Patterns of Infant Sleep and Care Practices: 2016-2020

The American Academy of Pediatrics (AAP) publishes evidence-based infant sleep recommendations to prevent sudden unexpected infant death (SUID). We defined common patterns of infant sleep and care practices in Illinois and assessed variation in patterns across demographic characteristics.

We measured maternal report of AAP recommended practices in the 2016-2020 Illinois Pregnancy Risk Assessment Monitoring System, including breastfeeding greater than or equal to 8 weeks; no maternal smoking; and 4 aspects of the sleep environment for infant sleeping on back, on an approved surface, without items in sleep area, and without bed sharing. We applied nonhierarchical cluster analysis, coupled with knowledge of AAP recommendations, to define 6 mutually exclusive patterns of infant sleep and care practices. We produced weighted prevalence estimates for each individual practice and pattern and examined differences by maternal race and ethnicity, age, parity, education, and socioeconomic status using χ2 tests.

Prevalence estimates for individual practices ranged from 49.6% for infants sleeping without items in sleep area to 90.8% for not smoking. When examining patterns, only 19.3% of new mothers reported all 6 recommended practices; this pattern varied significantly across all demographics examined. The prevalence of the other 5 patterns were as follows: 8.1% following all 4 sleep environment practices, 28.1% bed sharing and breastfeeding, 11.7% bed sharing and no breastfeeding, 25.1% no bed sharing and back sleep positioning, and 7.8% no bed sharing and no back sleep positioning.

Examining common patterns of infant sleep and care practices provides improved understanding of how infant sleep recommendations are followed and may inform intervention strategies.