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Despite significant reductions in infant sleep-related deaths, they continue to be a leading cause of infant mortality and further reductions have proven difficult to achieve compared with the initial dramatic reductions brought about by Back to Sleep campaigns. Because night-time caregiving behaviours and infant sleep environments involve a complex interplay between environmental, biological and behavioural variables, designing effective interventions to improve sleep-related outcomes represents a significant public health challenge.
Hayman and colleagues1 present data on infant suffocation deaths involving wedging or overlay in the sleep environment which occurred in New Zealand between 2002 and 2009. They examine the scenarios which resulted in sleep-related infant mortality and which may be used to refine existing paediatric recommendations. The authors claim that their data reinforce the need for ‘consistent, persistent’ safe sleep messages which are disseminated widely. However, this type of authoritative health promotion has been critiqued and other models for delivering negotiated, individualistic messages are considered to be more effective where complex behaviours are involved.
With regard to infant sleep safety, message exposure and awareness of sleep-related risk factors represents only one possible reason why sleep-related risks to infants exist. Furthermore, a singular focus on message delivery inhibits the very types of conversations with healthcare providers that are necessary for parents to engage in contingency planning. In many cases, healthcare providers are not well prepared for conversations with parents who cannot or will not comply with recommended practices. Situations which require contingency planning and challenge parents to know how to transfer recommendations to different sleeping arrangements than the one …