Current recommendations advise placing infants on a flat surface with no bumpers, pillows, blankets or toys. But a new study suggests 50% of infants are sleeping with hazardous bedding.
The study, from researchers at the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), is published in Pediatrics, the journal of the American Academy of Pediatrics (AAP).
In 1992, the AAP issued a recommendation that infants sleep on their backs, and 2 years later, the National Institute of Child Health and Human Development (NICHD) launched a campaign called Safe to Sleep, also advocating for placing babies on their backs to sleep.
Since 1992, the rate of sudden infant death syndrome (SIDS) has fallen by 50%, but the researchers note that since 2000, this rate has declined slowly, marked by a reported increase in other unexpected infant deaths related to accidental suffocation and entrapment in bedding material.
Such accidental suffocation deaths increased in the US from 7 in every 100,000 live births in 2000 to 15.9 in 2010.
Because soft objects and loose bedding can obstruct an infant's airway, posing a suffocation risk and increasing risk for SIDS, the NIH and AAP recommend placing infants to sleep on their backs on a firm sleep surface, covered by a fitted sheet.
Though they may be cute and cuddly, soft objects such as toys - or crib bumpers, quilts and comforters - should not be introduced into the baby's sleep area.
"Parents have good intentions," says study author Carrie K. Shapiro-Mendoza, from the CDC's Division of Reproductive Health, "but may not understand that blankets quilts and pillows increase a baby's risk of SIDS and accidental suffocation."
Bedding placed under the infant is a risk, too
Despite these recommendations, however, the researchers wanted to find out how many caregivers in the US are actually following the advice.
As such, they analyzed data from the National Infant Sleep Position Survey (NISP), which included responses from nearly 20,000 caregivers on the influence of infant sleep position and other infant care practices. The survey collected information from a random telephone sample of over 1,000 caregivers in US households between 1992-2010.
Caregivers were asked whether infants were placed to sleep on blankets, bean bag chairs, sheepskin, cushions or pillows. They were also asked whether the infant was ever covered with bedding materials.
Results showed that by 2007-2010, although most caregivers placed the infant in a crib on his or her back, the use of bedding was at 50% or higher.
Additionally - though from 1993-1995 and 2008-2010, covering with thick blankets dropped from 56% to 27.4% - the researchers found that 25.5-31.9% of respondents still placed blankets under the infants, and 3.1-4.6% placed cushions under the infants.
Commenting on their findings, study author Marian Williger, from the NIH, says:
"Parents receive a lot of mixed messages. Relatives may give them quilts or fluffy blankets as presents for the new baby, and they feel obligated to use them. Or they see magazine photos of babies with potentially unsafe bedding items. But babies should be placed for sleep on a firm, safety-approved mattress and fitted sheet, without any other bedding."
The researchers say their finding that there was a decline in bedding use over - but not under - the infants "raises a concern that parents may incorrectly perceive the recommendations as only pertaining to items covering or around the infant, and not include items under the infant."
Images reinforce use of hazardous bedding
Interestingly, a previous study of images from popular magazines aimed at women of a childbearing age revealed that more than two thirds of images showed infants sleeping with bedding that could be hazardous.
"Seeing images such as these may reinforce beliefs and perceptions that having these items in the infant sleep area is not only a favorable practice, but also the norm," say the researchers.
And another finding from this latest study revealed that the use of unsafe bedding materials was highest for infants of teen mothers (83.5%) and lowest for infants born at term (55.6%).
The Safe to Sleep campaign advises not using blankets or other coverings but recommends using sleep clothing such as a one-piece sleeper and keeping the room at a comfortable temperature.
Medical News Today recently reported on a study published in JAMA Pediatrics that suggested sofa sleeping is "particularly dangerous" for sleep-related infant deaths.