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The Influence of Grandmothers and Other Senior Caregivers on Sleep Position Used by African American Infants
Louise Flick, RN, DPH;
Caroline Vemulapalli;
Barbara B. Stulac, RN;
James S. Kemp, MD
Arch Pediatr Adolesc Med. 2001;155:1231-1237.
Objectives To describe beliefs about infant sleep position among African American
grandmothers and other older caregivers (senior caregivers [SCGs]) and to
measure the incremental effect on the rates of prone sleep after educating
a group of African American SCGs.
Design Survey of sleep practices and beliefs. Randomized, controlled trial
of a teaching intervention.
Setting Managed care prenatal clinic for normal risk obstetrics patients.
Participants Low-income pregnant women, self-identified as African American. An SCG
is an older family member or friend to whom they would go for advice about
routine child care. Pregnant women randomly assigned to the control group
(educated about safe sleep practices) or the experimental group (education
for both pregnant women and their SCG).
Intervention During the third trimester, 2 teaching sessions for pregnant women (both
control and experimental groups) and for the experimental group's SCGs. One-on-one
teaching emphasizing that infants should sleep supine.
Main Outcome Measures During the third trimester, description of rate of preference for prone
sleep for infants among pregnant women and SCGs. Effects of teaching SCGs
on (1) SCGs' postnatal beliefs about sleep position as a means to reduce the
risk of sudden infant death syndrome, and (2) the eventual rate of prone sleeping
among study infants.
Results One hundred twenty-five women were in the control group; 98 pregnant
women and SCG pairs were in the experimental group. Senior caregivers were
47.1 ± 12.4 years old (mean ± SD). Most were grandmothers (either
maternal, 72.5%, or paternal, 14.3%) or aunts or sisters (10.2%). No differences
were noted in the prenatal rates of the prone preference (controls, 36.3%;
experimental group, 35.7%; and SCGs, 34.7%). Teaching SCGs did not increase
the rate of the usual prone sleep in the experimental vs the control group
(13.3% vs 17.3%,  2 = 0.59, P = .44,
95% confidence interval for difference from –5.8% to +13.8%). After
the teaching and during the pregnancy, the SCGs became less worried that the
infant was susceptible to sudden infant death syndrome (2
= 16.6, P = .003) or likely to die of sudden infant
death syndrome (2 = 24.7, P<.001).
Their concerns about sudden infant death syndrome were significantly less
postnatally, in particular when the infant was placed supine (2 = 19.4, P<.001).
Conclusions Most African American women and SCGs endorsed the supine sleeping position
for infants. Among a group of African American infants, prenatal teaching
of their grandmothers and other SCGs did not have a statistically significant
incremental effect on the rates of the usual prone sleeping position. Contrary
to our starting hypothesis, the SCGs of pregnant women who receive prenatal
care seemed responsive to messages about supine sleeping. The Back-to-Sleep
message should be delivered prenatally, but special prenatal interventions
should attempt to reach women who do not receive prenatal care and SCGs who
persist in their opposition to the supine sleeping position.
From the the Schools of Nursing (Dr Flick) and Public Health (Drs Flick
and Kemp), St Louis University, and the Department of Pediatrics, St Louis
University School of Medicine (Mss Vemulapalli and Stulac and Dr Kemp), St
Louis, Mo.
Corresponding author: James S. Kemp, MD, Pediatric Pulmonary Division,
St Louis University School of Medicine and Cardinal Glennon Children's Hospital,
1465 S Grand Blvd, St Louis, MO 63104 (e-mail: kempj{at}slu.edu).
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