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Despite decades of public health campaigns advocating for safe sleep practices, a significant number of U.S. babies are still put to bed in positions that increase the risk of sudden infant death syndrome (SIDS), a new study reveals.
The research, published on December 12 in JAMA Network Open, shows that 12% of 4-month-old babies in the United States are placed to sleep on their sides or stomachs—positions known to elevate the risk of SIDS. This percentage increases to 19% for 9-month-olds and 23% for 1-year-olds. These findings are based on data from the U.S. National Survey of Children’s Health (NSCH), covering the years 2016 through 2022.
The study, led by Dr. Yongjun Zhang from Xinhua Hospital in Shanghai, reinforces the well-established recommendation from the American Academy of Pediatrics (AAP), which advises parents to place babies on their backs for sleep. This guidance has been linked to a reduction in SIDS risk by keeping airways open and reducing the likelihood of breathing difficulties during sleep.
Along with the “back-to-sleep” recommendation, the AAP also urges that cribs and bassinets be free of soft bedding, including blankets, pillows, and plush toys, which could lead to suffocation risks. The AAP further stresses that infants should sleep in their own space, on a firm, flat mattress with a fitted sheet.
However, the new study underscores that progress in promoting these safe sleep practices has stalled. Despite extensive education campaigns, the rate of babies sleeping in non-supine positions—either on their side or stomach—remains unchanged over the past seven years.
The researchers also identified certain demographic trends that suggest additional outreach efforts are necessary. Among 4-month-olds, Black and Hispanic babies were more likely to be placed to sleep in non-supine positions (23.2% and 21.6%, respectively) compared to their white counterparts (7.1%). Additionally, socioeconomic factors play a significant role: nearly a quarter (24.5%) of infants from families in the lowest income bracket were put to sleep in unsafe positions, compared to just 6.7% of babies from wealthier homes.
Education levels also appeared to influence sleep practices. Parents with less than a college degree were more likely to put their infants to sleep in unsafe positions. Furthermore, younger mothers, particularly those under the age of 30, were more likely to place their babies in positions that raised the risk of SIDS.
The study’s authors argue that these findings call for intensified efforts to reach vulnerable groups with lifesaving information about safe sleep practices. “Evidence-based interventions that promote safe sleep, particularly for younger parents and those in higher-risk groups, could reduce sleep-related infant mortality,” Zhang and colleagues concluded.
With approximately 3,500 sleep-related deaths reported annually among U.S. infants, it is critical to continue advocating for the safe sleep recommendations to reduce preventable deaths from SIDS.
For more information on the AAP’s infant sleep guidelines, parents can visit their official website for resources and support.
