Infant Safe Sleep

Nationally and in North Carolina, deaths from SIDS has declined dramatically since 1992 when the American Academy of Pediatrics first recommended that babies be placed on their backs to sleep. Unfortunately, in recent years North Carolina has seen a dramatic increase in sleep-related deaths from preventable causes including suffocation, entrapment and asphyxia.

In North Carolina, almost 150 families tragically lost a baby to a sleep-related death in 2015. Many of these can be prevented. 

Why is Infant Safe Sleep Important?

From 2010-2014, more than 125 North Carolina babies died each year related to sleeping. While sleep-related deaths due to Sudden Infant Death Syndrome (SIDS) have decreased greatly over the years, deaths from other sleep-related causes have increased. Some of these deaths could have been prevented. Sleep-related death rates for non-Hispanic, Black and American Indian infants remain higher than the rest of the state’s population.

Definition of Sleep-Related Infant Death:

Death of a baby linked to how or where the baby slept. Causes include:
  • Suffocation – Something blocks air from entering the baby’s lungs like soft bedding, blankets, pillows, crib bumpers or overlay (when a person rolls onto the baby).
  • Strangulation – When something cuts off the baby’s airway, like when a cord or piece of fabric gets wrapped around the baby’s neck.
  • Entrapment – A baby gets trapped or wedged in a small space or between two objects.

Definition of SIDS:

Sudden Infant Death Syndrome (SIDS) is the sudden death of an infant under one year of age that remains unexplained after a thorough case investigation, including a complete autopsy, examination of the death scene and review of the baby’s medical history.

Facts About SIDS:

  • Mostly occurs before six months of age (90%), but can happen later
  • Claims slightly more boys than girls
  • Occurs at a higher rate among African American babies than White babies
  • Is not preventable (but the risk can be reduced)

According to the Centers for Disease Control and Prevention, the overall rate of SIDS in the United States has declined by more than 50% since 1990. It is believed that better investigations of unexpected infant deaths and greater adoption of safe sleep practices have contributed to fewer SIDS deaths. 

Why Does SIDS Happen?

The cause of SIDS remains unknown. It is known that some risk factors can make a baby more vulnerable to SIDS. Some of these risk factors include brain abnormalities (which may impact a baby’s ability to control breathing, heart rate, waking, etc.), being born premature or low birth weight, having a respiratory infection, stomach or side sleeping, sleeping on a soft surface or co-sleeping with an adult or other child.

What are Sleep-Related Risks?


Research has identified factors that can put a baby at risk for SIDS or a sleep-related death:      

  • Tummy or side sleeping      
  • Sleeping on a soft sleeping surface (couch, adult mattress, chair)    
  • Cluttered sleeping area (crib bumpers, pillows, fluffy blankets or stuffed animals in crib)      
  • Sleeping with parents or anyone else      
  • Not sleeping in a crib or bassinet      
  • Overheating or excessive swaddling     
  • Baby’s exposure to secondhand smoke or a mother who smokes while pregnant      
  • Premature birth (born before 37 weeks gestation)      
  • Low birth weight (born less than 2,500 grams, or 5 pounds 8 ounces.)      
  • Multiple births (twins, triplets, etc.)      
  • Women using alcohol or illicit drug use during pregnancy and after birth      
  • Pregnant women not getting regular prenatal care 

Recommended Safe Sleep Practices

  • Place your baby to sleep on his back for naps and at night. If your baby can roll from his back to his side or stomach on his own, he can be left that way.
  • If your baby falls asleep in a car, stroller, swing, infant carrier or infant sling move her to a crib or bassinet as soon as possible.
  • Breastfeed as long as you can. Studies show that breastfeeding reduces the risk of SIDS. Exclusive breastfeeding (no baby formula) is best, but any breast milk is better than none.
  • Make sure your baby goes to all scheduled doctor visits and gets all recommended shots. Evidence suggests that immunizations may protect against SIDS.
  • Offer a dry pacifier (without a string) at nap time and bedtime. This helps reduce the risk of SIDS. If breastfeeding, wait at least 4 weeks (until breastfeeding is established) before offering a pacifier. If baby does not take a pacifier, do not force it.
  • Don’t let your baby get too hot. Dress him in one layers. Use clothing designed to keep babies warm without the risk of it covering their heads. Blankets are not recommended.*
  • Do not use home breathing or heart monitors to reduce the risk of SIDS. These can be helpful for babies with breathing or heart problems. They have not been found to reduce the risk of SIDS.
  • Do not use products that claim to reduce the risk of SIDS. Wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS. Some infants have suffocated using these items.
  • *If you decide to use a blanket, make sure it is tucked into the crib mattress to keep it from becoming loose and covering your baby’s face. Use the “feet-to-foot” guidelines: Put the baby so his feet are near the foot of the crib. Place a lightweight blanket across the baby’s chest just under the arm pits. Tuck the blanket securely along the two sides and foot of the crib.

Create a Safe Sleep Environment (for naps and nighttime)

  • Always place your baby to sleep in a safe crib, bassinet or portable crib.
  • Never let your baby sleep on a sofa, water bed, chair, cushion, car seat or anywhere else.
  • Place your baby to sleep in the same room where you sleep but not in the bed. Keep the crib or bassinet within an arm’s reach of your bed. Babies who sleep in the same bed as their parents are at greater risk of sleep-related death. 
  • Keep your baby away from people who are smoking and places where people smoke. If you smoke, try to quit. 
  • Keep your car and home smoke-free. Do not smoke anywhere near your baby and don’t let others either – even if you are outside. 
  • Do not let your baby get too hot. Keep the room where your baby sleeps at a comfortable temperature.

Crib Safety

All cribs sold after June 28, 2011 meet current safety standards. 

A safe crib must meet all requirements outlined below:
  • Have a firm mattress that is the correct size
  • Be less than 10 years old
  • Have slats that are no more than 2 3/8 inches (60 mm) apart
  • Be assembled using the manufacturer’s instructions

Cribs should not have:

  • Missing, broken or loose parts
  • Chipped, cracked or peeling paint
  • A drop side
  • Bumper pads (crib bumpers)
  • Corner posts that extend above the sides of the crib
  • Cut-out designs in the headboard or footboard

Suffocation Hazards

Keep soft objects, loose bedding, bumper pads, pillows, quilts, comforters, sheepskins, and stuffed toys out of the crib. These items can cause your baby to suffocate.