Abstract
This cross-sectional study investigates temporal changes in the prevalence of nonsupine sleep position among US infants from 4 to 12 months of age.
Introduction
Approximately 3500 sleep-related deaths among infants are reported annually in the US, including those from sudden infant death syndrome (SIDS), undetermined causes, and accidental suffocation and strangulation in bed.1 Ninety percent of SIDS cases occur before infants reach 6 months of age, with highest incidence between 1 and 4 months, and less common after 8 months of age.1 Safe sleep recommendations to place infants in a supine position were associated with a sharp decline in SIDS and other sleep-related mortality in the late 1990s,2,3 followed by a less pronounced downward trend thereafter.2,4 One-fifth of US mothers are placing their infants in a nonsupine sleep position within 6 months after birth.5 This report analyzed temporal changes in the prevalence of nonsupine sleep position among US infants at 4, 6, 9, and 12 months of age.
Methods
This study used the National Survey of Children’s Health (NSCH) data from 2016 to 2022 (released on April 24, 2024) on sleep position among US infants aged 0 to 12 months. The NSCH is a nationally representative survey for monitoring the health and well-being of noninstitutionalized children aged 0 to 17 years.6 The NSCH survey has been conducted annually since 2016, compared with previous 4-year intervals. Changes in survey design have enabled the annual release of national data and comprehensive state-level estimates every 2 to 3 years. Annual data were collected from parents or other primary caregivers through mail- or web-based questionnaires. Because we used publicly available, anonymized data, the institutional review board deemed this study exempt from review. This study followed the STROBE reporting guideline. Nonsupine sleep position was assessed by asking respondents, “In which position do you most often lay this baby down to sleep now?”, with possible answers of “on side,” “on back,” or “on stomach.” Respondents who selected on side or on stomach were classified as placing their infant in a nonsupine sleep position. Trend significance in the prevalence of nonsupine sleep positions among US infants at 4, 6, 9, and 12 months of age, overall and by sociodemographic subgroups, was assessed using a survey-weighted logistic regression model, with the survey year as a continuous variable. The confounders chosen were (1) self-reported race and ethnicity, (2) family income, (3) education level, (4) maternal age at delivery, (5) household smoking, and (6) infant gestation.5 All analyses were performed using R version 4.3.2 (R Project for Statistical Computing) from May to June 2024. Two-tailed P < .05 indicated significance.
Results
Among 9779 participants, 383 individuals with missing sleep position data were excluded, leaving 9396 infants (1321 [23.5%] Hispanic, 487 [11.6%] non-Hispanic Black, 6307 [52.4%] non-Hispanic White, and 1281 [12.4%] other race and ethnicity [American Indian or Alaska Native, Asian, Native Hawaiian and Other Pacific Islander, some other race, and 2 or more races]) in the study. There were 2978, 4512, and 6953 infants in the study of sleep positions at 4, 6, and 9 months, respectively.
The overall prevalence of nonsupine sleep position was 12.0%, 12.9%, 19.2%, and 23.0% at 4, 6, 9, and 12 months, respectively, and varied sociodemographically, with a substantially higher prevalence among Black infants and infants from low-income, low-education, and smoking households (Tables 1 and 2). There were no significant temporal changes in the prevalence of nonsupine sleep position at 4, 6, 9, and 12 months, from 2016 to 2022. However, downward trends in nonsupine sleep position at 9 and 12 months were found among other racial and ethnic groups and higher education households. In contrast, an upward trend in nonsupine sleep position occurred at 4 months among Hispanic infants.
Table 1. Trends in Prevalence of Nonsupine Sleep Position Among US Infants at Ages 4 and 6 Months From the National Survey of Children’s Health, 2016 to 2022a.
| Nonsupine sleep positioningb | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | Overall | Absolute (relative) difference, 2022 vs 2016c | P value for trend | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | |||
| Age 4 mo | ||||||||||||||||||
| Totald | 523 | 10.1 (4.9-15.2) | 247 | 11.2 (4.5-17.9) | 307 | 17.3 (8.6-26.0) | 270 | 15.4 (6.1-24.6) | 429 | 7.1 (2.9-11.4) | 632 | 9.6 (5.6-13.6) | 570 | 13.1 (8.0-18.3) | 2978 | 12.0 (9.5-14.5) | 3.1 (30.4) | .83 |
| Race and ethnicitye,f | ||||||||||||||||||
| Hispanic | 63 | 5.3 (0.1-10.4) | 20 | 7.6g (0.1-24.9)h | 46 | 6.0 (0.5-14.8)h | 41 | 4.0g (0.1-12.9)h | 67 | 3.8g (0.4-10.4)h | 94 | 12.2 (3.5-20.9) | 97 | 23.2 (9.2-37.1) | 428 | 9.2 (5.5-12.9) | 17.9 (339.4) | .048 |
| Non-Hispanic Black | 24 | 20.4 (4.7-37.4)h | 10 | 36.2g (6.7-65.2)h | 20 | 46.9 (19.0-74.8) | 15 | 27.6 (7.8-55.1)h | 33 | 18.3 (0.7-35.8) | 31 | 14.9 (3.6-29.8)h | 22 | 21.6 (5.2-40.3)h | 155 | 27.3 (16.4-38.3) | 1.2 (5.9) | .46 |
| Non-Hispanic White | 375 | 10.5 (2.7-18.3) | 180 | 11.5 (3.5-19.4) | 203 | 15.6 (3.2-28.1) | 172 | 11.1 (6.8-16.7) h | 279 | 6.7 (0.8-12.7) | 405 | 7.0 (1.7-12.3) | 367 | 7.1 (2.8-11.5) | 1981 | 10.0 (6.6-13.4) | −3.3 (−31.9) | .06 |
| Other | 61 | 11.6 (4.7-22.2)h | 37 | 1.6g (0.0-9.5)h | 38 | 10.7 (2.9-24.8)h | 42 | 28.7 (3.0-54.4) | 50 | 5.2g (0.5-13.7) h | 102 | 10.3 (1.3-19.4) | 84 | 7.9 (0.2-15.5) | 414 | 11.8 (5.2-18.4) | −3.7 (−32.1) | .97 |
| Family income, % federal poverty leveli,j | ||||||||||||||||||
| <100 | 65 | 13.9 (10.5-17.6)h | 30 | 27.0 (1.1-52.8) | 36 | 25.8 (6.7-44.9) | 37 | 31.8 (4.6-59.1) | 58 | 9.5 (6.4-12.9)h | 83 | 14.7 (5.1-24.3) | 80 | 24.5 (12.0-37.0) | 389 | 21.1 (13.6-28.6) | 10.6 (75.9) | .76 |
| 100-199 | 87 | 6.9 (1.4-12.3) | 28 | 2.9g (0.7-6.0)h | 61 | 17.3 (4.9-29.6) | 43 | 18.5 (0.7-36.2) | 66 | 10.3g (7.3-13.5)h | 104 | 11.4 (1.7-21.1) | 75 | 12.5 (1.8-23.2) | 464 | 11.6 (7.0-16.2) | 5.6 (81.7) | .19 |
| 200-399 | 164 | 11.5 (4.5-18.6) | 81 | 19.4 (4.7-34.1) | 101 | 21.1 (17.8-24.5)h | 97 | 4.7 (0.2-9.1) | 148 | 9.4 (2.7-16.1) | 190 | 11.7 (1.6-21.7) | 162 | 16.0 (3.6-28.3) | 943 | 13.0 (8.2-17.9) | 4.4 (38.6) | .51 |
| ≥400 | 207 | 7.4 (6.0-9.0)h | 108 | 3.8 (0.5-7.2) | 109 | 6.9 (5.1-9.1)h | 93 | 12.0 (9.4-15.0)h | 157 | 1.9 g (1.1-2.9)h | 255 | 4.3 (0.4-8.1) | 253 | 6.7 (1.7-11.6) | 1182 | 5.9 (3.2-8.6) | −0.8 (−10.5) | .82 |
| Highest education of adult in householdk,l | ||||||||||||||||||
| Less than college degreem | 150 | 13.7 (3.2-24.2) | 76 | 18.3 (3.4-33.2) | 108 | 18.4 (7.1-29.7) | 101 | 19.3 (3.8-34.9) | 159 | 10.5 (2.3-18.7) | 194 | 16.3 (7.8-24.8) | 165 | 17.8 (9.3-26.3) | 953 | 16.4 (12.0-20.9) | 4.1 (30.2) | .88 |
| College graduate or higher | 360 | 7.7 (2.8-12.5) | 171 | 6.4 (1.2-11.7) | 199 | 16.0 (2.5-29.5) | 169 | 11.4 (1.8-20.9) | 270 | 4.4 (0.7-8.2) | 438 | 4.1 (1.3-6.9) | 405 | 10.3 (3.7-16.8) | 2012 | 8.4 (5.6-11.2) | 2.6 (34.1) | .71 |
| Maternal age at deliveryk,n | ||||||||||||||||||
| ≤30 y | 262 | 10.7 (4.1-17.2) | 121 | 16.7 (3.1-30.4) | 154 | 16.1 (6.5-25.7) | 128 | 22.0 (7.1-36.9) | 193 | 5.7 (2.5-9.3)h | 261 | 11.7 (4.3-19.1) | 203 | 13.9 (5.7-22.0) | 1322 | 14.1 (10.1-18.2) | 3.2 (30.1) | .98 |
| >30 y | 236 | 9.8 (1.0-18.7) | 125 | 6.7 (2.2-11.3) | 150 | 18.3 (2.2-34.4) | 139 | 7.4 (3.5-12.8)h | 232 | 6.9 (2.2-11.5) | 363 | 7.1 (2.8-11.4) | 362 | 12.1 (5.4-18.7) | 1607 | 9.5 (6.4-12.5) | 2.2 (22.8) | .77 |
| Smoker in householdk,o,p | ||||||||||||||||||
| Yes | 57 | 11.2 (4.0-21.5)h | 24 | 32.7 (12.6-51.1)h | 28 | 7.1 (0.1-18.3)h | 22 | 42.2g (20.7-63.6)h | 50 | 13.1g (4.5-24.3)h | 51 | 23.1 (11.3-35.3)h | 32 | 1.8g (0.0-10.9)h | 264 | 17.9 (6.5-29.3) | −9.5 (−84.3) | .69 |
| No | 460 | 10.2 (4.5-15.8) | 222 | 8.9 (3.0-14.8) | 272 | 16.2 (6.9-25.4) | 245 | 13.0 (5.0-21.0) | 370 | 6.4 (2.7-10.1) | 566 | 7.6 (4.2-11.0) | 524 | 13.2 (7.7-18.6) | 2659 | 10.7 (8.4-13.1) | 3.0 (29.6) | .81 |
| Infant gestation, wkk,q | ||||||||||||||||||
| Preterm (<37) | 50 | 19.4 (8.6-31.4)h | 19 | 25.6g (6.1-45.6)h | 28 | 28.0 (10.7-44.9)h | 26 | 2.8g (0.0-13.2)h | 50 | 4.7g (0.5-13.7)h | 59 | 10.3 (3.8-20.8)h | 55 | 14.1 (1.5-26.8) | 287 | 13.4 (5.6-21.1) | −5.3 (−27.4) | .22 |
| Full term (≥37) | 468 | 8.6 (4.5-12.8) | 227 | 10.1 (3.8-16.3) | 273 | 14.6 (5.6-23.6) | 242 | 17.5 (7.0-28.0) | 379 | 7.5 (2.7-12.4) | 570 | 9.6 (5.3-13.9) | 512 | 12.8 (7.2-18.3) | 2671 | 11.6 (8.9-14.2) | 4.1 (47.6) | .80 |
| Age 6 mo | ||||||||||||||||||
| Totald | 813 | 15.0 (9.9-20.1) | 360 | 10.5 (5.6-15.3) | 469 | 15.8 (9.4-22.1) | 411 | 15.3 (8.2-22.4) | 638 | 8.9 (5.3-12.4) | 930 | 11.1 (7.5-14.6) | 891 | 14.0 (10.0-17.9) | 4512 | 12.9 (11.0-14.9) | −1.1 (−7.1) | .62 |
| Race and ethnicitye,f | ||||||||||||||||||
| Hispanic | 95 | 11.6 (4.2-19.0) | 37 | 6.2 (0.7-18.2)h | 62 | 5.0 (1.0-13.5)h | 58 | 11.7 (0.8-22.6) | 105 | 4.0 (1.0-9.5)h | 132 | 15.0 (6.0-24.0) | 149 | 23.3 (12.0-34.6) | 638 | 11.0 (7.7-14.4) | 11.7 (100.5) | .07 |
| Non-Hispanic Black | 34 | 20.1 (2.8-37.5) | 18 | 32.9 (1.8-64.1) | 33 | 49.8 (26.4-73.2) | 21 | 28.3 (1.6-55.1) | 42 | 19.7 (3.3-36.1) | 50 | 13.8 (2.2-25.5) | 33 | 20.2 (3.1-37.3) | 231 | 27.2 (18.3-36.1) | 0.1 (0.3) | .20 |
| Non-Hispanic White | 592 | 13.7 (6.8-20.6) | 262 | 11.0 (5.1-16.8) | 316 | 13.5 (5.0-21.9) | 275 | 9.5 (0.9-18.0) | 416 | 8.5 (3.7-13.4) | 602 | 8.9 (4.5-13.2) | 575 | 9.4 (5.7-13.2) | 3038 | 10.7 (8.2-13.2) | −4.2 (−30.9) | .17 |
| Other | 92 | 24.7 (6.1-43.3) | 43 | 1.3g (0.0-8.2)h | 58 | 10.7 (1.3-20.1) | 57 | 30.7 (8.3-53.2) | 75 | 13.3 (0.6-26.1) | 146 | 9.8 (3.2-16.4) | 134 | 9.8 (2.9-16.7) | 605 | 14.6 (9.0-20.2) | −14.9 (−60.2) | .58 |
| Family income, % federal poverty leveli,j | ||||||||||||||||||
| <100 | 100 | 20.1 (6.1-34.2) | 40 | 15.7 (10.9-20.5)h | 57 | 26.9 (9.5-44.3) | 51 | 31.1 (7.8-54.4) | 79 | 14.9 (4.2-25.7) | 126 | 20.9 (10.3-31.5) | 119 | 23.3 (13.2-33.4) | 572 | 22.1 (15.9-28.3) | 3.2 (15.7) | .99 |
| 100-199 | 142 | 17.2 (7.2-27.1) | 52 | 7.0 (0.8-13.3) | 84 | 15.9 (5.5-26.4) | 73 | 22.5 (8.6-36.3) | 100 | 11.3 (0.2-22.4) | 148 | 10.8 (3.2-18.4) | 115 | 15.7 (6.8-24.7) | 714 | 14.2 (10.4-18.1) | −1.4 (−8.2) | .82 |
| 200-399 | 252 | 12.2 (6.4-18.1) | 113 | 16.3 (5.0-27.6) | 154 | 13.8 (0.1-27.5) | 138 | 6.9 (2.3-11.4) | 219 | 11.8 (5.7-17.9) | 281 | 10.2 (3.4-17.0) | 267 | 16.2 (7.2-25.1) | 1424 | 12.4 (8.9-15.8) | 3.9 (32.1) | .73 |
| ≥400 | 319 | 10.9 (4.6-17.3) | 155 | 6.1 (2.4-9.8) | 174 | 11.0 (4.3-17.8) | 149 | 9.0 (7.1-11.0)h | 240 | 2.5 (0.3-4.7) | 375 | 6.6 (2.5-10.7) | 390 | 7.9 (3.9-11.9) | 1802 | 7.5 (5.4-9.7) | −3.0 (−27.5) | .28 |
| Highest education of adult in householdk,l | ||||||||||||||||||
| Less than college degreem | 245 | 20.7 (10.6-30.7) | 113 | 13.5 (3.9-23.2) | 161 | 16.9 (7.9-26.0) | 153 | 22.6 (9.8-35.5) | 227 | 12.9 (6.0-19.9) | 285 | 17.5 (10.1-25.0) | 252 | 21.0 (13.5-28.4) | 1436 | 17.8 (14.2-21.5) | 0.3 (1.6) | .93 |
| College graduate or higher | 548 | 11.5 (6.5-16.5) | 247 | 8.1 (3.6-12.7) | 308 | 14.7 (5.6-23.8) | 258 | 9.2 (2.4-15.9) | 411 | 5.8 (2.6-9.0) | 645 | 6.3 (3.5-9.2) | 639 | 10.2 (5.6-14.9) | 3056 | 9.3 (7.3-11.4) | −1.3 (−11.1) | .28 |
| Maternal age at deliveryk,n | ||||||||||||||||||
| ≤30 y | 391 | 13.1 (7.5-18.7) | 176 | 15.2 (5.3-25.1) | 231 | 15.5 (7.9-23.1) | 195 | 22.5 (10.6-34.4) | 289 | 9.5 (3.6-15.4) | 394 | 13.5 (7.1-19.8) | 338 | 15.5 (9.2-21.8) | 2014 | 15.1 (12.0-18.2) | 2.4 (18.3) | .65 |
| >30 y | 385 | 18.3 (9.4-27.3) | 182 | 6.8 (3.0-10.6) | 235 | 15.6 (4.8-26.4) | 211 | 7.9 (1.2-14.5) | 345 | 7.4 (3.6-11.2) | 524 | 8.6 (4.7-12.5) | 543 | 11.9 (6.8-16.9) | 2425 | 10.7 (8.2-13.2) | −6.5 (−35.3) | .25 |
| Smoker in householdk,o,p | ||||||||||||||||||
| Yes | 95 | 24.9 (5.8-43.9) | 36 | 31.5 (8.4-54.5) | 43 | 12.3 (3.9-25.1)h | 34 | 35.5 (19.7-53.5)h | 71 | 14.6 (7.0-24.4)h | 70 | 25.0 (3.9-46.1) | 53 | 13.5 (5.5-25.3)h | 402 | 22.2 (13.2-31.1) | −11.4 (−45.9) | .54 |
| No | 707 | 13.6 (8.7-18.4) | 323 | 7.9 (3.7-12.1) | 416 | 14.3 (7.7-20.9) | 373 | 13.6 (7.3-19.9) | 556 | 8.2 (4.8-11.5) | 836 | 9.4 (6.1-12.6) | 817 | 13.7 (9.5-17.8) | 4028 | 11.5 (9.7-13.3) | 0.1 (0.8) | .82 |
| Infant gestation, wkk,q | ||||||||||||||||||
| Preterm (<37) | 75 | 16.6 (8.6-26.3)h | 29 | 21.7 g (8.0-39.7)h | 39 | 22.4 (9.3-36.5)h | 37 | 3.8 g (0.1-14.2)h | 69 | 7.4 (2.4-16.1)h | 89 | 9.8 (1.8-17.8) | 93 | 12.0 (2.6-21.4) | 431 | 12.1 (6.2-18.1) | −4.6 (−27.6) | .40 |
| Full term (≥37) | 730 | 15.0 (9.9-20.1) | 328 | 9.7 (5.0-14.4) | 424 | 14.1 (7.6-20.6) | 372 | 17.0 (9.1-24.9) | 566 | 9.1 (5.2-13.0) | 836 | 11.2 (7.4-15.1) | 793 | 14.1 (9.8-18.4) | 4049 | 12.9 (10.8-14.9) | −0.8 (−5.6) | .84 |
All estimates, except sample sizes, are weighted.
Nonsupine sleep positioning was defined as sleep position where the baby predominantly lies on his or her side or stomach.
Absolute differences in estimated prevalence between 2016 and 2022 were calculated by treating each survey cycle as an indicator category, with the 2016 cycle as the reference. Values may not equal the difference between the beginning and ending estimates because of rounding. Relative difference, presented as a percentage, is the absolute difference divided by the prevalence in the referent category (2016) multiplied by 100.
P value for trend was adjusted for race and ethnicity, family income, highest education of adult in household, maternal age at delivery, smoker in household, and infant gestation.
Race and ethnicity (child’s Hispanic origin had 0.3% and race had 1.6% missing cases) was imputed by the Census Bureau using hot-deck imputation; other includes Asian, American Indian or Alaska Native, Native Hawaiian and Other Pacific Islander, some other race, and 2 or more races.
P value for trend was adjusted for family income, highest education of adult in household, maternal age at delivery, smoker in household, and infant gestation.
Number of individuals with nonsupine sleep positioning was less than 5.
95% CIs were derived according to binomial distribution for standardization; all negative values have been replaced with 0.
Family income (16.6%) was imputed by the Census Bureau using sequential regression imputation methods.
P value for trend was adjusted for race and ethnicity, highest education of adult in household, maternal age at delivery, smoker in household, and infant gestation.
Numbers vary slightly in the subgroups due to missing data.
P value for trend was adjusted for race and ethnicity, family income, maternal age at delivery, smoker in household, and infant gestation.
Includes less than high school, high school, and some college or technical school.
P value for trend was adjusted for race and ethnicity, family income, highest education of adult in household, smoker in household, and infant gestation.
Household smoking exposure was determined based on responses to the query: “Is there any individual residing in your household who consumes cigarettes, cigars, or pipe tobacco?”
P value for trend was adjusted for race and ethnicity, family income, highest education of adult in household, maternal age at delivery, and infant gestation.
P value for trend was adjusted for race and ethnicity, family income, highest education of adult in household, maternal age at delivery, and smoker in household.
Table 2. Trends in Prevalence of Nonsupine Sleep Position Among US Infants at Ages 9 and 12 Months From the National Survey of Children’s Health, 2016 to 2022a.
| Nonsupine sleep positioningb | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | Overall | Absolute (relative) difference, 2022 vs 2016c | P value for trend | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | |||
| Age 9 mo | ||||||||||||||||||
| Totald | 1231 | 20.8 (16.0-25.7) | 570 | 20.2 (13.1-27.4) | 703 | 18.2 (12.8-23.6) | 657 | 22.1 (15.1-29.2) | 1015 | 18.0 (13.8-22.2) | 1419 | 17.3 (12.9-21.8) | 1358 | 17.9 (14.5-21.4) | 6953 | 19.2 (17.2-21.3) | −2.9 (−13.8) | .36 |
| Race and ethnicitye,f | ||||||||||||||||||
| Hispanic | 143 | 23.9 (13.0-34.7) | 61 | 16.6 (8.2-28.1)g | 94 | 8.4 (0.6-16.2) | 94 | 10.6 (3.0-18.1) | 163 | 11.4 (3.4-19.4) | 203 | 23.4 (11.7-35.0) | 240 | 27.0 (18.1-35.9) | 998 | 17.6 (13.1-22.1) | 3.2 (13.3) | .57 |
| Non-Hispanic Black | 53 | 24.9 (5.3-44.4) | 31 | 49.7 (21.4-78.0) | 51 | 51.5 (33.3-69.7) | 41 | 41.1 (20.0-62.3) | 70 | 40.0 (22.2-57.7) | 74 | 25.3 (7.9-42.6) | 54 | 29.5 (13.1-45.9) | 374 | 38.6 (30.4-46.8) | 4.6 (18.7) | .59 |
| Non-Hispanic White | 886 | 14.2 (9.0-19.5) | 401 | 16.2 (10.6-21.7) | 475 | 14.1 (7.6-20.7) | 428 | 18.1 (7.8-28.4) | 639 | 15.5 (10.7-20.2) | 937 | 13.8 (8.6-19.0) | 863 | 11.9 (8.6-15.2) | 4629 | 14.9 (12.5-17.3) | −2.4 (−16.6) | .47 |
| Other | 149 | 38.6 (22.6-54.7) | 77 | 19.9 (2.3-37.5) | 83 | 16.3 (4.3-28.4) | 94 | 31.8 (13.6-49.9) | 143 | 20.1 (8.4-31.8) | 205 | 14.6 (7.2-21.9) | 201 | 15.3 (8.4-22.2) | 952 | 22.4 (16.9-27.8) | −23.3 (−60.4) | .04 |
| Family income, % federal poverty levelh,i | ||||||||||||||||||
| <100 | 152 | 25.9 (14.2-37.5) | 65 | 30.5 (7.7-53.2) | 89 | 26.4 (11.8-41.0) | 93 | 34.8 (17.7-52.0) | 141 | 22.6 (12.9-32.2) | 179 | 25.6 (12.7-38.4) | 184 | 27.6 (18.6-36.7) | 903 | 27.6 (21.8-33.5) | 1.8 (6.8) | .64 |
| 100-199 | 207 | 22.3 (11.7-32.8) | 87 | 17.1 (4.2-29.9) | 136 | 17.9 (9.0-26.8) | 114 | 25.7 (12.9-38.5) | 160 | 21.0 (11.1-30.9) | 231 | 21.0 (10.9-31.1) | 202 | 21.4 (13.3-29.5) | 1137 | 20.8 (16.7-24.9) | −0.9 (−3.9) | .75 |
| 200-399 | 376 | 21.4 (13.2-29.5) | 187 | 19.3 (10.8-27.7) | 220 | 16.5 (5.1-28.0) | 216 | 15.7 (6.8-24.6) | 332 | 17.3 (10.6-24.1) | 430 | 20.3 (10.3-30.2) | 387 | 17.1 (10.1-24.1) | 2148 | 18.1 (14.8-21.4) | −4.3 (−20.0) | .46 |
| ≥400 | 496 | 14.7 (8.9-20.6) | 231 | 16.4 (8.1-24.8) | 258 | 13.1 (6.9-19.3) | 234 | 18.2 (8.7-27.6) | 382 | 14.9 (7.8-22.0) | 579 | 8.6 (5.2-12.0) | 585 | 13.2 (9.1-17.3) | 2765 | 14.1 (11.6-16.6) | −1.5 (−10.3) | .21 |
| Highest education of adult in householdj,k | ||||||||||||||||||
| Less than college degreel | 366 | 24.2 (15.6-32.8) | 182 | 18.4 (7.6-29.3) | 254 | 19.9 (11.7-28.0) | 243 | 26.2 (13.5-38.9) | 367 | 19.9 (13.4-26.4) | 436 | 26.2 (17.1-35.3) | 398 | 25.3 (18.7-31.9) | 2246 | 22.6 (19.0-26.2) | 1.1 (4.6) | .65 |
| College graduate or higher | 840 | 18.8 (12.9-24.6) | 388 | 21.5 (12.1-31.0) | 449 | 16.4 (9.2-23.6) | 414 | 18.7 (11.7-25.8) | 648 | 16.5 (11.1-22.0) | 983 | 10.5 (7.6-13.4) | 960 | 14.1 (10.2-18.0) | 4682 | 16.7 (14.3-19.1) | −4.7 (−25.1) | .03 |
| Maternal age at deliveryj,m | ||||||||||||||||||
| ≤30 y | 589 | 18.3 (12.1-24.5) | 274 | 22.8 (11.0-34.5) | 342 | 15.9 (9.2-22.6) | 307 | 22.4 (13.1-31.7) | 459 | 15.6 (10.1-21.1) | 588 | 17.7 (11.2-24.2) | 526 | 20.6 (15.0-26.3) | 3085 | 19.0 (16.0-21.9) | 2.3 (12.7) | .98 |
| >30 y | 582 | 22.9 (15.2-30.7) | 289 | 18.6 (9.6-27.6) | 354 | 20.3 (11.8-28.9) | 341 | 17.4 (10.3-24.4) | 550 | 19.3 (13.4-25.3) | 816 | 16.7 (10.6-22.9) | 818 | 15.5 (11.3-19.7) | 3750 | 18.6 (15.9-21.3) | −7.4 (−32.4) | .26 |
| Smoker in householdj,n,o | ||||||||||||||||||
| Yes | 141 | 22.9 (8.8-37.1) | 63 | 26.9 (9.8-44.0) | 73 | 21.7 (5.3-38.0) | 60 | 52.5 (22.2-82.8) | 108 | 19.0 (5.5-32.4) | 114 | 29.6 (8.8-50.4) | 83 | 19.7 (7.2-32.3) | 642 | 27.4 (18.9-35.8) | −3.2 (−14.0) | .91 |
| No | 1072 | 20.5 (15.3-25.7) | 503 | 19.6 (11.9-27.3) | 615 | 16.5 (10.8-22.1) | 589 | 18.6 (13.0-24.2) | 890 | 18.0 (13.6-22.5) | 1269 | 15.1 (10.8-19.4) | 1240 | 17.5 (13.9-21.1) | 6178 | 18.0 (15.9-20.0) | −3.0 (−14.8) | .34 |
| Infant gestation, wksj,p | ||||||||||||||||||
| Preterm (<37) | 116 | 20.0 (2.3-37.8) | 50 | 20.7 (1.2-40.1) | 65 | 19.4 (2.4-36.5) | 69 | 10.1 (1.0-19.1) | 112 | 17.7 (6.3-29.1) | 144 | 23.6 (8.0-39.1) | 143 | 11.5 (4.2-18.8) | 699 | 17.5 (12.0-23.0) | −8.5 (−42.5) | .65 |
| Full term (≥37) | 1104 | 21.1 (16.1-26.1) | 516 | 20.4 (12.7-28.1) | 632 | 17.3 (11.7-23.0) | 583 | 23.8 (16.0-31.5) | 899 | 18.1 (13.6-22.5) | 1270 | 16.6 (12.0-21.2) | 1209 | 18.9 (15.1-22.6) | 6213 | 19.4 (17.2-21.6) | −2.2 (−10.4) | .43 |
| Age 12 mo | ||||||||||||||||||
| Totald | 1754 | 24.7 (20.0-29.3) | 759 | 23.9 (17.8-30.0) | 940 | 23.7 (18.9-28.6) | 881 | 21.9 (16.3-27.5) | 1364 | 22.8 (18.7-27.0) | 1839 | 21.2 (17.3-25.1) | 1859 | 22.2 (18.7-25.8) | 9396 | 23.0 (21.2-24.8) | −2.5 (−9.9) | .34 |
| Race and ethnicitye,f | ||||||||||||||||||
| Hispanic | 188 | 26.6 (14.4-38.9) | 96 | 23.3 (7.5-39.1) | 123 | 6.6 (0.8-12.4) | 130 | 13.2 (5.6-20.9) | 206 | 19.1 (10.0-28.2) | 252 | 24.9 (14.7-35.1) | 326 | 32.7 (23.8-41.6) | 1321 | 21.3 (17.1-25.5) | 6.0 (22.6) | .37 |
| Non-Hispanic Black | 78 | 27.9 (11.7-44.1) | 37 | 50.8 (25.9-75.7) | 66 | 59.6 (44.5-74.7) | 54 | 39.0 (20.9-57.2) | 86 | 44.4 (27.8-61.0) | 89 | 31.9 (16.0-47.9) | 77 | 34.1 (16.6-51.5) | 487 | 41.9 (34.8-49.0) | 6.2 (22.0) | .90 |
| Non-Hispanic White | 1268 | 18.4 (13.7-23.1) | 520 | 19.1 (14.0-24.3) | 632 | 20.8 (15.1-26.5) | 581 | 19.5 (11.4-27.5) | 878 | 18.7 (14.5-23.0) | 1241 | 17.7 (13.3-22.2) | 1187 | 15.3 (12.3-18.3) | 6307 | 18.6 (16.6-20.6) | −3.1 (−16.8) | .29 |
| Other | 220 | 43.4 (30.2-56.6) | 106 | 25.2 (9.7-40.7) | 119 | 26.8 (13.4-40.1) | 116 | 29.7 (13.7-45.6) | 194 | 23.6 (13.1-34.0) | 257 | 21.2 (12.5-30.0) | 269 | 19.2 (12.7-25.7) | 1281 | 27.0 (22.1-31.8) | −24.2 (−55.8) | .005 |
| Family income, % federal poverty levelh,i | ||||||||||||||||||
| <100 | 224 | 28.3 (17.1-39.4) | 85 | 33.0 (12.9-53.1) | 123 | 29.4 (16.8-42.0) | 127 | 27.4 (14.4-40.5) | 187 | 33.1 (20.8-45.5) | 232 | 28.3 (17.0-39.6) | 255 | 31.3 (21.1-41.5) | 1,233 | 29.9 (24.8-35.0) | 3.0 (10.6) | .95 |
| 100-199 | 287 | 24.8 (14.9-34.7) | 111 | 19.9 (8.1-31.7) | 182 | 21.0 (13.1-28.9) | 149 | 25.8 (15.3-36.4) | 211 | 22.0 (13.3-30.7) | 290 | 24.5 (15.2-33.9) | 279 | 24.2 (16.8-31.5) | 1509 | 23.1 (19.5-26.7) | −0.6 (−2.6) | .72 |
| 200-399 | 538 | 26.0 (19.0-32.9) | 246 | 21.1 (13.7-28.5) | 279 | 22.9 (12.7-33.1) | 280 | 16.3 (8.8-23.9) | 435 | 24.0 (17.3-30.7) | 558 | 21.6 (13.7-29.5) | 522 | 20.5 (13.8-27.2) | 2858 | 21.7 (18.8-24.7) | −5.5 (−21.2) | .37 |
| ≥400 | 705 | 20.2 (14.5-25.8) | 317 | 23.4 (15.6-31.3) | 356 | 22.2 (15.6-28.8) | 325 | 20.6 (12.7-28.5) | 531 | 17.4 (11.5-23.3) | 759 | 15.4 (11.3-19.6) | 803 | 18.7 (14.6-22.8) | 3796 | 19.6 (17.3-21.9) | −1.5 (−7.3) | .11 |
| Highest education of adult in householdj,k | ||||||||||||||||||
| Less than college degreel | 535 | 28.0 (19.6-36.4) | 236 | 19.4 (10.3-28.6) | 348 | 23.1 (15.9-30.3) | 328 | 23.3 (13.6-33.0) | 481 | 26.5 (19.4-33.6) | 557 | 27.2 (19.3-35.0) | 563 | 30.5 (23.1-37.8) | 3048 | 25.2 (22.0-28.3) | 2.5 (8.8) | .40 |
| College graduate or higher | 1191 | 22.4 (17.3-27.4) | 523 | 27.3 (19.5-35.2) | 592 | 24.4 (18.0-30.9) | 553 | 20.7 (14.7-26.7) | 883 | 20.0 (15.3-24.7) | 1282 | 16.8 (13.4-20.3) | 1296 | 17.5 (14.1-21.0) | 6320 | 21.3 (19.2-23.3) | −4.8 (−21.6) | .007 |
| Maternal age at deliveryj,m | ||||||||||||||||||
| ≤30 y | 832 | 23.7 (16.5-30.9) | 369 | 27.9 (18.2-37.5) | 451 | 20.8 (14.5-27.0) | 416 | 22.3 (15.0-29.7) | 625 | 20.0 (14.8-25.1) | 757 | 20.9 (15.1-26.8) | 726 | 24.0 (18.3-29.7) | 4176 | 22.8 (20.1-25.4) | 0.3 (1.1) | .44 |
| >30 y | 830 | 25.5 (18.9-32.0) | 379 | 21.1 (13.3-28.8) | 480 | 26.2 (18.9-33.6) | 453 | 18.0 (12.2-23.9) | 728 | 24.8 (18.7-30.9) | 1059 | 20.9 (15.6-26.2) | 1114 | 20.7 (16.1-25.2) | 5043 | 22.5 (20.1-24.8) | −4.8 (−18.9) | .59 |
| Smoker in householdj,n,o | ||||||||||||||||||
| Yes | 205 | 27.5 (15.2-39.8) | 87 | 28.0 (13.5-42.4) | 110 | 25.6 (11.2-40.0) | 85 | 42.1 (16.7-67.5) | 148 | 29.9 (16.1-43.8) | 143 | 35.8 (18.7-52.9) | 121 | 18.2 (8.2-28.2) | 899 | 30.2 (23.5-36.9) | −9.3 (−33.7) | .97 |
| No | 1528 | 24.3 (19.2-29.4) | 665 | 23.4 (16.9-30.0) | 810 | 23.0 (17.8-28.2) | 784 | 19.4 (14.7-24.1) | 1191 | 21.7 (17.4-26.0) | 1653 | 18.9 (15.1-22.8) | 1693 | 22.4 (18.6-26.2) | 8324 | 21.9 (20.1-23.8) | −1.9 (−7.8) | .29 |
| Infant gestation, wksj,p | ||||||||||||||||||
| Preterm (<37) | 164 | 20.9 (6.6-35.1) | 76 | 33.6 (15.6-51.6) | 90 | 24.5 (9.7-39.3) | 85 | 11.3 (2.6-19.9) | 146 | 19.5 (9.3-29.6) | 179 | 23.2 (9.9-36.5) | 196 | 14.4 (7.3-21.6) | 936 | 20.9 (16.1-25.8) | −6.4 (−30.8) | .31 |
| Full term (≥37) | 1574 | 25.2 (20.2, 30.2) | 677 | 23.1 (16.6-29.6) | 841 | 23.6 (18.4-28.8) | 790 | 23.2 (17.1-29.3) | 1212 | 22.9 (18.5-27.4) | 1654 | 21.0 (16.9-25.1) | 1653 | 23.2 (19.3-27.1) | 8401 | 23.2 (21.2-25.1) | −1.9 (−7.7) | .50 |
All estimates, except sample sizes, are weighted.
Nonsupine sleep positioning was defined as sleep position where the baby predominantly lies on his or her side or stomach.
Absolute differences in estimated prevalence between 2016 and 2022 were calculated by treating each survey cycle as an indicator category, with the 2016 cycle as the reference. Values may not equal the difference between the beginning and ending estimates because of rounding. Relative difference, presented as a percentage, is the absolute difference divided by the prevalence in the referent category (2016) multiplied by 100.
P value for trend was adjusted for race and ethnicity, family income, highest education of adult in household, maternal age at delivery, smoker in household, and infant gestation.
Race and ethnicity (child’s Hispanic origin had 0.2% and race had 1.8% missing cases) was imputed by the Census Bureau using hot-deck imputation; other includes Asian, American Indian or Alaska Native, Native Hawaiian and Other Pacific Islander, some other race, and 2 or more races.
P value for trend was adjusted for family income, highest education of adult in household, maternal age at delivery, smoker in household, and infant gestation.
95% CIs were derived according to the binomial distribution for standardization; all negative values have been replaced with 0.
Family income (16.6%) was imputed by the Census Bureau using sequential regression imputation methods.
P value for trend was adjusted for race and ethnicity, highest education of adult in household, maternal age at delivery, smoker in household, and infant gestation.
Numbers vary slightly in the subgroups due to missing data.
P value for trend was adjusted for race and ethnicity, family income, maternal age at delivery, smoker in household, and infant gestation.
Includes less than high school, high school, and some college or technical school.
P value for trend was adjusted for race and ethnicity, family income, highest education of adult in household, smoker in household, and infant gestation.
Household smoking exposure was determined based on responses to the query: “Is there any individual residing in your household who consumes cigarettes, cigars, or pipe tobacco?”
P value for trend was adjusted for race and ethnicity, family income, highest education of adult in household, maternal age at delivery, and infant gestation.
P value for trend was adjusted for race and ethnicity, family income, highest education of adult in household, maternal age at delivery, and smoker in household.
Discussion
To our knowledge, this study is the first to simultaneously investigate sleep positions among US infants in 4 different age groups. We found that the overall prevalence of nonsupine sleep positions during infancy remained stable over the 7-year study period, suggesting no changes in parental behavior toward the sleep hygiene of their infants. The prevalence was higher among infants from lower socioeconomic status households, consistent with similar sociodemographic patterns observed in previous studies.5 Evidence-based interventions that promote safe sleep practices, particularly among younger age groups where SIDS is more prevalent, could help reduce sleep-related infant mortality. We acknowledge that the predominance of the non-Hispanic White population may limit the generalizability of our findings to other populations.
Data Sharing Statement
References
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Associated Data
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Supplementary Materials
Data Sharing Statement
