Global & Disaster Medicine

Infant Safe Sleep Practices Not Well-Followed


Bombard JM, Kortsmit K, Warner L, et al. Vital Signs: Trends and Disparities in Infant Safe Sleep Practices — United States, 2009–2015. MMWR Morb Mortal Wkly Rep. ePub: 9 January 2018. DOI:

Key Points

•Infant safe sleep practices recommended by the American Academy of Pediatrics (AAP), including placing infants to sleep on their backs, room sharing but not bed sharing, and keeping soft objects and loose bedding out of the infant’s sleep environment, can help reduce sleep-related infant deaths; however, implementation of these recommendations remains suboptimal.

•Approximately one in five mothers reported placing their infant to sleep on their side or stomach. More than one half reported bed sharing with their infant, and more than one third reported using soft bedding in the infant’s sleep environment. Unsafe sleep practices varied by state, race/ethnicity, age, education, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children.

•Health care providers and state-based and community-based programs can identify barriers to safe sleep practices and provide culturally appropriate counseling and messaging to improve infant safe sleep practices.

•Additional information is available at

Introduction: There have been dramatic improvements in reducing infant sleep-related deaths since the 1990s, when recommendations were introduced to place infants on their backs for sleep. However, there are still approximately 3,500 sleep-related deaths among infants each year in the United States, including those from sudden infant death syndrome, accidental suffocation and strangulation in bed, and unknown causes. Unsafe sleep practices, including placing infants in a nonsupine (on side or on stomach) sleep position, bed sharing, and using soft bedding in the sleep environment (e.g., blankets, pillows, and soft objects) are modifiable risk factors for sleep-related infant deaths.

Methods: CDC analyzed 2009–2015 Pregnancy Risk Assessment Monitoring System (PRAMS) data to describe infant sleep practices. PRAMS, a state-specific and population-based surveillance system, monitors self-reported behaviors and experiences before, during, and shortly after pregnancy among women with a recent live birth. CDC examined 2015 data on nonsupine sleep positioning, bed sharing, and soft bedding use by state and selected maternal characteristics, as well as linear trends in nonsupine sleep positioning from 2009 to 2015.

Results: In 2015, 21.6% of respondents from 32 states and New York City reported placing their infant in a nonsupine sleep position; this proportion ranged from 12.2% in Wisconsin to 33.8% in Louisiana. Infant nonsupine sleep positioning was highest among respondents who were non-Hispanic blacks. Nonsupine sleep positioning prevalence was higher among respondents aged <25 years compared with ≥25 years, those who had completed ≤12 years compared with >12 years of education, and those who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children during pregnancy. Based on trend data from 15 states, placement of infants in a nonsupine sleep position decreased significantly from 27.2% in 2009 to 19.4% in 2015. In 2015, over half of respondents (61.4%) from 14 states reported bed sharing with their infant, and 38.5% from 13 states and New York City reported using any soft bedding, most commonly bumper pads and thick blankets.

Conclusions and Implications for Public Health Practice: Improved implementation of the safe sleep practices recommended by the American Academy of Pediatrics could help reduce sleep-related infant mortality. Evidence-based interventions could increase use of safe sleep practices, particularly within populations whose infants might be at higher risk for sleep-related deaths.


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