Safe Infant Sleep Practices: Maternal Knowledge, Practices, and Sudden Infant Death Syndrome (SIDS) Prevention — Systematic Review

Abstract

Background: Sudden Infant Death Syndrome (SIDS) and Sudden Unexplained Infant Deaths (SUIDs) remain leading causes of post-neonatal mortality worldwide. Safe infant sleep practices — particularly supine positioning, firm sleep surfaces, room-sharing without bed-sharing, and avoidance of soft bedding — are evidence-based interventions to reduce sleep-related infant deaths. Despite global campaigns such as the 'Back to Sleep' (now 'Safe to Sleep') initiative, maternal knowledge and adherence to safe sleep practices remain inadequate across many settings, from rural India to Sub-Saharan Africa. Objectives: To synthesize evidence on (1) the level of maternal knowledge and practice of safe infant sleep; (2) prevalence and patterns of unsafe sleep practices; (3) the effectiveness of behaviour change communication (BCC) interventions on care-seeking behaviour; (4) changes in knowledge and practices from prenatal to postnatal period; and (5) factors associated with safe sleep practices across diverse geographic settings. Review Methodology: A guided narrative systematic review was conducted. Five peer-reviewed studies published between 2009 and 2026, conducted across India (Karnataka & Uttar Pradesh), the United States and Ethiopia were included. Designs included cross-sectional observational, before-and-after intervention, pre-experimental prenatal postnatal cohort, and descriptive institution-based studies. Populations included mothers of infants (0–12 months), urban poor neonatal caregivers, pregnant women, and rural PHC attendees (total N = 1,910 participants across all included studies). Key Findings: Only 42.7% of Ethiopian mothers practiced supine (safe) infant sleep position. In rural Karnataka, 67.5% had average, 21.0% good, and 11.4% poor safe sleep practices. 90.9% of Karnataka mothers had received no information on safe infant sleep. In Iowa (USA), 13% of mothers who planned back-sleeping reverted to unsafe positions postnatally. BCC intervention in urban Lucknow significantly improved qualified medical care-seeking for neonatal illness (OR=2.12, p=0.0001). Maternal occupation, parity, information source, and knowledge were significant determinants of safe sleep practice. Conclusion: Maternal knowledge and practice of safe infant sleep remain globally suboptimal. Behaviour change communication, structured antenatal and postnatal health education, and community-based targeted interventions are effective and urgently needed. Healthcare providers, especially nurses and ANM/ASHA workers, must routinely counsel mothers on safe infant sleep at every contact point during the first year of life. Categories: Child Health; Neonatal Nursing; SIDS Prevention; Maternal Health; Community Medicine; Paediatric Nursing.