Public health advocacy groups across the United States have issued guidelines and recommendations to promote best practices for various infant care practices and behaviors, including immunizations, breastfeeding, and safe sleep behaviors. Research suggests that adherence to these recommendations is below targeted goals. Advice received by mothers from medical professionals, family, and other resources is an important modifiable factor that can influence mothers’ choices about infant care practices. However, data are lacking on the frequency with which mothers receive such advice and the extent to which the advice given is consistent with evidence-based guidelines.

The Study of Attitudes and Factors Effecting Infant Care Practices (SAFE) obtained national data on mothers’ choices regarding recommended safe sleep and other infant care practices. The study surveyed mothers about the advice they received from a variety of potentially influential sources and the extent to which the advice was consistent with current recommendations. “Data from SAFE give us a unique opportunity to better understand the quantity and quality of advice that is reported by mothers for important infant care practices,” says Staci R. Eisenberg, MD.


Assessing Current Trends

For a study published in Pediatrics, Dr. Eisenberg and colleagues set out to determine if mothers received advice from doctors, birth hospital nurses, family, and the media about immunization, breastfeeding, sleep position, sleep location, and pacifier use. “We also wanted to describe the extent to which the advice received was consistent with current recommendations,” Dr. Eisenberg says. The study surveyed more than 1,000 mothers of infants aged 2 to 6 months involved in SAFE.

According to the results, doctors were the most prevalent source for mothers receiving advice. “This finding illustrates how highly mothers value recommendations from doctors,” says Dr. Eiseberg. “However, many women reported that they did not receive advice from their physicians on several infant care practices.” About 20% of mothers received no advice from their doctor for breastfeeding or sleep position, and more than 50% reported no advice regarding sleep location or pacifier use. Advice from nurses was generally similar to that of doctors.

The prevalence of mothers receiving any advice from family or the media ranged between 20% and 56% for the infant care practices assessed in the study. “We also found that doctors commonly offered advice that was inconsistent with recommendations,” Dr. Eisenberg says (Table). The following factors were consistently associated with reporting recommendation-consistent advice:

  • Race/ethnicity and parity.
  • Black and Hispanic mothers.
  • First-time mothers.

The research team notes that it was unexpected to find that black and Hispanic mothers were more likely than white mothers to report receiving advice that was consistent with recommendations for all infant care practices (except sleep position). Previous studies indicate that white mothers generally have higher rates of adherence with recommendations. It was less surprising that mothers of more than one child reported receiving less advice than first time mothers, especially from family and the media. However, for each of these scenarios, it is possible that some mothers are perceived by their physicians as needing less advice, but no studies have suggested that this is the case.


Improvements Needed

“Our data demonstrate that mothers frequently appear to receive either no advice or recommendations that are inconsistent from healthcare professionals, even in cases when the recommendations are well-accepted, such as supine sleep, breastfeeding, and immunization,” says Dr. Eisenberg. “This information highlights the possibility that physicians to be more consistent and clear when they advise mothers on specific infant care practices. Efforts are needed to improve the content of advice that is delivered to mothers.” She notes that family and media may be an untapped resource for advice to mothers of infants.

Dr. Eisenberg says that it is important to identify targets for public health efforts to increase adherence to guideline recommendations. “It’s important to note that some controversy is associated with each of the elements we assessed in the study,” she says. “In light of these controversies, clinicians may need to spend extra time talking about infant care practices with mothers. Ideally, parents should be empowered to ask their healthcare provider questions about infant care. Clinicians can get the dialogue started by asking their patients open-ended questions about infant care practices.”


Future Initiatives

The study by Dr. Eisenberg and colleagues provides insights that may be useful to providers, public health professionals, and policy makers that develop and issue recommendations for infant care practices. “We’ve identified several care practices in which mothers are not reporting receipt of advice that is consistent with current recommendations,” Dr. Eisenberg says. Future research should assess if using a multimodal approach can improve the quality and quantity of advice that is reported by mothers. Plans are already in the works to conduct an intervention trial at 16 of the SAFE study hospitals to assess a multimodal approach to improving the consistency of recommended messages for infant care practices.