背景：國際研究顯示改變睡眠行為（譬如由趴睡改為仰睡），可以降低嬰兒睡眠相關死亡率。台灣相關單位已經積極宣導嬰兒安全睡眠環境多年。但是，台灣至今並沒有安全睡眠行為的盛行率調查。
目的：檢視台灣高雄市六個月或以下嬰兒照顧者不同類型安全睡眠行為的盛行率與相關影響因素。
方法：本研究是橫斷性問卷調查。由高雄市衛生局協助發函，邀請衛生所及醫療院所針對接受預防接種或健兒門診之六個月或以下嬰兒照顧者進行問卷訪談。問卷樣本數是依各院所疫苗接種數量按比例分派配額。問卷題目由研究者參考相關文獻設計，再經過專家效度檢定。問卷調查時間為2026年4至6月。統計分析以安全行為方向呈現各項行為之盛行率與95%信賴區間，除卡方檢定外，另以多變數邏輯迴歸檢視獨立相關因子。
結果：本研究回收1545份有效問卷進行分析，不過每一題目的有效問卷數目不一。安全睡眠行為盛行率分別為：仰臥入睡72.6% (1118/1539)、與照顧者同室82.8% (1275/1540)、不同床74.4% (1145/1540)、同室且不同床59.2% (909/1536)、睡於獨立睡覺空間85.9% (1325/1542)。床內個別鬆軟物件之未使用比率依序為：絨毛娃娃91.8%、枕頭75.1%、毯子60.7%、棉被58.3%、防撞護墊57.0%、軟墊43.8%；六項皆未使用之床內清空符合率僅14.3% (221/1544)。同時符合仰臥、同室、不同床、有獨立睡覺空間及床內清空五項核心安全條件者僅8.0% (122/1528)。雙變數卡方分析顯示，嬰兒性別、月齡、出生體重、出生週數、母親生產年齡、母親教育程度、家庭經濟狀況、同住吸菸、夜間主要照顧者、哺育母乳、是否看過安全睡眠五守則影片及行政區人口密度分級，分別與一項或多項安全睡眠行為呈統計顯著關聯。多變數邏輯迴歸校正九項共變項後，看過五守則影片者在不同床（aOR 1.51）、床內清空（aOR 2.84）及多數床內無鬆軟物件指標之勝算仍顯著較高，但與仰臥無關；人口密度較低地區在同室、不同床等指標之勝算較低。
結論：本研究提供台灣第一個安全睡眠行為盛行率數據，以及可能相關之照顧者與家戶因素；仰臥率72.6%與美國（78.0%）與澳洲（83.0%）研究結果接近，未來還應該針對難以落實行為的理由進一步探討，才能擬定更精準衛教宣導內容。

Background: International studies have indicated that changes in sleeping practices (such as from prone to supine position) could reduce sleep-related infant mortality. Health authorities in Taiwan have promoted safe environment among infants for years. However, no study has ever examined the prevalence of safe sleep practices in Taiwan.
Objectives: To examine the prevalence of various safe sleep practices and associated factors among caregivers of infants aged 6 months or younger in Kaohsiung City, Taiwan.
Methods: This is a cross-sectional questionnaire survey study. With the help of Kaohsiung City Health Bureau who sent invitation letters to health centers, clinics, and hospitals who provide vaccinations and well-baby clinics services and asking them to interview the caregivers of infants aged 6 months or younger by nurses. The number of questionnaires in each clinical setting was estimated according to the number of visits for vaccination in previous year. The questions in the questionnaire were designed based on previous studies by the researcher and the content validity was assessed by two experts. The survey was conducted from April to June 2026. Prevalence and 95% confidence intervals for each safe sleep practice were presented in the safe-behavior direction; in addition to chi-square tests, multivariable logistic regression was used to examine independent associated factors.
Results: We received 1562 questionnaires, of which 1545 valid responses were included in the analysis; however, the number of valid responses varied across questions. The prevalence of safe sleep practices was 72.6% (1118/1539) for the supine sleep position, 82.8% (1275/1540) for sharing a room with a caregiver, 74.4% (1145/1540) for not bed-sharing with another person, 59.2% (909/1536) for room-sharing without bed-sharing, and 85.9% (1325/1542) for the infant having an independent (own) sleep space (a descriptive indicator of whether a dedicated space was provided, not equivalent to the AAP concept of a separate approved sleep surface). The proportions of infants sleeping without each soft item were 91.8% for stuffed toys, 75.1% for pillows, 60.7% for blankets, 58.3% for quilts, 57.0% for bumper pads, and 43.8% for soft padding. Only 14.3% (221/1544) of infants had none of the six soft items in the sleep area, and only 8.0% (122/1528) met all five core safe sleep criteria, including the supine sleep position, room-sharing, no bed-sharing, an independent sleep space, and a clear sleep area. Bivariate chi-square analyses showed that infant sex, infant age, birth weight, gestational age, maternal age at delivery, maternal education, household economic status, household smoking, primary nighttime caregiver, breastfeeding, exposure to the safe sleep “Five Rules” film, and district population density level were each significantly associated with one or more safe sleep practices. In multivariable logistic regression adjusting for nine covariates, exposure to the “Five Rules” film remained independently associated with not bed-sharing (adjusted odds ratio [aOR] 1.51), a clear sleep area (aOR 2.84), and most soft-item-free indicators, but not with supine positioning; infants in the lowest population-density areas had lower odds of room-sharing and not bed-sharing after adjustment.
Conclusion: The present study provided the first data on the prevalence of safe sleep practices and associated caregiver and household characteristics in Taiwan. The supine positioning rate (72.6%) was similar to that reported in recent US (78.0%) and Australian (83.0%) surveys, and future study on reasons of non-adherence is needed to design precision educational content in Taiwan.

內政部戶政司（2025）。各鄉鎮市區人口密度。政府資料開放平臺。https://data.gov.tw/dataset/8410
呂宗學（2024年9月1日）。兒童死亡率如何由5.3降至4.0以下？自由時報。https://talk.ltn.com.tw/article/paper/1664693
財團法人靖娟兒童安全文教基金會（2026年5月14日）。九成家長知道卻做不到！夜間照顧成最大破口：靖娟調查揭睡眠安全衛教斷層。https://www.safe.org.tw/news-detail/362/
梁富文、呂宗學、江東亮（2023）。過度登錄與台灣新生兒死亡率上升。台灣衛誌，42(4)，352–359。https://doi.org/10.6288/TJPH.202308_42(4).112079
劉介宇、翁文舜、陳主智（2026）。更新版臺灣地區鄉鎮發展類型於大型健康調查之抽樣設計之應用。中國統計學報，64，232–258。https://jcsa.stat.org.tw/jcsa/Journal.html
衛生福利部（2024）。雙十國慶 共創健康台灣 讓人民健康、讓國家更強、讓世界擁抱臺灣。https://www.mohw.gov.tw/cp-16-80207-1.html
衛生福利部國民健康署（無日期）。嬰兒安全睡眠環境。2025年2月15日擷取網址：https://www.hpa.gov.tw/Pages/List.aspx?nodeid=4150
衛生福利部國民健康署（2022）。110年國民健康訪問調查結果報告。https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=364&pid=18514
衛生福利部國民健康署（2024）。六歲以下兒童死亡原因回溯分析結果報告（111-112年回溯個案）。https://www.mohw.gov.tw/cp-26-78898-1.html
衛生福利部國民健康署（2025）。兒童健康手冊（中文版）。https://www.hpa.gov.tw/Pages/EBook.aspx?nodeid=1139
總統府（2019年4月24日）。增訂並修正兒童及少年福利與權益保障法條文。https://www.president.gov.tw/Page/294/46538
AAP Task Force on Infant Positioning and SIDS. (1992). Positioning and SIDS. Pediatrics, 89(6), 1120–1126. https://doi.org/10.1542/peds.89.6.1120
Anuntaseree, W., Mo-Suwan, L., Vasiknanonte, P., Kuasirikul, S., Ma-a-Lee, A., & Choprapawon, C. (2008). Factors associated with bed sharing and sleep position in Thai neonates. Child: Care, Health and Development, 34(4), 482-490. https://doi.org/10.1111/j.1365-2214.2008.00832.x
Bryan, M. A., Florence, A., Gower, A. D., Evans, Y. N., & Moreno, M. A. (2022). Safe sleep behaviors and factors associated with infant second sleep practices. Pediatrics, 149(6), e2021053935. https://doi.org/10.1542/peds.2021-053935
Canty, E. A., Fogel, B. N., Batra, E. K., Schaefer, E. W., Beiler, J. S., & Paul, I. M. (2020). Improving infant sleep safety via electronic health record communication: A randomized controlled trial. BMC Pediatrics, 20, Article 468. https://doi.org/10.1186/s12887-020-02369-2
Centers for Disease Control and Prevention. (2024a, May 20). Data methodology. Pregnancy Risk Assessment Monitoring System (PRAMS). https://www.cdc.gov/prams/php/methodology/index.html
Centers for Disease Control and Prevention. (2024b, May 15). PRAMS questionnaires. Pregnancy Risk Assessment Monitoring System (PRAMS). https://www.cdc.gov/prams/php/questionnaires/index.html
Centers for Disease Control and Prevention. (2024c, May 15). Success story: New Jersey. Pregnancy Risk Assessment Monitoring System (PRAMS). https://www.cdc.gov/prams/php/success-stories-data-to-action/new-jersey.html
Cole, R., Young, J., Kearney, L., & Thompson, J. M. (2020). Infant care practices and parent uptake of safe sleep messages: A cross-sectional survey in Queensland, Australia. BMC Pediatrics, 20, Article 27. https://doi.org/10.1186/s12887-020-1917-5
Cole, R., Young, J., Kearney, L., & Thompson, J. M. (2021a). Awareness of infant safe sleep messages and associated care practices: Findings from an Australian cohort of families with young infants. BMJ Paediatrics Open, 5(1), e000972. https://doi.org/10.1136/bmjpo-2020-000972
Cole, R., Young, J., Kearney, L., & Thompson, J. M. (2021b). Challenges parents encounter when implementing infant safe sleep advice. Acta Paediatrica, 110(11), 3083-3093. https://doi.org/10.1111/apa.16040
Cole, R., Young, J., Kearney, L., & Thompson, J. M. (2022). Infant care practices, caregiver awareness of safe sleep advice and barriers to implementation: A scoping review. International Journal of Environmental Research and Public Health, 19(13), 7712. https://doi.org/10.3390/ijerph19137712
Colson, E. R., Bergman, D. M., Shapiro, E., & Leventhal, J. H. (2001). Position for newborn sleep: Associations with parents' perceptions of their nursery experience. Birth, 28(4), 249-253. https://doi.org/10.1046/j.1523-536X.2001.00249.x
Cunningham, H. M., Vally, H., & Bugeja, L. (2018). Bed-sharing in the first 8 weeks of life: An Australian study. Maternal and Child Health Journal, 22(4), 556-564. https://doi.org/10.1007/s10995-017-2424-7
Daniels, L., Taylor, B. J., Haszard, J. J., Camp, J., Magrath, K. L., Tipa, Z. K., Bryant, V., & Gibb, S. J. (2026). Early infant sleep environments: An observational study of New Zealand electronic health data. Journal of Paediatrics and Child Health, 62(2), 171-180. https://doi.org/10.1111/jpc.70245
Eunice Kennedy Shriver National Institute of Child Health and Human Development. (n.d.). Campaign history. Safe to Sleep. Retrieved July 25, 2026, from https://safetosleep.nichd.nih.gov/campaign/history
Filiano, J. J., & Kinney, H. C. (1994). A perspective on neuropathologic findings in victims of the sudden infant death syndrome: The triple-risk model. Biology of the Neonate, 65(3-4), 194-197. https://doi.org/10.1159/000244052
Fowler, A. J., Evans, P. W., Etchegaray, J. M., Ottenbacher, A., & Arnold, C. (2013). Safe sleep practices and sudden infant death syndrome risk reduction: NICU and well-baby nursery graduates. Clinical Pediatrics, 52(11), 1044-1053. https://doi.org/10.1177/0009922813506038
Hauck, F. R., Signore, C., Fein, S. B., & Raju, T. N. K. (2008). Infant sleeping arrangements and practices during the first year of life. Pediatrics, 122(Supplement 2), S113-S120. https://doi.org/10.1542/peds.2008-1315o
Hirabayashi, M., Yoshinaga, M., Nomura, Y., Ushinohama, H., Sato, S., Tauchi, N., Horigome, H., Takahashi, H., Sumitomo, N., Shiraishi, H., & Nagashima, M. (2016). Environmental risk factors for sudden infant death syndrome in Japan. European Journal of Pediatrics, 175(12), 1921-1926. https://doi.org/10.1007/s00431-016-2786-7
Hirai, A. H., Kortsmit, K., Kaplan, L., Reiney, E., Warner, L., Parks, S. E., Perkins, M., Koso-Thomas, M., D'Angelo, D. V., & Shapiro-Mendoza, C. K. (2019). Prevalence and factors associated with safe infant sleep practices. Pediatrics, 144(5), e20191286. https://doi.org/10.1542/peds.2019-1286
Hwang, S. S., Weikel, B. W., Palau, M. A., Greenfield, J. C., Klawetter, S., Neu, M., Roybal, K. L., Scott, J., Shah, P., & Bourque, S. L. (2023). NICU visitation time and adherence to safe sleep practices among mothers of very preterm infants. Advances in Neonatal Care, 23(4), 365-376. https://doi.org/10.1097/ANC.0000000000001066
Kanits, F., L'Hoir, M. P., Boere-Boonekamp, M. M., Engelberts, A. C., & Feskens, E. J. M. (2021). Risk and preventive factors for SUDI: Need we adjust the current prevention advice in a low-incidence country. Frontiers in Pediatrics, 9, Article 758048. https://doi.org/10.3389/fped.2021.758048
Kotelchuck, M. (2006). Pregnancy Risk Assessment Monitoring System (PRAMS): Possible new roles for a national MCH data system. Public Health Reports, 121(1), 6-10. https://doi.org/10.1177/003335490612100105
Michalska, A., Zmyślna, A., Pogorzelska, J., Mierzwa-Molenda, M., Mazur, J., Gładyś-Jakubczyk, A., & Żak, M. (2025). Awareness regarding an infant's sleep environment and safe sleep practices among Polish caregivers: A cross-sectional survey. Journal of Clinical Medicine, 14(12), 4295. https://doi.org/10.3390/jcm14124295
Moon, R. Y., & Task Force on Sudden Infant Death Syndrome. (2011a). SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), 1030–1039. https://doi.org/10.1542/peds.2011-2284
Moon, R. Y., & Task Force on Sudden Infant Death Syndrome. (2011b). SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), e1341–e1367. https://doi.org/10.1542/peds.2011-2285
Moon, R. Y., & Task Force on Sudden Infant Death Syndrome. (2016). SIDS and other sleep-related infant deaths: Evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics, 138(5), e20162940. https://doi.org/10.1542/peds.2016-2940
Moon, R. Y., Abu Jawdeh, E. G., Bundock, E. A., Carlin, R. F., Colvin, J. D., Hauck, F. R., & Hwang, S. S. (2023, May 4). Safe infant sleep: Landmark articles that contributed to the decline in SIDS and other sleep-related infant deaths. Pediatrics. https://publications.aap.org/pediatrics/resources/24358/Safe-Infant-Sleep-Landmark-Articles-That
Moon, R. Y., Carlin, R. F., Hand, I., & the Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. (2022a). Sleep-related infant deaths: Updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics, 150(1), e2022057990. https://doi.org/10.1542/peds.2022-057990
Moon, R. Y., Carlin, R. F., Hand, I., & the Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. (2022b). Evidence base for 2022 updated recommendations for a safe infant sleeping environment to reduce the risk of sleep-related infant deaths. Pediatrics, 150(1), e2022057991. https://doi.org/10.1542/peds.2022-057991
Nelson, E. A. S., Taylor, B. J., Jenik, A., Vance, J., Walmsley, K., Pollard, K., Freemantle, M., Ewing, D., Einspieler, C., Engele, H., Ritter, P., Hildes-Ripstein, G. E., Arancibia, M., Ji, X., Li, H., Bedard, C., Helweg-Larsen, K., Sidenius, K., Karlqvist, S., . . . Nepomyashchaya, V. (2001). International Child Care Practices Study: Infant sleeping environment. Early Human Development, 62(1), 43-55. https://doi.org/10.1016/S0378-3782(01)00116-5
Office of Disease Prevention and Health Promotion. (n.d.). Increase the proportion of infants who are put to sleep on their backs—MICH-14: Data. Healthy People 2030. Retrieved August 2, 2026, from https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/infants/increase-proportion-infants-who-are-put-sleep-their-backs-mich-14/data
Osberg, S., Kalstad, T. G., & Stray-Pedersen, A. (2021). Norwegian parents avoid placing infants in prone sleeping positions but frequently share beds in hazardous ways. Acta Paediatrica, 110(7), 2119-2125. https://doi.org/10.1111/apa.15797
Parker, J. J., Simon, C., Bendelow, A., Bryan, M., Smith, R. A., Kortsmit, K., Salvesen von Essen, B., Williams, L., Dieke, A., Warner, L., & Garfield, C. F. (2023). Fathers, breastfeeding, and infant sleep practices: Findings from a state-representative survey. Pediatrics, 152(2), e2022061008. https://doi.org/10.1542/peds.2022-061008
Parks, S. E., DeSisto, C. L., Kortsmit, K., Bombard, J. M., & Shapiro-Mendoza, C. K. (2023). Risk factors for suffocation and unexplained causes of infant deaths. Pediatrics, 151(1), e2022057771. https://doi.org/10.1542/peds.2022-057771
Parks, S. E., Erck Lambert, A. B., Hauck, F. R., Cottengim, C. R., Faulkner, M., & Shapiro-Mendoza, C. K. (2021). Explaining sudden unexpected infant deaths, 2011-2017. Pediatrics, 147(5), e2020035873. https://doi.org/10.1542/peds.2020-035873
Pourhoseingholi, M. A., Vahedi, M., & Rahimzadeh, M. (2013). Sample size calculation in medical studies. Gastroenterology and Hepatology From Bed to Bench, 6(1), 14-17. https://pmc.ncbi.nlm.nih.gov/articles/PMC4017493/
Ruiz Botia, I., Cassanello Peñarroya, P., Díez Izquierdo, A., Martínez Sánchez, J. M., & Balaguer Santamaria, A. (2020). Sudden infant death syndrome: Do the parents follow the recommendations? Anales de Pediatría (English Edition), 92(4), 222-228. https://doi.org/10.1016/j.anpede.2019.06.009
Shapiro-Mendoza, C. K., Colson, E. R., Willinger, M., Rybin, D. V., Camperlengo, L., & Corwin, M. J. (2015). Trends in infant bedding use: National Infant Sleep Position Study, 1993-2010. Pediatrics, 135(1), 10-17. https://doi.org/10.1542/peds.2014-1793
Shulman, H. B., D'Angelo, D. V., Harrison, L., Smith, R. A., & Warner, L. (2018). The Pregnancy Risk Assessment Monitoring System (PRAMS): Overview of design and methodology. American Journal of Public Health, 108(10), 1305-1313. https://doi.org/10.2105/AJPH.2018.304563
Smith, L. A., Geller, N. L., Kellams, A. L., Colson, E. R., Rybin, D. V., Heeren, T., & Corwin, M. J. (2016). Infant sleep location and breastfeeding practices in the United States, 2011-2014. Academic Pediatrics, 16(6), 540-549. https://doi.org/10.1016/j.acap.2016.01.021
Specker, B. L., Minett, M., Beare, T., Poppinga, N., Carpenter, M., Munger, J., Strasser, K., & Ahrendt, L. (2020). Safe sleep behaviors among South Dakota mothers and the role of the healthcare provider. South Dakota Medicine, 73(4), 152–162. https://openprairie.sdstate.edu/eam_pubs/115/
Task Force on Infant Sleep Position and Sudden Infant Death Syndrome. (2000). Changing concepts of sudden infant death syndrome: Implications for infant sleeping environment and sleep position. Pediatrics, 105(3), 650–656. https://doi.org/10.1542/peds.105.3.650
Task Force on Sudden Infant Death Syndrome. (2005). The changing concept of sudden infant death syndrome: Diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics, 116(5), 1245–1255. https://doi.org/10.1542/peds.2005-1499
Task Force on Sudden Infant Death Syndrome. (2016). SIDS and other sleep-related infant deaths: Updated 2016 recommendations for a safe infant sleeping environment. Pediatrics, 138(5), e20162938. https://doi.org/10.1542/peds.2016-2938
U.S. Consumer Product Safety Commission. (2022). Safe Sleep for Babies Act business guidance. https://www.cpsc.gov/Business--Manufacturing/Business-Education/Business-Guidance/Safe-Sleep-for-Babies-Act-Business-Guidance
UNICEF. (2015). SDG goal 3: Good health and well-being. UNICEF DATA. https://data.unicef.org/sdgs/goal-3-good-health-wellbeing/
United Nations. (2000). United Nations Millennium Development Goals. https://www.un.org/millenniumgoals/
Wennergren, G., Strömberg Celind, F., Goksör, E., & Alm, B. (2021). Swedish survey of infant sleep practices showed increased bed-sharing and positive associations with breastfeeding. Acta Paediatrica, 110(6), 1835-1841. https://doi.org/10.1111/apa.15719
Willinger, M., Hoffman, H. J., Wu, K. T., Hou, J. R., Kessler, R. C., Ward, S. L., Keens, T. G., & Corwin, M. J. (1998). Factors associated with the transition to nonprone sleep positions of infants in the United States: The National Infant Sleep Position Study. JAMA, 280(4), 329-335. https://doi.org/10.1001/jama.280.4.329
Willinger, M., Ko, C. W., Hoffman, H. J., Kessler, R. C., & Corwin, M. J. (2003). Trends in infant bed sharing in the United States, 1993-2000: The National Infant Sleep Position Study. Archives of Pediatrics & Adolescent Medicine, 157(1), 43-49. https://doi.org/10.1001/archpedi.157.1.43
World Health Organization. (2014). Every newborn: An action plan to end preventable deaths. https://www.who.int/publications/i/item/9789241507448