Navigating Infant Sleep Choices. A Study on Maternal Decision-Making

The 2023 study “Things changed very quickly”: Maternal intentions and decision-making about infant sleep surface, location, and position” provides crucial insights into the complexities of parental decision-making regarding infant sleep. This article offers an analysis suitable for child sleep consultants.

Study Context

With around 3,400 infants dying suddenly and unexpectedly each year in the United States, often due to modifiable sleep-related risk factors, understanding parental decision-making is key to preventing such tragedies.

The study aimed to delve into the decision-making processes of parents, particularly mothers, regarding infant sleep practices. It sought to understand the disconnect between knowledge of safe sleep recommendations and actual practices.


Researchers conducted semi-structured in-home interviews with 22 families, including 20 mothers and 2 mother–father dyads, of infants up to 6 months old.

Results and Analysis

In the 2023 study “Things changed very quickly”: Maternal intentions and decision-making about infant sleep surface, location, and position”, researchers explored how parents navigate the complex world of infant sleep. This article delves deeper into the six themes identified in the study’s findings:

Plans Change Post-Birth

Parents often enter parenthood with certain expectations about how they will manage their infant’s sleep. However, the study highlights that once the baby arrives, many parents find their pre-birth plans need to be revised. This shift can be due to several factors, such as the baby’s temperament, the realities of caring for a newborn, or unexpected challenges.

Adapting to Infant Preferences – parents try various approaches to figure out what suits the baby’s preferences.

A key finding is that parents are willing to try different strategies to accommodate their infant’s unique preferences and needs. This could involve experimenting with various sleep locations, positions, and routines until they find what works best for their baby. This theme underscores the flexibility and responsiveness parents often need to navigate infant sleep successfully.

Safety Concerns – safety is a significant consideration in how parents decide where and how their infant should sleep.

Parents in the study expressed that safety was a paramount concern in their decision-making process. Decisions about where the baby should sleep, the type of sleep surface, and the position in which the baby sleeps were often influenced by a desire to minimize risk and ensure the baby’s well-being.

Maternal Comfort – mothers’ comfort and convenience play a role in these decisions.

The study also found that the mother’s comfort and convenience play a significant role in decisions about infant sleep. This includes considerations like ease of nighttime feeding, the mother’s sleep quality, and the practicality of the sleep arrangement for the family.

Heeding Advice – parents are influenced by the advice they receive from various sources.

Another theme that emerged was the impact of advice from various sources on parental decisions. This advice could come from healthcare professionals, family members, friends, or online resources. The study suggests that parents often weigh this advice carefully, sometimes finding it conflicting or challenging to reconcile with their own instincts or preferences.

Cautious Approach – there’s a general theme of trying to be careful and mindful about infant sleep practices.

Finally, a general theme of cautiousness was evident among the parents. Many parents in the study were mindful and careful in their approach to infant sleep, often erring on the side of caution, particularly when it came to safety concerns.

Knowledge vs. Practice

The central conclusion drawn from the study is a critical one: the possession of knowledge regarding infant sleep recommendations is necessary but insufficient to guarantee that parents will consistently adhere to these recommendations in practice. This finding underscores a significant challenge in the field of infant sleep—bridging the gap between awareness and action.

Parents may be well-informed about the safest sleep practices for infants, but their ability to put this knowledge into practice is influenced by a multitude of dynamic factors. These factors can include the evolving nature of parenting, the unique preferences and needs of each infant, and the impact of external advice and societal norms. The study underscores that parenting decisions, particularly those related to infant sleep, are complex and multifaceted.

Implications for Sleep Consultants

As experienced child sleep consultants, it’s essential to grasp the profound implications of this study’s findings. Here’s a closer look at what this means for your role:

  1. Recognizing that a universal approach to sleep recommendations may not be effective, sleep consultants should emphasize personalized advice. This involves taking into account each family’s specific circumstances, including the infant’s preferences, the parents’ comfort, and the cultural context in which they operate. Tailored guidance can enhance the likelihood of successful implementation.
  2. Understanding the challenges parents face in navigating the gap between knowledge and practice is crucial. Sleep consultants should adopt an empathetic and non-judgmental stance when working with families. Parents often grapple with feelings of uncertainty and anxiety, and offering support that aligns with their unique needs can be immensely reassuring.
  3. Consultants must not only possess the knowledge of safe sleep practices but also excel in communication. Listening attentively to parents’ questions and concerns and providing clear, comprehensible explanations can facilitate a deeper understanding and acceptance of recommended practices.
  4. Parenting is a dynamic journey, and what works for one family may not work for another. Consultants should encourage parents to be flexible and adaptable in their approach to infant sleep. By emphasizing that it’s okay to adjust practices based on the baby’s changing needs, consultants can empower parents to make informed decisions confidently.
Implications for Practice

For child sleep consultants, this study serves as a poignant reminder of the need to consider the full spectrum of factors that influence parental decisions concerning infant sleep. These dynamics are not only complex but also subject to change over time. Understanding and acknowledging these influences are crucial steps toward developing more effective, empathetic, and personalized strategies to support families in adopting safe sleep practices. By tailoring guidance, offering empathetic support, facilitating effective communication, and promoting flexibility, child sleep consultants can play a pivotal role in ensuring that infants sleep safely and soundly.