Background Advice to families to sleep infants on their backs, avoid smoke exposure, reduce excess bedcovering and avoid specific risks associated with cosleeping has greatly reduced sudden unexpected death in infancy (SUDI) rates worldwide. The fall in rates has not been equal across all groups, and this advice has been less effective for more socially deprived families. Understanding decision-making processes of families with infants at risk would support the development of more effective interventions. Aim To synthesise the qualitative evidence on parental decision-making for the infant sleep environment among families with children considered to be at increased risk of SUDI. Methods This study was one of three related reviews of the literature for the Child Safeguarding Practice Review Panel’s National Review in England into SUDI in families where the children are considered at risk of harm. A systematic search of eight online databases was carried out in December 2019. Metasynthesis was conducted, with themes extracted from each paper, starting with the earliest publication first. Results The wider review returned 3367 papers, with 16 papers (across 13 studies) specifically referring to parental decision-making. Six overall themes were identified from the synthesis: (1) knowledge as different from action; (2) external advice must be credible; (3) comfort, convenience and disruption to the routine; (4) plausibility and mechanisms of protection; (5) meanings of safety and risk mitigation using alternative strategies; and (6) parents’ own expertise, experience and instincts. Conclusion Interventions that are intended to improve the uptake of safer sleep advice in families with infants at risk of sleep-related SUDI need to be based on credible advice with mechanisms of protection that are understandable, consistent with other sources, widened to all carers of the infant and fit within the complex practice of caring for infants.

中文翻译：

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有婴儿猝死风险的家庭对婴儿睡眠环境的决策：系统评价和定性综合分析

背景 建议家庭让婴儿仰卧睡觉、避免暴露于烟雾、减少过多的被褥以及避免与同睡相关的特定风险，这大大降低了全球婴儿猝死率 (SUDI)。所有群体的发病率下降幅度并不相同，而且这一建议对社会贫困程度较高的家庭效果较差。了解有危险婴儿家庭的决策过程将支持开发更有效的干预措施。目的在有儿童被认为处于 SUDI 风险增加的家庭中，综合父母对婴儿睡眠环境决策的定性证据。方法 这项研究是儿童保护实践审查小组在英格兰对儿童被认为有伤害风险的家庭中的 SUDI 进行国家审查的三项相关文献审查之一。2019 年 12 月对八个在线数据库进行了系统搜索。进行了 Metasynthesis，从每篇论文中提取主题，从最早的出版物开始。结果 更广泛的审查返回了 3367 篇论文，其中 16 篇论文（涉及 13 项研究）专门针对父母的决策。从综合中确定了六个总体主题：（1）知识不同于行动；(2) 外部建议必须可信；(3) 舒适、方便和对日常生活的干扰；(4) 合理性和保护机制；(5) 使用替代策略的安全和风险缓解的含义；(6) 父母自身的专业知识、经验和直觉。结婴儿并适应照顾婴儿的复杂实践。