Factors influencing African American mothers' decisions about sleep position: a qualitative study

African American infants continue to be at more than twice the risk for sudden infant death syndrome (SIDS) than Caucasian Americans. In addition, African Americans are twice as likely to place their infants prone for sleep.

To investigate, using qualitative methods, factors influencing African American parents' decisions regarding infant sleep position.

Eighty-three mothers participated in focus groups or individual interviews. Questions probed reasons for infant sleep position decisions and influences on decision making.

All of the mothers in this study were aware of the recommendation to place infants supine for sleep. Mothers largely chose infant sleep position for either safety or comfort reasons. Many mothers who chose the prone position did so because they perceived it to be safer than supine. Sleep position decisions were influenced by parental needs (largely the need for sleep), perception of SIDS risk and biological plausibility, and trusted sources of information. Mothers sought information from multiple trusted sources before making any decision. Even if mothers had trust in their pediatrician, they were comfortable making decisions counter to their pediatrician's recommendations if they felt it to be in the best interests of their infant.

African American mothers are generally aware of the Back to Sleep recommendation. However, many may not believe that the supine position is the safest position. Other mothers may use the prone position because of infant comfort or parent's need for longer sleep. Trust in the pediatrician may not be sufficient reason for parents to use the supine position.