Sudden Infant Death Syndrome (SIDS) risk reduction and infant sleep location - moving the discussion forward

The notion that infant sleep environments are 'good' or 'bad' and that parents who receive appropriate instruction will modify their infant-care habits has been fundamental to SIDS reduction campaigns. However infant sleep location recommendations have failed to emulate the previously successful infant sleep position campaigns that dramatically reduced infant deaths. In this paper we discuss the conflict between 'safeguarding' and 'well-being', contradictory messages, and rejected advice regarding infant sleep location. Following a summary of the relevant background literature we argue that bed-sharing is not a modifiable infant-care practice that can be influenced by risk-education and simple recommendations. We propose that differentiation between infant-care practices, parental behaviors, and cultural beliefs would assist in the development of risk-reduction interventions. Failure to recognize the importance of infant sleep location to ethnic and sub-cultural identity, has led to inappropriate and ineffective risk-reduction messages that are rejected by their target populations. Furthermore transfer of recommendations from one geographic or cultural setting to another without evaluation of variation within and between the origin and destination populations has led to inappropriate targeting of groups or behaviors. We present examples of how more detailed research and culturally-embedded interventions could reorient discussion around infant sleep location.