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  1. Capper, Beverly DNP
  2. Damato, Elizabeth G. PhD, RN
  3. Gutin-Barsman, Sarah PhD, MSN
  4. Dowling, Donna PhD, RN


Background: Parental decisions regarding infant sleep practices vary widely, resulting in a lack of adherence to the American Academy of Pediatrics safe sleep recommendations (SSR) and consequently an increased risk of sudden infant death syndrome (SIDS). Preterm infants are among those at a highest risk for SIDS, yet few studies focus on parental decision-making surrounding sleep practices for preterm infants.


Purpose: The purpose of this study was to identify factors influencing decisions concerning infant sleep practices of mothers of preterm infants.


Methods: This study used a mixed-methods design. Recruitment was through social media messaging by 2 parent support organizations. An online survey was used to assess factors influencing mothers' decisions regarding sleep practices for preterm infants.


Findings/Results: Survey participants (n = 98) were from across the United States. Mothers of preterm infants (mean gestational age at birth = 29.42 weeks) most often reported positioning infants on their back to sleep (92.3%) and a low (15.4%) use of a pacifier at sleep time. Three themes emerged for the decisions made: adherence to SSR; nonadherence to SSR; and infant-guided decisions. Regardless of the decision, mothers indicated that anxiety over the infant's well-being resulted in a need for sleep practices that facilitated close monitoring of the infant.


Implications for Practice and Research: The findings of this study indicate the need for understanding the underlying anxiety preventing mothers from adhering to SSR despite knowing them, along with tailoring infant sleep messaging and education to improve safety of sleep practices for preterm infants. Research is needed to examine decision making in more diverse populations.