Fathers key to supporting breastfeeding and safe infant sleep

Fathers can make a huge difference in whether an infant is breastfed and placed to sleep safely, according to a recent survey of new fathers via the Pregnancy Risk Assessment Monitoring System (PRAMS) for Dads. This new tool is modeled on the annual surveillance system that the Centers for Disease Control and Prevention (CDC) and public health departments have used for more than 35 years to survey new mothers. By utilizing PRAMS for Dads, this article is the first to describe father-reported rates of infant breastfeeding and sleep practices in a state-representative sample. Findings are published in the journal Pediatrics.

Among fathers who wanted their infant's mother to breastfeed, 95% reported breastfeeding initiation and 78% reported breastfeeding at eight weeks. This is significantly higher than the rates reported by fathers who had no opinion or did not want their infant's mother to breastfeed—69% of these fathers reported breastfeeding initiation and 33% reported breastfeeding at eight weeks.

Researchers also found that 99% of fathers reported placing their infant to sleep, but only 16% implemented all three recommended infant sleep practices (using the back sleep position, an approved sleep surface, and avoiding soft bedding). Almost a third of fathers surveyed were missing at least one key component of safe sleep education.

Black fathers were less likely to use the back sleep position and more likely to use soft bedding than White fathers. Nationally, the rate of sudden unexpected infant death of Black infants is more than twice that of White infants, and unsafe sleep practices may contribute to this disparity.

"Our findings underscore that new fathers are a critical audience to promote breastfeeding and safe infant sleep," said lead author John James Parker, MD, a pediatrician at Ann & Robert H. Lurie Children's Hospital of Chicago, an internist at Northwestern Medicine, and an Instructor of Pediatrics at Northwestern University Feinberg School of Medicine. "Many families do not gain the health benefits from breastfeeding because they are not provided the support to breastfeed successfully. Fathers need to be directly engaged in breastfeeding discussions and providers need to describe the important role fathers play in breastfeeding success. Additionally, fathers need to receive counseling on all of the safe sleep practices for their infants. To reduce racial disparities in sudden unexpected infant death, we need tailored strategies to increase safe infant sleep practices in the Black community, including public campaigns to increase awareness and home visiting programs. These interventions must involve both parents to be most effective."

The study included 250 fathers who were surveyed two to six months after their infant's birth.

"As pediatricians we focus on how to ensure the best health outcomes for children, with successful breastfeeding and safe sleep practices being two key behaviors that impact children's health," said senior author Craig Garfield, MD, MAPP, founder of the Family & Child Health Innovations Program (FCHIP) at Lurie Children's. He is Professor of Pediatrics and Medical Social Sciences at Northwestern University Feinberg School of Medicine. "Our study highlights the fact that fathers play a big role in both these behaviors but there is more to be done to support fathers. For example, we found that fathers with college degrees were more likely to report that their baby breastfed, and they were more likely to receive guidance on infant sleep safety. To improve child health outcomes, we need to make sure that breastfeeding and safe sleep guidance reaches all new parents equitably."

Dr. Garfield partnered with the CDC and the Georgia Department of Public Health to develop and pilot PRAMS for Dads, the new survey tool used in this study that gathers data on the health behaviors and experiences of men as they enter fatherhood.

This project was supported by the Centers for Disease Control and Prevention (Cooperative agreement #U38OT00140) and CDC Innovation Fund, Office of Science/Office of Technology and Innovation.

Research at Ann & Robert H. Lurie Children's Hospital of Chicago is conducted through Stanley Manne Children's Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children's is a nonprofit organization committed to providing access to exceptional care for every child. It is ranked as one of the nation's top children's hospitals by U.S. News & World Report. Lurie Children's is the pediatric training ground for Northwestern University Feinberg School of Medicine.