Sleeping on the job: unsafe infant sleep environments depicted in the news coverage of the 2016 AAP safe sleep recommendations

Background: As sleep position and environment are known to contribute to the risk for infant death, and media images have been shown to sway healthcare decision-making, in 2016 the American Academy of Pediatrics (AAP) updated their sleep guidelines to explicitly call for the media to refrain from depicting infants in unsafe sleeping positions/environments. Objective: We aimed to assess whether the images accompanying the news coverage of the press release summarizing these new safe sleep guidelines were consistent with the recommendations. Method: We searched the Google News™ archives, the largest compilation of searchable news coverage in the world, in the month after the AAP issued its press release. Two coders independently analyzed all pictures of sleeping infants accompanying the news reports for adherence to the guidelines regarding sleep position/environment. Results: We identified 44 news articles with 39 accompanying images showing a sleep environment with or without an infant. The majority of these images (26/39; 67%) contained at least one violation of the safe sleep recommendations with most of the violations (21/26; 81%) depicting an unsafe sleep environment (e.g. bumpers, bed-sharing) and 5 of the 22 (23%) pictures of sleeping infants showed the infant sleeping in an unsafe position. Conclusion: Two-thirds of the pictures that accompanied the online news coverage of the new AAP safe sleep guidelines depicted infants in unsafe sleep positions or environments. As imagery has been shown to be potentially more powerful than text in public health messaging, editors should give careful consideration to their choice of photographs accompanying their news coverage.