Sudden unexpected death in infancy (SUDI) is four times higher for Australian Indigenous compared to non-Indigenous babies. Co-sleeping is a culturally valued practice by many Indigenous families, however is associated with an increased risk of infant death in hazardous circumstances. Portable sleep spaces that allow for a separate surface adjacent to close parental contact on the adult sleep surface have been used successfully in high risk populations in New Zealand, with infant mortality reductions observed. Indigenous communities identified this area as a priority for investigation.
A project team from USC have collaborated with Change for our Children Limited in New Zealand for the first trial of a safe sleep enabler in Australia. The Pēpi-Pod® Safe Sleep Program was initiated in New Zealand by Change for our Children in 2011 as a public health response for babies at a higher risk of SUDI in collaboration with the Wahakura basket program.
This study aimed to determine:
a) safety and feasibility of the Pēpi-Pod® Program within Queensland Aboriginal and Torres Strait Islander families identified at higher risk for SUDI;
b) effectiveness of Pēpi-Pod® Program in achieving safer sleep environments for vulnerable infants as measured by use of a separate infant sleep surface in the context of shared sleep with identified risk.
The Pēpi-Pod® Program comprised a portable sleep space, safe sleeping parent education and safety briefing; and a family commitment to share safe sleeping messages within social networks. The NZ Program was adapted for an Australian context and delivered to consenting Aboriginal and Torres Strait Islander families with identified SUDI risks, recruited through government and non government maternal child health services (n=11 services, 27 communities) who undertook Pēpi-Pod® competency training, across Queensland’s metropolitan, regional and rural/remote areas, encompassing a geographical area of 1,727,000 square kilometres. Parent questionnaires were administered face-to-face or by telephone within 2 weeks of receiving the Pēpi-Pod®; then monthly thereafter until Pēpi-Pod use ceased.
Data collection continues; >300 families recruited to date. Of respondents, all had SUDI risk factors; 76% had ≥2 known risks including smoking during pregnancy (53%), LBW (15%), prematurity (14%), alcohol use (8%), recreational (3%) and prescription drugs (4%), crowded living conditions (35%). Most families intended to cosleep (79%); shared infant sleep with a maternal smoker was common (41%). Responses to Pēpi-Pod related to three key themes: safety, convenience and portability. Safe sleeping awareness was raised within families (99%) and through community social networks (90%). Most families utilised the pod beyond infant age 4 weeks (71%); 14.5% beyond >17weeks. Pēpi-Pod use reduced co-sleeping with known risk factors including: smoking, drug and alcohol use, multiple bed-sharers, prematurity, low birth weight. Health professional feedback relating to implementation indicated that the Pēpi-Pod® Program was feasible, accessible, sustainable, and built local workforce capacity with integration into current service models.
This is the first evaluation of a safe sleep enabler in Australia. The Pēpi-Pod® Program was accepted and used appropriately by parents living in Queensland Indigenous communities and reduced the risk of SUDI in the context of co-sleeping with known risk factors. Program principles are applicable to mainstream services which care for vulnerable families. Innovative strategies which allow for co-sleeping benefits, respect cultural norms and infant care practices, whilst enabling safe sleep environments are necessary to further reduce SUDI.
The Wahakura and Pēpi-Pod® Programs in New Zealand are believed to be associated with the 36% reduction achieved in post-perinatal infant mortality (1-52 weeks) during the period 2009-2016. Infant mortality rates in Queensland will continue to be monitored during program implementation.
The Queensland Pēpi-Pod® Program has been recognised with two national awards:
- Winner, HESTA Australian Nursing Awards - Team Innovation
- National Winner, National Lead Clinicians Group Award for Excellence in Innovative Implementation of Clinical Practice (Indigenous Health Category)
Future of the Queensland Pēpi-Pod® Program
The Pēpi-Pod® Program has been integrated into maternal and child health service delivery in partnership with maternal and child health services.
With the support of the Change for our Children New Zealand, Department of Communities, Child Safety and Disability, The Rural Doctors Association of Queensland Foundation the Pepi-Pod Program continued at several participating during 2017-2019 with a focus on Aboriginal and Torres Strait Islander mothers aged 25 years or less.
During 2020-2021 the Queensland Paediatric Quality Council and USC formed a collaboration to undertake an evaluation to determine the role of the Pēpi-Pod® Program in reducing infant mortality in Queensland.
Please contact Professor Jeanine Young, Chief Investigator, Australian Pepi-Pod® Program.
For more information about the New Zealand and Australian Pepi-Pod® Safe Sleep Program please see:
- Introducing the Pepi-Pod Safe Sleep Program,
- Change for our Children website, and
- Australian Pepi-Pod® Safe Sleep Program Service Provider Support Information.
- YOUNG J, COWAN S, KEARNEY L, WATSON K, CRAIGIE L. (2020) A strategy to promote safe sleeping environments and reduce the risk of Sudden Unexpected Death in Infancy in Aboriginal and Torres Strait Islander communities. (ID: 99489008702621) Final Implementation Project Report for the Department of Child Safety, Youth and Women, Queensland Government, 2018. Available at https://doi.org/10.25907/00011
- YOUNG J, CRAIGIE L, COWAN S, KEARNEY L, WATSON K. (2018) Reducing risk for Aboriginal and Torres Strait Islander babies: trial of a safe sleep enabler to reduce the risk of sudden unexpected deaths in infancy in high risk environments (The Queensland Pepi-Pod Program). Final Research Project Report. University of the Sunshine Coast, Sippy Downs, Queensland. DOI: http://dx.doi.org/10.25907/5c6b462922760
Peer Review Publications
- YOUNG J, WATSON K, CRAIGIE L, NEVILLE J, HUNT J. (2019) Best practice principles for research with Aboriginal and Torres Strait Islander communities in action: Case study of a safe infant sleep strategy. Women and Birth 32(5): 460-465. 10.1016/j.wombi.2019.06.022.
- YOUNG J, WATSON K, CRAIGIE L, COWAN S, KEARNEY L. (2017) Uniting cultural practices and safe sleep environments for vulnerable Indigenous Australian infants. Australian Nursing and Midwifery Journal. April 24(9): 37. [PMID: 29272090]