Nocturnal Video Assessment of Sleep Environments Erich K. Batra, MD,a, b Douglas M. Teti, PhD,c Eric W. Schaefer, MS,d Brooke A. Neumann,c Elizabeth A. Meek, c Ian M. Paul, MD, MSca,d

BACKGROUND AND OBJECTIVE: Reports describing factors associated with sleep-related infant abstract death rely on caregiver report or postmortem findings. We sought to determine the frequency of environmental risk factors by using nocturnal sleep videos of . METHODS: Healthy, term newborns were recruited for a parent study examining the role of parenting in the development of nighttime infant sleep patterns. For 1 night at ages 1, 3, and 6 months, video recordings were conducted within family homes. Videos were coded for sudden infant death syndrome risk factors in post hoc secondary analyses after the parent study was completed. RESULTS: Among 160 one-month-olds, initially 21% were placed to sleep on nonrecommended sleep surfaces and 14% were placed nonsupine; 91% had loose/nonapproved items on their sleep surface, including , bumper pads, , stuffed animals, and sleep positioners. Among 151 three-month-olds, 10% were initially placed on a nonrecommended sleep surface, 18% were placed nonsupine, and 87% had potentially hazardous items on their sleep surface. By 6 months, 12% of the 147 infants initially slept on a nonrecommended surface, 33% were placed to nonsupine, and 93% had loose/ nonrecommended items on their surface. At 1, 3, and 6 months, 28%, 18%, and 12% changed sleep locations overnight, respectively, with an increased likelihood of bed-sharing and nonsupine position at the second location at each time point. CONCLUSIONS: Most parents, even when aware of being recorded, placed their infants in sleep environments with established risk factors. If infants were moved overnight, the second sleep environment generally had more hazards. NIH

Departments of aPediatrics, bFamily and Community Medicine, and dPublic Health Sciences, Penn State College WHAT’S KNOWN ON THIS SUBJECT: Risk and c of Medicine, Hershey, Pennsylvania; and Human Development and Family Studies, Penn State University, protective factors for sleep-related infant death, University Park, Pennsylvannia including sudden infant death syndrome, have been Dr Batra participated in the data analysis, drafted the initial manuscript, and participated in established by epidemiologic studies. These reports critical revision of the manuscript; Dr Teti conceptualized the parent study, led the participant are typically limited by subjective reporting by recruitment and data collection, and participated in critical revision of the manuscript; Mr parents/caregivers or postmortem fi ndings and may Schaefer led the data management, performed the data analyses, and participated in critical underestimate the prevalence of these factors. revision of the manuscript; Ms Neumann and Ms Meek participated in data collection, coding and entry, and critical revision of the manuscript; and Dr Paul conceptualized the study and analysis, WHAT THIS STUDY ADDS: Most parents placed their and participated in data analysis and critical revision of the manuscript. All authors approved the infants in sleep environments with established risk fi nal manuscript as submitted. factors. When infants were moved to a different DOI: 10.1542/peds.2016-1533 sleep environment in the middle of the night, the new sleep environment often included more unsafe Accepted for publication Jun 27, 2016 elements. Address correspondence to Ian M. Paul, MD, MSc, Penn State College of Medicine, , HS83, 500 University Dr, Hershey, PA 17033. E-mail: [email protected] PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). To cite: Batra EK, Teti DM, Schaefer EW, et al. Nocturnal Copyright © 2016 by the American Academy of Pediatrics Video Assessment of Infant Sleep Environments. Pediatrics. 2016;138(3):e20161533

Downloaded from www.aappublications.org/news by guest on September 23, 2021 PEDIATRICS Volume 138 , number 3 , September 2016 :e 20161533 ARTICLE Sleep-related infant deaths, the in infant sleep environments. To (Bosch, Fairpoint, NY), Infrared most common cause of postneonatal overcome previous limitations, the Color Couple Charged Device (ML) infant mortality, 1 are defined as present study analyzed nocturnal Cameras (Spectral Instruments deaths occurring during sleep or in sleep videos collected from a Inc, Tuscan, AZ), Channel Vision a sleep environment, and include parent, longitudinal study of infant 5014 Microphones (Channel Vision sudden infant death syndrome sleep arrangements, maternal Technology, Costa Mesa, CA), and (SIDS), accidental suffocation and endorsement of these arrangements, an Audiovox D9000 Portable DVD/ strangulation in bed, and ill-defined and their association with emotional CD Player (Voxx Electronics Corp, deaths. Risk factors that have been and marital difficulties. 12 The aim Hauppauge, NY). All cameras were associated with sleep-related deaths of this secondary analysis was to wired directly to the digital video include, but are not limited to, determine the frequency of known recorder by using Mini coaxial cable side and prone sleeping, soft sleep risk factors for sleep-related infant television cables with an option of surface, loose bedding, bed-sharing, deaths by using these objective data a wireless setup by using a Video tobacco use, and not . 2 in the 6 months after birth. Transmitter Kit from Videocomm Efforts to eliminate risk factors began Technologies (Burlington, ON, in 1992 in the United States, when Canada). Up to 3 more cameras were the American Academy of Pediatrics METHODS placed for each family depending (AAP) recommended against Participants on parental reports of bedtime or prone positioning. 3 Subsequent sleep locations. For all families, 1 AAP guidelines, 4,5 the most recent The parent study was an camera and microphone setup were published in 2011, 2 have also observational evaluation of families suspended on a boom stand above recommended avoidance of “soft whose newborns were delivered at the infant’s primary sleep location to materials in the infant’s sleeping 2 hospitals in central Pennsylvania. provide a clear view of the infant’s environment” and room-sharing Mothers were approached within 48 head, body, and primary sleep without bed-sharing. hours of delivery by project staff, who surface. Other cameras were set described the study and provided up to provide alternate views or in contact information on a handout. Despite substantial publicity for alternative sleep locations. Infrared Those participating were healthy, these recommendations and public illuminators were set up to provide term newborns. All mothers were education campaigns, many of bounce lighting to illuminate the aged ≥18 years, of any ethnicity, these recommendations are not infants’ room if needed. At each study fluent in English, and living with their fully followed by parents. Data from time point, video recordings were infants as an independent family unit. the National Infant Sleep Position initiated by parents 1 hour before Interested mothers were called at Study (NISP) report that 73% of the start of bedtime. Recordings home within 3 weeks of discharge, parents placed their infants in a continued throughout the night until and a home visit was scheduled 4 to 6 nonsupine position for sleep in the infant was fully awake in the weeks after delivery. All participating 2010,6 that rates of bed-sharing morning. mothers provided informed consent doubled from 6.5% in 1993 to 13.5% before enrollment, and they in 2010,7 and that 55% of parents Video Analysis completed a baseline demographic continue to use loose bedding questionnaire. in the infant sleep environment, After downloading the recordings despite recommendations to the This study was approved by the Penn to an external hard drive, the videos contrary by the AAP. 8 Data also State University’s Office of Research were viewed by using Bosch Divar show that soft bedding and bumpers Protections and the secondary XF/700 Software 3.33. Videos continue to be found in the cribs of analysis was approved by Penn State were reviewed and coded by 1 of infants who died in sleep-related College of Medicine’s Human Subjects 2 research assistants with data deaths. 9 However, publications Protection Office. entered, including sleep location(s), describing parental practice have surface(s), position(s), and other been limited by their methods. They Study Procedures objects on or around the sleep have typically been based on either At infant ages 1, 3, and 6 months, surface. For purposes of assessing parental self-report or death scene research staff visited each family inter-rater reliability, a total of investigations. Some studies have to set up video equipment in the 56 videos (25 at 1 month, 16 at 3 used video recording to analyze the area(s) of the home where the infant months, and 15 at 6 months) were safety of sleep environments, 10, 11 commonly slept. The equipment coded by both research assistants, but none used direct observation consisted of a Bosch Divar XF 8 and Cohen’s κ statistic was to quantify modifiable risk factors channel digital video recorder calculated. 13 The κ statistics indicated

Downloaded from www.aappublications.org/news by guest on September 23, 2021 2 BATRA et al TABLE 1 Study Baseline Participant Demographic Characteristics (N = 162) dropped out were less likely to Variable Value breastfeed at 1 and 3 months, Child sex compared with those who remained Male 77 (48) in the study for 6 months. Female 85 (52) Maternal demographic characteristics Sleep Position and Environment Age, y 29.3 ± 5.3 1-Month Videos Race/ethnicity White 135 (84) Fifty-eight percent of 1-month-old Black 6 (4) infants began the night in their Asian 5 (3) parents’ room, and the majority Hispanic/Latina 9 (6) Other 5 (3) (79%) were on an AAP-approved Education sleep surface (eg, crib, , High school graduate or less 22 (14) , ) ( Table 2). A Some college 30 (19) playpen is defined as a portable play College graduate or more 110 (68) yard that conforms to standards set Marital status Single 4 (2) by the US Consumer Product Safety Single, cohabitating with partner 22 (14) Commission. 14 Although 86% were Married, cohabitating with partner 132 (82) initially placed supine, 12 (8%) and Father involved, living separately 4 (2) 7 (4%) were placed in the side and Paternal demographic characteristics prone positions, respectively. Nearly Age, y 32.0 ± 5.9 Race/ethnicity all (91%) participants had a loose/ White 124 (85) nonapproved item on their sleep Black 5 (3) surface. The most common items Asian 5 (3) were loose bedding, bumper pads, Hispanic/Latino 7 (5) pillows, stuffed animals, and sleep Other 5 (3) Education positioners. High school graduate or less 23 (15) Forty-five (28%) infants slept in Some college 26 (17) at least 2 locations at the 1-month College graduate or more 100 (67) Family income, thousands of dollars, median (interquartile range) 60 (37–90) observation; 91% of infants ended up on a nonapproved sleep surface (eg, Unless otherwise indicated, data are presented as n (%) or mean ± SD. adult bed, sofa, car seat, co-sleeper, or swing) for the second sleep location. perfect or near perfect agreement, month of age (median, 1.2 months; Only 64% were placed in a supine with values of 1.00 for sleep surface range, 0.9–1.9 months), 151 at 3 position at this second location, and and position, 0.94 for sleep location, months (median, 3.1 months; range, 67% shared their sleep surface with and 0.87 to 0.95 for each individual 2.3–4 months), and 147 at 6 months another person ( Table 3). When the object on or around the sleep (median, 6.1 months; range, 4.8–7.3 entire night was considered, 36% of surface. For statistical analysis, months). Forty-eight percent of the the cohort of 160 infants were placed data coded from video recordings infants were male ( Table 1). The nonsupine, and 28% shared a sleep were summarized and/or described median age of mothers and fathers surface at some point in the night. by using frequency counts and was 29 and 32 years, respectively. percentages for categorical variables Eighty-four percent of the mothers 3-Month Videos and means, SDs, medians, and ranges and 85% of the fathers were white, About one-half (52%) of 3-month-old for continuous variables. and most parents attended at least infants began the night in their own some college. More than 80% of room, and 90% were on an AAP- RESULTS mothers were married and living approved sleep surface. Eighty-two with their partner. Exclusive percent began the night supine, with Demographic Characteristics breastfeeding was reported for 59%, 10% and 8% being placed on their Of the 167 infants enrolled in the 52%, and 18% of infants at 1, 3, and side and prone, respectively, and study, 162 (97%) had at least 1 video 6 months, respectively. Regarding 87% had loose/nonapproved items and comprised our analysis sample. attrition, there were no demographic in their sleep environment. Of these, 142 (88%) had videos from differences between those who did Twenty-seven (18%) infants slept in all 3 time points. One hundred sixty and did not complete the 6-month at least 2 locations, with an increase of the infants were observed at 1 observation period. Those who in unsafe sleep risk factors in the

Downloaded from www.aappublications.org/news by guest on September 23, 2021 PEDIATRICS Volume 138 , number 3 , September 2016 3 second location; the proportion of TABLE 2 Initial Sleep Location, Surface, Position, and Sleep Environment According to Age infants sleeping in a crib, bassinet, or Variable 1 Month 3 Months 6 Months playpen decreased from 93% to 11%, (n = 160) (n = 151) (n = 147) only one-third were placed supine, First sleep location and 81% shared their sleep surface Parent room 93 (58) 68 (45) 38 (26) with another person. When the entire Own room 54 (34) 78 (52) 101 (69) night was considered, 35% of the Other room 13 (8) 4 (3) 7 (5) Sleep surface cohort of 151 infants were placed Crib (crib, cradle, bassinet, playpen) 127 (79) 136 (90) 130 (88) nonsupine, 22% shared a sleep Adult bed or 13 (8) 10 (7) 11 (7) surface, and 89% slept with loose and Car seat 10 (6) 3 (2) 2 (1) nonapproved items at some point Swing 4 (3) 0 0 during the night. Other 3 (2) 1 (1) 1 (1) Bedside co-sleeper (“sidecar”) 2 (1) 1 (1) 1 (1) 6-Month Videos Sofa 0 0 2 (1) Position placed on fi rst sleep surface Two-thirds (69%) of 6-month-old Supine 138 (86) 123 (82) 98 (67) infants began the night in their own Side 12 (8) 15 (10) 22 (15) Prone 7 (4) 12 (8) 25 (17) room, and 88% were on an AAP- Indeterminate (not supine) 3 (2) 1 (1) 2 (1) approved sleep surface. Sixty-seven Loose/nonapproved items on sleep surface percent were placed supine in their Loose bedding 134 (84) 112 (74) 101 (69) initial sleep location, with 15% and Bumper pads 39 (24) 64 (42) 70 (48) 17% being placed on their side and / 31 (19) 29 (19) 30 (20) Stuffed animal/pillow-like toy 26 (16) 39 (26) 49 (33) prone, respectively, and 93% had Sleep positioner/wedge 22 (14) 11 (7) 1 (1) loose/nonapproved items in their Another person 14 (9) 9 (6) 12 (8) sleep environment. Other 11 (7) 8 (5) 5 (3) Mobile/hanging toy within child’s reach 6 (4) 7 (5) 11 (7) Eighteen infants (12%) slept in at Hard toy 5 (3) 5 (3) 18 (12) least 2 locations, with an increase in SIDS monitor 5 (3) 4 (3) 2 (1) unsafe sleep risk factors in the second Bottle 3 (2) 1 (1) 8 (5) location; there was a decrease in the Loose cord/electrical wire 3 (2) 2 (1) 2 (1) Pet 1 (1) 1 (1) 3 (2) proportion of infants sleeping in a crib, Is fi rst sleep location shared with another person? bassinet, cradle, or playpen from 78% No 145 (91) 142 (94) 135 (92) to 17%, a decrease in supine sleep Yes; parent 14 (9) 9 (6) 11 (7) position (50% to 22%), and an increase Yes; other 0 0 1 (1) in the sleep surface being shared with another person (17% to 67%). When common limitations for research on sleep environment for healthy living the entire night was considered, 44% sleep-related infant deaths and risk infants and for infants who have of the 147 infants with 6-month videos factors, as they are not self-reported, died suddenly and unexpectedly. were placed nonsupine, 16% shared and suggest that current public The NISP, an annual cross-sectional a sleep surface, and 93% had a loose education and health care provider telephone survey conducted from or nonapproved item in their sleep guidance related to safe infant sleep 1992 to 2010, provided parent- environment at some point during the are not being carefully adhered reported data about infant sleep night. to, even in a relatively educated, practices and reported that affluent patient population. Although approximately three-quarters of the parent study that supported infants were both placed supine 6 and DISCUSSION this analysis was not designed or in a crib or bassinet. 7 This finding is Our data show that most parents, originally intended to serve as an consistent with our data for initial even when they were aware of being evaluation of SIDS risk factors, position and placement. However, recorded, placed their infants in sleep these findings are a reminder that when we included subsequent environments with established risk efforts to improve parent education position and placement in the middle factors for sleep-related infant deaths. and understand real-world parent of the night, 38% of infants were ever In addition, infants being moved in the practices must continue. placed nonsupine during the night, middle of the night were often moved and 91% of 1-month-old infants who to more unsafe sleep environments These objective data may help to were moved during the night ended than where they began the night. explain some of the discordance up in an unsafe environment. These These objective findings overcome the in reporting of risk factors in the findings are more consistent with

Downloaded from www.aappublications.org/news by guest on September 23, 2021 4 BATRA et al TABLE 3 Sleep Location, Surface, Position, and Sleep Environment for Infants Moved to a Second Location Variable 1 Month (n = 45) 3 Months (n = 27) 6 Months (n = 18) Location 1 Location 2 Location 1 Location 2 Location 1 Location 2 Sleep location Own room 7 (16) 3 (7) 7 (26) 1 (4) 7 (39) 4 (22) Parent room 34 (76) 34 (77) 20 (74) 25 (93) 9 (50) 13 (72) Other room 4 (9) 7 (16) 0 1 (4) 2 (11) 1 (6) Sleep surface Crib (crib, cradle, bassinet, playpen) 36 (80) 4 (9) 25 (93) 3 (11) 14 (78) 3 (17) Adult bed or mattress 3 (7) 23 (51) 2 (7) 20 (74) 2 (11) 10 (56) Sofa 0 2 (4) 0 0 1 (6) 0 Car seat 1 (2) 4 (9) 0 1 (4) 0 3 (17) Bedside co-sleeper (“sidecar”) 1 (2) 0 0 0 1 (6) 0 Swing 2 (4) 6 (13) 0 1 (4) 0 0 Other 2 (4) 6 (13) 0 2 (7) 0 2 (11) Position child placed in Supine 39 (87) 29 (64) 21 (78) 9 (33) 9 (50) 4 (22) Side 3 (7) 9 (20) 6 (22) 7 (26) 5 (28) 6 (33) Prone 0 2 (4) 0 0 3 (17) 4 (22) Other 1 (2) 0 0 0 0 0 Indeterminate (nonsupine) 2 (4) 5 (11) 0 11 (41) 1 (6) 4 (22) Items on bed excluding pacifi er, mean ± SD 1.8 ± 1.3 2.5 ± 1.3 1.7 ± 1.0 2.7 ± 1.0 2.1 ± 1.3 2.4 ± 1.6 Shared sleep surface 4 (9) 30 (67) 1 (4) 22 (81) 3 (17) 12 (67) Unless otherwise indicated, values are given as n (%). data from Child Death Review teams, not include thin (as thin as There are 2 likely reasons that which reported that in sleep-related or thinner than a receiving ) utilization of nocturnal videos deaths, 38% of infants were found or sheets, whereas these items were resulted in the finding of higher on their stomach, and only 28% of included in our count. rates of unsafe sleep environments infants were found in a crib, bassinet, than have been previously reported. Approximately 90% of infants had or playpen. 15 First, objective video observations loose or soft bedding, including loose eliminate the bias inherent in We also found higher rates of blankets, stuffed animals, pillows, self-reporting. Participants bed-sharing and loose bedding bumper pads, and sleep positioners, may be reluctant to admit to in the environment than studies in their sleep areas. Some of these relying on parental report have items were found on shared sleep behaviors, particularly when they noted. The most recent report from surfaces, which is not surprising. are inconsistent with infant care NISP demonstrated that 13.5% of Adult beds frequently have parental recommendations. In addition, videos families usually shared a bed. 7 Our bedding (eg, blankets, pillows); in allowed us to view the infant sleep observations found that a sleep addition, many parents who sleep environment throughout the entire surface was shared by 28%, 23%, and with their infant use bedding to night. This approach is in contrast 16% of infants during a single night’s build a barrier in the belief that the to surveys, in which questions about observation at 1, 3, and 6 months, bedding will protect the infant from sleep position, sleep location, and respectively. Importantly, <10% falling off the bed or from rollover bedding are often asked in isolation, at each time point were observed accidents. 16 We also found that the and the entire sleep environment sharing a surface at the beginning of majority of cribs contained soft or may not be considered holistically. the night, but this scenario increased loose bedding. Many parents use Furthermore, many parents may overnight. Interestingly, Colvin et al 15 soft bedding because of concerns assume that the question refers only reported that 69% of infant deaths about infant warmth and comfort, to initial placement at the beginning reviewed by Child Death Review and to prevent infants from hurting of the sleep period and not to teams occurred while the infant was themselves, and they may not be changes occurring during the night. sharing a sleep surface. Similarly, aware that soft bedding in the infant Indeed, we found that 28%, 18%, and NISP reported a lower rate (55%) of sleep environment creates a hazard. 12% of participating infants slept in soft or loose bedding use, 8 compared However, soft bedding in the sleep >1 location during the night at 1, 3, with ∼75% in our observations. environment is the most common and 6 months, respectively. When the However, this difference may be risk factor seen in sudden and infant was moved in the middle of the partially explained by how bedding unexpected infant deaths that occur night, there was a higher likelihood was defined in the 2 studies. NISP did in infants aged ≥4 months. 15 that the infant was placed in an

Downloaded from www.aappublications.org/news by guest on September 23, 2021 PEDIATRICS Volume 138 , number 3 , September 2016 5 unsafe sleep environment. We found nighttime sleep environment is not with safe sleep guidelines. Future that for all 3 observation times, the static, but fluid, with potentially studies in other populations will be second sleep environment was more several changes during the course needed to confirm this. hazardous than the initial setting of the night. Kendall-Tackett et al 29 in terms of sleep location, sleep found that when parents were asked position, and sharing the surface with about infant sleep location at the CONCLUSIONS another person. beginning of the night, 31% reported This longitudinal study of infant These findings have important bed-sharing, compared with 59% sleep environments using videotaped implications for public health when parents were asked about observations found that among a messaging regarding both initial sleep location at the end of the night. predominantly highly educated, placement and handling of the It is possible that well-intentioned white population, infants were infant in the middle of the night. parents consider safe sleep guidelines frequently placed in unsafe sleep Although safe sleep messages have to be those that are applicable for environments, both with initial been emphasized for years, our the onset of sleep but less so in the placement and during the course data suggest that parents are not middle of the night. It is therefore of the night. Our study found strictly adhering to the guidance on prudent for health care providers to a higher proportion of sleep safe sleep environments. This lack ask about sleep environment for the environment risk factors than of adherence may be at least partly entire night and provide anticipatory have been reported in previous because of persistent cultural norms guidance accordingly. In addition, studies. Additional research on and beliefs. For instance, decorative future epidemiologic studies should parental beliefs and understanding bedding products displayed at and consider the fluid nature of the sleep of when safe sleep guidelines sold in retail establishments (and environment. are applicable and on barriers shown in parenting magazines) We acknowledge that this study to safe sleep will be important, have influenced what is seen as has limitations. Our cohort was with the goal of developing more 17 appropriate by parents. In addition, largely white, with socioeconomic effective educational materials and infant comfort, which includes longer and educational levels higher interventions. sleep duration, is a priority for many than the norm. These results may parents, and this goal often results in therefore not be generalizable 18–26 prone and side positioning and to other demographic groups. In 27,28 ABBREVIATIONS sharing of sleep surfaces. Health addition, parents were aware that AAP: American Academy of care providers should be aware of they were being videotaped. It is thus Pediatrics these influences on parental decision- possible that we underestimated NISP: National Infant Sleep making so that appropriate guidance the proportion of families who did Position Study can be given. not adhere to safe sleep guidelines. SIDS: sudden infant death It is also important for health Nonetheless, our direct observations syndrome care providers to realize that the revealed high rates of nonadherence

FINANCIAL DISCLOSURE: The authors have indicated they have no fi nancial relationships relevant to this article to disclose. FUNDING: Supported by National Institutes of Health grant R01HD052809-01 and the Ashley Nicole Shellenberger SIDS Research Fund at the Penn State College of Medicine. Funded by the National Institutes of Health (NIH). POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential confl icts of interest to disclose.

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Downloaded from www.aappublications.org/news by guest on September 23, 2021 PEDIATRICS Volume 138 , number 3 , September 2016 7 Nocturnal Video Assessment of Infant Sleep Environments Erich K. Batra, Douglas M. Teti, Eric W. Schaefer, Brooke A. Neumann, Elizabeth A. Meek and Ian M. Paul Pediatrics 2016;138; DOI: 10.1542/peds.2016-1533 originally published online August 15, 2016;

Updated Information & including high resolution figures, can be found at: Services http://pediatrics.aappublications.org/content/138/3/e20161533 References This article cites 26 articles, 13 of which you can access for free at: http://pediatrics.aappublications.org/content/138/3/e20161533#BIBL Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): Fetus/Newborn Infant http://www.aappublications.org/cgi/collection/fetus:newborn_infant_ sub SIDS http://www.aappublications.org/cgi/collection/sids_sub Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.aappublications.org/site/misc/Permissions.xhtml Reprints Information about ordering reprints can be found online: http://www.aappublications.org/site/misc/reprints.xhtml

Downloaded from www.aappublications.org/news by guest on September 23, 2021 Nocturnal Video Assessment of Infant Sleep Environments Erich K. Batra, Douglas M. Teti, Eric W. Schaefer, Brooke A. Neumann, Elizabeth A. Meek and Ian M. Paul Pediatrics 2016;138; DOI: 10.1542/peds.2016-1533 originally published online August 15, 2016;

The online version of this article, along with updated information and services, is located on the World Wide Web at: http://pediatrics.aappublications.org/content/138/3/e20161533

Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. Pediatrics is owned, published, and trademarked by the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2016 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

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