onset difficulty, and caregiver confidence improved for both groups, with the PS group showing a greater magnitude of change. Thus, a real-world, publicly available, mHealth behavioral sleep intervention was associated with improved outcomes for older infants. Intervention recommendations resulted in changes in caregivers' behavior and improvements in caregiver-reported sleep outcomes in infants, in as few as 4 days.

Background: Optimal growth and development of babies can be done through stimulation of the touch by containing massage. Babies who are massaged sleep more and compile waking up fresher. In Klaten District, parents ask for masseur services because their children are fussy and have trouble sleeping. No less than 30 babies every day who come in one massage place, even on holidays more than 60 babies who come. If you can do the massage yourself, you will be able to save money and get closer to the relationship between mother and baby, including other developments and developments, and help the baby's development. Purpose this study is analyze the effect of infant massage conducted by the mother on the growth and development of infants in Klaten Regency, it can be seen the growth and development of infant sleep. Methods: The research method is quasi-experimental with control. The study was conducted for 6 months, the intervention for 1 month consisted of training in infant massage in the group of mothers who had babies and conditioning other groups as a control group (not suitable for training). The group treated massage their babies every week for 1 month, while the other group (control) did not do massage. Data collected includes body, body length, the ability of motion received by the baby and the quality of sleep performed before and after massage in the control groups, as well as in the control groups at the time performed for 1 month. The research location is in Klaten Regency with a sample of the area in the working area of ​​Trucuk and Central Klaten Puskesmas. Data analysis was carried out for 1 month to test hypotheses using the paired "t" test to measure body weight, body length and sleep quality before and then get a good massage in the treated group with good control, through the unpaired "t" test to measure the babies given massage compared to babies who are not massaged. Results: Tests of growth and development of babies and sleep between before and after the baby was massage by the results obtained with p

Despite reductions in the rate of sudden infant death syndrome (SIDS) over the last 25 years, over 3000 infant deaths annually in the US are attributable to sleep-related causes. We aimed to improve safe sleep practice (SSP) adherence by healthcare providers working with infants admitted to an inpatient pediatric unit in an urban academic center specifically increasing compliance on five core SSP (supine, alone in the crib, no objects in crib, appropriate bundling, and flat crib).This Quality Improvement project evaluated a staff education intervention using a pre- and post-design. Surveys of providers determined baseline SSP knowledge. Adherence to SSP in the hospital was audited before and after education. One hundred pre-intervention infant sleep placement observations were recorded and 123 were collected post-intervention.Surveyed providers had appropriate knowledge of SSP; however, baseline audits indicated that no patients met all SSP practices in the hospital. Post-intervention adherence to SSP showed significant (p .05) improvements in keeping the crib flat, removing objects from the crib, and avoiding over-bundling. Overall, SSP adherence increased by 12.5% post-intervention.This quality improvement project suggests that the inpatient setting provides opportunities for providers to demonstrate SSP but that healthcare providers often do not follow SSP in practice. Continued education can lead to improvements in SSP adherence ensuring that hospitals are modeling SSP for the families of infants.Limited improvements to SSP adherence illustrate the complexities of modifying provider behaviors in the absence of formal policy.

Inconsistent conclusions from infant sleep and feeding studies may influence parents feeding-related decisions. This study aimed to systematically review the existing literature on infant sleep and its relation to the timing of introduction to complementary foods and type of milk feeding to better understand their role(s) in infant sleep. Cohort, longitudinal, cross-sectional studies, and controlled trials were identified using online searches of five databases up to April 2020. Twenty-one articles with a total of 6225 infants under 12 months-of-age were eligible. Exclusively breastfed infants (≤6 months-of-age) had a greater number of night wakings, but most studies (67%) reported no difference in night-time and 24 h sleep duration compared to formula-fed infants. However, after 6 months-of-age, most studies (>65%) reported breastfed infants to sleep less in the night-time and over 24 h compared to formula-fed infants. Furthermore, studies reported no association between the timing of introduction to complementary foods and infant sleep duration (

BackgroundApproximately 3600 sudden unexpected infant deaths (SUID) occur annually in the United States, and a quarter of SUIDs are caused by unintentional suffocation and strangulation in bed, with soft bedding use being a significant risk factor. Therefore, The American Academy of Pediatrics (AAP) recommends infants sleep on a “firm” surface, though neither an objective definition nor national standard has been established. The purpose of this study is to report on the performance of a device that measures mattress softness and to provide quantitative values of softness for various infant sleep surfaces.MethodsIn collaboration with the authors and a national child product safety organization (Kids in Danger), University of Michigan engineering students designed and validated a device that measures the vertical depression (softness) of a simulated 2-month-old’s head on a sleep surface. A total of 17 infant sleep surfaces − 14 household surfaces and 3 hospital mattresses - were measured between April 2019 and January 2020. The average softness of each surface was calculated. Surfaces were also measured with soft bedding, which included an infant fleece blanket, and firm and soft pillows.ResultsThe average softness for the 14 household sleep surfaces ranged from 7.4–36.9 mm. The 2019 cribette playard and the 2018 infant spring had similar softness (21 mm) as the 2018 and 2019 adult foam and 2015 sofa. An infant’s fleece blanket folded once added an additional 2.3–6.5 mm of softness, folded twice added 4.8–11.6 mm, and folded three times added 11–21.8 mm. Using a firm pillow added 4.0–20.9 mm of softness while using a soft pillow added 24.5–46.4 mm. The softness for the 3 hospital sleep surfaces ranged from 14 to 36.9 mm, with the infant bassinet being the firmest and the pediatrics mattress being the softest.ConclusionsWe found a wide range of softness among sleep surfaces, with some infant mattresses as soft as some adult mattresses. Adding blankets and pillows to mattresses measurably increased softness. Quantifying sleep surface softness will advance our understanding of how softness relates to SUID risk. We hope this new information will further inform safe infant sleep recommendations and improve mattress safety standards nationally.

Objective: Management of obstructive sleep apnea in infants with Robin sequence (RS) includes prone positioning during sleep, which conflicts with safe infant sleep data. We examined changes in polysomnography (PSG) parameters for prone versus nonprone body positions in these infants. Design: Pre–post interventional, nonblinded study. Participants: Infants with RS referred for PSG were recruited from craniofacial clinic and inpatient units at Children’s Hospital Los Angeles, a tertiary pediatric center. Fourteen infants were recruited, and 12 studies were completed on both body positions; 11 studies were used in the analysis. Interventions: The PSG was divided into nonprone and prone sleep, moving from their usual sleep position to the other position midway in the study. Main Outcome Measures: Data was collected in each position for obstructive apnea–hypopnea index (oAHI), central apnea index (CAI), sleep efficiency (SE), and arousal index (AI). Signed rank test was used to evaluate the change in body position. Results: All infants were term except 1, age 7 to 218 days (mean: 55 days; standard deviation: 58 days), and 8 (57%) of 14 were female. From nonprone to prone sleep position, the median oAHI (16.0-14.0), CAI (2.9-1.0), and AI (28.0-19.9) decreased ( P = .065); SE increased (67.4-85.2; P = .227). Conclusions: Prone positioning may benefit some infants with RS. However, even those with significant improvement in obstructive sleep apnea did not completely resolve their obstruction. The decision to use prone positioning as a therapy should be objectively evaluated in individual infants.

Aim: To compare parental reports of position found in sudden unexpected deaths in infancy (SUDI) to autopsy reports of lividity, to more accurately classify infant sleep position. Methods: Cases of SUDI in Queensland between 2010 and 2014 were reviewed to determine the position in which infants were reported to have been placed and found. This was compared to the distribution of post‐mortem lividity at autopsy. Evidence of lividity present during early death scene investigation was also recorded. Results: There was a discordance between the position an infant was reported to have been found and the position of lividity at autopsy in 22/228 SUDI (9.6%). All infants had anterior lividity despite 13 reportedly found supine, three on their side, and six in an unknown position. Using anterior lividity at autopsy to change the position found increased the proportion of prone infants from 37.7% to 47.4%. In 47.8% cases, anterior or lateral lividity reported at the scene was no longer present at autopsy. Conclusion: Previously published odds ratios may have under estimated the risk of sudden infant death associated with prone sleep position. SUDI death scene investigation protocols should require photographic documentation of lividity prior to transporting an infant.

Every day, 10 otherwise healthy infants die from sleep-related deaths in the United States. These deaths, termed sudden unexpected infant death, remain the leading cause of post-neonatal death in the United States despite known modifiable risk factors and prevention recommendations. In birthing hospitals, many parents report being given incorrect and sometimes no information about infant sleep safety, which creates immediate and long-term safety concerns. In this article, we provide an overview of sudden unexpected infant death, including sudden unexpected postnatal collapse, and the latest safe sleep recommendations from the American Academy of Pediatrics. We also offer practical guidelines for nurses-those working at the bedside and those in leadership positions-who may be seeking to improve the quality of infant sleep practices in their organizations.

Background : Baby massage is the oldest and most popular touch therapy known to mankind, which is also the art of health care and treatment that has been practiced for centuries. This study aims to determine the effect of infant massage on bonding attachments between mother and baby and the quality of infant sleep. Subjects an d Met h od: This was experimental study with Randomized Controlled Trial (RCT) design conducted in five health centers in Ponorogo Regency, East Java in March to April 2019. The total sample was 120 mothers and infants aged 3 to 6 months divided between massage groups (treatment) and not massage (control) based on The dependent variable of this study was bonding attachment and sleep quality. The independent variable in this study was infant massage. Data collection was using questionnaires and checklists. This study used the Mann-Whitney test Result : Infant massage effectively increased bonding attachment (effect size = 6.19; p

AIMS To examine the association of the timing and consistency of parent bedtime routines with infant night-time sleep duration and variability. DESIGN This was a prospective observational study conducted between November 2012 and November 2016. METHODS Three hundred and twenty healthy 6-month-old infants were recruited from the well-child clinics of a university-affiliated hospital in northern Taiwan. Participating families provided sociodemographic, health and bedtime routine information. Infants wore an actigraph on the ankle for a week. General linear model analysis was performed with the frequency and timing of bedtime routines treated as the primary predictor variables of interest. RESULTS One hundred and ninety-seven (61.6%) parents started the bedtime routine for infants after 9 PM, with 162 (50.6%) not having the exact same bedtime routine every night. In both crude and adjusted analyses, starting a bedtime routine after 9 PM was associated with shorter infant night-time sleep duration (b = -23.55, p

The present study explored (a) the unidirectional and bidirectional links between maternal depression symptoms and infant sleep problems and (b) the moderating role of the infant's sex on these unidirectional and bidirectional links. Mothers (N = 312) completed measures of depression symptoms at the third pregnancy trimester, and measures of depression symptoms and infant sleep problems at 2 weeks, and at 3 and 6 months postpartum. The findings revealed: (a) a main unidirectional link between maternal depression symptoms during the third trimester and infant sleep problems, particularly on infant unsettled sleep and daytime sleepiness at 3 and 6 months; (b) bidirectional links between maternal postpartum depression symptoms and infant unsettled sleep at 2 weeks, 3 and 6 months of life; and (c) the reported links between maternal depression symptoms and infant sleep problems occur specifically in boys and their mothers. Maternal prenatal depression symptoms are linked to infant sleep problems and infant sleep problems are linked to maternal postnatal depression symptoms. Boys are more susceptible to the effects of maternal prenatal and postnatal depression symptoms, and mothers of boys are more susceptible to the effects of boys' sleep problems.

BackgroundAdvice 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.AimTo 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.MethodsThis 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.ResultsThe 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.ConclusionInterventions 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.

OBJECTIVES: This study longitudinally compared the sleep of infants in the United States whose mothers were in home confinement to those whose mothers were working as usual throughout the COVID-19 pandemic. METHODS: Mothers of 572 infants (46% girls) aged 1-12 months (M = 5.9, standard deviation = 2.9) participated. Assessments were conducted on 4 occasions from late March to May 2020. Infant sleep was measured objectively using auto-videosomnography. Mothers reported their sheltering status, demographic characteristics, and infant sleep. RESULTS: Infants of mothers in home confinement had later sleep offset times and longer nighttime sleep durations, compared to infants of mothers who were working as usual. At the end of March, these infants also had earlier bedtimes, more nighttime awakenings, and more parental nighttime visits, but differences were not apparent during April and May. CONCLUSIONS: Living restrictions issued in the United States may have led to longer sleep durations and temporary delays in sleep consolidation for infants of mothers in home confinement.

Objectives We examine infant sleep from evolutionary, historico‐cultural, and statistical/epidemiological perspectives and explore the distinct conceptions of “normal” produced by each. We use data from the “Sleeping Like a Baby” study to illustrate how these perspectives influence the ideals and practices of new parents. Methods The “Sleeping Like a Baby” study investigated maternal–infant sleep in north‐east England. Sleep data for exclusively breastfeeding (EBF) and formula‐feeding (EFF) dyads were captured every 2 weeks from 4 to 18 weeks postpartum through actigraphy and maternal report. Mothers also reported their infant sleep ideals and practices. Results explore objective and maternally‐reported infant sleep parameters, and concordance of maternal ideals and practices with public health guidance. Results Comparison of sleep measures showed that mothers overestimate infant sleep duration compared with actigraphy; EFF mothers' reports were significantly more inaccurate than those of EBF mothers. For infants moved to a separate bedroom, maternally‐reported sleep increases were not borne out by actigraphy. Across the study period, concordance of maternal ideal sleep location with public health recommendations occurred on average for 54% of mothers, while concordance in practice fell from 75% at 4–8 weeks to 67% at 14–18 weeks. Discordance for EBF dyads occurred due to bedsharing, and for EFF dyads due to infants sleeping in a room alone. Conclusions Beliefs about “normal” infant sleep influence parents' perceptions and practices. Clinical and scientific infant sleep discourses reinforce dominant societal norms and perpetuate these beliefs, but biological and evolutionary views on infant sleep norms are beginning to gain traction with parents and health practitioners.

Background Sudden infant death syndrome (SIDS) is defined as the sudden unexpected death of an infant, even after investigations and autopsy. SIDS is related to many factors, such as the baby’s position and objects in the crib. Adherence to safe sleep recommendations in Saudi Arabia is unclear. This study aims to assess caregivers’ implementation of safe sleep practices and if they received any safe sleep education through health care workers. Methods This was a cross-sectional, descriptive study. Inclusion criteria included all infants below the age of one year. Exclusion criteria included infants who were born premature, used ventilation, had a tracheostomy, any anomaly in the upper airway, or underwent spine surgery. A semi-structured questionnaire was used. Data were collected from mothers who had infants visiting the outpatient department of King Abdulaziz University Hospital in Jeddah, Saudi Arabia. An electronic survey was also created and published on a social platform. Statistical analysis was conducted with the aid of the Statistical Package for Social Sciences (SPSS) software, version 26 (IBM SPSS Statistics, Armonk, NY). Results Among 506 participants, only 22.5% were found to receive education about safe practices from health care providers. Fortunately, most of the infants (63.2%) were found to sleep in a supine position most of the nights. Adherent caregivers to placing the child in a designated baby bed and in a supine position most nights represented 44.86% of the sample. However, when asked about placing any of the following objects in the bed (pillows, blankets, soft toys, hard toys, and electric wires), the percentage of adherence dropped down to only 1.58%. Conclusion There was an obvious non-adherence among caregivers and a possible lack of knowledge of safe sleep recommendations for infants. This highlights the need for optimal education by health care workers and the rule of media and campaigns is obvious and essential to improving their practices and, hopefully, decreasing the risk of SIDS.

An amendment to this paper has been published and can be accessed via the original article.

Study Objectives Evidence for the association between screen time and insufficient sleep is bourgeoning, and recent findings suggest that these associations may be more pronounced in younger compared to older children, and for portable compared to non-portable devices. However, these effects have yet to be investigated within the beginning of life. Importantly, there are no data for the relationship between screen exposure and objectively measured infant sleep. This study examined the moderating role of age for both touchscreens’ and television’s relationship with sleep, using auto-videosomnography within a big-data sample of infants. Methods The sleep of 1074 infants (46% girls) aged 0–18 months was objectively assessed using computer-vision technology in this cross-sectional study. Sleep was additionally reported by parents in an online survey, as was infant exposure to screens. Results Age significantly moderated the relationship between daytime touchscreen exposure and sleep with a distinct pattern for younger infants, in which screen exposure was associated with decreased daytime sleep, but with a proposed compensatory increase in nighttime sleep consolidation. Compared to touchscreens, television exposure was less likely to be associated with sleep metrics, and age moderated this relationship only for daytime and 24-hour sleep duration. Conclusions In young infants, a daytime-nighttime sleep “trade-off” emerged, suggesting that the displacement of daytime sleep by screens may lead to greater accumulation of sleep homeostatic pressure, which in turn facilitates more consolidated nighttime sleep.

The American Academy of Pediatrics recommends, through the implementation of the “Back to Sleep (BTS)” campaign, the supine sleeping position for infant sleeping since it prevents to prevent Sudden Infant Death Syndrome (SIDS). Objective: To describe the sleeping position of a group of infants and the risk factors associated with sudden infant death syndrome (SIDS). Subjects and Method: Prospective pilot study, including infants < 45 days of life in well-child care visits at a medical center. Exclusion criteria: Preterm-born infant (gestational age < 37 weeks) and/or comorbidities (pulmonary, metabolic, cardiologic). A brief parental questionnaire was conducted regarding general demographic data and sleep habits. The questioner was based on the BISQ - Spanish version, due to the lack of validated instruments for infants < 3-month-old. Results: We included a sample of 100 infants between 16.78 ± 12.88 days old (57% girls). Mothers were the main information source (84%). 79% of the infants slept in supine position, 19% slept on their sides, and 2% in prone position. Regarding the place where the infants slept, 66% did in their crib in the parents’ room and 31% slept in parents’ bed. 74% of infants fell asleep while being fed. 28% of infants were exposed to passive smoking at home. 91% of parents were informed about safe sleep positions, reporting that pediatricians were the main source of information (54%). Conclusion: We found a high percentage of infants < 45 days of life who slept in an unsafe position, and frequently co-sleep with their parents. Thus, it is important to implement local SIDS prevention campaigns to reinforce safe infant sleep.

To identify barriers and facilitators to adherence to safe sleep practices (SSP) among mothers of preterm infants using qualitative methodology. We conducted 23 in-depth interviews in English or Spanish with mothers of preterm infants who were recently discharged from four hospitals, utilizing a grounded-theory approach and framework of the Theory of Planned Behavior (attitudes, perceived control, social norms). For attitudes, mothers’ fear about their infants’ vulnerable preterm state related to suffocation, apnea of prematurity, and reflux influenced infant sleep practices. For social norms, education received in the NICU and advice from other health care providers, family, friends, and media impacted their choices. For perceived control, mothers adapted infant sleep practices to meet their own needs and address the perceived safety and comfort of infants. Factors identified that influence maternal decision-making about infant sleep practices can inform interventions to address sudden unexpected infant death reduction in preterm infants.

BACKGROUND: Rapid weight gain (RWG) by 6 months of life is a significant risk factor of childhood overweight (OW)/obesity. Infant sleep patterns are associated with incident OW in childhood, but few have examined its relationship with RWG. OBJECTIVE: Examine associations between newborn sleep-wake patterns and incident RWG at 6 months of life and OW at 36 months. METHODS: Low-income Mexican/Mexican-American women with OW/obesity and their infants (n = 126) enrolled in a 1-year randomized controlled trial designed to prevent incident, infant RWG and toddlerhood OW/obesity. Sleep pattern metrics at 1 month were extracted from the Brief Infant Sleep Questionnaire-Revised. Outcome measures included RWG (>0.67 positive change in weight-for-age Z-score) from birth to 6 months and incident OW (body mass index percentile ≥85) at 36 months. RESULTS: By 6 months, 35.7% (n = 45) of infants experienced RWG, and by 36 months 42.3% (n = 41) of toddlers were OW. Napping ≥5x/day at 1-month was significantly associated with decreased odds for RWG compared to napping

We all have a role in advocating for our most vulnerable. A systematic and coordinated approach to advocating for safe sleep will result in a significant reduction in preventable sleep-related infant deaths. Using a foundation of the psychology of risk with targeted messaging and methods will result in sustained improvement. This advocacy should be routed in an understanding of established beliefs, norms, and structures. Through effective advocacy across the infant life course, we will change the culture of infant sleep. Thousands of infant deaths can be prevented if we choose to advocate and act.

Peak sound levels during sleep can compromise the development of hospitalized infants. Quiet time is a strategy implemented in neonatal units to promote the sleeping of neonates by reducing noise levels, luminosity, and handling during particular periods of the day.To determine the impact of quiet time on reducing sound levels and increasing total sleep time.This longitudinal study was conducted at a neonatal intermediate care unit with a convenience sample of 12 premature infants. Four times per day, 60-minute quiet times were provided in the neonatal unit. Sleep-awake states and sound levels were evaluated during quiet times as well as 60 minutes before and afterward. Polysomnography was used for sleep-awake state assessment, and a noise dosimeter was used to check sound levels every 24 hours.The preterm infants had a corrected gestational age of 35.0 ± 1.5 weeks and weighed 1606.0 ± 317.8 g. Total sleep time was highest during quiet time (P = .005). Premature infants remained awake for longer following quiet times (P = .005). There was also a reduction in sound level during quiet times compared with the other time frames (P = .006). No statistically significant relationship was found between total sleep time and sound levels more than 24 hours.Quiet time is a nursing intervention that should be implemented in all neonatal units.Future research should use a greater sample size and other factors that influence sleep should be further investigated.

Parents of infants expect their baby will sleep safely in any of a number of products that are intended for overnight sleep (e.g., crib, bassinet, cradle, play yard) as well as products in which infants routinely nap (e.g., infant seat, swing). Yet each year, infants die while napping or sleeping. The Consumer Product Safety Commission (CPSC) is an independent federal agency charged with protecting the public from unreasonable risk of injury associated with consumer products, including infant sleep products. In this panel, technical experts from the CPSC address issues relating to infant sleep safety including physiological factors associated with infant death and findings from incident data. Case studies for two infant products (handheld infant carriers and infant bouncer seats) and focus group research findings with parents of infants shed light on consumer behavior as it relates to perceptions of infant comfort and product use.

Previous studies have found that exclusively breastfeeding (EBF) mothers get more sleep and report higher levels of well-being than mothers who are not EBF. We do not know whether infant sleep location influences these findings. The present analyses are from the Survey of Mothers’ Sleep and Fatigue, an online survey of 6,410 mothers from 59 countries. Feeding method and sleep location do interact and are related to babies’ and mothers’ sleep and measures of mothers’ well-being. EBF/bedsharing mothers reported more sleep, better physical health, and less depression, anger, and anxiety than non-EBF or nonbedsharing mothers. Conversely, bedsharing/non-EBF mothers had some of the worst outcomes. Bedsharing was related to positive outcomes for EBF mothers. Our findings are consistent with recommendations that non-EBF mothers avoid bedsharing.

Many countries have guidelines that recommend safety practices for infant sleep. However, it is not known whether guidelines between countries are similar or different. The purpose of this paper is to compare national public health infant sleep safety guidelines among highly developed countries. Criteria for inclusion were: countries defined by United Nations as "very high human development," guideline related to infant sleep position and safety practices, evidence of it being a national guideline, and published in English. Guidelines from nine countries met inclusion criteria, and data were extracted across 13 categories. All guidelines recommended the supine sleep position and avoidance of smoke exposure. While most guidelines addressed the remaining 11 categories, specific recommendations varied among guidelines. These findings can inform the broad context of SIDS reduction work, offer opportunities for collaboration among countries, and promote multi-country and global conversations about how research evidence is translated into recommendations for practice.

Background: As sleep position and environment are known to contribute to the risk for infant death, and media images have been shown to sway healthcare decision-making, in 2016 the American Academy of Pediatrics (AAP) updated their sleep guidelines to explicitly call for the media to refrain from depicting infants in unsafe sleeping positions/environments.Objective: We aimed to assess whether the images accompanying the news coverage of the press release summarizing these new safe sleep guidelines were consistent with the recommendations.Method: We searched the Google News™ archives, the largest compilation of searchable news coverage in the world, in the month after the AAP issued its press release. Two coders independently analyzed all pictures of sleeping infants accompanying the news reports for adherence to the guidelines regarding sleep position/environment.Results: We identified 44 news articles with 39 accompanying images showing a sleep environment with or without an infant. The majority ...

Objectives: This study proposed a version of the Children’s Sleep Habits Questionnaire for infants under 12 months (CSHQ-I). Methods: The sample was comprised of 299 infants, aged between 2 weeks and 12 months. Results: Exploratory factor analysis revealed four subscales: Bedtime Resistance, Sleep Anxiety, Positive Sleep Habits, and Daytime Sleepiness. The CSHQ-I total scale presented good test- retest reliability and internal consistency. The CSHQ-I also showed good concurrent validity, with significant associations found between the CSHQ-I total scale and subscales and a measure of infant sleep-wake behaviors. Conclusions: The present study suggested the CSHQ-I as a reliable instrument to assess sleep problems in infants during the first year of life., Ministry of Education and Science(UID/PSI/01662/2013), info:eu-repo/semantics/acceptedVersion

Sleep-related infant deaths are a leading cause of infant mortality in Georgia, and these deaths are largely associated with unsafe sleep practices among caregivers. In early 2016, the Georgia Department of Public Health launched the Georgia Safe to Sleep Hospital Initiative, providing hospitals with safe infant sleep information and educational materials to be distributed to families and newborns. This study examined the knowledge and behaviors of a sample of Georgia parents after the implementation of the Hospital Initiative and identified the family characteristics and intervention components most closely associated with the knowledge and practice of safe infant sleep. The primary caretakers of all infants born in Georgia from August to October 2016 were invited to complete a web-based survey 1 month after hospital discharge. The final sample size included 420 parents of newborns, and the primary outcomes assessed included two measures of knowledge and four measures of infant sleep behaviors regarding infant sleep position and location. Most respondents demonstrated knowledge of the correct recommended sleep position (90%) and location (85%). Logistic regression revealed that receipt of information in the hospital was significantly correlated with safe sleep behaviors, and infant sleep habits tended to influence safe sleep practices. Additionally, Medicaid parents receiving bassinets from the hospital were 74% less likely to bed share (OR 0.26; 95% CI 0.007). Implementation of a statewide hospital initiative was associated with high levels of parental knowledge and behavior and may have been successful in reducing the practice of bed sharing among Medicaid parents. Electronic supplementary material The online version of this article (10.1007/s10900-017-0449-x) contains supplementary material, which is available to authorized users.

Aims To examine the sleep characteristics of infants with parentally reported sleep problems, with parentally reported no sleep problems and with parentally reported uncertain sleep conditions. Background Infant sleep problems are recognized as a major health issue worldwide. However, in our daily clinical practices it is not uncommon for parents not to know whether their infant sleep is problematic. Design and Methods A prospective study conducted between 2012 - 2015 where 219 parents completed questionnaires and infants wore an actigraph monitor for 7 days. Multinomial logistic regression models were used to evaluate the actigraphic and parentally reported infant sleep behaviors between the groups. Results Thirty-two (14.61%) parents did not know whether their infant sleep was problematic and 118 (53.88%) parents considered their infant sleep a problem. Compared with infants without sleep problems, infants with uncertain sleep conditions had significantly increased odds of having shortened longest sleep duration according to parental report. A significant association was found for infants without sleep problems compared with those with sleep problems who had significantly more wake after sleep onset as measured by actigraphy, as well as reduced longest sleep duration according to parental report. Conclusion Infants with uncertain sleep conditions have the same problematic sleep behaviors resembling those of children with reported sleep problems. Healthcare professionals should actively disseminate sleep knowledge to help parents interpret infant sleep behaviors and consider possible intervention strategies for improving parental sleep-related knowledge and infant sleep. This article is protected by copyright. All rights reserved.

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.

Optimal sleeping habits are important for health development of infants. The role of culture in sleep habits cannot be underestimated. We aimed to characterize sleep patterns, sleep practices, and sleep problems; and assess the sleep settings and parental perceptions of sleep problems in children from birth to 36 months in countries in the Southeast Asian (SEA) region.Parents and caregivers of infants and toddlers (birth to 36 months old) from countries in Southeast Asia participated in this study.Data was collected using the Brief Infant Sleep Questionnaire for a total of 5,987 children from 6 countries in the SEA region (967 Indonesia/ID, 997 Malaysia/MY, 1,034 Philippines/PH, 1,001 Singapore/SG, 988 Thailand/TH, and 1,000 Vietnam/VN).The sleep variables varied among SEA children studied. Bedtimes and nighttime sleep varied across the region by as much as 1 hr 34 min and 1 hr 15 min respectively.Despite being geographically very close together and having some common sociocultural characteristics, sleep variables in the young child within the SEA region do differ in significant ways.

Introduction: Sleep patterns in infants is one of the main issues regarding children upbringing and has different positions in publications.Objective: To analyze 63 publications with parenting advice on sleep in infants to subsequently characterize them in terms of their position on co-sleeping and sleep training.Materials and methods: Publications issued in the past two decades, available for purchase and/or reference in Chile. 63 publications, including parenting advice books and 32 web sites, were identified.Results: 65% of the analyzed publications favored some form co-sleeping; 76% mentioned sleep training, expressing a tendency to defend and/or accept the strategy known as ‘positive routines’ rather than ‘cry it out methods’.Conclusions: Chilean parents are confronted with contradictory information. The current debate on the regulation of infant sleep is also seen in Ibero-America, although expert opinion differs from that found in Anglo-Saxon samples. Introducción. Uno de los temas centrales en la crianza de los hijos, y que se sabe tiene muchas posiciones diferentes en las publicaciones, es el sueño en los bebés.Objetivo. Describir las diferentes posiciones de las publicaciones que ofrecen asesoramiento a los padres chilenos sobre el sueño en bebés durante las últimas dos décadas.Materiales y métodos. Se seleccionaron 63 publicaciones disponibles para su compra o de referencia en Chile de las dos últimas décadas, las cuales dan consejos a los padres en relación al sueño de los bebés. Estas publicaciones se analizaron para luego caracterizarlas en relación a las posiciones de colecho y entrenamiento del sueño.Resultados. Se encontró que el 65% de las publicaciones analizadas aconseja, de alguna forma, el colecho y el 76% menciona el entrenamiento del sueño, expresando una tendencia a defender o aceptar la estrategia conocida como “rutinas positivas” en lugar del “dejar llorar”.Conclusiones. Los padres chilenos se enfrentan con información contradictoria: existe un debate sobre la regulación del sueño infantil en Iberoamérica y la opinión de los expertos difiere de la encontrada en muestras anglosajonas.