Guiding Sleep: A Cross-National Comparison of Professional Advice to Parents for SIDS Prevention

Background:  The Public Health community has championed the success of the “Back to Sleep” campaign, which has helped to curb the SIDS rate in the US and globally by targeting prone sleeping.  However, progress in reducing the incidence of SIDS and SUID during sleep has slowed.  Risks and benefits of bed-sharing continue be an area of active research although this practice remains controversial, especially in the US

Methods: We examined parenting information regarding safe sleep from public health websites in four countries to explore how countries identified modifiable factors associated with safe sleep.  We performed a qualitative analysis of selected materials from the US, Canada, the UK, and Japan; these countries have differing incidence rates of SIDS and cultural norms surrounding sleeping practices. 

Results: All countries promoted the supine sleeping position and either advised or implied for room-sharing.  The US, Canada, and UKwarned parents about room-sharing with parents who smoke, while Japan did not have any recommendations concerning parental substance use.  The United States, Canada, and UK all endorsed infant crib sleeping as the preferred arrangement. While the US and Canada had firm denunciations against bed-sharing, the UK offered recommendations for safe bed-sharing, as connected their all-encompassing goal of promoting nighttime breastfeeding.  Japan, which has one of the lowest rate of SIDS in the world and a high prevalence of bed-sharing, did not address bed-sharing in its recommendations. 

Conclusions: Official recommendations vary with regard to risk and protective factors.  Content reflects dominant cultural practices and beliefs.