Definition

Percentage of people who reported their newborn infants sleep on their backs.

Numerator

Number of mothers who reported their newborn infant most often sleeps on his or her back.

Denominator

Number of Utah residents who gave birth to live infant.

Why Is This Important?

About 3,400 babies in the U.S. die suddenly and unexpectedly every year while sleeping. Sudden infant death syndrome (SIDS) is the sudden and unexplained death of a baby younger than 1 year of age. Most SIDS deaths are associated with sleep. SUID (Sudden Unexpected Infant Death) includes all unexpected infant deaths: those due to SIDS, and those from other causes like accidental suffocation and entrapment. As the rate of SIDS has decreased, the rate of SUID has remained steady. Research has shown that placing babies on their backs to sleep is the most effective action that parents and caregivers can take to reduce the risk of Sudden Unexpected Infant Death (SUID).

Other Objectives

HP 2030 Objectives: MICH-D03: Increase the proportion of infants who are put to sleep in a safe sleep environment (developmental objective)

How Are We Doing?

In 2022, Utah Pregnancy Risk Assessment Monitoring System (PRAMS) data showed 86.0% of infants were most often put to sleep on their backs (recommended). This is an increase from 85.7% in 2021. During 2021-2022, 44.2% reported their babies did not always sleep alone in their own crib or bed and 51.0% said their babies slept with blankets, toys, cushions, or pillows, including nursing pillows (not recommended).

How Do We Compare With the U.S.?

According to the most recently available U.S. PRAMS data (2022), 82.4% of infants were most often put to sleep on their backs.

What Is Being Done?

The Safe to Sleep Campaign led by the National Institutes for Health (NIH) addresses SUID which includes all unexpected infant deaths: those due to SIDS, and those from other causes like accidental suffocation and entrapment. The Safe to Sleep campaign emphasizes placing an infant on his or her back to sleep as well as other ways to provide a safe sleep environment for infants. These include using a firm sleep surface; placing infants in their own sleep environment and not on an adult bed, couch, or chair; and ensuring no blankets, quilts, or other soft bedding is present in the infant bed. This includes keeping toys, crib bumpers, positional wedges, and soft sheepskins out of an infant's sleep area. The Safe to Sleep campaign recommends that infants sleep alone, not with an adult or anyone else. Safe to Sleep also emphasizes prenatal care, breastfeeding, the use of a pacifier when putting infant down to sleep, daily supervised tummy time, and immunization. Safe to Sleep advises avoidance of the following: infant exposure to tobacco smoke, mother's use of alcohol and other drugs, and use of commercial sleep devices (positioners, wedges).

Evidence-based Practices

SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment. American Academy of Pediatrics (AAP) [https://pediatrics.aappublications.org/content/138/5/e20162940]: #Place infants on their back to sleep (supine) for every sleep period until they are 1 year old. This position does not increase the risk of choking and aspiration. # Use a firm sleep surface. # Breastfeeding is recommended. # Infants should sleep in the parents' room, close to the parents' bed but on a separate surface designed for infants, ideally for the first year, but at least for the first six months. # Keep soft objects and loose bedding out of the infant's sleep area. # Consider offering a pacifier at naptime and bedtime. # Avoid smoke exposure during pregnancy and after birth. # Avoid alcohol and illicit drug use during pregnancy and after birth. # Avoid overheating and head covering in infants. # Pregnant women should obtain regular prenatal care. # Infants should be immunized according to the recommended schedule. # Avoid using commercial devices that are inconsistent with safe sleep recommendations, such as wedges and positioners. # Don't use home cardiorespiratory monitors as a strategy to reduce SIDS risk. # Supervised tummy time while the infant is awake can help development and minimize positional plagiocephaly. # There is no evidence to recommend swaddling to reduce the risk of SIDS. # Health care professionals and staff in newborn nurseries and neonatal intensive care units as well as child care providers should endorse and model recommendations to reduce SIDS risk. # Media and manufacturers should follow safe sleep guidelines in messaging and advertising. # Continue the Safe to Sleep campaign, focusing on ways to further reduce sleep-related deaths. # Research and surveillance should continue on all risk factors.

Available Services

Baby Your Baby[[br]] [https://babyyourbaby.org/infants/safe-sleep/][[br]][[br]] CDC Providing Care for Babies to Sleep Safely [[br]][https://www.cdc.gov/sudden-infant-death/sleep-safely/index.html][[br]] ==Information and referrals== National Center for Fatality Review and Prevention: [https://www.ncfrp.org][[br]] *Utah State Profile: [https://ncfrp.org/cdr-map/spotlight-utah/][[br]] [[br]] Sudden Death in the Young Registry: [https://www.sdyregistry.org/]

Health Program Information

As part of the Sudden Unexpected Infant Death (SUID) and Sudden Death in the Young (SDY) Case Registry, the CDC Division of Reproductive Health supports SUID monitoring programs in 22 states and jurisdictions (including Utah) covering about 1 in 3 SUID cases in the United States. Participating states and jurisdictions work to improve data quality on SUID cases. This effort leads to a better understanding of circumstances that may increase the risk of SUID.

Relevant Population Characteristics

Non-Hispanic Black and American Indian/Alaskan Native infants have a higher incidence of SUID and other sleep-related deaths. Poverty is another common risk factor for SUID because it can complicate a caregiver's ability to provide a safe sleep environment for their child.

Health Care System Factors

Pediatricians, family physicians, and other primary care providers should actively participate in the Safe to Sleep campaign. Providers should ensure infants be immunized according to the American Academy of Pediatrics/Centers for Disease Control and Prevention schedule. Furthermore staff in newborn nurseries and NICUs (newborn intensive care units) should endorse and practice the SIDS/SUID risk-reduction recommendations from birth.

Risk Factors

Risk factors for SUID include maternal smoking, environmental tobacco smoke, overheating/overbundling, having soft items in baby's sleeping area, being male, being 2-4 months of age, and being born preterm. In the U.S., African American and American Indian/Alaskan Native infants have higher incidence of SUID and other sleep-related deaths. According to 2021-2022 PRAMS data, mothers younger than 20 years of age are statistically less likely to put their babies to sleep on their backs when compared with mothers older than 20 years.

Health Status Outcomes

Since 1994 SIDS deaths have been dramatically reduced nationally by over 50%. However, deaths from other sleep-related causes have risen over the last decade.

Data Notes

*Use caution in interpreting; the estimate has a coefficient of variation > 30% and is therefore deemed unreliable by Utah Department of Health and Human Services standards.

Data Source

Utah Department of Health and Human Services Pregnancy Risk Assessment Monitoring System (PRAMS)

Data Source

Utah Department of Health and Human Services Pregnancy Risk Assessment Monitoring System (PRAMS)

References and community resources

"SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment." Task Force on Sudden Infant Death Syndrome, Pediatrics, October 17, 2011. Safe to Sleep Public Education Campaign. National Institute of Child Health and Human Development (NICHD)[[br]] [http://www.nichd.nih.gov/sts] The Centers for Disease Control and Prevention (CDC), Division of Reproductive Health[[br]] [https://www.cdc.gov/sudden-infant-death/index.html] The American Academy of Pediatrics (AAP)[[br]] [https://www.aap.org] The American College of Obstetricians and Gynecologists (ACOG)[[br]] [http://www.acog.org/]