Images of infants sleeping in unsafe environments are pervasive in women’s magazines and on stock photo websites, which could create confusion among parents and put babies at risk, according to a study presented April 25 at the Pediatric Academic Societies (PAS) annual meeting in San Diego.

Since 1992, the American Academy of Pediatrics (AAP) has recommended that babies be put to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). The AAP also discourages bed-sharing and advises parents to keep soft objects out of cribs, including pillows, blankets, and bumper pads.

“Sleep-related deaths are the third leading cause of infant mortality, responsible for more than 3,500 deaths each year,” says lead author Michael Goodstein, MD, FAAP, attending neonatologist, WellSpan York Hospital, and clinical associate professor of pediatrics, Pennsylvania State University, in a release.

Since advertisements and photographs can influence behavior, Goodstein and his colleagues wanted to determine if magazine images and stock photos used by advertisers are consistent with AAP safe sleep recommendations.

Researchers searched the top three stock photo websites and 26 magazines published in 2014 that target expectant parents or parents of young children. They found 579 stock photos of sleeping babies not being held and 12 magazine pictures that accompanied articles or ads.

Pictures were analyzed for the infant’s sleep position, sleep location (eg, crib) and presence of other people on the same sleep surface as the infant. In addition, researchers looked for bumper pads, blankets, stuffed animals, and other items.

About half of the stock photos and 67% of magazine pictures showed babies correctly positioned on their backs. In addition, only about 16% of stock photos and 29% of magazine images depicted safe sleep environments according to AAP guidelines.

“One-third of the magazine images showed infants sleeping on the tummy, which doubles the risk of SIDS,” Goodstein says.

Stock photography websites are of even greater concern because images available on the Internet routinely depict hazardous sleep conditions regarding SIDS and suffocation, he says.

“Magazines that are geared toward expectant mothers and new parents and manufacturers of infant products and their advertisers need to take the lead in using images that promote infant sleep safety,” Goodstein says.