The weighted mean infant age was 4.1 months with 97.4% ≤6 months. After adjustment for covariates, state estimates changed by <1 percentage point across outcomes on average. The findings from this 29-state PRAMS analysis indicate that most mothers place their infants to sleep on their back (78.0%), whereas fewer room share without bed-sharing (57.1%), and less than half report using separate approved sleep surfaces (31.8%) and avoiding soft bedding (42.4%). Differences by sociodemographic, behavioral, and health care characteristics were larger for safe sleep practices (∼10–20 percentage points) than receipt of advice (∼5–10 percentage points). Similarly, our measure of separate approved sleep surface did not distinguish between intentional versus incidental sleep in a car seat or swing. There was also an age gradient for soft bedding use, with teenaged mothers having the lowest prevalence of following recommendations to avoid soft bedding (25.0%) compared with approximately half of mothers ≥30 years. Glycine. National action partnership to promote safe sleep improvement and innovation network (NAPPSS-IIN). One investigation found that, compared with a placebo, a CBD dosage of 160 milligrams (mg) increased sleep duration. Operationalization of these 2 measures offers a consistent assessment of usual practice across items, which aligns with previous national studies.6,8,14,15,19 We also examined report of the infant “always” versus “often, sometimes, rarely, or never” sleeping in their own crib or bed for “separate approved sleep surface” and “room-sharing without bed-sharing” to more closely reflect adherence to the AAP recommendation of separate sleep surfaces for infants. Address correspondence to Ashley H. Hirai, PhD, Maternal and Child Health Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD 20857. The Stanford Center for Human Sleep Research conducts clinical trials that improve ways to treat and manage sleep disorders. Glycine is an amino acid that plays an important role in the nervous system. Although the Safe Infant Sleep Study of Attitudes and Factors Effecting Infant Care Practices (SAFE), the most recent national study, assessed both bed-sharing and usual sleep surface (eg, crib, bassinet, adult bed, car seat, sofa), 19 we developed a composite measure to assess usual use of a separate approved (crib, bassinet, or pack and play) sleep … 11. Research shows that infants who sleep in a crib are twice as likely to suffer a sleep related fatality (including SIDS) than infants who sleep in bed with their parents. The purpose of this study was to evaluate the effectiveness of the curriculum and train-the-trainer model in changing knowledge, attitudes, and behaviors (reported and observed) in child care providers with regards to sleep position and other elements of a safe sleep … Usual safe infant sleep practice prevalence by state, PRAMS, 2016. With funding from the Health Resources and Services Administration (HRSA), new PRAMS questions capturing expanded sleep-related recommendations were added for all participating states in 2016 as part of a new national performance measure for the Title V Maternal and Child Health Services State Block Grant Program.16 Given that provider advice influences sleep practices,8,10,14,17 questions assessing the reported receipt of advice for sleep-related practices were also included. After adjustment, most characteristics remained significantly related to one or more safe sleep practice, with the exception of WIC participation (Table 4). Learn more about the Safe to Sleep® campaign. The average change across outcomes, before and after adjustment, was <1 percentage point. Reported receipt of provider advice was associated with increased prevalence of each corresponding safe sleep practice. It can give you the peace of mind to enjoy this special time. Health care characteristics obtained from the birth certificate that may influence the delivery of provider advice and sleep practices included prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); timing of prenatal care initiation; and insurance coverage at delivery. Polysomnography records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study.Polysomnography is usually done at a sleep disorders unit within a hospital or at a sleep center. Additionally, our estimates of usual practice do not represent consistent adherence to AAP recommendations. COMPANION PAPER: A companion to the article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2019-2310. What Does A Safe Sleep Environment Look Like? Combined, SIDS and other sleep-related causes of infant deaths exact too high a toll on communities in the United States and abroad. Safe to Sleep ® CDC collaborates with the Eunice Kennedy Shriver National Institute of Child Health and Human Development in its Safe to Sleep ® campaign, formerly known as the Back to Sleep campaign. Although we compared “always” versus “always or often” sleeping separately, it is unclear whether “often” responses reflected bed-sharing with a sleeping parent versus incidental infant sleep while feeding or bonding with an awake adult. When sharing the video, use the accompanying handout to help explain the information presented. US Department of Health and Human Services, Common SIDS and SUID Terms And Definitions, Ways To Reduce The Risk Of SIDS And Other Sleep-Related Causes Of Infant Death, 2020 SIDS Awareness Month #SafeSleepSnap Digital Toolkit, The Science Of SIDS And Safe Infant Sleep. Available at: Trends and factors associated with infant sleeping position: the national infant sleep position study, 1993-2007, Vital signs: trends and disparities in infant safe sleep practices - United States, 2009-2015, Factors associated with choice of infant sleep position, Task Force on Sudden Infant Death Syndrome, SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment, American Academy of Pediatrics task force on infant positioning and SIDS, Positioning and sudden infant death syndrome (SIDS): update, American Academy of Pediatrics task force on infant Sleep Position and Sudden Infant Death Syndrome, Changing concepts of sudden infant death syndrome: implications for infant sleeping environment and sleep position, Trends and factors associated with infant bed sharing, 1993-2010: the National Infant Sleep Position Study, Trends in infant bedding use: National Infant Sleep Position study, 1993-2010, Health Resources and Services Administration, Title V Maternal and Child Health Services Block Grant to States Program: Appendix of Supporting Documents, Influence of prior advice and beliefs of mothers on infant sleep position, The pregnancy risk assessment monitoring system (PRAMS): overview of design and methodology, Infant sleep location and breastfeeding practices in the United States, 2011-2014, Influence of bedsharing activity on breastfeeding duration among US mothers, Maternal-infant bedsharing: risk factors for bedsharing in a population-based survey of new mothers and implications for SIDS risk reduction, Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data, Classification system for the Sudden Unexpected Infant Death Case Registry and its application, Sleep-related infant suffocation deaths attributable to soft bedding, overlay, and wedging, Racial and ethnic trends in sudden unexpected infant deaths: United States, 1995-2013, Beyond “back to sleep”: ways to further reduce the risk of sudden infant death syndrome, Centers for Disease Control and Prevention (CDC), Trends in smoking before, during, and after pregnancy–Pregnancy Risk Assessment Monitoring System, United States, 40 sites, 2000-2010, Racial and ethnic differences in breastfeeding initiation and duration, by state - National Immunization Survey, United States, 2004-2008, Centers for Disease Control and Prevention. Both racial and ethnic groups have SUID rates twice as high as non-Hispanic white mothers.27 However, non-Hispanic Asian or Pacific Islander mothers had the lowest prevalence of using separate approved sleep surfaces and were less likely to report back sleep position and avoiding soft bedding yet have SUID rates less than half of non-Hispanic white mothers.27 This paradox may arise from differences in other risk and protective factors,28 such as lower smoking22,29 and higher breastfeeding30,31 rates. An analysis from two case-control studies conducted in the UK, Bed sharing when parents do not smoke: is there a risk of SIDS? Mothers currently smoking had a lower prevalence of using separate approved sleep surfaces (25.6% vs 32.5%) and no soft bedding (31.2% vs 43.8%) than nonsmokers. Early studies indicate that high dosages of CBD may support sleep. The study involves the recruitment of a nationally representative sample of 1,000 new mothers, annually for 3 years, from 32 statistically selected U.S. maternity hospitals. Amamantar y sueño seguro (videos/folleto), Healthy Native Babies Project Toolkits and Guides, Baby’s Anatomy When on the Stomach and on the Back, Infografia: Padres ayuden a sus bebes a dormir seguros, Infographic: Accidental Suffocation and Strangulation, Parents Placing Baby into a Safe Sleep Environment, Safe Sleep for Your Baby Infographic (Horizontal), Safe Sleep for Your Baby Infographic (Vertical), Safe Infant Sleep Social Media Block Party, Outreach Activities In Specific Communities, Building Relationships With Trusted Community Members. Although nearly 90% of mothers reported their infant usually slept in a crib, bassinet, or pack and play, only about one-third reported it as a sole usual sleep surface, which may represent an underacknowledged risk. Get Safe to Sleep® materials for outreach and sharing. Source: Federal SUIDS/SIDS Workgroup Safe Sleep Photo Repository. Sleep enhances moods. Polysomnography, also called a sleep study, is a test used to diagnose sleep disorders. PRAMS data from 2015 showed that unsafe sleep practices were common and indicated demographic and state-level variation.9 However, analyses beyond sleep position were limited to <15 states. In this article, the authors looked at Sudden Infant Death Syndrome (SIDS) from an evolutionary perspective. Popular parenting advice ignores the idea that sleep … Mothers who reported currently breastfeeding had a higher prevalence of using the back sleep position (80.5% vs 75.2%) and no soft bedding (46.8% vs 37.5%) than mothers not breastfeeding. Mothers who were older, non-Hispanic white, more educated, and married were more likely to report the following usual safe sleep practices: back sleep position, separate approved sleep surface, and no soft bedding (Table 2). In collaboration with other organizations. No sleep environment is completely safe. Safe Sleep for Oregon’s Infants is now an interactive online training. Research on Back Sleeping And SIDS. (Free for members) Yet, 15% of mothers reported not receiving advice to use a separate sleep surface and avoid soft bedding, whereas over half reported not receiving advice to room share without bed-sharing. Follow these Safe Sleep Steps to keep your baby safe: Place your baby on their back, in a crib, bassinet or pack n' play for every sleep time - nap time and night time. Recommendations To Reduce the Risk of SIDS and Other Sleep-Related Infant Deaths. I do support the USCPSC’s efforts to research sleep safety and to decrease the incidence of SIDS, but I feel they should go about it differently. Sleep studies are safe despite death Sleep studies have gotten some unwanted publicity recently with a wrongful death lawsuit on behalf of a 25-year-old man who died during a study. We have information and materials for many audiences, including parents, grandparents, and health care providers. John Villa, D.O., medical director of the sleep lab at Hackensack University Medical Center, and Adrian Pristas, M.D., medical director of Sleep Medicine at Bayshore Medical Center and Riverview Medical Center, share why we need to take sleep apnea seriously, and how at-home sleep … Data were weighted to account for selection probability, differential nonresponse by demographic characteristics, and noncoverage, representing all births in 29 states (51% of all 2016 US births). Sleep problems can affect your quality of life, and some can pose a serious The CDC and each state’s institutional review board approved the PRAMS protocol. Safe Sleep Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality. Non-Hispanic black mothers had the lowest prevalence of using the back sleep position (62.3%), Non-Hispanic Asian or Pacific Islander mothers had the lowest prevalence of using separate approved sleep surfaces (20.6%), and non-Hispanic American Indian or Alaska Native mothers had the lowest prevalence of room-sharing without bed-sharing (50.5%) and avoiding soft bedding (25.6%). Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness: 95806: Sleep study, … Professor James J. McKenna’s Mother-Baby Behavioral Sleep Laboratory studies how sleeping environments reflect and respond to family needs—in particular how they affect mothers, breastfeeding, and infants’ physiological and psychological well-being and development. Prenatal alcohol and/or illicit drug … Safe sleep collaborative improvement and innovation network (CoIIN) to reduce infant mortality. We examined reported receipt of advice from a doctor, nurse, or other health care worker corresponding to the 4 safe sleep practices. The safest place for infants to sleep is on their backs, on separate, firm sleep surfaces without any soft bedding and in the same room as caregivers.3 Safe sleep practices, especially those other than back sleep position, are suboptimal, with demographic and state-level differences indicating improvement opportunities. Download your copy! Having a separate safe sleep surface for the baby reduces the risk of SIDS and the chance of suffocation, strangulation and entrapment. Some studies combine sofa sleeping with bedsharing, making it more difficult to separate the risk factors for each scenario. Using a separate approved sleep surface and avoiding soft bedding had some of the largest sociodemographic differences. Enter multiple addresses on separate lines or separate them with commas. We found that non-Hispanic black mothers were least likely to report back sleep position and also had lower prevalence of using separate approved sleep surfaces and avoiding soft bedding compared with non-Hispanic white mothers. Less than one-third of infants (31.8%) “always or often” slept separately on an approved sleep surface; a smaller proportion (26.3%) “always” slept separately on an approved sleep surface. Early studies indicate that high dosages of CBD may support sleep. and parents of special needs children, a safer night's sleep using specialist equipment like sensory weighted blankets and calming bed tents. Lack of sleep can make a person irritable, drag down their energy level, and cause or worsen feelings of depression. For example, infants may fall asleep during usual commuting without being intentionally placed to sleep in a car seat. The Safe Sleep Seven ... or a sidecar cot cot attached to the bed. Provider advice is an important, modifiable factor to improve safe sleep practice. C, Room-sharing without bed-sharing. Source: Federal SUIDS/SIDS Workgroup Safe Sleep Photo Repository. For sleep, Wyatt says the evidence isn’t strong enough to issue a blanket recommendation on blue light. PRAMS data collection methodology has been previously described.18 Briefly, mothers are randomly sampled from birth certificate records and complete the PRAMS survey (mail or telephone) within 2 to 9 months postpartum. Swaddling is a way to make your baby feel safe and comfortable by wrapping the baby in a blanket. When an infant lies on its back with no pressure on its abdomen, it takes less effort to breath. If you bring your baby into your bed for feeding or comforting, remove all soft items and bedding from the area. This study aims to assess caregivers’ implementation of safe sleep … Simple care giving techniques can play a critical role in keeping infants safe during sleep. Based on studies showing that increasing the arousal threshold with a different hypnotic improves sleep apnea severity, we hypothesize that trazodone will increase the arousal threshold and this will be associated with an improvement in sleep … With convenient locations across the Oklahoma City metro area, Oklahoma Sleep Institute provides the ideal environment for your sleep study … Blankets were most commonly reported (50.5%), followed by crib bumper pads (17.6%) and toys, cushions, or pillows (8.9%). The weighted overall mean response rate was 61% (range: 55%–73%). Education on safe sleep. This study broke with a long term recommendation from the American Academy of Pediatrics on room-sharing with children, and the data showed that infants who slept alone, sooner, had better sleep. To reduce the risk of SIDS, infants should be placed for sleep in a supine position (wholly on the back) for every sleep by every caregiver until the child reaches 1 year of age. Although this analysis offers a recent, population-based assessment of safe sleep practices and provider advice, the analysis was limited to 29 states and lacks representation from southeastern states, which have some of the highest SUID rates in the nation.4,50 Thus, our 29-state range in safe sleep practices may be narrower than the total US state range. Learn more about the Safe to Sleep® campaign. Since the Safe-to-Sleep Program [13,18] (previously called the Back-to-Sleep program) was introduced in the early 1990’s, the rate of death due to SIDS has been cut in half.The Safe-to-Sleep program reduced the number of deaths by giving recommendations that would improve oxygen intake. Now Available in Spanish: Safe infant sleep and breastfeeding video and handout. Separate approved sleep surface ranged from 20.1% in New Mexico to 40.0% in West Virginia, whereas room-sharing without bed-sharing ranged from 46.8% in Alaska to 65.5% in Delaware. A sleep study provides valuable insight into the causes of a person’s symptoms including which, if any, sleep disorder is present. Interventions where an organization with the goal of promoting safe sleep engages multiple partners to deliver safe sleep messages. 1. Safe Sleep Experts agree that there is no "safe co-sleeping." Perhaps the best evidence to date comes from a study published in 2015 in the Journal of Sleep Medicine and Disorders. The prevalence of each safe sleep practice varied significantly by state, ranging ∼20 to 25 percentage points across outcomes (Supplemental Table 6). Bed-sharing was not specifically assessed either in the measurement of the outcome or provider advice. Although adjustment mitigated many racial and ethnic disparities, crude prevalence may be more informative in identifying a need for culturally appropriate and focused programmatic efforts. Sudden Infant Death Syndrome (SIDS) is the leading cause of death among infants 1 month to 12 months old and is the third-leading cause overall of infant mortality in the United States. Mothers reported whether they were told by a provider to (1) place their infant on their back to sleep; (2) place their infant to sleep in a crib, bassinet, or pack and play; (3) place infant’s crib or bed in the mother’s room; and (4) what items should and should not be in the infant sleep environment. 1 The mechanisms by which stomach sleeping … Mothers who participated in WIC, received late or no prenatal care, and were Medicaid insured or uninsured generally had lower rates of safe sleep practices. Receipt of Health Care Provider Advice by Sociodemographic, Behavioral, and Health Care Characteristics, 29 States, PRAMS, 2016. Our advice is based on strong scientific evidence and should be followed for all sleep periods, not just at night. Currently breastfeeding mothers were 22% less likely than mothers not breastfeeding to use separate approved sleep surfaces, whereas mothers who were smoking were 23% less likely than nonsmokers to use separate approved sleep surfaces and 13% less likely to avoid soft bedding. National immunization survey: breastfeeding rates. We update previous estimates of safe infant sleep and include a new composite measure assessing the use of separate approved sleep surfaces. Back sleep position ranged from 67.4% in Louisiana to 87.7% in Iowa. The test records your nighttime sleep patterns. Taking up to 0.8 grams/kg of body weight per day appears to be safe, but more studies are needed. Sociodemographic characteristics obtained from the birth certificate included maternal age, race and ethnicity, education, marital status, and state of residence as well as infant gestational age. Approximately 3500 infants die annually in the United States from sleep-related sudden unexpected causes. We do not capture any email address. While some of our U.K. clients have told us that sleep positioners are approved for overnight crib-use in the U.K., this is not the case in the U.S. D, No soft objects or loose bedding. Many of these deaths o… We thank the PRAMS Working Group for coordinating collection of the data used in this analysis. Maybe you’ve participated in a sleep research study. In 2017, a study was published on the topic of infants and sleep. Overall, most (78.0%) mothers reported placing their infants to sleep on their backs (Table 1). Most short-term studies show that melatonin is safe with little to no side effects and may help kids fall asleep faster and sleep longer. Sleep Studies: In the Sleep Laboratory and in the Home. Available at: The effect of nursing quality improvement and mobile health interventions on infant sleep practices: a randomized clinical trial, Use of a computerized decision aid for developmental surveillance and screening: a randomized clinical trial, Council on Clinical Information Technology, Pediatric aspects of inpatient health information technology systems, Disclosure of infant unsafe sleep practices by African American mothers in primary care settings [published online ahead of print July 1, 2019], Implementation of safe sleep practices in Massachusetts NICUs: a state-wide QI collaborative, Implementation of safe sleep practices in the neonatal intensive care unit, TodaysBaby quality improvement: safe sleep teaching and role modeling in 8 US maternity units, The EASE quality improvement project: improving safe sleep practices in Ohio children’s hospitals, The National Network of State Perinatal Quality Collaboratives, The national network of state perinatal quality collaboratives: a growing movement to improve maternal and infant health, The collaborative improvement and innovation network (CoIIN) to reduce infant mortality: an outcome evaluation from the US South, 2011 to 2014. OBJECTIVES: To examine prevalence of safe infant sleep practices and variation by sociodemographic, behavioral, and health care characteristics, including provider advice. By contrast, smoking is a SIDS risk factor, and risk is particularly pronounced when combined with bed-sharing.20,33,34 Current smoking was associated with lower rates of using separate approved sleep surfaces and avoiding soft bedding even after adjustment for demographic characteristics, suggesting a need for enhanced counseling among women with smoking histories. Ongoing collection and analysis of PRAMS and other data are essential to inform and evaluate both national and state-specific efforts. Receipt of provider advice is an important modifiable factor to improve infant sleep practices. Statistical significance was defined as a P value <.05 with only practically meaningful differences of at least 5 percentage points highlighted within the text. This study included 31 adults with chronic insomnia. In particular, teenage mothers were 34% less likely than 25- to 29-year-olds to avoid soft bedding, whereas non-Hispanic Asian or Pacific Islander mothers were ∼40% less likely than non-Hispanic white mothers to use separate approved sleep surfaces and avoid soft bedding. In contrast, younger, Hispanic, less-educated, and unmarried mothers had a higher prevalence of usually room-sharing without bed-sharing. Racial and ethnic differences existed across all safe sleep practices. Safe to Sleep® started in 1994 as Back to Sleep to teach people about reducing the risk of SIDS. What is swaddling? See Further Reading for more details, or for more information on these definitions, see here. Case studies, including one published in 2017 and another in 2013, have also linked using zolpidem to suicidal behavior, potentially even during sleep. Guidelines to Sleeping Safe with Infants: Adapted from: Maximizing the chances of Safe Infant Sleep in the Solitary and Cosleeping (Specifically, Bed-sharing) Contexts, by James J. McKenna, Ph.D. Fewer reported avoiding soft bedding (42.4%) and using a separate approved sleep surface (31.8%). The hallmark of getting a sleep study done is—well, looking something … The Guidelines-at-a-Glance e-book is now available for all current AASM Practice Parameters or Clinical Practice Guidelines. Many sleep study participants only took 3 grams a day . “Separate approved sleep surface” was assessed with a 5-item composite indicating how the infant usually slept in the past 2 weeks: (1) separate was defined as an infant sleeping alone in their own crib or bed (always or often versus sometimes, rarely, or never) and (2) an approved sleep surface was defined as the infant usually sleeping in a crib, bassinet, or pack and play but not in a twin or larger bed, couch or armchair, or infant car seat or swing (no versus yes). Receipt of provider advice was associated with increased use of safe sleep practices, ranging from 12% for room-sharing without bed-sharing (adjusted prevalence ratio: 1.12; 95% confidence interval: 1.09–1.16) to 28% for back sleep position (adjusted prevalence ratio: 1.28; 95% confidence interval: 1.21–1.35). Babies born premature or underweight shouldn't sleep in the parental bed. Besides depression, studies have found that a lack of sleep is linked with mental health conditions like anxiety disorder, bipolar disorder, and Post-Traumatic … There have been dramatic improvements in reducing baby deaths during sleep since the 1990s, when recommendations were introduced to place babies on their back for sleep. Non-Hispanic American Indian or Alaska Native mothers were least likely to avoid soft bedding, had lower use of separate approved sleep surfaces, and had doubled prevalence of couch or arm chair sleeping compared with non-Hispanic white mothers. Safe to Sleep® started in 1994 as Back to Sleep to teach people about reducing the risk of SIDS. Promoting safe sleep practices is a public health priority. Oklahoma Sleep Institute is Oklahoma’s premier provider of diagnostic sleep studies and treatment. An individual level analysis of five major case-control studies, Maternal report of advice received for infant care, Physician recommendations regarding SIDS risk reduction: a national survey of pediatricians and family physicians, Building on Campaigns With Conversations: An Individualized Approach to Helping Families Embrace Safe Sleep and Breastfeeding, National Center for Education in Maternal and Child Health, National Institute for Children’s Health Quality. Results from multiple studies indicate that valerian — a tall, flowering grassland plant — may reduce the amount of time it takes to fall asleep and help you sleep better. A new study suggests more sleep may be the key to helping kids get active. Placing the DockATot in a crib, bassinet or other sleep surface is against the manufacturer's warnings and is not safe. State-level differences in safe sleep practices spanned ∼20 to 25 percentage points and did not substantially change after adjustment to promote comparability across demographic, behavioral, and health care characteristics. B, Separate approved sleep surface. Infants of non-Hispanic American Indian or Alaska Native mothers had notably higher rates of sleeping on a couch or armchair (18.2% vs 9.0% overall) and with a blanket (70.3% vs 50.5% overall). Our estimate from the component of usual (“always or often”) sleep on a separate sleep surface (74.4%; “always”: 55.7%, “often”: 18.7%) was comparable to the not usually bed-sharing estimate from SAFE (79.3%). Delta-9 tetrahydrocannabinol (THC) may decrease sleep latency but could impair sleep quality long-term. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Missing data ranged from 2% to 6% across outcomes. Our goal is to provide special needs children (i.e. … The single most effective action that parents and caregivers can take to lower a baby's risk of SIDS is to place the baby to sleep on his or her back for naps and at night. CONCLUSIONS: Safe infant sleep practices, especially those other than back sleep position, are suboptimal, with demographic and state-level differences indicating improvement opportunities. One investigation found that, compared with a placebo, a CBD dosage of 160 milligrams (mg) increased sleep duration. Video Abstract OBJECTIVES: To examine prevalence of safe infant sleep practices and variation by sociodemographic, behavioral, and health care characteristics, including provider advice. Co-Sleeping With Infants: Science, Public Policy, and Parents Civil Rights, with James McKenna, PhD. Group for coordinating collection of the training click on the button below: access online training ended 2010. 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