Caregiver lived experiences attempting to follow safe sleep recommendations to sleep their baby in a cot: a qualitative directed content analysis

AIM: To examine parents' lived experiences of implementing cot-only advice in a contemporary Australian cohort, assess alignment with the international literature on infant sleep and shared sleep practices, and determine whether explicit risk minimization guidelines address information needs identified by parents. BACKGROUND: The risk elimination approach to shared sleeping has dominated public health messaging for decades but has been unsuccessful in reducing Sudden Unexpected Deaths in Infancy (SUDI) rates, while bedsharing rates have remained stable. The risk minimization approach offers an alternative, pragmatic framework for reducing controllable risks. METHODS: A retrospective, secondary, qualitative directed content analysis of free-text responses related to bed-sharing drawn from the 2017 Infant Care Awareness and Routines Evaluation among Queenslanders (I-CARE Qld Study) cross-sectional survey dataset. 3,341 primary caregivers (97% mothers) of infants aged approximately three months, born in Queensland between April and May 2017. For this secondary analysis, free-text responses related to co-sleeping/bedsharing were extracted and analysed qualitatively in line with study objectives. FINDINGS: Queensland parents expressed a desire for more information and non-judgemental education on improving safety while sharing sleep with their baby. Nearly a third of this cohort reported difficulty following advice to sleep their baby separately citing infant temperament/ needs, breastfeeding and caregiver fatigue or exhaustion as top rationales for this difficulty, aligning with earlier international findings. Some awareness by parents of risk minimization strategies to improve shared sleep safety was evident and in alignment with current Queensland Clinical Guidelines. There is an urgent need for public health messaging on safer infant sleep to better align with the lived experiences of parents and families through the adoption of a universal, proactive risk minimization approach to shared sleep. Co-designing guidance with parents may serve to bridge the gap between idealized and real-world implementation of safer infant sleep strategies.