Safe Infant Sleep Survey
Help us understand infant sleep practices and promote safe sleep environments.
Your relationship to the infant
*
Parent
Guardian
Grandparent
Other
Infant's age (in months)
*
Where does your infant usually sleep?
*
Own crib or bassinet
Co-sleeping in adult bed
Pack 'n Play or portable crib
Other
What position is your infant placed in to sleep most often?
*
On the back
On the side
On the stomach
Which items are present in your infant's usual sleep area? (Select all that apply)
*
Blankets
Pillows
Stuffed animals
Bumper pads
Sleep sack/wearable blanket
Nothing except fitted sheet
Other
Do you smoke or does anyone smoke inside your home?
*
Yes
No
How often do you follow safe sleep guidelines (placing infant on back, firm mattress, no loose bedding)?
*
1
2
3
4
5
Please indicate your agreement with the following statements about infant sleep:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I am confident in my knowledge of safe sleep practices.
1
2
3
4
5
I believe following safe sleep guidelines is important.
6
7
8
9
10
I have received enough information about safe infant sleep.
11
12
13
14
15
Safe sleep recommendations are easy to follow.
16
17
18
19
20
Where did you learn about safe infant sleep practices?
*
Healthcare provider
Family or friends
Online resources
Parenting classes
Other
What challenges, if any, do you face in following safe infant sleep recommendations?
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