Human infant sleeping locations as determined by adolescent and adult primiparous mothers K.P. Klingaman, L.E. Volpe, a

1. Human infant sleeping locations as determined by adolescent and adult primiparous mothers K.P. Klingaman, L.E. Volpe, and J.J. McKenna University of Notre Dame Rationale Results Sleep Summary Relatively little is known about how parents care for their infants at night. Studies of the ecology of nighttime parenting behavior have become a focus of medical and anthropological inquiry only within the last decade. Previous studies have shown that factors intrinsic to the infant intersect with care-giving decisions and parental expectations to determine where an infant will sleep on any given night (Ball 2002). Blanket recommendations for where all infants should sleep ignore the fluidity of infant sleeping locations and fail to acknowledge the reasons parents choose to relocate infants. Publicly preferred and reported arrangements often differ from those actually practiced (McKenna 2000). The purpose of the study is to identify the range of infant sleeping locations and to determine what infant behavior, if any, precipitates change in nighttime arrangements. By studying where parents put infants to sleep and what nighttime events result in a change in sleeping locations, health care practitioners can better design safety recommendations that apply to a variety of sleeping locations, and that acknowledge the fluidity of arrangements for individual parents across time. 94.6% of infants slept in multiple locations. For 16.1% of participants, the first arrangement in which the mother and infant were both asleep was not their primary sleeping location. The primary location was defined as the arrangement in which the infant spent the majority of sleep time. 34.3% of mothers woke, relocated their infants, and then fell asleep with the infant in the new sleeping location. Figure 1. Infant Sleeping Locations Adult Bed Sofa Table 1. Events Among Mother-Infant Dyads in the Infant Primary Sleeping Location of: The majority of infant sleep time was spent in an adult bed. This location was not the initial sleeping arrangement among 27.3% of the 62.2% of the infants who spent the majority of sleep time in an adult bed. Overall, 86.5% of infants slept in an adult bed at some point during the night. Initial infant sleeping location placement was most often on the sofa at 28.6%, in the bassinet at 22.9%, on the adult bed at 20.0%, in the crib at 17.2%, and in the car seat at 11.4%. 77.8% of infants fell asleep in their mother’s arms for at least one sleep period. Among breastfeeding participants, 80.8% of infants fell asleep in their mother’s arms. 11.4% of infants were in their mothers’ arms each time that they fell asleep. Adolescent mothers were most likely to first place sleeping infants on the sofa and adult mothers were most likely to first place sleeping infants in the crib. Methods Participants Data on 37 mother-infant dyads were drawn from a larger longitudinal project investigating the effects of parenting on child development and exploring behavioral differences between adolescent and adult primiparous (Centers for the Prevention of Child Neglect, 2001). The sample consisted of 23 adolescent mothers (mean age at childbirth 17.7 years) and 14 adult mothers (mean age at childbirth 25.3 years). The sample was 24.3% adolescent and 18.9% adult European-American, 21.6% adolescent and 16.2% adult African-American, 2.7% adolescent and 2.7% adult European-Mexican American, 8.1% adolescent European-African American, 2.7% adolescent Mexican-American, and 2.7% adolescent Native American. 59.5% of the infants in the sample were female. Figure 2. Infant Awakenings, Crying Behavior, Feeding Practices and Relocations Design and Procedures Overnight infrared video recordings were collected at the Mother-Baby Behavioral Sleep Laboratory when infants were four months of age. Participants were allowed to maintain typical sleeping arrangements and routines, and all caregiver interventions were performed at will. Sleep lab data were analyzed for group differences in sleeping location, crying, and feeding practices so that information could be acquired to facilitate safer infant sleep. Conclusions Overall, infants woke an average of 3.6times throughout the night and 9.1% of infant wakings resulted in a relocation. Of all infant awakenings, the mother was also awake 86.8% of the time before the infant fell back asleep. Infants exhibited sustained crying 18.2% of the time they woke and were relocated 40.9% of the time afterward. Infants who spent the majority of the night in the crib or car seat exhibited both the greatest frequency and duration of crying. Infants were fed 43.8% of the time they woke and were relocated 17.0% of the time afterward. 55.6% of mothers who relocated their infants were adults. • This preliminary study suggests that the typical adolescent mother intentionally shares a bed with her infant and bottle feeds. The typical adult mother places her infant to sleep in a crib or adult bed and is more likely to breastfeed her infant at four months of age. Nighttime arrangements for individual families vary across time and during the course of a single night. Many parents initially place their infant to sleep in a location in which the infant will not spend the majority of the sleep period. Maternal response to infant wakings, cries, and feeding needs often result in an unintentional change in infant sleeping location. In order to assist parents in determining safe and enjoyable nighttime caregiving strategies, policy must address the reality of infant sleep, not socially constructed ideals. Health care practitioners need to acknowledge the fluidity of infant sleeping arrangements and provide safety information for each location. • Research Funded by NICHD HD 39456-03 • References and reprints available upon request : Kklingam@nd.edu University of Notre Dame Mother-Baby Behavioral Sleep Laboratory Sofa in Lounge Figure 3. The Direction of Nighttime Infant Sleep Relocations Lounge Infants were most likely to be relocated to the adult bed. Following relocation to the adult bed, 70.0% of the infants were not moved again. 66.7% of infants were later relocated to the adult bed for a second time. Overall, 80.0% of infants who were relocated completed the night in the adult bed. 11.1% of participants returned to the original nighttime sleeping arrangement. Only 2.9% of infants who began their nighttime sleeping location in the adult bed completed the sleep period in another arrangement. Crib and Rocking Chair Adult Bed and Bassinet