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• Posted December 12, 2024

Too Many U.S. Babies Still Sleep in Positions That Raise SIDS Risk

Despite decades of campaigns highlighting the "baby on back" recommendation for safe infant sleep, 12% of 4-month-old babies in the United States are still put to bed lying on their sides or tummies, a new report finds.

That number rises to 19% among infants aged 9 months and 23% among 1-year-olds.

Putting an infant to bed in a "non-supine" position raises the risk of breathing difficulties and even sudden infant death syndrome (SIDS), said a team led by Dr. Yongjun Zhang, of Xinhua Hospital in Shanghai.

The research was published Dec. 12 in the journal JAMA Network Open.

Per recommendations from the American Academy of Pediatrics (AAP), parents should "place infants on their backs for sleep in their own sleep space with no other people."

Cribs and bassinets should also be free of blankets, pillows and plush toys to avoid suffocation, and have only a "firm, flat mattress and a fitted sheet," the AAP says.

All of this helps lower the odds for SIDS.

However, as the study authors pointed out, "approximately 3,500 sleep-related deaths among infants are reported annually in the U.S.," with 90% of those tragedies occurring among babies less than 6 months old.

Placing babies on their backs as they go to sleep is key to keeping airways open and cutting SIDS risk.

Have efforts to educate parents about this simple step worked?

To find out, Zhang's group looked at data for 2016 through 2022 from the ongoing U.S. National Survey of Children's Health (NSCH).

As part of the survey, the parents of almost 9,400 infants were asked "In which position do you most often lay this baby down to sleep now?" Parents could reply "on side," "on back" or "on stomach."

For infants ages 4, 6, 9 and 12 months of age, an average of 12%, 12.9%, 19.2% and 23% of parents answered either "on side" or "on stomach" -- two positions known to raise SIDS risk.

These percentages didn't change much over the seven years covered by the study, suggesting that the success of getting the "baby on back" message out to new parents has stalled.

Outreach to particular groups also seems warranted, the study authors noted.

For example, among parents of babies aged 4 months, rates of non-supine infant sleep in 2022 were much higher among Black or Hispanic babies (23.2% and 21.6%, respectively) than white infants (7.1%), the report found.

Income mattered, too: Nearly a quarter (24.5%) of 4-month-olds born into families in lowest income bracket were put to bed in non-supine positions, Zhang's team found, compared to just 6.7% of infants from the most affluent homes.

Similar trends were found when it came to parental education, with rates of non-supine infant sleep much higher among parents with less than a college degree.

Finally, the younger the mother, the more likely it was that a baby would be put to sleep on their side or tummy. In 2022, this happened for 15.5% of 6-month-olds born to moms under the age of 30, compared to 11.9% of babies born to women over 30, the study found.

All of these numbers mean that efforts must be redoubled to reach parents who haven't gotten the potentially lifesaving "baby on back" message.

"Evidence-based interventions that promote safe sleep practices, particularly among younger age groups where SIDS is more prevalent, could help reduce sleep-related infant mortality [death]," Zhang and colleagues concluded.

More information

Get the details on the AAP's infant sleep recommendations.

SOURCE: JAMA Network Open, Dec. 12, 2024