Safe Infant Sleep Research Articles

The Role of Cosmetologists as Health Promoters in the Prevention of Infant Mortality

Safe sleep practices reduce an infant's risk for sudden infant death syndrome and sleep-related death. While rates of infants placed on their back to sleep are high, other safe sleep practices are less widely implemented. Our objective was to evaluate the feasibility of using cosmetologists as health promoters for infant safe sleep to reduce infant mortality. In this descriptive study, a 27-item survey was mailed to the 405 licensed cosmetologists residing in the five zip codes with the highest infant mortality rates in the county. Of 149 completed surveys (36.8 %), 103 cosmetologists (69.1 %) were currently working. Most were comfortable (68.9 %) promoting health topics with their clients. Popular health-related topics currently discussed included: diet/weight control, healthy eating, and physical activity. Few (≤13 %) were interested in discussing infant mortality prevention or safe sleep promotion. Most respondents were either unsure (56 %) or did not feel infant mortality was a problem in their community (41 %); however, more than half (53 %) knew someone who had experienced an infant death. Cosmetologists were not highly interested in providing safe sleep education; however they engaged in diet and exercise talk already. Cosmetologists may be more appropriate for obesity-prevention programs to reduce infant mortality than safe sleep promotion.

Improving Safe Sleep Environments for Well Newborns in the Hospital Setting

Following the "Back to Sleep" campaign, deaths from sudden infant death syndrome (SIDS) were reduced. However, SIDS and sleep-related deaths continue to occur. Studies demonstrate that modeling by health care workers influences parents to place infants supine for sleep. Recently, additional emphasis has been placed on environment. The purpose of this study was to improve sleep position and environment in the hospital. A Plan-Do-Study-Act cycle was initiated. Sleeping infants were observed at baseline. A bundled intervention was implemented; infants were again observed. Parents were surveyed. At baseline, 25% (36/144) of sleeping infants were safe; the majority of unsafe sleep was a result of environment. Postintervention, significantly more (58%; 145/249) had safe sleep (P < .0001). Most parents planned to use the supine position (95%; 96/101); none planned to cosleep. Many intended to adjust their infants' home sleep environment. Using a multifaceted approach significantly improved infant safe sleep practice in the hospital setting.

Helping New Mothers and Newborns Sleep: An Innovative Sleep Support Program

Purpose for the Program The goal of the Sleep Support program is to improve newborn/infant and maternal sleep opportunities by using a personalized education approach focused on evidence‐based behavioral and environmental sleep hygiene adjustments. Proposed Change Families frequently voice frustration with newborn and infant sleep patterns, often holding unrealistic expectations or lack of understanding of expected sleep patterns during the day and night. Typical resources used for seeking sleep pattern information include the pediatric visit, popular books, and the Internet. The Sleep Support consultation offers parents an opportunity to speak by phone with a trained sleep counselor for targeted education. Anticipatory guidance, a supportive sleep plan that is designed in conjunction with family desires, and follow‐up are provided. Implementation, Outcomes, and Evaluation New parents who were self‐selected participated in the Sleep Support option. Once the consult request was initiated, families completed a detailed intake form outlining their infant's current sleep habits, patterns, routines, environmental factors, and any medical, clinical, or feeding issues. The intake form served as an initial screening tool: infants with snoring, sleep apnea, severe reflux, severe eczema, or other clinical factors that affect sleep were referred to the pediatrician for treatment or clearance. The phone‐based 45‐minute consultation included the mother/parents and consultant. Other family members or caregivers involved in the infant's care were invited to participate. Information about the sleep environment, newborn/infant sleep and feeding patterns, sleep safety, and maternal sleep hygiene were reviewed. Appropriate suggestions were designed into a sleep plan in accordance with the mother's/parents’ situation and reasonable goals. A 15‐minute follow‐up call occurred within 1 to 2 weeks. Continuous evaluation found that 90% of the participants felt the consultation provided increased understanding of infant sleep, sleep safety, environmental and behavioral sleep approaches, and consequently, had improved sleep for infant and mother. Evaluation methods included feedback during follow‐up calls, survey scores, requests for additional consultations, referrals of family, and numerous unsolicited e‐mails. Parents most often stated that the individualized approach was key to the success of the intervention. Implications for Nursing Practice Infant and maternal sleep is highly personalized. When areas for adjustment or improvement are identified and effective education provided, sleep health can be improved. Nurses are able to use their unique skills to assess and educate a family struggling with newborn/infant sleep and suggest individualized environmental and behavioral adjustments to improve overall sleep health. The goal of the Sleep Support program is to improve newborn/infant and maternal sleep opportunities by using a personalized education approach focused on evidence‐based behavioral and environmental sleep hygiene adjustments. Families frequently voice frustration with newborn and infant sleep patterns, often holding unrealistic expectations or lack of understanding of expected sleep patterns during the day and night. Typical resources used for seeking sleep pattern information include the pediatric visit, popular books, and the Internet. The Sleep Support consultation offers parents an opportunity to speak by phone with a trained sleep counselor for targeted education. Anticipatory guidance, a supportive sleep plan that is designed in conjunction with family desires, and follow‐up are provided. New parents who were self‐selected participated in the Sleep Support option. Once the consult request was initiated, families completed a detailed intake form outlining their infant's current sleep habits, patterns, routines, environmental factors, and any medical, clinical, or feeding issues. The intake form served as an initial screening tool: infants with snoring, sleep apnea, severe reflux, severe eczema, or other clinical factors that affect sleep were referred to the pediatrician for treatment or clearance. The phone‐based 45‐minute consultation included the mother/parents and consultant. Other family members or caregivers involved in the infant's care were invited to participate. Information about the sleep environment, newborn/infant sleep and feeding patterns, sleep safety, and maternal sleep hygiene were reviewed. Appropriate suggestions were designed into a sleep plan in accordance with the mother's/parents’ situation and reasonable goals. A 15‐minute follow‐up call occurred within 1 to 2 weeks. Continuous evaluation found that 90% of the participants felt the consultation provided increased understanding of infant sleep, sleep safety, environmental and behavioral sleep approaches, and consequently, had improved sleep for infant and mother. Evaluation methods included feedback during follow‐up calls, survey scores, requests for additional consultations, referrals of family, and numerous unsolicited e‐mails. Parents most often stated that the individualized approach was key to the success of the intervention. Infant and maternal sleep is highly personalized. When areas for adjustment or improvement are identified and effective education provided, sleep health can be improved. Nurses are able to use their unique skills to assess and educate a family struggling with newborn/infant sleep and suggest individualized environmental and behavioral adjustments to improve overall sleep health.

Usage and impact of an online education tool for preventing sudden unexpected death in infancy

This paper describes the usage, impact and reach of an online education tool for preventing sudden infant death. A 24-slide presentation was formatted for online access. Content was designed for mainstream audiences to align current knowledge, attitudes and actions for a blitz approach to preventing sudden infant death in New Zealand (NZ). The tool was promoted through a network of 'safe sleep' champions across the country and collected basic information on usage, reach and impact. From 3286 completed online sessions between 18 November 2009 and 31 December 2011, there were 2683 (81.7%) with complete data. Average usage was 24.4 completed sessions/week, over a 2-year period, at a cost of NZD1.11 per completed session. Usage reached across regions, ethnic groups and roles. On completion of the course, most rated highly (7-9/9) (68.8%) their 'increased confidence' to discuss infant sleep safety with others. A high increased confidence rating was significantly influenced by spending more time per slide (P < 0.05) and being Maori, Pacific, Asian or 'other' compared with NZ European (P < 0.05). This simple online education tool achieved its aims of high usage, broad participation and cost-effective impact on increasing confidence to discuss infant sleep safety with others. e-Learning modes should be considered where there is a need to align large numbers of people in a short time with understandings and actions for addressing a specific health issue.

Breaking New Ground: The Text4baby Program

On February 4, 2010, White House Chief Technology Officer Aneesh Chopra announced the launch of text4baby, the nation’s first free mobile health service, developed in partnership by the National Healthy Mothers, Healthy Babies Coalition (HMHB), Voxiva, CTIA—The Wireless Foundation, the U.S. Department of Health and Human Services (HHS), and Johnson & Johnson, the founding sponsor. Text4baby, which has been implemented through an unprecedented public-private partnership, has reached more than 400,000 people with critical health and safety information about pregnancy and a baby’s first year of life. Text4baby aims to reduce barriers to accessing information and resources, increase knowledge around key health topics, improve positive health behaviors, and build a mother’s selfefficacy to engage in healthy behaviors that will benefit herself and her baby. Individuals enroll in text4baby by texting ‘‘BABY’’ for the English service or ‘‘BEBE’’ for the Spanish service to 511411; they can also enroll on the http://www.text4baby.org Web site. A user is asked to register her due date or her baby’s birth date and provide her zip code. The user receives a message on her cell phone on Monday, Wednesday, and Friday every week timed to her due date or baby’s birthday. A user can sign up at any time during pregnancy or the baby’s first year of life and can cancel at any time. The primary target audience for text4baby is women who may be at higher risk for poor health outcomes and may have problems accessing health information: young women (younger than age 25 years), low-income women, and women of color, such as women who identify as AfricanAmerican or Hispanic/Latina. To ensure that text4baby is accessible to mothers of all income levels, CTIA—The Wireless Foundation worked with the U.S. wireless phone companies to waive all text messaging fees associated with the program. Text4baby Content In the first phase of the program, an interdisciplinary team of clinicians, medical epidemiologists, public health practitioners, and communications experts identified potential topics for inclusion. Key sources included federal government materials (e.g., http://www.cdc.gov, http:// www.womenshealth.gov) and national medical association guidelines (e.g., American College of Obstetricians and Gynecologists [http://www.acog.org]), American Academy of Pediatrics (AAP; Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed.). The topics were prioritized based on public health importance (e.g., the number of mothers and babies affected), health disparities, and the strength of the supporting evidence. Text4baby messages are 160 characters in length, and each message includes ‘‘Free msg’’ at the beginning of each text, as required by the Mobile Marketing Association. Messages are available in English and Spanish and are written at a sixth grade reading level. Text4baby messages have actionoriented educational content, and many include phone numbers connecting users to resources for more information or for help. There are 114 messages included in the pregnancy protocol and 159 messages in the infant protocol. As of January 2012, 28 million text messages had been sent to users. The text messages provide information on a variety of topics critical to maternal and child health, such as prenatal care, influenza, immunization, developmental milestones, breastfeeding, safe infant sleep, injury prevention, mental health, and tobacco use. Visit http://www. text4baby.org for a comprehensive list of topic areas. Sample prenatal messages include the following.

Parental Adherence to Infant Sleep Safety Recommendations

Objective: Key infant sleep safety messages to prevent sudden infant death syndrome (SIDS) recommend putting infants to bed in the supine position and not sharing a bed with infants in order to prevent them from suffocating. Though these messages have been promoted by health care providers and health educators, adhering to them regularly remains a challenge for parents. Methods: Using a web-based survey on a national sample, factors associated with increased probability of adherence were examined to assess how parents negotiate infant safety recommendations. Results: Findings revealed that parents had knowledge of these recommendations but did not always follow them; adherence depended on how effective parents believed the recommendations are at preventing death and how the messages were presented. Conclusion: Health care providers and educators of infant safety should continue to focus on changing the public’s beliefs about the risks of the prone position and bed sharing, with an understanding of how and why the information about infant sleep safety is negotiated in the day to day lives of parents.

Sleeping Arrangements in Families With Twins

This study describes home sleeping arrangements used by parents of twins and investigates whether room sharing (twins in the same room as parents) or cobedding (crib sharing between twins) influences parental nighttime sleep duration or sleep quality. A secondary analysis of data obtained from a longitudinal study of sleep in 104 families with twins was undertaken. More than 65% of twins were cobedded at 4 weeks; this decreased to approximately 42% by 13 weeks of age. Approximately 64% of families practiced room sharing at 4 weeks; this decreased to approximately 40% by 13 weeks of age. Mothers and fathers who both room shared and cobedded their twins at 9 weeks of age were most likely to experience restricted sleep duration when compared with other sleeping arrangements. Results suggest that parents of twins may not be following the most recent American Academy of Pediatrics recommendations regarding safe infant sleep for multiple-birth infants.

Safe Infant Sleep Recommendations on the Internet: Let's Google It

To determine the accuracy of information on infant sleep safety on the Internet using Google. We hypothesized that the majority of Web sites would accurately reflect the American Academy of Pediatrics (AAP) recommendations for infant sleep safety. We searched for advice using 13 key phrases and analyzed the first 100 Web sites for each phrase. Web sites were categorized by type and assessed for accuracy of information provided, based on AAP recommendations. The accuracy of information was classified as "accurate," "inaccurate," or "not relevant." Overall, 43.5% of the 1300 Web sites provided accurate information, 28.1% provided inaccurate information, and 28.4% were not relevant. The search terms "infant cigarette smoking," "infant sleep position," and "infant sleep surface" yielded the highest percentage of Web sites with accurate information. "Pacifier infant," "infant home monitors," and "infant co-sleeping" produced the lowest percentage of Web sites with accurate information. Government Web sites had the highest rate of accuracy; blogs, the lowest. The Internet contains much information about infant sleep safety that is inconsistent with AAP recommendations. Health care providers should realize the extent to which parents may turn to the Internet for information about infant sleep safety.

Internet infant sleep safety information may be suspect

Internet infant sleep safety information may be suspect

Nighttime parenting strategies and sleep-related risks to infants

A large social science and public health literature addresses infant sleep safety, with implications for infant mortality in the context of accidental deaths and Sudden Infant Death Syndrome (SIDS). As part of risk reduction campaigns in the USA, parents are encouraged to place infants supine and to alter infant bedding and elements of the sleep environment, and are discouraged from allowing infants to sleep unsupervised, from bed-sharing either at all or under specific circumstances, or from sofa-sharing. These recommendations are based on findings from large-scale epidemiological studies that generate odds ratios or relative risk statistics for various practices; however, detailed behavioural data on nighttime parenting and infant sleep environments are limited. To address this issue, this paper presents and discusses the implications of four case studies based on overnight observations conducted with first-time mothers and their four-month old infants. These case studies were collected at the Mother-Baby Behavioral Sleep Lab at the University of Notre Dame USA between September 2002 and June 2004. Each case study provides a detailed description based on video analysis of sleep-related risks observed while mother–infant dyads spent the night in a sleep lab. The case studies provide examples of mothers engaged in the strategic management of nighttime parenting for whom sleep-related risks to infants arose as a result of these strategies. Although risk reduction guidelines focus on eliminating potentially risky infant sleep practices as if the probability of death from each were equal, the majority of instances in which these occur are unlikely to result in infant mortality. Therefore, we hypothesise that mothers assess potential costs and benefits within margins of risk which are not acknowledged by risk-reduction campaigns. Exploring why mothers might choose to manage sleep and nighttime parenting in ways that appear to increase potential risks to infants may help illuminate how risks occur for individual infants.

Knowledge, Opinions, and Practices of Infant Sleep Position Among Parents

This study's objective was to assess the knowledge, opinions, and practices of infants' sleep positions and their association with demographics. A cross-sectional descriptive design was used to survey a convenience sample of military beneficiary parents being seen at a military treatment facility in the United States. A 19-item investigator-designed questionnaire was adapted using the "Safe Sleep Survey" developed by Indiana Perinatal Network. A sample of 161 parents responded. Forty percent were fully aware of the safe sleep facts for infants; 85% believed supine position was the safest; and 69% of those who believed supine position to be the safest also practiced their belief. Major reasons for nonsupine sleeping positions were for infant preference, comfort, and fear of choking; whereas supine position was for safety reasons. Parents' opinions of safe position and their practices (p < 0.001) were significantly associated, whereas knowledge on infant safe sleep facts (p = 0.611) was not. The results indicate that there is still a need for education. However, merely providing information to increase knowledge alone is not enough to change behavior, as attitude was an important factor for the behavior. Theory-based intervention associated with change in behavior will have an impact on parents' attitudes.

Infant Safe Sleep: Efforts to Improve Education and Awareness

According to the Centers for Disease Control and Prevention (2011), more than 4,500 infants die annually in the United States of no apparent cause of death. These deaths are defined as sudden unexplained infant deaths (SUID). Half of these SUIDs are because of sudden infant death syndrome (SIDS). SIDS is defined as the sudden death of an infant less than 1 year of age that remains unexplained after a thorough case investigation, autopsy, examination of the death scene, and review of clinical history (Willinger, James, & Catz, 1991).

New AAP Recommendations for Creating a Safe Infant Sleep Environment

Although the incidence of sudden infant death syndrome (SIDS) has declined by 53% since the American Academy of Pediatrics's (AAP's) “Back to Sleep”

Supporting midwives in delivering evidence-based public health recommendations: Effectiveness of a Safe Infant Sleeping E-learning program

Supporting midwives in delivering evidence-based public health recommendations: Effectiveness of a Safe Infant Sleeping E-learning program

Implementation of the American Academy of Pediatrics Recommendations to Reduce Sudden Infant Death Syndrome Risk in Neonatal Intensive Care Units

There is a direct relationship between nonsupine sleeping and sudden infant death syndrome (SIDS). Premature infants are at greater risk for SIDS and are often cared for in nonsupine positions during the course of hospitalization. Healthy premature infants should be placed supine for sleep before discharge from the neonatal intensive care unit (NICU), and parents receive specific instruction about infant sleep position and other risk factors for SIDS. Most published literature addressing nursing practices for SIDS reduction reflects practices with the healthy newborn population. To examine and describe NICU nurses' knowledge of SIDS risk-reduction measures, modeling of safe infant sleep interventions prior to discharge, and inclusion of SIDS risk reduction in parent education. Convenience sample of nurses practicing in level II and III NICUs located in 2 Middle Atlantic States. A prospective survey design was used for the study. The 14-item questionnaire was developed by a team of neonatal clinical experts and distributed via site coordinators to nurses in 19 NICUs. A total of 1080 surveys were distributed and 430 (40%) NICU nurses completed the survey. The majority of nurses (85%) identified the American Academy of Pediatrics SIDS risk-reduction strategies for safe sleep. The investigators found that age, years of nursing and neonatal nursing experience, and educational preparation did not significantly contribute to the practice of "supine-only" position for sleep for infants in NICUs. The study revealed that nurses frequently position healthy preterm infants supine for sleep when weaned to an open crib (50%). Others wait one to a few days before discharge (15%) and some never position supine for sleep (6%). Stuffed toys are removed from cribs 90.5% of the time. For term infants without major medical complications, 45.5% of surveyed nurses continued to use positioning aids/rolls in infants' cribs. The most common reasons nurses cited to position preterm infants side-lying or prone in a crib were fear of aspiration (29%), infant comfort (28%), and infant safety (20%). NICU nurses educated parents about SIDS and reduction strategies, using various media. At discharge, 73% of the nurses verbally communicated with parents, 53% provided printed literature, and 14% used audiovisual aids with parents. NICU nurses are in influential positions to educate parents and model SIDS risk-reduction strategies. This study supports other published research that points to inconsistencies in nursing practice regarding implementation of methods to reduce the risk of SIDS.

Mother–Infant Sleep Locations and Nighttime Feeding Behavior: U.S. Data from the Survey of Mothers’ Sleep and Fatigue

The controversy around mother–infant bedsharing continues to grow. In order to make sound policy recommendations, policy makers need current data on where infants sleep and how families handle nighttime feedings. The present study is a survey of 4,789 mothers of infants 0–12 months of age in the U.S. The findings indicate that almost 60% of mothers bedshare and that this occurs throughout the first year. These findings also indicate that 25% of mothers are falling asleep with their infants in dangerous sleep locations, such as chairs, sofas or recliners. Recommendations for promoting safe infant sleep are made.

Never Sleep with Baby? Or Keep Me Close But Keep Me Safe: Eliminating Inappropriate &amp;#x201C;Safe Infant Sleep&amp;#x201D; Rhetoric in the United States

Creating public health messages regarding how mothers should sleep close and safely with their babies is tricky and complex. It requires an appreciation of what exactly the term “sleeping with baby” and “co-sleeping” can mean. It also requires sensitivity to what parents will or can do if told emphatically “never sleep with your baby.” In the United States, well-intentioned public health messages from prominent government agencies about safe infant sleep have increasingly used language that equates “safe infant sleep” with the absence of the mother. Many messages seemingly imply that all forms of “co-sleeping” are dangerous and that those parents that practice it are acting irresponsibly. Messages such as “babies sleep safest alone” conflict with both laboratory and epidemiological findings as well as with recommendations from most medical organizations, including the American Academy of Pediatrics, who state that mothers and babies should sleep on separate surfaces close together in the same room. Moreover, studies reveal that breastfeeding and forms of co-sleeping, including both roomsharing and bedsharing, are functionally interdependent and that many mothers worldwide find that they can manage their own and their infants needs more easily by adopting at least intermittent bedsharing. Hence, simple, unqualified recommendations against ever bedsharing are not likely to be followed. According to recent studies the most effective public health recommendations are likely to be those that educate parents and facilitate parents in implementing bedsharing safeguards alongside their own choices. This approach does not exclude informing parents of what we know can be dangerous about some bedsharing practices, nor where and when it should be avoided altogether. Rather, it acknowledges that while separate surface co-sleeping in the form of roomsharing should always be recommended, nonetheless, many parents will appreciate and benefit from the opportunity to learn how to reduce the risks associated with bedsharing.

Infant Sleep Environments Depicted in Magazines Targeted to Women of Childbearing Age

The goal was to evaluate pictures in magazines widely read by women of childbearing age, for adherence to American Academy of Pediatrics (AAP) guidelines for safe infant sleep practices. Magazines were included in this study if they had an average female readership of >5 million, circulation of >900000, and median age of female readers of 20 to 40 years. Twenty magazines met these criteria. An additional 8 magazines targeted toward expectant parents and parents of young children were included, for a total of 28 magazines. Pictures of infant sleep environments and sleeping infants in articles and advertisements in issues of these 28 magazines were analyzed for adherence to AAP guidelines for decreasing the risk of sudden infant death syndrome. A total of 391 unique pictures from 34 magazine issues were included in the analysis. Only 57 pictures (64%) portraying sleeping infants not being held by an adult portrayed the infants in the supine position, and 14.8% of sleeping infants were portrayed as sleeping with another person. Only 36 pictures (36.4%) of infant sleep environments portrayed a safe sleep environment, as recommended by the AAP. More than one third of pictures of sleeping infants in magazines geared toward childbearing women demonstrated infants in an inappropriate sleep position, and two thirds of pictures of infant sleep environments were not consistent with AAP recommendations. Messages in the media that are inconsistent with health care messages create confusion and misinformation about infant sleep safety and may lead inadvertently to unsafe practices.

Sudden Infant Death Syndrome Prevention: A Model Program for NICUs

Health care providers' opinions can influence how parents place their infant to sleep. Neonatal nurses can improve how they teach and model safe infant sleep practices to parents. To increase neonatal nurses' knowledge, a sudden infant death syndrome (SIDS) prevention program was implemented. Program components included a computerized teaching tool, a crib card, sleep sacks, and discharge instructions. Initial program evaluation showed that 98 percent of infants slept supine and 93 percent slept in sleep sacks in open cribs. However, nurses continued to swaddle some infants with blankets to improve thermoregulation. To increase nursing compliance in modeling safe infant sleep practices, Halo SleepSack Swaddles were provided for nurses to use in place of a blanket to regulate infant temperature. Recent data show that 100 percent of infants in open cribs are now sleeping supine wearing a Halo Swaddle or a traditional Halo SleepSack. This model program can easily be replicated to enhance neonatal nurses' knowledge about SIDS prevention.

Abstracts

Objective: To identify knowledge, attitudes and practices of child health nurses relating to infant wrapping as an effective settling/sleep strategy. Methods: A pre-test/post-test intervention design was used to explore knowledge, attitudes and practices relating to wrapping in a sample of child health nurses (n=182): a) pre-test survey; b) educational intervention incorporating evidence relating to infant wrapping; SIDSK Safe Sleeping recommendations. Emphasis was placed on infant wrapping as an effective settling strategy for parents to use as an alternative to prone positioning; c) post-test survey to evaluate intervention effectiveness. Results: Pretest results identified wide variation in nurses’ knowledge, attitudes and practices of infant wrapping as a settling/sleep strategy. The intervention increased awareness of wrapping guidelines and self-reported practices relating to parent advice. Significant positive changes in nurses’ awareness of wrapping guidelines (p<0.001); to wrap in supine position only (p<0.001); and parental advice to use wrapping as an alternative strategy to prone positioning to assist settling/sleep (p<0.01), were achieved post-test. Conclusions: Managing unsettled infants and promoting safe sleeping practices are issues routinely addressed by child health nurses working with parents of young infants. Queensland has a high incidence of prone sleeping. Infant wrapping is an evidence-based strategy to improve settling and promote supine sleep consistent with public health recommendations. Infant wrapping guidelines are now included in Queensland Health’s state policy and Australian SIDSandKids information relating to safe infant sleeping. In communicating complex health messages to parents, health professionals have a key role in reinforcing safe sleeping recommendations and offering safe, effective settling/sleep strategies to address the non-recommended use of prone positioning for unsettled infants.