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Study: More than half of infants sleep with soft bedding or on unapproved surface :

October 21, 2019

Many infants aren’t being put to sleep in safe conditions, according to a new study.

Each year in the U.S., about 3,500 infants die from sudden unexpected infant death (SUID), largely during sleep.

The AAP recommends infants sleep on their back on a firm sleep surface like a crib, with no soft bedding or loose objects. In addition, infants should share a room with their caregiver without sharing a bed.

Researchers from several federal health agencies assessed data from the 2016 Pregnancy Risk Assessment Monitoring System spanning 29 states to see how many parents were following safe sleep guidance. They reported their findings in “Prevalence and Factors Associated with Safe Infant Sleep Practices,” (Hirai AH, et al. Pediatrics. Oct. 21, 2019,

Maternal reports about how their infants usually slept showed

  • 78% slept on their back,
  • 57% shared a room without bed-sharing,
  • 42% avoided soft bedding and
  • 32% used a separate, approved sleep surface.

Among those who used soft bedding, the most common was a blanket. A crib, bassinet or pack and play were the most common sleep surfaces followed by an infant car seat or swing. Authors noted some infants may not intentionally be put to sleep in a car seat and if this group was excluded, the rate of those putting their infant to sleep on a safe surface would be higher.

The study also noted racial differences in safe sleep practices. Children of black mothers were least likely to sleep on their back, while separate approved sleep surfaces were least common among Asian/Pacific Islanders. Room-sharing without bed-sharing and avoiding soft bedding were least likely among American Indian/Alaska Native mothers.

Breastfeeding mothers had higher rates of infants sleeping on their back and avoiding soft bedding but lower rates of room-sharing without bed-sharing compared to those who weren’t breastfeeding. In addition, smokers were less likely than nonsmokers to use approved sleep surfaces and avoid soft bedding.

Just under half of mothers said their health care provider recommended room-sharing without bed-sharing, and authors said these recommendations can carry significant weight.

Rachel Y. Moon, M.D., FAAP, who wrote the AAP’s safe sleep policy, co-authored a commentary to the new study stressing the importance of pediatricians providing guidance.

“Even if this anticipatory guidance was given but not remembered by the mothers, these numbers should certainly alert our profession to the need to repeatedly discuss safe sleep,” authors wrote in the commentary. “As there are multiple opportunities to discuss safe sleep in the newborn nursery and at the frequent well-child visits and weight checks in early infancy, this is one area where we can make a difference in infant mortality.”

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