Objective To independently assess compliance with safe sleeping guidelines for infants <12 months in licensed childcare services.

Design Full-day, in-situ observations of childcare practices (including sleep and non-sleep periods) conducted in 2016–2017.

Setting Australian home-based and centre-based licensed childcare services. All subject to national regulation and legislation to comply with safe sleeping guidelines.

Participants The sample was 18 licensed childcare settings (15 centre-based, 3 home-based) that had infants <12 months (n=49) attending at the time of observation. 31 educators completed self-report surveys.

Main outcomes and measures Standard observations of childcare practices, including a 20-item infant Safe Sleeping Guideline checklist. Educator characteristics, including each individual’s knowledge, beliefs and attitudes regarding safe sleeping practices.

Results 83% of childcare services were observed to be non-compliant on at least 1 of 20 target guidelines (median 2.5, max=7); 44% were observed placing infants prone/side and 67% used loose bedding, quilts, doonas/duvets, pillows, sheepskins or soft toys in cots. 71% of the childcare settings had a copy of current safe sleeping guidelines displayed either in or at entry to the infant sleep room.

Conclusion Despite 25 years of public health messaging, non-compliance with safe sleeping guidelines was observed to be high in childcare services. Understanding of the reasons underlying non-compliance, particularly in contexts were legislative mandate and access to information regarding safe sleeping is high, is critical to informing ongoing public health messaging and should be the focus of future studies.

Trial registration number ANZCTR 12618001056280—pre-results.