Mothers knowledge and practice of infant sleep position

Niger J Paed 2014; 41 (4):312– 315

ORIGINAL

Okpere AN

Mothers’ knowledge and practice of

Opara PI

infant sleep position

DOI:http://dx.doi.org/10.4314/njp.v41i4,4

Accepted: 12th April 2014

Abstract

Background:

Prone

education while 265 (94.0%) were

sleeping by infants has been asso-

married. The commonest sleep

Okpere AN

(

)

ciated with increased risk of sud-

position

was

prone

position

Opara PI

den

infant

death

syndrome

(44.3%).Baby’s comfort was the

Department of Paediatrics

University of Port Harcourt Teaching

(SIDS). Many child caregivers

commonest reason for choice of

Hospital, Port Harcourt, Nigeria

continue to be unaware of the

position. There was no significant

E-mail: anokpere@yahoo.com

association of SIDS and infant

relationship between mother’s age

sleep position and/or are misin-

and education and choice of infant

formed as to the risks and benefits

sleep position (p > 0.05).A total of

of the various sleep positions.

229(81.2%) respondents were un-

Objectives: To explore mothers’

aware of any medically recom-

knowledge and practice of infant

mended sleep position. Of those

sleep position and SIDS.

who were aware, the commonest

Methods: The study was con-

source of knowledge was grand-

ducted in April – August 2012

mothers. A total of 99 (35.1%)

amongst mothers of infants at-

respondents had heard of SIDS but

tending the Paediatric Outpatient

over 80% of them did not know

Clinics of the University of Port

the cause.

Harcourt Teaching Hospital, Port

Conclusion: Mothers in Port Har-

Harcourt, Nigeria. A structured

court have poor knowledge of in-

questionnaire was used to obtain

fant sleep position. Doctors should

information

biodata

and

take more active part in educating

knowledge and practice of infant

mothers on safe child care prac-

sleep position and SIDS. Data

tices.

were analyzed using SPSS version

16.0.

Key words: Infant sleep position,

Results: A total of 282 mothers

mothers, sudden infant death syn-

participated in the study; 167

drome, Nigeria

(59.2%) of them had tertiary

Introduction

SIDS.⁶ In many developed countries including the United

States of America that implemented the ‘Back to Sleep’

Sleeping in the prone position by infants has been asso-

public education campaign, there has been remarkable

reduction in the incidence of SIDS

7,8,9,10

ciated with increased risk of sudden infant death syn-

. However,

drome (SIDS) . SIDS is defined as the sudden death of

many child caregivers continue to be unaware of the

an infant less than one year of age that cannot be ex-

association of SIDS and infant sleep position and/or are

plained after a thorough investigation is conducted, in-

misinformed as to the risks and benefits of the various

sleep positions .

cluding a complete autopsy, examination of the death

scene, and review of the clinical history . It is the

leading cause of postneonatal death in the UnitedStates,

The choice of infants sleep position by caregivers is

accounting for approximately2200 infant deaths each

influenced by many factors. These include maternal age,

year . Although the aetiology ofSIDS is unknown,

3,4

race, parity, education, income, parental needs and

placing the infant to sleep in the supine position has

beliefs, prematurity, infant’s age and recommendations

received from specific sources

12,13

been found to besignificantly associated with a decrease

. Young maternal age,

in the rate of SIDS .

high parity, black race, preterm birth, maternal smoking

and substance abuse during pregnancy and postnatal

Reducing the risk of SIDS is an important public health

exposure to environmental cigarette smoke are some of

the identified risk factors for SIDS

12,13,14

priority in the United States of America (USA) . This

. Recent data

has led to the recommendation by the American Acad-

from the National Infant Sleep Position Survey in the

emy of Pediatrics (AAP) that infants be placed to sleep

USA suggests that African American infants born to

in the supine position in other to reduce the incidence of

mothers in all educational and income categories are

313

consistently and increasingly placed in the prone sleep

Table 1: General characteristics of the mothers

position and remain twice as likely to die from SIDS as

Age range (years)

Frequency

Percent (%)

Caucasian infants

15,16,17

. In Africa, there is paucity of

data on the relationship between infant sleep position

20 – 24

9.6

and SIDS. The present study was conducted to explore

25 – 29

35.1

mothers’ knowledge and practices concerning infant

30 – 34

115

40.8

≥ 35

14.5

sleep position and SIDS in Port Harcourt, Nigeria.

Marital status

Married

265

94.0

Single

6.0

Educational status

Materials and Methods

Primary

6.4

Secondary

34.4

A cross-sectional survey carried out over a period of

Tertiary

167

59.2

four months from April to August, 2012 among mothers

Number of children

of infants attending the Paediatric Outpatient and Well–

1 – 3

250

88.7

4-6

10.6

baby clinics of the University of Port Harcourt Teaching

≥ 6

0.7

Hospital (UPTH), Port Harcourt, Nigeria. The study

group comprised of mothers who presented with their

Table 2: Reasons for non use of cots/cribs by the

children to the hospital on each clinic day. The partici-

mothers (n=179)

pants were selected by random sampling of these moth-

Reason

(%)

ers using the numbers assigned to them by the nurses

and only those mothers with infants were recruited for

Baby refuses to sleep on cot/crib

5.6

Easy to reach baby when he/she needs help

48.6

the study. A total of 282 mothers were recruited into the

Father wants to get used to baby

5.6

study.

No cot/crib

12.8

None stated

21.8

A structured, anonymous questionnaire was used to ob-

tain information on biodata, knowledge and practice of

Table 3 shows sleep position and reasons for choice of

infant sleep position and locations as well as knowledge

position. Two hundred and thirty four (83.0%) of the

on SIDS. Data was analyzed using the Statistical Pack-

babies had a particular sleep position. Of these, 125

age for Social Sciences (SPSS) version 16.0(SPSS Inc.,

(44.3%) usually slept in the tummy down/ prone posi-

Chicago, Illinois, USA). The differences among groups

tion. The commonest reason for choice of sleep position,

were assessed using Pearson’s Chi- square ( χ ) test.

irrespective of whether it was side, supine or prone was

Probability (p) values of less than 0.05 were considered

that it was more comfortable for the baby (Fig 1). Per-

statistically significant.

ceived comfort of the baby was significantly associated

with the choice of sleep position (p< 0.001). There was

no significant relationship between mothers’ age and

choice of infant sleep position (p=0.291), or between

Results

mothers educational status and choice of infant sleep

position (p= 0.608).

Two hundred and eighty two mother–infant pairs par-

Fifty three (18.8%) respondents were aware of a recom-

ticipated in the study. Majority of the mothers were in

mended sleep position for infants. Sources of knowledge

the age range 25 - 34 years. Two hundred and sixty five

on infant sleep position are shown in Table 3. Grand-

(94.0%) of them were married while the others were

mothers were the highest source (33%) of knowledge,

single mothers. One hundred and sixty seven (59.2%)

followed by nurses. Ninety nine (35.1%) respondents

had tertiary education while 250 (88.7%) had between

had heard of SIDS. Reported causes of SIDS amongst

one and three children (Table 1). The mean age of the

the mothers included suffocation (5.3%), aspiration

babies was 5.9 ± 3.8 months. One hundred and three

(7.4%) and spiritual attack (1.1%). The rest of the moth-

(36.5%) were reported to sleep on a cot/crib while 179

ers either did not know or had never heard of SIDS.

(63. 5%) did not. Of these, 114 (63.7%) slept with their

mothers on the bed, 60 (33.5%) slept with both parents

Table 3: Infant sleep position and reasons for choice of posi-

on the same bed whilst 5 (2.8%) shared a bed with one

tion

or more siblings.

Sleep position

Frequency

On the side

20.6

Table 2 shows reasons for not putting babies to sleep on

On the back (supine)

18.1

a cot or crib. The commonest reason given was that it

Tummy down (prone)

125

44.3

was easier to reach the babies when they needed help.

No particular position

17.0

Reasons for choice of sleep position

Baby sleeps longer

3.5

Helps baby breathe well

7.1

More comfortable for baby

175

62.1

Prevents aspirations/choking

7.1

Prevents vomiting

1.4

Aids breast feeding

1.8

None

17.0

314

Fig 1: Reasons for choice of infant sleep position

Bed sharing either with parents or siblings was a com-

mon phenomenon noted in the present study. Although

only a small proportion of mothers reported not having

cots/cribs, most still preferred to share a bed with their

infants. Sharing a bed with an infant is common practice

in our environment and many other countries and there

have been controversies over its contribution to

SIDS

23,24

. However, in recent times there seems to be

growing evidence linking the practice and SIDS. To

prevent sleep-related infant deaths, the recommendation

is that infants share a room with their parents, but not a

bed for sleeping .

Very few respondents in the present study were aware of

a recommended sleep position for infants. This may be

Table 4: Sources of knowledge on infant sleep position

because unlike in many developed countries, SIDS does

not feature as one of the major causes of infant mortality

Source

Frequency

Percentage

in Nigeria and so rarely features as a topic for health

Books

1.8

education even among healthcare providers. Many of the

Doctors

4.6

respondents had also not heard of SIDS. This may imply

Friends

6.4

as earlier stated that healthcare providers in this environ-

Grandmother

33.0

ment do not educate parents about the condition. This is

Neighbours

3.5

Nurses

14.2

further supported by the finding that doctors were a very

Other relatives

8.2

small source of knowledge on infant sleep position.

Self

8.9

Grandmothers and nurses were high contributors as

None /unaware

19.5

sources of knowledge on infant sleep position. The

Total

282

100.0

study did not go on to explore what knowledge was

passed on by these individuals to mothers but it has been

reported that advice from doctors and nurses tended to

affect mothers’ choice of infant sleep position. Oden et

Discussion

in a study conducted in Washington DC in the

United States of America (USA), found that infants with

The present study showed that close to half of the babies

a grandmother living in the home were more likely to be

sleep in the prone position. This is very worrisome as

placed in the prone position for sleep.Grandmothers play

this position has been recognised as a risk factor for

an important role in maternal and child care in Nigeria

SIDS in several reported studies

1,7,8,9

. The commonest

and Africa at large; they are therefore an important tar-

reason given for choice of sleep position irrespective of

get group for education on improved child care practices

whether supine, prone or otherwise was comfort. Differ-

including safe sleep position for infants.

ent authors had reported that the position perceived by

mothers as most comfortable for their babies was very

influential in choosing the sleep position for their in-

fants

19,20,21

. Mothers who thought that their infants were

Conclusion

more comfortable sleeping in the prone position were

more likely to choose this position for their infants and

In conclusion, mothers in Port Harcourt have very poor

those who thought that their babies were more comfort-

knowledge of safe sleep position for infants irrespective

able in the supine position were more likely to place

of their age or educational status. The prone position

their infants in the supine position

19,20

. This is in conso-

was the preferred infant sleep position and infants’ com-

nance with the findings in this study. Another important

fort was the greatest reason for choice of any sleep posi-

factor affecting mother’s choice of infant sleep position

tion. Health care providers are not providing needed

is the risk of choking and ability of the baby to breathe

information to mothers on safe sleep practices for in-

well and this has also been reported in a previous

fants. It is thus recommended that heath workers, espe-

study . Mothers who believe that their infants will

cially doctors should play a key role in disseminating

choke in the supine position are also less likely to lie

information on safe sleep practices for infants in the

their infants on their back to sleep .

clinics, through the media and in any contact with moth-

ers of young infants.

There was no significant relationship between mothers’

age or educational status and choice of infant sleep posi-

Authors' contributions

tion. This emphasizes the fact that mothers need to be

Both authors conceived the study, designed the study

given specific information about safe infant sleep posi-

instrument, prepared and approved the final version of

tion. This may be inculcated into the school curriculum

the manuscript.

as part of health education or information given rou-

Conflict of Interest: None

tinely to mothers during the antenatal period.

Funding: None

315

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