More than half of American parents continue to use soft bedding for their sleeping babies, even though research has linked such bedding to an increased risk of sudden infant death syndrome (SIDS), according to a study published Monday in the journal Pediatrics.
In the United States, SIDS is the leading cause of death for babies aged 1 month to 1 year, claiming about 2,500 lives each year.
Back in the 1990s, the American Academy of Pediatrics, the Consumer Product Safety Commission and other groups recommended that all babies be put to sleep on their backs on a firm, tight-fitting mattress (not their parents’ bed), without any pillows, comforters, quilts, crib bumpers or other loose bedding and soft objects (such as stuffed animals and dolls). Soft bedding and other items can obstruct a baby’s airway, raising the risk of suffocation.
If babies are put in appropriate clothing — tight-fitting sleepers — they will not be cold, the health officials pointed out.
After those recommendations were made, the incidence of SIDS began a precipitous decline, falling from 130.3 deaths per 100,000 live births in 1990 to 55.7 deaths per 100,000 live births in 2001, according to the Centers for Disease Control and Prevention.
But then the decline began to level off. In 2010, the SIDS rate was only slightly lower than in 2001: 52.7 per 100,000 live births.
The authors of this new study decided to look at current trends in bedding use by parents to see if that might explain, at least in part, why the U.S. SIDS rate has plateaued in recent years. (Other factors put babies at risk for SIDS, including being born prematurely or being exposed to secondhand cigarette smoke.)
Key demographics and findings
For the study, researchers analyzed data collected from almost 19,000 parents with children under the age of 8 months who participated in the National Infant Sleep Position survey between 1993 and 2010. Most were mothers (80 percent), white (83 percent) and had attended (if not graduated from) college (71 percent). Almost half were aged 30 or older, and almost a third lived in the Midwest.
The study found that despite a substantial decline since 1993 in the use of soft bedding for babies, the practice is still common. About 50 percent of the survey’s respondents in 2010 said they placed their babies to sleep with some type of soft bedding. For example, 37 percent of the parents reported covering their babies with thick blankets, and 20 percent said they did so with quilts or comforters. In addition, 30 percent of the parents said they had placed blankets under their babies while they slept — a behavior that appears to reflect the parents’ incorrect perception that the experts’ warnings about soft bedding pertain only to items that cover the baby.
The mothers most likely to put their babies to sleep with soft bedding were teenagers (77 percent) and those with less than a high school education (72 percent). Still, half of college-educated mothers also used soft bedding, the study found.
Black and Hispanic mothers were more likely than white mothers to use soft bedding. The authors of the study note, however, that making any kind of demographic generalizations from these findings may be limited because the parents who participated in the survey were overwhelmingly white, higher educated and older.
Other research has found that one of the most frequently reported reasons for using soft bedding — regardless of socioeconomic status or educational background — is the parent’s mistaken belief that the soft items make the baby more comfortable.
Parents also use pillows, blankets and other soft objects to keep babies from rolling off sofas, but, as the American Academy of Pediatrics and other experts warn, sofas are not safe surfaces for babies to sleep on.
Media messages may also contribute to the continued use of soft bedding. A 2009 study found that two-thirds of images in popular magazines aimed at pregnant women and new mothers showed infants sleeping with potentially hazardous bedding.
“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,” write the authors of the current study.