Parental decision-making about infant sleep environment is dominated by 'decisional conflict,' with caregivers simultaneously weighing safety, feasibility and family logistics, and infant preference and developmental needs, often in opposition to one another.
Key Findings
Results
Decisional conflict was a dominant theme in parental decision-making about infant sleep location.
Caregivers reported multiple factors simultaneously affecting decision-making about sleep location, often acting in opposition with one another.
This theme emerged from in-depth individual interviews analysed using grounded theory methodology.
14 caregivers were interviewed until saturation of themes was reached.
Data collection occurred from November 2017 to January 2018 at a large paediatric hospital in Toronto, Canada.
Results
Three major themes categorized the factors influencing parental decision-making about infant sleep environment.
The three themes were: (1) safety, (2) feasibility and family logistics, and (3) perception of infant preference and developmental needs.
These themes were identified through analysis of interview transcripts for recurrent and emergent themes with a developed coding structure.
Caregivers described a range of sleep locations and environments, indicating variability in practice.
The themes reflect factors that sometimes worked in opposition, contributing to decisional conflict.
Results
Caregivers drew on multiple information sources when making decisions about infant sleep.
Information sources included family, friends, healthcare providers, and media.
These sources were reported by caregivers of infants less than 6 months of age admitted to a large paediatric hospital.
The variety of sources suggests caregivers are not relying solely on formal health guidance such as Canadian Paediatric Society or American Academy of Paediatrics recommendations.
Methods
The study was conducted using a qualitative grounded theory methodology with in-depth individual interviews.
Interviews were conducted with 14 caregivers of infants less than 6 months admitted to a large paediatric hospital in Toronto, Canada.
Data collection occurred from November 2017 to January 2018 until saturation of themes was achieved.
Interview transcripts were analysed for recurrent and emergent themes and a coding structure was developed.
Grounded theory methodology was selected to explore perceptions, beliefs, and influences regarding safe infant sleep environment.
Background
Despite broad dissemination of safe sleep recommendations, significant caregiver nonadherence has been documented.
Both the Canadian Paediatric Society and American Academy of Paediatrics have issued safe sleep recommendations.
Studies demonstrate significant caregiver nonadherence to these recommendations.
Sudden unexplained death in infants is responsible for a significant proportion of infant deaths.
The authors note that few prior studies have examined caregiver reasons for low uptake of recommendations.
What This Means
This research suggests that parents of young infants face genuine internal conflict when deciding where and how their baby should sleep. Even when parents are aware of official safe sleep guidelines — such as placing babies on their back, alone, in a crib — many factors pull them in different directions at the same time. These include concerns about safety, practical issues like family schedules and living arrangements, and beliefs about what their baby needs or prefers in order to sleep well. The study interviewed 14 parents of babies under 6 months old who were admitted to a children's hospital in Toronto, and found that this 'decisional conflict' was the most prominent theme across conversations.
Parents reported getting information about sleep choices from a wide range of sources, including family members, friends, healthcare providers, and media — not just from medical guidelines. This mix of sometimes contradictory input likely contributes to the gap between what guidelines recommend and what parents actually do. The study also found that parents described using a variety of sleep locations and environments for their infants, reflecting real-world variability in practice.
This research suggests that simply distributing safe sleep guidelines may not be enough to change parental behaviour. Healthcare providers and public health campaigns may be more effective if they acknowledge the genuine competing pressures parents face, address practical barriers like family logistics, and engage with parents' beliefs about their baby's comfort and development. Understanding why parents make the choices they do — rather than just telling them what to do — could be key to reducing preventable infant deaths.
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Smith J, Johnstone J, Mahant S, Shouldice M. (2026). Understanding Parental Behaviours Related to Infant Sleep Environment: A Qualitative Study.. Child: care, health and development. https://doi.org/10.1111/cch.70337