Many parents place their infants in sleeping environments with established risk factors, according to data published in Pediatrics.

Prior studies such as the National Infant Sleep Position Study (NISP) have established risk factors for sleep-related infant death, although these reports have been limited by data reported by parents and caregivers or postmortem findings. Therefore, Erich K. Batra, MD, from the Departments of Pediatrics and Family and Community Medicine at the Penn State College of Medicine in Hershey, Pennsylvania, and colleagues sought to determine the frequency of these risk factors by watching nocturnal sleep videos of 160 infants.

The researchers conducted video recordings within family homes for 1 night when the infant was 1 month, 3 months, and 6 months of age. They noted any risk factors of sudden infant death syndrome that were observed in the video.

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“Our study found a higher proportion of sleep environment risk factors than have been reported in previous studies,” the study authors wrote. “Additional research on parental beliefs and understanding of when safe sleep guidelines are applicable and on barriers to safe sleep will be important, with the goal of developing more effective educational materials and interventions.”

During the 1-month evaluation, 21% of the 160 infants were initially placed on nonrecommended sleep surfaces and 14% were placed nonsupine. In addition, 91% of the infants had loose items on the sleeping surface, including bedding, bumper pads, pillows, stuffed animals, and sleep positioners.

Of the 151 infants included in the 3-month evaluation, 10% were placed on nonrecommended sleep surfaces, 18% were not supine, and 87% had loose items on their sleep surface. At the 6-month evaluation, 12% of the 147 infants slept on a nonrecommended surface, 33% were not supine, and 93% had nonrecommended items on the sleep surface.

The investigators noted that the sleeping positions were not consistent throughout the night. At 1 month, 28% of infants changed sleep locations during the night, 18% changed locations at 3 months, and 12% changed locations at 6 months. There was an increased likelihood of bed-sharing and a nonsupine position at the second location.

“Although safe sleep messages have been emphasized for years, our data suggest that parents are not strictly adhering to the guidance on safe sleep environments,” the authors noted. “This lack of adherence may be at least partly because of persistent cultural norms and beliefs.… Health care providers should be aware of these influences on parental decision making so that appropriate guidance can be given.”


  1. Batra EK, Teti DM, Schaefer EW, et al. Nocturnal video assessment of infant sleep environments. Pediatrics. 2016;138(3). doi: 10.1542/peds.2016-1533.