The Journal of pediatrics · 2026
Inconsistency in Maternal Report of Infant Sleep Characteristics: Results from a National Survey and Implications for Sudden Unexpected Infant Death.
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Tor Shaelise, Wang Hongyue, Bartick Melissa
Аннотация
OBJECTIVES: To evaluate infant sleep practices and risk factors for sudden unexpected infant Death (SUID) and and to explore the relationship of sleep practices to breastfeeding duration.
STUDY DESIGN: Using national data from the Pregnancy Risk Assessment Monitoring System, 2016-2021, we evaluated infant sleep practices and tobacco use among 181,075 mothers of infants born at term. We compared how often mothers reported infants sleeping "alone in their own crib," with their reports of "usual" sleep surface using descriptive statistics. Because of disparities in SUID by race and ethnicity, we used descriptive statistics to examine racial and ethnic differences in sleep practices, tobacco exposure, and exposure to safe sleep recommendations. We also performed a survival analysis examining breastfeeding cessation by alone/crib.
RESULTS: Of mothers reporting "Often" alone/crib, 39.4% reported usual infant sleep was on a bed. Among usual bed sleepers, 18.4% also usually slept on a sofa. Although a causal relationship cannot be inferred, descriptive statistics revealed that racial and ethnic differences in prone sleep, sofa-sleeping, and smoking largely align with known differences in SUID, but differences in alone/crib and bed-sleeping do not. Having a health professional recommend supine sleep and separate sleep did not consistently correlate with how often these were practiced nor to known racial and ethnic differences in SUID. Compared with those who "Never" reported alone/crib, those who "Always" reported alone/crib had a higher risk of breastfeeding cessation (adjusted Hazard Ratio 1.74, 95% Cl: 1.68, 1.81).
CONCLUSIONS: Mothers' reports of alone/crib are discordant with their reports of infants' sleeping in a bed, and the ascertainment of what mothers are doing is challenging. Mothers may not appreciate that sofa-sleeping is uniquely dangerous. Sleeping alone/crib is strongly associated with earlier breastfeeding cessation, which, if causal, has implications for the health of women and children.
STUDY DESIGN: Using national data from the Pregnancy Risk Assessment Monitoring System, 2016-2021, we evaluated infant sleep practices and tobacco use among 181,075 mothers of infants born at term. We compared how often mothers reported infants sleeping "alone in their own crib," with their reports of "usual" sleep surface using descriptive statistics. Because of disparities in SUID by race and ethnicity, we used descriptive statistics to examine racial and ethnic differences in sleep practices, tobacco exposure, and exposure to safe sleep recommendations. We also performed a survival analysis examining breastfeeding cessation by alone/crib.
RESULTS: Of mothers reporting "Often" alone/crib, 39.4% reported usual infant sleep was on a bed. Among usual bed sleepers, 18.4% also usually slept on a sofa. Although a causal relationship cannot be inferred, descriptive statistics revealed that racial and ethnic differences in prone sleep, sofa-sleeping, and smoking largely align with known differences in SUID, but differences in alone/crib and bed-sleeping do not. Having a health professional recommend supine sleep and separate sleep did not consistently correlate with how often these were practiced nor to known racial and ethnic differences in SUID. Compared with those who "Never" reported alone/crib, those who "Always" reported alone/crib had a higher risk of breastfeeding cessation (adjusted Hazard Ratio 1.74, 95% Cl: 1.68, 1.81).
CONCLUSIONS: Mothers' reports of alone/crib are discordant with their reports of infants' sleeping in a bed, and the ascertainment of what mothers are doing is challenging. Mothers may not appreciate that sofa-sleeping is uniquely dangerous. Sleeping alone/crib is strongly associated with earlier breastfeeding cessation, which, if causal, has implications for the health of women and children.