Objective: To determine infant sleep instructions that hospital personnel in our community were giving to parents and actual positions practiced after the April 15, 1992 American Academy of Pediatrics recommendation for nonprone positioning.

Design: Survey of mothers of infants </=4 months of age from November 1993 to March 1994 with follow-up survey of selected birth hospitals.

Setting: A private practice (PP) serving predominantly white middle- and upper-income children and a pediatric clinic (CY) serving inner-city predominantly African-American low-income children in Louisville, Kentucky.

Patients: Fifty infants from each practice site.

Outcome measure: The sleep instructions given and practiced, and other risk factors for sudden infant death syndrome (SIDS).

Results: Nonprone sleeping instructions were received by 72% of the PP and only 48% of the CY parents, with 72% of the PP and 54% of the CY following the nonprone recommendations. Infants were more likely to be in smoking households (60% vs 12%) from the CY practice than the PP practice.

Conclusions: Our study showed that, despite having a higher prevalence of SIDS risk factors, there was a greater delay in discontinuing prone positioning instructions in the hospital serving the CY infants. The evidence suggests that this population is as likely as the PP group to follow medical advice given.