Inconsistency of Infant Caretakers’ Visual Exposome with Safe Infant Sleep Recommendations

BackgroundRates of sudden unexpected death in infancy remain high in several high-income countries. Rates of parental practices for infant sleep were recently found frequently inconsistent with safe infant sleep recommendations (SISRs). Among the various factors reported to influence infant caretakers’ behaviors, images act via the influence mechanisms of authority, social proof, and unity. We systematically assessed the level of inconsistency between SISRs and pictures of sleeping infants or infant sleep environments that were visible in public spaces.MethodsIn November 2023, we searched PubMed, Web of Science, and Google Scholar to identify studies evaluating the level of inconsistency between SISRs and pictures in physical and digital public spaces. Data were extracted independently by 2 authors. Random-effects meta-analysis was used to obtain summary estimates of the proportions of pictures inconsistent with SISRs.FindingsWe screened 1,086 articles and included 7 studies conducted between 2008 and 2023 analyzing pictures found in parenting magazines, online and print newspapers, baby diaper packaging, commercial stock photography websites, and Instagram. The overall risk of bias was deemed low. Among the 5,442 pictures depicting sleeping infants or infant sleep environments, the summary estimates of the proportion of inconsistencies with SISRs were 39% (95% confidence interval –CI- 25-56) for a non-supine sleeping position, 5% (95% CI 2-16) for a soft sleeping surface, 8% (95% CI 4-16) for sharing the sleeping surface, 22% (95% CI 8-49) for an unsafe crib, 58% (95% CI 38-76) for soft objects or loose bedding, 17% (95% CI 15-20) for a covered head, and 85% (95% CI 66-94) for at least one inconsistency. All summary estimates had a significant between-study heterogeneity.InterpretationInfant caretakers’ visual exposome is greatly inconsistent with SISRs and could lead to dangerous practices. Actions from stakeholders and legislators are needed.