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Factors influencing maternal decision-making for the infant sleep environment in families at higher risk of SIDS: a qualitative study
  1. Anna Pease,
  2. Jenny Ingram,
  3. Peter S Blair,
  4. Peter J Fleming
  1. Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr Anna Pease; a.pease{at}


Objective Qualitative interviews with mothers of babies at higher risk of sudden infant death syndrome (SIDS) were carried out to understand their views and decision-making process on the infant sleep environment and safe sleep messages.

Design and setting Twenty semi-structured interviews were conducted between February and November 2014 in deprived areas of Bristol, UK. Mothers were asked about their decision-making for the infant sleep environment and safe sleep messages including infant sleep position, co-sleeping, smoking, dummy use, feeding and disrupted routines. The interviews were transcribed, coded and thematic analysis carried out.

Participants Participants were invited based on an algorithm developed in a previous SIDS case control study that identified an increased risk of SIDS from four demographic characteristics: young maternal age, smoking during pregnancy, three or more children, and a measure of deprivation. The presence of three, or more characteristics led to being invited to take part in the qualitative study.

Results Factors influencing mothers’ adherence to the safe sleep messages included previous experience and the credibility of the advice given. They described disrupted routines that led to risky scenarios with a belief that occasional risks were acceptable. Where circumstances made following the advice more difficult they found alternative strategies to reduce the risk, including the use of movement monitors, regular checking and a belief that lighter maternal sleep in the presence of a baby was protective.

Conclusions Safer sleep messages should be tailored to fit with the lived realities of mothers, especially those at higher risk. The traditional list of ‘do’s’ and ‘don’ts’ was not well accepted by this group. Interventions that seek to influence this higher-risk group should acknowledge mothers’ own protective instincts and consider their beliefs and understanding behind the safer sleep messages if they are to be effective and encourage this group to change.

  • sids
  • sleep
  • epidemiology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors The study was conceptualised by the research team: AP, JI, PJF and PSB. The research team was involved in designing the study and applying for ethical approval. AP conducted the interviews and analysis, JI provided guidance and support with coding and the continuous comparative analysis process. The research team together reached a consensus on the final themes. AP wrote the paper with input from JI, PJF and PSB.

  • Funding The Lullaby Trust; grant number 267.

  • Competing interests None declared.

  • Ethics approval West Midlands NHS Research Ethics Committee; ref: 13/WM/0403.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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