Perceptions of Childhood Injuries and Safe Sleep Practices Among New Parents: What They Know Versus Reality

Mary Grace Chiu, BS
Madison Tuazon, BSA
Sandra McKay, MD

A decade review (2008-2017) by the Harris County Child Fatality Review Team (HCCFRT) recorded 2,260 child deaths from non-natural causes. They found that the leading non-natural cause was infant sleep-related deaths, which made up 32% of deaths for children under 18 years old, but accounts for 78% of all deaths for children under 1 year of age. Other causes of child death reviewed by HCCFRT include firearm-related deaths as the 2nd leading cause of death (13.8%) and drowning ranking 4th (9.6%). With the multitude of causes of death for children, increasing awareness and disseminating safety information continues to be an important method for prevention. This study focuses on the current safe sleep practices and perceptions of common childhood injuries by parents.

An IRB-approved cross-sectional observational study was conducted with caregivers of newborns 4 weeks of age or under via an online or printed survey from 11/15/2021 - 05/25/2022. The anonymous survey was administered to 103 caregivers at an outpatient clinic. Descriptive analysis was performed. Questions with multiple responses for questions that required only one answer or left blank were excluded from analysis.

86% (86/100) of caregivers reported laying their infant on their back to sleep, and 22% (22/101) reported using at least one unsafe item with the child when sleeping (pillow, loose blanket, propped up bottles or stuffed toys). In total, 72% (73/102) of caregivers reported receiving education about safe sleep practices in the hospital. 59% (13/22) of caregivers who reported having an unsafe item with the child while sleeping also reported receiving safe sleep education in the hospital. Of those who received safe sleep education, 41% (30/73) of them reported at least one of the following (1) having an unsafe item in bed, (2) recorded not having the baby in their own crib or bassinet, or (3) responded neutral, disagree, or strongly disagree to the statement “It is dangerous for an infant to sleep in the same bed as a parent.” Of all respondents, 73% (73/100) agreed or strongly agreed that sleeping in the same bed with an infant is dangerous. Most caregivers disagreed or strongly disagreed that drownings, falls, or firearm injuries were problems impacting children.

Despite receiving safe sleep education, over a third of caregivers engaged in unsafe sleep practices or did not perceive co-sleeping as dangerous. Interestingly, among the caregivers who utilized an unsafe item with the infant during sleep, more respondents received safe sleep education than not. It would be interesting to explore this finding further to determine if it is consistent among a larger sample. In other areas of injury prevention such as drowning and firearm injury, despite the prevalence in Harris County, parents fail to perceive the risk. Further studies should be conducted to determine if increased education on the rates of injury in the community would impact perceived risk.

Describe current safe sleep recommendations and actual sleep practices in new caregivers.
Gauge the occurrence of safe sleep education recalled by new caregivers.
Explore caregivers perceptions of safe sleep practices and preventable childhood injuries.