Response to Bartick: Babies Can Sleep Safe and Sleep Well

We thank Dr Bartick for her thoughtful comments.The purpose of our qualitative article was to highlight some of the sleep challenges that parents face with their young infants. We believe that every parent wants their infant to be safe and to sleep well, and this is our goal as well. However, our study highlights that most parents do not know how to accomplish this.Dr Bartick asserts that, because parents in our study have described the safe sleep recommendations as "unrealistic," the recommendations "must change." She also suggests that the AAP should follow the lead of the UK, which has changed its recommendations regarding bedsharing and notes that there has been no decline in rates of sudden and unexpected infant death in the United States since the AAP first recommended against bedsharing in 2016.1We do not believe that our study, in which we held group discussions with 25 mothers, should be used to justify upending evidence-based recommendations for a safe sleep environment, which are based on case-control studies involving thousands of infants. Additionally, we would like to note that the United Kingdom has also not seen a decline in rates of sudden and unexpected infant deaths since 2014.2 As pediatric clinicians and researchers, we also recognize that there are many evidence-based recommendations, including those to limit screen time, eliminate sugar-sweetened beverages, and use of car seats starting with their first ride home from the hospital, which may be difficult for some parents to follow with their children. Because some parents describe these recommendations as "unrealistic" does not mean that the recommendations must change or be wholly discarded as Dr Bartick would suggest.With regards to Dr Bartick's concern that we did not distinguish feeding types, this was a small qualitative study, and feeding type was not a focus of the study. However, we know from the discussions that our participants included parents who fed human milk and parents who fed formula.Finally, Dr Bartick states that parents should be provided with "realistic, physiologic, and safe alternatives." Two studies have shown that parent-reported sleep quality is better when infants are independent sleepers, sleeping on a separate surface or location.3,4 Parents reported increased sleep consolidation and decreased parent-perceived sleep problems. These results and the findings of our recent study align with our goals, which we expect are Dr Bartick's as well - to keep babies safe and ensure that all infants get the sleep they need.