Addressing Caregiver Challenges with Inconsistent and Unrealistic Safe Sleep Messaging: a Safer Sleep Guideline informed by Risk Minimisation

Safe sleep messaging varies considerably in clinical practice and guidelines within and between Australian states and territories. Risk elimination approaches which attempt to enforce idealistic expectations of where and how a baby sleeps have been demonstrated to alienate parents. Risk minimisation approaches which support ‘safer sleep’ offer flexibility and practical strategies that are more likely to engage families in risk reduction and infant health promoting behaviours. This analysis aims to share safe sleep messages that parents identified as most challenging to implement and introduce the Safer Infant Sleep clinical guideline designed to address common barriers encountered. A cross-sectional survey of 3341 Queensland families with infants aged approximately 3-months, birthed April-May 2017. Data included family characteristics, infant care practices used and engagement with safe sleep recommendations. Qualitative free-text items explored challenges with current safe sleep recommendations. Of caregivers, 1033 (31%) reported difficulty with at least one recommendation. Infant sleep position and avoiding a shared-sleep surface presented the greatest challenges. Families experiencing challenges were significantly less likely to employ advice compared to those not reporting difficulty (sleep position: 198/473, 42% vs 2548/2837, 90%[p<0.0001]; own sleep space: (269/344, 78% vs 1331/2884, 46%[ p <0.0001]). Parenting strategies believed to be unsupported weren’t disclosed, reducing opportunities between family and health professionals to share information and inform safer strategies. A tiered approach to tailor interventions for priority families based on identified vulnerabilities has been designed to develop safer sleep plans for every sleep. Structured support such as the Pēpi-Pod® Program is included. Many families encounter difficulties in implementing safe sleep advice; these challenges negatively impact infant care practices. The Safer Sleep guideline provides families a voice for collaborative and informed decision-making and provides professionals a tiered approach to manage risk whilst recognising their clinical judgement and reasoning to meet the needs of families.