Now, more than ever, it is important to know the steps to take to prevent Sudden Unexpected Infant Deaths or SUID.
After initial safe sleep recommendations were released in 1994 as part of the American Academy of Pediatrics’ (AAP) ‘Safe to Sleep’ campaign (formerly ‘Back to Sleep’), the rate of deaths nationwide decreased by 60 percent. That progress has waned in recent years, and evidence suggests many parents co-sleep with their babies at some point during a child’s infancy.
Despite outreach, education and guidance for new parents about safe sleep practices, infant deaths related to safe sleep have plateaued, and even increased, in recent years. Sleep-related deaths in Tennessee account for approximately 1 in 4 infant fatalities. Deaths due to unsafe sleep continue to be one of the leading causes of preventable infant deaths in the state.
Who is Most at Risk?
Infants from birth through four months of age make up 79% of Sudden Unexpected Infant Deaths (SUID). 21% of SUID deaths occur in infants between five and eleven months.
Causes of death that fall under the SUID umbrella are:
- Sudden infant death syndrome (SIDS).
- Unknown cause.
- Accidental suffocation and strangulation in bed.
Moreover, racial and ethnic disparities exist. Black infants are 2-4 times as likely to suffer a sleep-related fatality as White infants. These statistics reflect complex and deeply rooted social, environmental, and health factors, which all play a role in how safe sleep risks affect different communities.
Preventive Steps for Safer Sleep
Research has identified actionable steps to lower the risk of sleep-related infant deaths, particularly through the AAP’s Safe to Sleep campaign, which was most recently updated in 2022.
The ABCDs of Safe Sleep
- Alone: Babies should sleep alone, not sharing their sleeping surface. Avoid placing your infant in bed with adults or other children. Though room-sharing is encouraged, it’s best if the baby has their own sleep space, ideally in a crib or bassinet.
- Back: Always place babies on their backs to sleep. Since the Safe to Sleep campaign began, the rate of parents placing babies on their backs has gone from 25% to about 70%, a practice proven to reduce sleep-related deaths.
- Crib: Use a firm, flat surface, like a crib, bassinet, or play yard that meets current safety standards. Avoid soft surfaces and items like pillows, comforters, and crib bumpers.
- Don’t Smoke: The risk of SUID is much higher if you or your partner smokes and you share a bed with your baby. This is true even if you don’t smoke in the bedroom.
Additional Safety Measures
According to the AAP’s 2022 guidance, the following factors play a significant role in reducing the likelihood of SUID.
- Breastfeeding: Studies show that breastfeeding reduces the risk of SUID. By three months, only about 4% of SUID-affected infants were still breastfeeding.
- Avoid Sitting Devices for Sleep: Car seats, strollers, and other sitting devices aren’t recommended for sleep. Babies should sleep on a flat, safe surface.
- Routine Immunizations: Keeping babies up to date on vaccinations is another way to protect against SUID.
- Avoid Commercial SIDS Products: Be cautious with items that claim to prevent SIDS or other sleep-related issues. Most are not backed by evidence.
- Introduce Pacifiers: Offering a pacifier at sleep time has been associated with a lower risk of SUID.
- Encourage Tummy Time When Awake: Supervised tummy time helps with motor development and reduces flat spots on the head.
Are There Protective Factors?
Yes! In addition to following the ABCDs, research suggests that breastfeeding and room-sharing (not bed-sharing) are beneficial. Babies who are breastfed and sleep in the same room as their parents—but on separate surfaces—show a reduced risk of SUID. Using a pacifier during naps and nighttime sleep can also offer protection.
Public Awareness in Tennessee
The Tennessee Department of Health (DOH) partners with other state departments, first responders and hospitals to increase public awareness on the topic of safe sleep. All birth hospitals now require parents to have safe sleep education prior to discharge. First responders are educated about safe sleep practices through DOH trainings. The Department of Children’s Services trains staff on how to discuss safe sleep with families and how to provide culturally relevant information so the information given is well-received. In addition, DCS provides no-cost safe sleep surfaces to parents and caregivers of infants who do not otherwise have access to a safe sleep environment for their baby. The Tennessee Department of Human Services requires all licensed child care providers to follow safe sleep practices as well.
Final Thoughts for Parents
Becoming a parent means making a lot of choices, and some can feel overwhelming—especially when it comes to sleep safety. By following the ABCDs of safe sleep, breastfeeding if possible, and avoiding cigarette smoke and unsafe sleep products, you’re taking meaningful steps to keep your little one safe.