"Things changed very quickly": Maternal intentions and decision-making about infant sleep surface, location, and position.

Introduction: Approximately 3400 infants die suddenly and unexpectedly each year in the United States; many of these deaths include modifiable risk factors (such as a non-supine position, sleeping on a soft surface, or loose bedding or items in the environment). Interventions have been successful at improving parental knowledge about recommendations to reduce risk of sleep-related infant deaths, as well as improving intention to adopt recommendations. However, follow-up studies have found a disconnect between knowledge/intentions to adhere to recommendations and actual practices. Exploring maternal decision-making about infant sleep practices can better elucidate the disconnect between knowledge of infant sleep recommendations and the practice of it, and thus, inform more effective safe sleep interventions. The purpose of this study was to gain a more in-depth understanding of decision-making around infant sleep practices, and barriers and facilitators to adopting safe infant sleep recommendations.

Methods: Semi-structured in-home interviews were conducted with 22 families (20 mothers and 2 mother-father dyads) of infants up to 6 months of age.

Results: Thematic analysis of the transcripts revealed six themes: Plans changed when baby came, Trying things to figure out what works (infant preferences), Safety concerns, What's comfortable for me (maternal preferences), They say…(advice), and Trying to be careful.

Conclusion: These results suggest that knowledge of infant sleep recommendations alone is not enough to ensure adherence and that decision-making is a dynamic and ongoing process affected by multiple factors. Findings have implications for timing and content of risk reduction efforts, as well as for data collection in research studies.