Trends in infant bedding use: National Infant Sleep Position study, 1993-2010

Abstract

Background: Use of potentially hazardous bedding, as defined by the American Academy of Pediatrics (eg, pillows, quilts, comforters, loose bedding), is a modifiable risk factor for sudden infant death syndrome and unintentional sleep-related suffocation. The proportion of US infants sleeping with these types of bedding is unknown.

Methods: To investigate the US prevalence of and trends in bedding use, we analyzed 1993-2010 data from the National Infant Sleep Position study. Infants reported as being usually placed to sleep with blankets, quilts, pillows, and other similar materials under or covering them in the last 2 weeks were classified as bedding users. Logistic regression was used to describe characteristics associated with bedding use.

Results: From 1993 to 2010, bedding use declined but remained a widespread practice (moving average of 85.9% in 1993-1995 to 54.7% in 2008-2010). Prevalence was highest for infants of teen-aged mothers (83.5%) and lowest for infants born at term (55.6%). Bedding use was also frequently reported among infants sleeping in adult beds, on their sides, and on a shared surface. The rate of decline in bedding use was markedly less from 2001-2010 compared with 1993-2000. For 2007 to 2010, the strongest predictors (adjusted odds ratio: ≥1.5) of bedding use were young maternal age, non-white race and ethnicity, and not being college educated.

Conclusions: Bedding use for infant sleep remains common despite recommendations against this practice. Understanding trends in bedding use is important for tailoring safe sleep interventions.

Keywords: accidental suffocation; infant mortality; safe sleep; sudden infant death syndrome; sudden unexpected infant death; surveillance.

FIGURE 1

Prevalence of the use of bedding according to race and ethnicity: 3-year moving averages, NISP, 1993 to 2010. Bedding refers to certain types of bedding reported under the infant (blanket, bean bag, waterbed, rug, sheepskin, cushion, sleeping bag, or pillow) or covering the infant (blanket, quilt/comforter, sheepskin, pillow, or other) while sleeping in last 2 weeks. Covers exclude sheets and blankets not thicker than a receiving blanket.