Fathers’ Roles in Helping with Infant Sleep & Breastfeeding Found to Be ‘Suboptimal,’ New Study Says

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06/20/2023

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Fathers matter.

A new study — a rare effort that focuses solely on the father’s involvement in an infant’s life — shows a striking link between the support that dads offer and better infant outcomes.

The research sought to answer several questions about paternal participation in breastfeeding and the use of safe sleep practices for babies. The results showed that fathers play a crucial role in both — and it highlights the need for bolstered parental leave policies in the United States, according to the study, which published Friday in the journal Pediatrics.

The results of the survey, which included 250 fathers, were “suboptimal,” the study concluded, revealing only 16% of dads followed all the recommended safe sleeping practices for infants. And many could do more to support mothers who breastfeed, which can provide key health benefits for babies, the study indicated.

The reason the researchers asked these questions in the first place? Moms wanted them to, said study coauthor Dr. Craig Garfield, a pediatrician at Lurie Children’s Hospital of Chicago and professor at Northwestern University’s Feinberg School of Medicine.

For more than 30 years, the US Centers for Disease Control and Prevention has carried out a Pregnancy Risk Assessment Monitoring System — or PRAMS — survey that seeks to gather data from mothers before, during and after birth.

“The moms actually started to write in the margins of the survey,” Garfield said. “The only question they asked (originally in the survey) about dads was: ‘Did your partner hit, kick, beat or slap you during your pregnancy?’ ”

Mothers knew that a father’s active support could be critical in the early months of an infant’s life, and they wanted that data reflected, too, Garfield said. Ultimately, the CDC reached out to the Northwestern researchers for help, providing funding for the study.

“We focused on breastfeeding and infant sleep because they are two key national health targets,” said lead study author Dr. John James Parker, who is a pediatrician, internist and researcher at Northwestern.

The study started small: Researchers collected data, via a survey, from 250 fathers in Georgia within the first two to six months after the birth of their child. Fathers were eligible if the infant’s mother also took the PRAMS survey.

It found 99% of fathers had put their child to bed, but less than a quarter of them used all the methods recommended by the American Academy of Pediatrics. These recommendations include:

• Always place infants to sleep on their backs.
• Use an approved sleep surface, one specifically designed for infant sleep (i.e., crib, bassinet, bedside sleeper).
• The surface should be firm with no soft bedding or other items, such as blankets or stuffed animals.

Those are all recommended strategies for preventing sudden infant death syndrome, which causes about 3,400 deaths in the United States every year, according to the CDC.

The research also found racial disparities in sleep practices, with Black fathers less likely than White fathers to follow those practices.

“I think that more needs to be done in this space to understand some of the reasons between the disparities,” Parker said. “But I think one scenario that we’ve seen play out is that racial and ethnic minorities have less availability to things like paternity leave … so it’s possible that it gets harder to get to appointments, or to be at the newborn nursery, the OB-GYN office.”

Those are key places where fathers learn about these best practices, Parker said.

Overall, almost a third of the fathers involved in this survey did not receive enough or any advice about safe sleep practices, according to the study.

Breastfeeding can be a huge boon for an infant’s health, aiding immunity, overall well-being and parental bonding. The American Academy of Pediatrics recommends exclusively breastfeeding a child for at least the first six months.

Previous studies have suggested that fathers can play a key role in helping mothers breastfeed. But researchers in this new study were struck by how strong the correlation appeared to be.

In this survey sample, the study found that “among fathers who wanted their infant’s mother to breastfeed, 95% reported breastfeeding initiation and 78% reported breastfeeding at (eight) weeks, which is significantly higher than fathers who had no opinion or did not want their infant’s mother to breastfeed, of whom 69% reported breastfeeding initiation and 33% reported breastfeeding at (eight) weeks.”

The difference is “dramatic,” Parker added.

Going forward, Parker said he hopes “we can tell fathers how valuable they are in the successful breastfeeding — tell them that this is a team effort.”

Fathers can play an active role, ensuring mothers have food to eat and a comfortable place to breastfeed, and they can help with other household work to give moms the time and space to breastfeed their child.

Parker urged fathers to continue breaking down the barriers on roles that society typically assigns to men and women.

“We’ve made a lot of progress, promoting the importance of women in the workplace,” Parker said. “And I think to continue that — and for it to be as accessible — we need to have fathers who are equal parents and contributing in many ways at home.”

Dr. Jennifer Lansford called the study results “sobering.”

“We’re still not meeting guidelines and recommendations for these very basic physical caregiving practices,” said Lansford, director of the Center for Child and Family Policy and research professor in the Sanford School of Public Policy at Duke University in North Carolina. She was not involved in the study.

Lansford’s own research focuses on parenting cultures across nine countries, and she said this study is just more evidence that the United States lags behind others when it comes to supporting and educating parents.

“For example, in this country, we still don’t even have universal paid leave for mothers, let alone for fathers,” Lansford said. “Even if individual parents want to do the best they can … we don’t always have societal supports in place that let that be possible.”

She added that another key takeaway from this study should be that, while the historical paradigm may have emphasized mothers as the caregivers, fathers are not just supporters.

“More contemporary views suggest there are healthier ways to think about fatherhood — fathers are important in their own right, not just as helpers for mothers.”

The Northwestern researchers are looking to expand their fatherhood research beyond Georgia, rolling out surveys into other states.

But Garfield acknowledges that this information may not be particularly helpful for same-sex couples or single mothers with no other paternal support.

“It took the CDC and the country 35 years to recognize we had a very biased — and not gender equal — approach to collecting this data,” he said. “My hope is (that it’s not another) 35 years till we start to understand what’s happening in (all) sorts of families.”

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