Even parents who've been educated about baby sleeping safety and who know they're being video-recorded sometimes put babies to sleep in either unsafe ways or risky environments, according to a new study in the journal Pediatrics.
Researchers from Penn State University used video recordings to see how parents put their babies to bed, filming the infants for one night each at 1, 3 and 6 months old. Many of the risks they found are directly linked to sudden infant death syndrome.
"Pediatricians talk about safe sleep positions during the newborn hospital stay. They are supposed to talk about it at every checkup through six months," said Dr. Ian M. Paul, chief of the Division of Academic General Pediatrics and vice chairman of Clinical Affairs at Penn State College of Medicine, who was one of the study's authors. But when the researchers examined the videos, "almost all had risk factors for SID," he said.
The videos show bed sharing and infants placed on their stomachs or sides to fall asleep despite a concerted nationwide campaign by pediatricians to educate parents that babies should always sleep on their backs.
The most common risk that the videos showed was babies put in cribs with loose bedding, bumper pads, positioners and other items that increase danger, Paul said.
The study also noted that babies often sleep in "multiple places over the course of the night. And when it happens, the second position is riskier than the first," Paul said. "Many parents are putting the baby in bed with them and not putting them back onto the original surface. That's a big one."
Troubling numbers
The Centers for Disease Control and Prevention finds that in America each year, about 3,500 sudden unexpected infant deaths (SUID) occur. The most common are SIDS, those of unknown cause and accidental suffocation and strangulation in bed. The numbers have been declining, however, since 1992, when the American Academy of Pediatrics began issuing safe sleep recommendations.
When the study started, the researchers had 160 1-month-old babies whose parents agreed to be filmed. They found that 21 percent were placed to sleep on surfaces that were not recommended and 14 were positioned poorly. More than 90 percent had loose or unapproved items in the sleep area, from stuffed animals to bumper pads, pillows or loose bedding.
Besides that, when babies were 1 month old, nearly 3 in 10 "changed sleep locations overnight with an increased likelihood of bed-sharings" and not being placed to sleep on their backs, the researchers wrote. "If infants were moved overnight, the second sleep environment generally had more hazards."
At age 3 months, 151 were still participating and 10 percent of the parents placed babies on surfaces that were not recommended, 18 percent in the wrong position and 87 percent with loose bedding and other items.
By 6 months old, 12 percent of the remaining 147 infants slept on surfaces deemed unsafe, 33 percent were positioned incorrectly and 93 percent had loose bedding and other items where they should not be.
Paul believes both parents and pediatricians should take note that recommendations are being ignored. It is, perhaps, lack of knowledge for some parents or denial that SIDS could happen in their family, he said.
"Perhaps they're being bombarded with too many 'do this, don't do this' messages," Paul said. "Perhaps we're not doing a good enough job of getting parents to soothe and put baby to sleep in safe ways." The "don't, don't, don't" advice for parents who have a fussy baby is not being given along with adequate ways to soothe the infant, he noted.
"When you're exhausted, you may do what works to get a baby to sleep," he said.
Asked if some baby-sleep-related behaviors are more risky than others, Paul replied, "There probably is a hierarchy of risk. Certainly, sleeping on a sofa or on their bellies is a bigger deal than having a bottle in a sleep environment. But I can't rank it. We want babies to sleep on their backs every time. We want them to not have loose bedding. We know we don't want them to bed share. Those are big things."
Not all agree
While experts agree on many of the risks, like the dangers of loose bedding that can suffocate the child or placing the baby on her stomach rather than her back, bed-sharing is more contested, more common than admitted and more nuanced in its effect, according to anthropologist James McKenna. Notre Dame calls him "the world’s leading authority on mother-infant co-sleeping in relationship to breastfeeding and SIDS." He directs the Mother-Baby Behavioral Sleep Laboratory at Notre Dame. He was not involved in the Penn State study.
"Two recent studies reveal either that many mothers do not accept that bed-sharing is by default 'an unsafe sleep environment' and bed-share — many, many more than is ever reported," he wrote in an email to the Deseret News.
Nightly in America, potentially 2 million new moms put their babies in bed with them, usually when the baby wakes up fussy and is breastfed. But they tend to lie about it to their pediatricians, he added, for fear of disapproval. A British study found that "47 percent of mothers lie to their pediatricians as to where their baby is really sleeping, which is with them." Similarly, he added, a study in the Journal of Pediatrics found universal lying by moms who sleep with their infants in their bed.
McKenna and his colleagues refer to a type of bed-sharing they believe is safe and helpful, calling it "breastsleeping." The "physiology of sleep" is very different when a baby is breastfeeding than when he or she is simply lying in the bed taking a bottle and it's "much, much safer. In the absence of all known hazardous factors such as maternal smoking during pregnancy, drug or alcohol abuse, prone sleep, other children in bed or babies being positioned on top of or close to pillows, breastsleeping is in fact safe," he said. He also said "sustained contact between mother and infant is necessary for optimal milk production and management of sleep."
Even when breastsleeping, though, Notre Dame's guidelines say "infants should always sleep on their backs, on firm surfaces, on clean surfaces, in the absence of (secondhand) smoke, under light (comfortable) blanketing and their heads should never be covered."
