RESEARCH
Sleep Behaviors of Infants and Young Children Associated Demographic and Acculturation Characteristics Among Hispanic Teen Mothers Sarah V. Duzinski, MPH ■ Paula J. Yuma-Guerrero, MPH ■ Adrienne Fung, BS ■ Juliette M. Brown, MHS ■ Tareka Wheeler, BA ■ Amanda N. Barczyk, PhD, MSW ■ Karla A. Lawson, PhD, MPH
ABSTRACT Accidental suffocation and strangulation in bed is a leading cause of preventable infant death. Bed sharing, teen motherhood, and Hispanic ethnicity have been associated with infant sleep suffocation death. Fifty-five Hispanic teen mothers were surveyed regarding acculturation/demographic characteristics and their infants’ sleep behaviors. Most participants had 2 foreign-born parents from Latin America. Participants with 2 US-born parents were less likely to bed share than their less-acculturated peers. Many participants reported not always placing their infant in a supine sleep position. There is a significant need to reach out to Hispanic teen mothers, particularly from newer immigrant families, with culturally and linguistically appropriate multigenerational clinical messaging on the risks of infant bed sharing and nonsupine sleep positioning.
Key Words Hispanic teens, Safe sleep education, SIDS, Sleep suffocation, SUIDS, Teen mothers
S
leep-related injury death in infants has emerged as a significant health problem in the United States. Sudden unexpected infant death (SUIDS) can include any deaths attributed to accidental suffocation and strangulation in bed (ASSB), hypo- or hyperthermia, poisoning, ingestions, infections, metabolic diseases, trauma (accidental or nonaccidental), and sudden infant death syndrome (SIDS).1,2 Accidental suffocation and strangulation in bed is the leading mechanism of unintentional injury-related infant death in the United States.1,3 Accidental suffocation and strangulation in bed can occur Author Affiliations: Dell Children’s Medical Center of Central Texas, Trauma Services, Austin (Mss Duzinski and Brown and Drs Barczyk and Lawson); University of Texas School of Social Work, Austin (Ms YumaGuerrero); University of Texas School of Public Health–Austin Campus (Ms Fung); and SafeKids Worldwide, Washington, DC (Ms Wheeler). The authors declare no conflicts of interest. Correspondence: Sarah V. Duzinski, MPH, Dell Children’s Medical Center of Central Texas, Trauma Services, 4900 Mueller Blvd, Austin, TX 78723 ([email protected]). DOI: 10.1097/JTN.0000000000000011
JOURNAL OF TRAUMA NURSING
when an infant suffocates in soft or excessive bedding, is rolled on or overlaid by another person, is wedged or entrapped between objects such as a mattress and wall or couch cushions, or is asphyxiated by strangulation, such as from a cord located near the sleep area.4 Each year, almost 400 infant deaths are now classified as ASSB.5,6 From 1984 to 2004, ASSB rates in the United States have quadrupled from 2.8 to 12.5 deaths per 100,000.3 The reason for this increase is not fully understood. However, researchers suspect that an increase in infant bed sharing behaviors combined with more precise classification of SUIDS, SIDS, and ASSB deaths because of improved death scene investigation may be at play.2-4,7 Infant deaths formerly thought to be inexplicable (and thus classified as SIDS) may now be more readily recognized and classified as ASSB.2,3 This rise in ASSB has underscored the need for infant sleep death prevention. Research has highlighted a number of risk factors associated with infant sleep death. Accidental suffocation and strangulation in bed disproportionately impacts infants younger than 1 year and is commonly associated with infant sleep practices.8-10 Sleep practices linked to ASSB among infants and toddlers include sleeping prone (face down), bed sharing with other children or adults, and the presence of soft bedding and items such as stuffed animals in the sleep space.9,11 The American Academy of Pediatrics now recommends that infants and toddlers avoid bed sharing with parents in an adult bed and sleep in a supine position, on a firm mattress, and free of excess and soft bedding and toys to lessen the risk of preventable sleep-related infant deaths.2 Many maternal risk factors associated with ASSB have also been identified. Infants of teen mothers are at particular risk for ASSB death. Lower socioeconomic status, unmarried status of mother, younger maternal age at time of birth (
Sleep Behaviors of Infants and Young Children Associated Demographic and Acculturation Characteristics Among Hispanic Teen Mothers Sarah V. Duzinski, MPH ■ Paula J. Yuma-Guerrero, MPH ■ Adrienne Fung, BS ■ Juliette M. Brown, MHS ■ Tareka Wheeler, BA ■ Amanda N. Barczyk, PhD, MSW ■ Karla A. Lawson, PhD, MPH
ABSTRACT Accidental suffocation and strangulation in bed is a leading cause of preventable infant death. Bed sharing, teen motherhood, and Hispanic ethnicity have been associated with infant sleep suffocation death. Fifty-five Hispanic teen mothers were surveyed regarding acculturation/demographic characteristics and their infants’ sleep behaviors. Most participants had 2 foreign-born parents from Latin America. Participants with 2 US-born parents were less likely to bed share than their less-acculturated peers. Many participants reported not always placing their infant in a supine sleep position. There is a significant need to reach out to Hispanic teen mothers, particularly from newer immigrant families, with culturally and linguistically appropriate multigenerational clinical messaging on the risks of infant bed sharing and nonsupine sleep positioning.
Key Words Hispanic teens, Safe sleep education, SIDS, Sleep suffocation, SUIDS, Teen mothers
S
leep-related injury death in infants has emerged as a significant health problem in the United States. Sudden unexpected infant death (SUIDS) can include any deaths attributed to accidental suffocation and strangulation in bed (ASSB), hypo- or hyperthermia, poisoning, ingestions, infections, metabolic diseases, trauma (accidental or nonaccidental), and sudden infant death syndrome (SIDS).1,2 Accidental suffocation and strangulation in bed is the leading mechanism of unintentional injury-related infant death in the United States.1,3 Accidental suffocation and strangulation in bed can occur Author Affiliations: Dell Children’s Medical Center of Central Texas, Trauma Services, Austin (Mss Duzinski and Brown and Drs Barczyk and Lawson); University of Texas School of Social Work, Austin (Ms YumaGuerrero); University of Texas School of Public Health–Austin Campus (Ms Fung); and SafeKids Worldwide, Washington, DC (Ms Wheeler). The authors declare no conflicts of interest. Correspondence: Sarah V. Duzinski, MPH, Dell Children’s Medical Center of Central Texas, Trauma Services, 4900 Mueller Blvd, Austin, TX 78723 ([email protected]). DOI: 10.1097/JTN.0000000000000011
JOURNAL OF TRAUMA NURSING
when an infant suffocates in soft or excessive bedding, is rolled on or overlaid by another person, is wedged or entrapped between objects such as a mattress and wall or couch cushions, or is asphyxiated by strangulation, such as from a cord located near the sleep area.4 Each year, almost 400 infant deaths are now classified as ASSB.5,6 From 1984 to 2004, ASSB rates in the United States have quadrupled from 2.8 to 12.5 deaths per 100,000.3 The reason for this increase is not fully understood. However, researchers suspect that an increase in infant bed sharing behaviors combined with more precise classification of SUIDS, SIDS, and ASSB deaths because of improved death scene investigation may be at play.2-4,7 Infant deaths formerly thought to be inexplicable (and thus classified as SIDS) may now be more readily recognized and classified as ASSB.2,3 This rise in ASSB has underscored the need for infant sleep death prevention. Research has highlighted a number of risk factors associated with infant sleep death. Accidental suffocation and strangulation in bed disproportionately impacts infants younger than 1 year and is commonly associated with infant sleep practices.8-10 Sleep practices linked to ASSB among infants and toddlers include sleeping prone (face down), bed sharing with other children or adults, and the presence of soft bedding and items such as stuffed animals in the sleep space.9,11 The American Academy of Pediatrics now recommends that infants and toddlers avoid bed sharing with parents in an adult bed and sleep in a supine position, on a firm mattress, and free of excess and soft bedding and toys to lessen the risk of preventable sleep-related infant deaths.2 Many maternal risk factors associated with ASSB have also been identified. Infants of teen mothers are at particular risk for ASSB death. Lower socioeconomic status, unmarried status of mother, younger maternal age at time of birth (
