Breastfeeding benefits both infant and mother, including reducing the risk of Sudden Infant Death Syndrome (SIDS). To further reduce risk of SIDS, the American Academy of Pediatrics recommends infants sleep on their backs on a separate sleep surface. Our objective was to describe trends and factors associated with breastfeeding and infant sleep practices in Georgia. Pregnancy Risk Assessment Monitoring System 2004–2013 data were obtained from the Georgia Department of Public Health. Chi square tests for trends were utilized to determine whether there were significant linear trends in breastfeeding and infant sleep overtime and by survey phase. After exclusions, 4643 cases remained for analysis. From 2004 to 2013, there was a slight (insignificant) decrease in breastfeeding initiation, with the highest proportion in 2010 (79.9%) and the lowest in 2013 (66.9%). Rates of exclusive breastfeeding increased significantly from 2004 (31.3%) to 2013 (81.7%). During that time, the proportion of infants being placed back to sleep slightly decreased (though not significantly), from 59.7 to 48.9%. The proportion of mothers who reported never bed-sharing increased significantly from 26.7 to 45.1% over this period. The decreasing breastfeeding initiation rates in Georgia diverge from national upward trends, however, exclusive breastfeeding rates by survey phase were slightly higher than national trends. Our results suggest the need for targeted education and support for breastfeeding and safe sleep practices. State-level trends data on breastfeeding and infant sleep practices provide valuable information for state-level public health professionals and policy makers, health care providers, and breastfeeding and safe sleep advocates.
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American Academy of Pediatrics (AAP). (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827–e841. https://doi.org/10.1542/peds.2011-3552.
Hauck, F. R., Thompson, J. M. D., Tanabe, K. O., Moon, R. Y., & Vennemann, M. M. (2011). Breastfeeding and reduced risk of Sudden Infant Death Syndrome: A meta-analysis. Pediatrics, 128(103), 103–110. https://doi.org/10.1542/peds.2010-3000.
Moon, R. Y. & AAP Task Force on Sudden Infant Death Syndrome. (2016). SIDS and other sleep-related infant deaths: Evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics, 138(5), e20162940. https://doi.org/10.1542/peds.2016-2940.
United States Department of Health & Human Services. (2016). Healthy People 2020. Retrieved from http://healthypeople.gov.
Smith, L. A., Geller, N. L., Kellams, A. L., Coslon, E. R., Rybin, D. V., Heeren, T., & Corwin, M. J. (2016). Infant sleep location and breastfeeding practices in the United States: 2011–2014. Academic Pediatrics, 16(6), 540–549. https://doi.org/10.1016/j.acap.2016.01.021.
CDC. (2016). PRAMStat PRAMS data query system. Retrieved from http://nccd.cdc.gov/PRAMStat/.
Salm Ward, T. C. (2015). Reasons for mother-infant bed-sharing: A systematic narrative synthesis of the literature and implications for future research. Maternal & Child Health Journal, 19(3), 675–690. https://doi.org/10.1007/s10995-014-1557-1.
Academy of Breastfeeding Medicine [ABM] Protocol Committee. (2008). ABM clinical protocol #6: Guideline on co-sleeping and breastfeeding. Breastfeeding Medicine, 3(1), 38–43. https://doi.org/10.1089/bfm.2007.9979.
Bartick, M., & Smith, L. J. (2014). Speaking out on safe sleep: Evidence-based infant sleep recommendations. Breastfeeding Medicine, 9(9), 417–422. https://doi.org/10.1089/bfm.2014.0113.
Kendall-Tackett, K., Cong, Z., & Hale, T. (2016). Factors that influence where babies sleep in the United States: The impact of feeding method, mother’s race/ethnicity, partner status, employment, education, and income. Clinical Lactation, 7(1), 18–29. https://doi.org/10.1891/2158-0718.104.22.168.
International, La Leche League, Wiessinger, D., West, D., Smith, L. J., & Pitman, T. (2014). Sweet sleep: Nighttime and naptime strategies for the breastfeeding family. New York: Ballantine Books.
McKenna, J. J., & Gettler, L. T. (2015). There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping. Acta Paediatrica. https://doi.org/10.1111/apa.13161.
McKenna, J. J., & Gettler, L. T. (2017). Supporting a ‘bottom-up,’ new, no-holds-barred, psycho-anthro-pediatrics: Making room (scientifically) for bedsharing families. Sleep Medicine Reviews, https://doi.org/10.1016/j.smrv.2016.06.003.
ABM Protocol Committee. (2010). ABM clinical protocol #7: Model breastfeeding policy (revision 2010). Breastfeeding Medicine, 5(4), 173–177. https://doi.org/10.1089/bfm.2010.9986.
UNICEF. (2013). Facilitator guide: The community infant and young child feeding counselling package. Retrieved from https://www.unicef.org/nutrition/files/Facilitator_Guide_September_2013.pdf.
Kendall-Tackett, K., Cong, Z., & Hale, T. W. (2010). Mother-infant sleep locations and nighttime feeding behavior: U.S. data from the Survey of Mothers’ Sleep and Fatigue. Clinical Lactation, 1, 27–31. https://doi.org/10.1891/215805310807011837.
Broussard, D. L., Sappenfield, W. M., & Goodman, D. A. (2012). The black and white of infant back sleeping and infant bed-sharing in Florida, 2004–2005). Maternal & Child Health Journal, 16, 713–724. https://doi.org/10.1007/s10995-011-0768-y.
Norton, P. J., & Grellner, K. W. (2011). A retrospective study on infant bed-sharing in a clinical practice population. Maternal & Child Health Journal, 15, 507–513.
Centers for Disease Control and Prevention (CDC). (2014). Pregnancy Risk Assessment Monitoring System. Retrieved from http://www.cdc.gov/PRAMS/.
Gilbert, B. C., Shulman, H. B., Fischer, L. A., & Rogers, M. M. (1999). The Pregnancy Risk Assessment Monitoring System (PRAMS): Methods and 1996 response rates from 11 states. Maternal & Child Health Journal, 3(4), 199–209. https://doi.org/10.1177/003335490612100114.
Georgia Department of Public Health (DPH). (2017). Pregnancy Risk Assessment Monitoring System (PRAMS). Retrieved from https://dph.georgia.gov/PRAMS.
Engstrom, J. L., Patel, A. L., & Meier, P. P. (2017). Eliminating disparities in mother’s milk feeding in the Neonatal Intensive Care Unit. Journal of Pediatrics, 182, 8–9. https://doi.org/10.1016/j.jpeds.2016.12.038.
Patton, C., Stiltner, D., Wright, K. B., & Kautz, D. D. (2015). Do nurses provide a safe sleep environment for infants in the hospital setting? An integrative review. Advances in Neonatal Care, 15(1), 8–22. https://doi.org/10.1097/ANC.0000000000000145.
Shattnawi, K. K. (2017). Healthcare professionals’ attitudes and practices in supporting and promoting the breastfeeding of preterm infants in NICUs. Advances in Neonatal Care. https://doi.org/10.1097/ANC.0000000000000421.
Fellenzer, J. L., & Cibula, D. A. (2014). Intendedness of pregnancy and other predictive factors for symptoms of prenatal depression in a population-based study. Maternal & Child Health Journal, 18(10), 2426–2436. https://doi.org/10.1007/s10995-014-1481-4.
Humbert, L., Saywell, R. M., Zollinger, T., Priest, C. F., Reger, M. K., & Kochhar, K. (2011). The effect of pregnancy intention on important maternal behaviors and satisfaction with care in a socially and economically at-risk population. Maternal & Child Health Journal, 15(7), 1055–1066.
CDC. (2017). Nutrition, physical activity and obesity data, trends and maps. Retrieved from http://www.cdc.gov/nccdphp/DNPAO/index.html.
Colson, E. R., Willinger, M., Rybin, D., Heeren, T., Smith, L. A., Lister, G., & Corwin, M. J. (2013). Trends and factors associated with infant bed sharing, 1993–2010: The National Infant Sleep Position Study. JAMA Pediatrics, 167(11), 1032–1037. https://doi.org/10.1001/jamapediatrics.2013.2560.
Colson, E. R., Rybin, D., Smith, L. A., Colton, T., Lister, G., & Corwin, M. J. (2009). Trends and factors associated with infant sleeping position: The National Infant Sleep Position Study, 1993–2007. Archives of Pediatric & Adolescent Medicine, 163(12), 1122–1128. https://doi.org/10.1001/archpediatrics.2009.234.
Colson, E. R., Geller, N. L., Heeren, T., & Corwin, M. J. (2017). Factors associated with choice of infant sleep position. Pediatrics, 140(3), e20170596. https://doi.org/10.1542/peds.2017-0596.
Langellier, B. A., Chaparro, P., Wang, M. C., Koleilat, M., & Whaley, S. E. (2014). The new food package and breastfeeding outcomes among Women, Infants, and Children participants in Los Angeles County. American Journal of Public Health, 104(Suppl 1), S112–S118. https://doi.org/10.2105/AJPH.2013.301330.
Panzera, A. D., Castellanos-Brown, K., Paolicelli, C., Morgan, R., Potter, A., & Berman, D. (2017). The impact of federal policy changes and initiatives on breastfeeding initiation rates and attitudes toward breastfeeding among WIC participants. Journal of Nutrition Education and Behavior, 49(7S2), S207–S211. https://doi.org/10.1016/j.jneb.2017.04.026.
National Conference of State Legislators (NCSL). (2017). Breastfeeding state laws. Retrieved from http://www.ncsl.org/research/health/breastfeeding-state-laws.aspx.
AAP. (2005). The changing concept of Sudden Infant Death Syndrome (SIDS): Diagnostic coding shifts, Controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics, 116(5), 1245–1255. https://doi.org/10.1542/peds.2005-1499.
Moon, R. Y. & AAP Taskforce on Sudden Infant Death Syndrome. (2011). SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), 1030–1039. https://doi.org/10.1542/peds.2011-2284.
Weimer, D. R. (2005). Summary of state breastfeeding laws and related issues: Congressional Research Service report for Congress. Retrieved from Congresswoman Maloney’s website: https://maloney.house.gov/sites/maloney.house.gov/files/documents/olddocs/breastfeeding/20050519_CRS_State%20Laws.pdf.
AAP. (2000). Changing concepts of Sudden Infant Death Syndrome: Implications for infant sleeping environment and sleep position. Pediatrics, 105(3), 650–656.
Georgia DPH. (2016). Georgia 5-STAR. Retrieved from https://dph.georgia.gov/georgia-5-star.
World Health Organization & UNICEF. (2012). Baby friendly hospital initiative. Retrieved from http://www.unicef.org/nutrition/files/BFHI_section_2_2009_eng.pdf.
Georgia DPH. (2017). Georgia Safe to Sleep Campaign. Retrieved from https://dph.georgia.gov/safetosleep.
Ball, H. L., & Volpe, L. E. (2013). Sudden infant death syndrome (SIDS) risk reduction and infant sleep location—Moving the discussion forward. Social Science & Medicine, 79, 84–91. https://doi.org/10.1016/j.socscimed.2012.03.025.
UNICEF Baby Friendly Initiative. (2012). Caring for your baby at night: A guide for parents. Retrieved from https://www.bristol.gov.uk/documents/20182/32995/caringatnight_web_0.pdf.
Georgia Pregnancy Risk Assessment Monitoring System (PRAMS) data were collected and provided by the PRAMS Project in the Maternal and Child Epidemiology Section of the Georgia Department of Public Health (DPH). The Centers for Disease Control and Prevention Cooperative Agreement grant number 1U01DP006194 provided funding to DPH for data collection and some staff support. We also acknowledge The PRAMS Working Group. The authors also acknowledge the efforts of Mumbi Mwaura, MSW, MPH.
The authors received no financial support for the research, authorship, and/or publication of this article.
Conflict of interest
The authors declare that they have no conflict of interest.
This study was reviewed and approved by the Georgia Department of Public Health and the University of Georgia Institutional Review Boards.
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Salm Ward, T.C., Kanu, F.A. & Anderson, A.K. Trends and Factors Associated with Breastfeeding and Infant Sleep Practices in Georgia. J Community Health 43, 496–507 (2018). https://doi.org/10.1007/s10900-017-0442-4
- Breastfeeding initiation
- Exclusive breastfeeding
- Infant sleep practices
- Trend analysis