What TiKtok Taught Me About Safe Sleep: Rethinking Sudden Unexpected Infant Death Messaging to Adolescent Parents and Caregivers

Felicia Scott-Wellington, MD
Gina Lowell, MD, MPH
Eliot England, MPH

The transition through adolescence can be a challenging journey for most teens. Becoming a parent during adolescence is an additional transition. After the birth of a new baby, an adolescent shifts from being parented to becoming a parent who can plan appropriately, assert one's voice, and assess risk for their own child. This adaptation, however, is often met with substantial obstacles and challenges. Many parenting youth have experienced numerous negative health care encounters that contribute to disengagement and mistrust of the health care system, encouraging them to seek information from sources outside of healthcare providers.

A qualitative study of new mothers found that images of sleeping infants and infant sleep environments, as found in photographs, television, and social media platforms, were one of the most consistent influences on their decisions about how infants slept at home. Adolescents are particularly vulnerable to these images, especially when posted by peers who are strong influencers during this stage of brain development. Adolescents may rely on their parents or other family members for their infants’ care and find themselves waffling between accepting “Grandma knows best” , peer influences, and their own instincts. Those providing safe sleep counseling may inadvertently direct their guidance towards an adolescent’s parent, leaving adolescents excluded from effective safe sleep messaging, adolescent appropriate conversations, and situationally specific solutions.

This workshop will review adolescent brain development and the importance of appropriate adolescent discussions when reviewing safe sleep recommendations. We will review quotes from teen parents regarding barriers to safe sleep, highlighting the importance of engaging teens in discussions and solutions regarding infant safe sleep. Lastly, we will discuss the importance of recognizing cultural influences on safe sleep practices and historical challenges teen parents face when trying to reorganize these deeply embedded familial structures. To engage adolescents and young adults in health care, practitioners are encouraged to consider their own biases when serving this population. Together we must work towards fostering a positive, nonjudgmental approach, thereby providing supportive environments for our young parents to thrive.

1. Review data on SUID in infants with adolescent parents in temporary housing situations

2. Review adolescent brain development and its importance in adolescent specific messaging to parenting youth

3. Highlight challenges adolescent and young adult parents face when following safe sleep recommendations

4. Provide strategies to aid in discussions about safe sleep practices in parenting youth

Understanding Sudden Unexpected Infant Death during Temporary Living Situations

Eliot England, MPH
Sumihiro Suzuki, PhD
Kyran Quinlan, MD, MPH
Felicia Scott, MD
Gina Lowell, MD, MPH

In the first year of life, Sudden Unexpected Infant Death (SUID) is the leading cause of death from 1-month to 1-year-old in the United States, claiming ~3500 lives each year. In 2019, Cook County joined the Center for Disease Control and Prevention’s national SUID surveillance system in efforts to expand knowledge and improve prevention strategies. Nearly all SUID in Cook County have been found to occur in unsafe sleep environments. Non-Hispanic Black (NHB) and Hispanic infants from high hardship communities die more often than their White counterparts. Families from high hardship communities in Cook County experience housing instability and crowded housing. We aim to describe the characteristic differences between SUID that occurred in temporary living situations compared to those that occurred in an infant’s usual home to identify actionable prevention approaches.

Data from the Cook County IL SUID Case Registry between 2019 and 2022 were analyzed to compare SUID that occurred in the infant’s usual home with those that occurred when an infant was not in their usual home, or “temporary stay” SUID. SUID were analyzed for statistically significant differences between groups using chi-squared tests for infant age, sex, and combined race/ethnicity; maternal age and supervisor age and relationship; sleep position, bedsharing, bed-sharers and whether a crib was available for use. SUID narratives were reviewed to further identify patterns and themes to supplement the descriptive analysis between groups.

Of 181 SUID in Cook County from 2019-2022, 173 were sleep-related. Of these sleep-related SUID, 143 (83%) occurred in the infant’s usual home and 30 (17%) occurred during a temporary stay. Peak age for usual home SUID was 1-2-months and peak age for temporary stay SUID was 4-months. Ninety-eight (68.5%) usual home SUID and 30 (100%) temporary stay SUID were NHB infants (p<0.05). Thirty-one (22%) usual home SUID and 12 (40%) temporary stay SUID were bedsharing with both adults and children (p<0.05). Supervisors were non-parental relatives for 2 (1%) usual home SUID and 10 (33%) temporary stay SUID (p<0.05). Twenty-five (18%) usual home SUID and 10 (33%) temporary stay SUID had no crib available for use (p<0.05). Narrative review of temporary stay SUID revealed a pattern of young parents (<25 years-old) whose parents were also young when parenting them as infants.

Nearly 1 in 5 SUID in Cook County involve a temporary living situation. SUID during temporary stays were older, less likely to have a crib available for sleep, more likely to be bedsharing with both adults and children, more often supervised by a relative and more often non-Hispanic Black infants. Practicing safe sleep may be especially challenged in temporary stay situations. Housing instability plays a role in putting infants at risk of SUID. These findings have implications for providing contextual safe sleep counseling as parents want or need their infants to temporarily stay with others. Exploring the environmental and social reasons for temporary stays may improve relevant guidance for families facing similar circumstances.

1. Describe characteristics of SUID that occur during temporary living situations
2. Recognize situational circumstances that inhibit safe sleep practices
3. Consider changes to safe sleep counseling for families requiring alternate living or caregiving situations