A study involving videos of slumbering infants found the vast majority of parents placed babies in unsafe sleep environments associated with an increased risk of death despite guidance from health care providers and public education campaigns.
The American Academy of Pediatrics report released Monday is the first to look at video recordings of parental behavior rather than relying on self-reported surveys or police reports after an infant’s death.
Researchers recorded infants for one night at ages 1, 3 and 6 months in family homes. The videos revealed most parents placed children at risk by positioning infants on their sides or stomachs, using soft sleep surfaces or loose bedding or sharing a bed with a parent.
Sleep-related infant deaths are the most common cause of death for babies between one month and one year of age, according to the United States Department of Health and Human Services. Such deaths include sudden infant death syndrome (SIDS) and accidental suffocation and strangulation in bed.
More than 160 infants were enrolled in the study, though some dropped out before the six month mark. Across the three time periods, 10-21% of babies were placed on a non-recommended sleep surface, 14-33% were placed in non-recommended positions and 87-93% had potentially hazardous items on their sleep surface.
Risky items include loose blankets, stuffed animals, pillows, bumper pads and sleep positioners. Unsurprisingly, some of these items were found on the sleep surfaces the infants shared with a parent, but the majority of cribs also contained soft or loose bedding.
About 12-28% of the infants changed sleep locations overnight, with the higher percentage occuring among younger babies. When moved in the middle of the night, the babies were often placed in an even riskier environment, such as sharing a bed with an adult.
Elizabeth Murray, a pediatrician at Golisano Children’s Hospital at the University of Rochester, said fatigue and exhaustion may play a role in parental decision making if infants start the night in a safe sleep environment and are moved to an unsafe place.
“Is it that people are frustrated?” Murray said. “What’s going on in the middle of the night that’s making people change what they are doing?”
The study involved a group of predominantly white and highly educated parents, a group pediatricians often think of as being at lower risk.
“It reminds us that this is something for all people to be aware of regardless of socioeconomic background or education levels,” said Murray, who is also an American Academy of Pediatrics fellow. “This is a group of people you’d assume have access to resources and knowledge and are still not following the advice.”
Efforts to educate the public about risk factors began in 1992, when the American Academy of Pediatrics recommended placing babies on their backs for sleep. Subsequent advisories have since been released concerning the dangers of loose items on the sleep surface.
“We are getting the word out but people aren’t acting on that,” said Catherine Spong, acting director of the National Institute of Child Health and Human Development, which launched the Safe to Sleep campaign in 1994.
Families with infants are often inundated with recommendations while leaving the hospital or at a check-up, said Ian Paul, author of the report and Professor of Pediatrics and Public Health Sciences at Penn State College of Medicine.
“Perhaps we have to make it even simpler,” he said. “We need to be extremely clear and unambiguous in our advice and we need to make sure we model safe sleep environment when babies are in the hospital.”
Murray said the simplest way parents can think about infants’ sleep environments is “boring is best.”
“The best thing you can do to show your baby you love them is to put the baby alone, and on its back,” she said.