Reports describing factors associated with sleep-related infant death rely on caregiver report or postmortem findings. We sought to determine the frequency of environmental risk factors by using nocturnal sleep videos of infants.
Healthy, term newborns were recruited for a parent study examining the role of parenting in the development of nighttime infant sleep patterns. For 1 night at ages 1, 3, and 6 months, video recordings were conducted within family homes. Videos were coded for sudden infant death syndrome risk factors in post hoc secondary analyses after the parent study was completed.
Among 160 one-month-olds, initially 21% were placed to sleep on nonrecommended sleep surfaces and 14% were placed nonsupine; 91% had loose/nonapproved items on their sleep surface, including bedding, bumper pads, pillows, stuffed animals, and sleep positioners. Among 151 three-month-olds, 10% were initially placed on a nonrecommended sleep surface, 18% were placed nonsupine, and 87% had potentially hazardous items on their sleep surface. By 6 months, 12% of the 147 infants initially slept on a nonrecommended surface, 33% were placed to bed nonsupine, and 93% had loose/nonrecommended items on their surface. At 1, 3, and 6 months, 28%, 18%, and 12% changed sleep locations overnight, respectively, with an increased likelihood of bed-sharing and nonsupine position at the second location at each time point.
Most parents, even when aware of being recorded, placed their infants in sleep environments with established risk factors. If infants were moved overnight, the second sleep environment generally had more hazards.
Comments
Is it time to redefine what constitutes a risky sleep environment?
I thank the authors for a thoughtful study and a valuable contribution to our knowledge on the issue of parent/infant sleep patterns. The question I would put forth is: if a study of predominately white parents of higher socioeconomic status shows that they too place their infants in risky sleep environments, why is it that these infants do not die of SIDS and suffocation at the same rates? Could this indicate that other modifiable risk factors have much more potential to impact infant death rates during sleep?
Furthermore, if evidence shows that over 20 years of public health campaigns regarding safe sleep have not impacted patient behavior or infant death rates, perhaps our assumptions as health care providers, not patient lack of compliance, is at fault.
Given what we know about the relationship between bedsharing and successful exclusive breastfeeding duration (http://onlinelibrary.wiley.com/doi/10.1111/apa.13354/full), I would like to propose that we begin to study this phenomenon separately rather than lumping it with "unsafe sleep." Doing so may allow us to make more practical, yet still safe, recommendations to parents who wish to breastfeed and co-sleep. It may also result in more successful breastfeeding efforts of frustrated, sleep-deprived parents.
With respect and gratitude.
Ann Ledbetter CNM