More than three-quarters of moms said they usually put their babies on their backs to sleep. Fewer — 57% — said their babies slept in their room, but not in their beds. Even fewer were consistently following the advice on sleep surfaces and keeping babies’ sleep areas clear.

The vast of majority of mothers — 93% — said their doctor had recommended back-sleeping, and around 84% said they’d received advice on sleep surfaces and what items should be kept out of the crib. But less than half said their doctor had recommended room-sharing but avoiding bed-sharing.

Beyond doctors’ advice — or lack thereof — parents may be swayed by various influences, said Dr. Rachel Moon.

She co-wrote an editorial accompanying the study, which was published online Oct. 21 in the journal Pediatrics.

“We’ve learned that one’s attitudes and the social norms are incredibly powerful forces,” said Moon, who heads general pediatrics at the University of Virginia, in Charlottesville. “Particularly in the internet age, parents are getting information from so many sources besides their doctor.”

And then there’s marketing. When parents walk into a store, Moon noted, they see soft bedding and may think they “need to buy it.” When they see pictures of celebrities’ nurseries, “stuffed with soft bedding,” they may be influenced, consciously or not, Moon said.

Bed-sharing — which has increased nationwide since the 1990s — is a particular problem, she noted.

“Many people believe that you cannot successfully breastfeed unless you bed-share,” Moon said. And in some cultures, she added, you’re considered a “bad parent” if you don’t sleep with your baby.

The study also found racial and ethnic disparities: Black mothers were least likely to report putting their babies on their backs to sleep, while room-sharing without bed-sharing was least common among black and American Indian/Alaskan Native families.

It’s not clear why, Hirai said. But, she added, less access to health care and other barriers — like having the space and money for a crib — could be among the factors.

“We need to work on multiple levels to address these disparities,” Moon said. That, she added, includes getting accurate information on safe sleep to everyone — not just new parents — and making neighborhoods and housing safer.

That’s “so parents don’t feel like they have to bed-share to keep their baby away from rodents in the house or gunfire outside,” Moon explained.

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