Sudden infant death syndrome: In Europe, nearly 80% of baby product packaging show unsafe positions

Imagine you’re lounging comfortably at home, watching TV, when a car ad comes up showing a vehicle travelling at high speed on a windy road. Inside, an infant is shown in a baby seat that… isn’t secured. How would that commercial make you feel about the advertiser? Thankfully that never happens in real life, right?

Unfortunately, that’s precisely what does happen in a related domain, as our research team revealed. In a study just published in The Journal of Pediatrics, we find that almost 80% of baby product packaging depicting a sleeping infant show a sleep position clearly identified as a major risk factor for sudden infant death syndrome (SIDS).

SIDS is the unexpected death of a baby under the age of 1 year old that remains unexplained after a full investigation. Every year in the United States, there are about 1,400 deaths due to SIDS (figures for the year 2020).

More than 600 baby diaper packages investigated in 11 countries

As part of this project, researchers from Inserm, Université Paris Cité and HEC Paris, in collaboration with the Greater Paris University Hospitals (AP-HP), Nantes University Hospital and other European research structures, studied images shown on baby diaper packages in 11 European countries, including France, Germany, Italy and Spain.

The research team identified 631 diaper packages for babies weighing less than 5 kg. On 49% of them, there was a picture with a sleeping baby. The analyses indicated that 79% of packages depicting a sleeping baby were inconsistent with at least one recommendation for the prevention of SIDS. For example, a baby was depicted in prone position or on the side 45% of the time, with soft objects or loose bedding (pillows, pillow-like toys, stuffed toys, quilts, comforters, sheepskins, blankets, nonfitted sheet, or bumper pads) on 51%, or sharing the sleep surface with another person on 10%.

Examples of diaper packaging for babies in Europe with an image that is inconsistent with the recommendations for the prevention of SIDS: baby not sleeping on their back (A, C); baby sleeping with loose bedding or a soft object (pillow, blanket, toy) (A, B, C, D); baby sharing the sleep surface with another person (D).
Author provided (no reuse)

In sum, across countries, the team consistently showed that a very high proportion of pictures were inconsistent with safe infant sleep recommendations – with many images depicting babies sleeping on their stomach (prone position) or on their side, on loose bedding or surrounded by objects, or sharing a sleeping surface with another person.

Prevention recommendations based on scientific data

There are, however, recommendations for preventing sudden infant death syndrome published by the American Academy of Pediatrics, data known since the 1990s and updated in October 2016.

Its main recommendations are as follows:

Place infants on their backs for sleep in their own sleep space with no other people.

Use a crib, bassinet or portable play yard with a firm, flat mattress and a fitted sheet. Avoid sleep on a couch or armchair or in a seating device, like a swing or car safety seat (except while riding in the car).

Keep loose blankets, pillows, stuffed toys, bumpers and other soft items out of the sleep space.

Breastfeed if possible and avoid smoking.

Advertising can create a illusory sense of truth

In the behavioural sciences and medical literature, it is well known that images have the power to impact consumer habits, ranging from alcohol to breastfeeding. We also know that while advertising images have historically been important tools for persuasion, they have equally been a source of information for consumers. It is important to remember that the term advertisement comes from the French word avertissement, which means “warning”; and the term publicity means “to make public”. Therefore, advertising’s key mission is to inform, warn as well as persuade.

When an ad conveys invalid information, such as depicting a baby in a dangerous sleeping position, it presents two important issues in terms of how parents process that information. A first issue is that consumers generally believe that advertisement images are crafted by experts and therefore regard them as authoritative sources.

In particular, an advertising image for baby products acts as authority to young parents, since – particularly for a vulnerable population such as babies – manufacturers are expected to know what they are doing. As a result, parents are likely to accept and value the information presented without critically evaluating its validity. This phenomenon has long been known as the authority bias in decision-making.

A second issue may be even more pernicious: You may argue that parents know about the safe sleep recommendations, which are often communicated to them at the maternity hospital or when they visit their paediatrician. Unfortunately, the repeated exposure to the same wrong information on baby packaging (e.g., the repeated exposure to a baby not sleeping on their back) can create an illusion of truth. Even when people know that the information is incorrect, they can end up believing it is not that incorrect. In sum, while knowing that sleeping on the back is recommended, parents may end up believing that sleeping in a prone position is also just fine.

Legislators must deal with this issue

Launched in the 1990s, the “Safe to Sleep” campaign (also known as “Back to Sleep”) promoted safe infant sleep recommendations around the world, and resulted in a sharp decrease in sudden infant death syndrome (SIDS). Sadly, the effects of that campaign are no longer felt today.

For example, in France, the incidence of sudden unexpected infant death, which includes Sudden Infant Death Syndrome (SIDS), has dropped by 75% since the 1990s, and currently stands between 250 and 350 deaths per year (French Health Agency Santé Publique France estimates that SIDS deaths represents 50% of sudden unexpected infant deaths). Nowadays, however, the French incidence rate of SIDS is no longer decreasing.

For these reasons, it should be no wonder that Martin Chalumeau, one of the study co-authors, concludes:

“We need to reduce exposure to commercial or official images that are inconsistent with the recommendations for the prevention of SIDS in order to prevent unsafe sleep practices. In doing so, manufacturers and legislators would fully contribute to accurate health information.”

This article was collectively written by Sophie de Visme, MSc; Daniel A. Korevaar, MD, PhD; Christèle Gras-Le Guen, MD, PhD; Alix Flamant, MD; Martina Bevacqua, MD; Anna Stanzelova, MD, MSc; Nhung TH Trinh, PharmD, PhD; Dalia-Alexandra Ciobanu, MD; Ana Araújo Carvalho, MD; Ifigeneia Kyriakoglou, MD; Maria Fuentes, MD; Yacine Refes, PhD; Elisabeth Briand-Huchet, MD; Anne-Laure Sellier, PhD; Inge Harrewijn, MD; Jérémie F. Cohen, MD, PhD; and Martin Chalumeau, MD, PhD.