A new Pediatrics study that analyzed the sleep-related deaths of infants found that those who died at an out-of-home setting were approximately twice as likely to be in a car seat, stroller, or other location (such as the floor or futon) than infants who died in the home.

The study, “Risk Factors for Sleep-Related Infant Deaths in In-Home and Out-of-Home Settings,” to be published in the November 2016 Pediatrics (published online Oct 24) found that out-of-home infants were slightly more likely to have been placed to sleep on their stomachs, according to the analysis of 11,717 infant deaths between 2004 to 2014.

The data, provided by the National Center for the Review and Prevention of Child Deaths database, included all deaths of infants younger than age 1 that occurred during sleep or in a sleep environment. Cases were assigned to three categories based on death determination: sudden infant death syndrome (SIDS); sudden unexpected infant death (SUID); or accidental suffocation and strangulation in bed.

Nearly 80% of total deaths occurred in-home. The majority of the out-of-home deaths occurred at relatives’ homes (60%), followed by childcare settings. Out-of-home infants had 30% lower odds of bed-sharing at the time of death than those who died at home. The authors conclude that more education is needed to inform parents and caregivers to place infants on their backs, in a crib or bassinet, to protect against sleep-related deaths.