P2C137: A Qualitative Evaluation of Parental Safe Sleep Perceptions and Practices Following the Provision of a Free Portable Crib

Background: Unsafe sleep practices are a leading cause of infant mortality, contributing to about 3,500 deaths in the United States each year. Research addressing parental perceptions and practices following targeted provision of a safe sleep space is limited. This qualitative study investigated parental safe sleep perceptions and practices for their infants among families who received a free portable crib in the hospital after delivery or at the baby’s pediatric clinic.

Methods: Parents who received a free portable crib through our health system were invited to participate in a structured 11-question interview regarding their safe sleep perceptions and practices including use of the crib. Interviews were transcribed, and the research team conducted an inducted thematic analysis to identify the most prominent themes.

Results: Family interviews (n=11) resulted in six saturated themes: (1) parents remembered receiving safe sleep counseling and often recalled it in detail, (2) many parents planned to have their babies sleep in bed with them prior to receiving the free crib, (3) when describing their infants’ sleep practices, parents described many habits that were contrary to the safe sleep guidelines, (4) parents expressed a range of reasons for why they were not following the safe sleep guidelines, (5) parents recommended that the healthcare team continue providing free cribs and counseling all parents on safe sleep guidelines, and (6) overall parents found the free crib to be helpful and sometimes used it in combination with other sleep settings. During the interviews, parents cited generational family practices, cultural differences, a desire for a softer sleep surface, and caretaker fatigue as reasons they may not adhere to safe sleep guidelines.

Conclusion: For many families, the free crib provided a safe place for their infants to sleep when this was otherwise unlikely based on their plans for sleeping arrangements prior to receiving the crib. Though parents demonstrated extensive knowledge and support of safe sleep guidelines, there was a discrepancy between this knowledge and what they reported practicing in their homes. Parents described several reasons for not following safe sleep guidelines, but they also widely advised health care professionals to continue counseling all parents on the guidelines. Further investigation is needed to better understand this disconnect between knowledge and practice.