Abstract
Background and objectives Despite the risks of bed-sharing, little is known about what pediatricians tell parents about bed-sharing with infants and whether pediatricians provide specific recommendations outlined by the American Academy of Pediatrics (AAP). This study aimed to understand pediatricians’ opinions about bed-sharing and the advice pediatricians provide to parents about bed sharing. Methods The study employed a qualitative study design and the conceptual framework of the Theory of Planned Behavior. 24 primary care pediatricians from a variety of practice settings were interviewed about the anticipatory guidance they provide to families whose infants are in the at-risk age group for SIDS. Results Pediatricians’ opinions about bed-sharing differed widely both with respect to identifying bed-sharing as a topic they routinely address in anticipatory guidance as well as in what they tell parents about bed sharing. Some strongly and routinely advise against bed-sharing and identify bed-sharing as a clear risk to infants. Others believe bed-sharing to be both safe and useful. A third group allow the content of anticipatory guidance to be driven by parental concerns. Most pediatricians are clearer in their recommendation to place infants supine to sleep than in their recommendation to avoid bed-sharing. Conclusions Overall, there is considerable variation among pediatricians in the advice they provide about bed-sharing, and most advice is not congruent with the AAP recommendations. Additional efforts to educate pediatricians may be necessary to change attitudes and behaviors with respect to anticipatory guidance about safe sleep.

Similar content being viewed by others
Explore related subjects
Discover the latest articles and news from researchers in related subjects, suggested using machine learning.References
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211.
American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. (2005). The changing concept of sudden infant death syndrome: Diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics, 116(5), 1245–1255.
Blair, P. S., Sidebotham, P., Evason-Coombe, C., Edmonds, M., Heckstall-Smith, E. M., & Fleming, P. (2009). Hazardous cosleeping environments and risk factors amenable to change: Case-control study of SIDS in south west England. BMJ, 339, b3666.
Bradley, E. H., Curry, L. A., & Devers, K. J. (2007). Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Services Research, 42(4), 1758–1772.
Centers for Disease Control & Prevention. (2014). About Sudden Unexpected Infant Death and Sudden Infant Death Syndrome. Retrieved from http://www.cdc.gov/sids/aboutsuidandsids.htm.
Centers for Disease Control & Prevention. (2017). PRAMS Data to Action Success Stories. Retrieved from https://www.cdc.gov/prams/dta-successstories.html.
Colson, E. R., Bergman, D. M., Shapiro, E., & Leventhal, J. H. (2001). Position for newborn sleep: Associations with parents’ perceptions of their nursery experience. Birth, 28(4), 249–253.
Colson, E. R., Rybin, D., Smith, L. A., Colton, T., Lister, G., & Corwin, M. J. (2009). Trends and factors associated with infant sleeping position: The national infant sleep position study, 1993–2007. Archives of Pediatrics and Adolescent Medicine, 163(12), 1122–1128.
Colson, E. R., Willinger, M., Rybin, D., Heeren, T., Smith, L. A., Lister, G., & Corwin, M. J. (2013). Trends and factors associated with infant bed sharing, 1993–2010: The National Infant Sleep Position Study. JAMA Pediatrics, 167(11), 1032–1037. doi:10.1001/jamapediatrics.2013.2560.
Fu, L. Y., Colson, E. R., Corwin, M. J., & Moon, R. Y. (2008). Infant sleep location: Associated maternal and infant characteristics with sudden infant death syndrome prevention recommendations. The Journal of Pediatrics, 153(4), 503–508.
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: strategies for qualitative research. New York: Aldine Publishing Company.
Goodstein, M. H., Bell, T., & Krugman, S. D. (2015). Improving infant sleep safety through a comprehensive hospital-based program. Clinical Pediatrics, 54(3), 212–221.
Health Resources & Services Administration. (2017). Perinatal and Infant Health. Retrieved from https://mchb.hrsa.gov/maternal-child-health-topics/perinatalinfant-health.
Heron, M. (2013). Deaths: Leading causes for 2010. National Vital Statistics Reports, 62(6), 1–96.
Hwang, S. S., O’Sullivan, A., Fitzgerald, E., Melvin, P., Gorman, T., & Fiascone, J. M. (2015). Implementation of safe sleep practices in the neonatal intensive care unit. Journal of Perinatology: Official Journal of the California Perinatal Association, 35(10), 862–866. doi:10.1038/jp.2015.79.
Kottke, T. E., Battista, R. N., DeFriese, G. H., & Brekke, M. L. (1988). Attributes of successful smoking cessation interventions in medical practice. A meta-analysis of 39 controlled trials. JAMA: The Journal of the American Medical Association, 259(19), 2883–2889.
Kuhlmann, S., Ahlers-Schmidt, C. R., Lukasiewicz, G., & Truong, T. M. (2016). Interventions to improve safe sleep among hospitalized infants at eight children’s hospitals. Hospital Pediatrics, 6(2), 88–94.
Li, L., Fowler, D., Liu, L., Ripple, M. G., Lambros, Z., & Smialek, J. E. (2005). Investigation of sudden infant deaths in the State of Maryland (1990–2000). Forensic Science International, 148(2–3), 85–92.
Li, L., Zhang, Y., Zielke, R. H., Ping, Y., & Fowler, D. R. (2009). Observations on increased accidental asphyxia deaths in infancy while cosleeping in the state of Maryland. The American Journal of Forensic Medicine and Pathology: Official Publication of the National Association of Medical Examiners, 30(4), 318–321. doi:10.1097/PAF.0b013e31819df760.
Moon, R. Y., & American Academy of Pediatrics, Task Force on Sudden Infant Death Syndrome. (2011). Policy Statement: SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), 1030–1039.
Muhr, T. (1997). ATLAS/ti User’s Manual and Reference (Version 4.1). Berlin: Scientific Software Development.
National Institute of Health. (2017). Safe to sleep public education campaign. Retrieved from https://www.nichd.nih.gov/sts/Pages/default.aspx.
Salm Ward, T. C., & Balfour, G. M. (2016). Infant safe sleep interventions, 1990–2015: A review. Journal of Community Health, 41(1), 180–196.
Shapiro-Mendoza, C. K., Kimball, M., Tomashek, K. M., Anderson, R. N., & Blanding, S. (2009). US infant mortality trends attributable to accidental suffocation and strangulation in bed from 1984 through 2004: Are rates increasing? Pediatrics, 123(2), 533–539.
Smith, L. A., Colson, E. R., Rybin, D., Margolis, A., Colton, T., Lister, G., & Corwin, M. J. (2010). Maternal assessment of physician qualification to give advice on AAP-recommended infant sleep practices related to SIDS. Academic Pediatrics, 10(6), 383–388.
Strauss, A., & Corbin, J. M. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Thousand Oaks, CA: Sage Publications, Inc.
Von Kohorn, I., Corwin, M. J., Rybin, D. V., Heeren, T. C., Lister, G., & Colson, E. R. (2010). Influence of prior advice and beliefs of mothers on infant sleep position. Archives of Pediatrics and Adolescent Medicine, 164(4), 363–369.
Acknowledgements
We would like to thank our colleagues John M. Leventhal, MD and Eugene Shapiro, MD from Yale University School of Medicine who provided insights and comments on our manuscript and figures.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schaeffer, P., Asnes, A.G. What Do Pediatricians Tell Parents About Bed-Sharing?. Matern Child Health J 22, 51–58 (2018). https://doi.org/10.1007/s10995-017-2353-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-017-2353-5