Safe Sleep for Infants: Reduce Risk With the Right Message

Christine K. Olson, MD, MPH


August 13, 2018

Editorial Collaboration

Medscape &

I'm Dr Christine Olson, Preterm/Infant Health Team Lead in the Center for Disease Control and Prevention's (CDC's) Division of Reproductive Health. I'm reaching out to clinicians to share important health news.

Every year, there are about 3500 sleep-related deaths among babies in the United States, and a recent CDC report underscores that despite safe sleep recommendations to reduce the risk, unsafe sleep practices with infants are still common.

In the 1990s, there were sharp declines in sleep-related infant deaths following the National Institute of Health's "Back to Sleep" educational campaign, now known as the Safe to Sleep® campaign.

However, those declines have slowed since the late 1990s—and a recent CDC report[1] shows that the risk for sleep-related deaths for babies continues. In 2015, within states included in the analysis, about 1 in 5 mothers reported placing their babies to sleep on their sides or stomachs, more than half of mothers reported any bed-sharing with their babies, and 2 in 5 mothers reported using any soft bedding in the baby's sleep area. Unsafe sleep practices were more common among mothers who were younger than age 25 years, had 12 or fewer years of education, and identified as racial or ethnic minorities.

As a trained healthcare provider, I am acutely aware of the sheer number of topics you have to keep in mind as you see patients throughout your busy day. However, it is clear that we need to do a better job discussing and promoting the current American Academy of Pediatrics (AAP) recommendations on safe sleep with patients, particularly among populations where unsafe infant sleep practices are higher. Safe sleep practices recommended by the AAP include[2]:

  • Placing the baby on his or her back at all times—including naps and at night;

  • Using a firm, flat sleep surface, such as a safety-approved crib or bassinet;

  • Keeping soft bedding and soft toys out of the baby's sleep area; and

  • Sharing a room with the baby, but not the same bed.

Healthcare providers practicing in a range of specialties play a vital role in educating infant caregivers to help reduce risk.

Prenatal care providers are the first line of education about infant care for many pregnant women. Discussion of safe sleep as providers see their patients throughout a pregnancy may improve safe sleep practices. Safe sleep for babies can be addressed along with other important infant care topics, such as breastfeeding and immunizations. Discussions with patients should include information about safe infant positioning and practices. This is where we can be especially effective—ensuring that caregivers receive this information as early and as often as possible during pregnancy.

The hospital stay after delivery is another prime opportunity for encouraging safe sleep. By modeling and practicing safe sleep throughout the hospital stay, we can offer parents a memorable example of a safe sleep environment.

Pediatric and family medicine providers should also include guidance on safe sleep as they are seeing their newborn and infant patients. Providers can ask caregivers how they place the baby to sleep; discuss any challenges with following recommendations; and help them find solutions, including linking patients to services, such as free or reduced-cost cribs.

By providing educational materials on safe sleep at visits, we can help patients share safe sleep information with other caregivers, such as grandparents.

I hope the information I have offered here gives you realistic, tangible suggestions for incorporating safe sleep into your daily practice or reinvigorating your current efforts. The loss of a baby is a devastating tragedy for families and communities. Everyone has a role to play in helping parents and caregivers keep babies safe and healthy, and your contributions are essential. You are your patient's most credible, reliable source of health information and best source about safe sleep. Thank you for all that you do.

Web Resources to Help Healthcare Professionals Provide Infant Sleep Guidance

Vital Signs: Trends and Disparities in Infant Safe Sleep Practices—United States, 2009–2015
This study identifies which parents are most at risk of not following safe sleep recommendations.

SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment
Recommendations from the AAP to protect against SIDS and other sleep-related infant deaths.

Building on Campaigns with Conversations
A series of learning modules designed for a range of health professionals who interact with families on topics of safe sleep and breastfeeding.

Continuing Education Activity on Risk Reduction for Sudden Infant Death Syndrome (SIDS) and Other Sleep-Related Causes of Infant Death: Curriculum for Nurses
A learner-led or instructor-led CE program enables nurses to receive continuing education credits by completing a module about reducing the risk for SIDS and other sleep-related infant deaths.