Despite a significant decrease in Sudden Infant Death Syndrome (SIDS), infant sleep-related mortality continues to affect many families in North Carolina. Disparities continue to persist among non-Hispanic Black and American Indian infants who show higher rates of sleep-related deaths than other racial groups in North Carolina.
Causes of sleep-related infant death include suffocation, strangulation, entrapment, and Sudden Infant Death Syndrome (SIDS).
- Suffocation occurs when something (such as soft bedding, blankets, pillows, crib bumpers or overlay – when a person rolls onto the infant) prevents air from entering the infant’s lungs.
- Strangulation occurs when something cuts off the baby’s airway, such as a cord or piece of fabric.
- Entrapment occurs when a baby gets trapped or wedged in a small space or between two objects.
- Sudden Infant Death Syndrome (SIDS) occurs when an infant under the age of 1 year dies suddenly and unexpectedly, and the death cannot be explained after a thorough investigation is conducted, a complete autopsy, an examination of the death scene and a review of the baby’s medical history.
Sudden Infant Death Syndrome
Sudden Infant Death Syndrome (SIDS) occurs when infants under the age of 1 die suddenly and unexpectedly and the death cannot be explained after a thorough investigation, a complete autopsy, an examination of the death scene, and a review of the baby’s medical history. According to the Centers for Disease Control and Prevention, the overall rate of SIDS in the United States declined by more than 50% since 1990. However, better investigations of unexpected infant deaths and greater adoption of safe sleep practices may have contributed to fewer SIDS deaths.
The cause of SIDS remains unknown, however there are some risk factors that can make infants more vulnerable to SIDS including brain abnormalities (which may impact a baby’s ability to control breathing, heart rate, waking, etc.), being born premature or low birthweight, having a respiratory infection, stomach or side sleeping, sleeping on a soft surface or co-sleeping with an adult or other child.
- 90% of SIDS cases occur before six months of age.
- Higher rates of SIDS are observed in boys compared to girls.
- African American infants also tend to show higher rates of SIDS compared to white infants.
- SIDS is not preventable (but the risk of SIDS can be reduced with safe sleep practices).
Sleep-Related Infant Death Risks Factors
The following factors are believed to increase the risk of SIDS or sleep-related infant 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 birthweight (born less than 2,500 grams, or 5 lbs. 8 oz.)
- Multiple births (twins, triplets, etc.)
- Not breastfeeding
- Women using alcohol or illicit drug use during pregnancy and after birth
- Pregnant women not getting regular prenatal care
Unexpected Infant Death
An unexpected infant death is usually investigated to find the cause. An autopsy is done by a medical examiner or coroner. The baby’s health history is reviewed. Law enforcement examines the place where the baby died.
In North Carolina, counselors are available, at no cost, through local health departments. Counselors are trained in grief counseling and can help families deal with their loss. Counselors can:
- Provide support and answer questions
- Collect information about the baby’s health history and death
- Follow-up with the medical examiner’s office
- Help families understand the autopsy report
- Link the family with other local resources
Strategies to Reduce the Risk of Sleep-Related Infant Death and SIDS
- Avoid Smoke.
- Do not smoke or expose yourself to others’ smoke while you are pregnant and after the baby is born.
- Keep your car and home smoke-free at all times.
- Do not drink alcohol or use drugs while pregnant or after the birth.
- Get regular prenatal care to reduce your risk of having a low birthweight or premature baby.
Preparing for Baby
- Have a crib or bassinet with a firm mattress and fitted sheet.
- Keep pillows, quilts, comforters, bumper pads, stuffed toys and cords out of the crib.
- Make sure the baby’s room does not get too hot.
When Baby Comes Home
- 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 layer. Use clothing designed to keep babies warm without the risk of it covering their heads. Blankets are not recommended but 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.
- 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.
Strategies to Create a Safe Sleep Environment
- 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.
- 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
- All cribs sold after June 28, 2011 meet current safety standards.
- 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
- 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.
- Place your baby to sleep in the same room where you sleep but not in the same 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.
Safe Sleep, Child Care, and Childcare Licensing
Choosing Safe Child Care
- If you plan to enroll your infant in child care make sure that the place you are considering is licensed by the state of North Carolina. Licensed childcare providers are taking important steps to be informed about SIDS and are working to help your baby sleep safely. North Carolina has important legal and licensing requirements designed to reduce the risks of SIDS/ SUIDS in childcare settings.
- When considering a childcare provider ask if the childcare provider is ITS-SIDS certified and look for the ITS-SIDS symbol. Ask to see the provider’s “Safe Sleep” policy.
- You can read the Safe Sleep Rules for Caregivers to see how caregivers are helping keep babies safer while they sleep and the steps they are taking to keep SIDS from happening.
- North Carolina law and childcare licensing rules require that in childcare settings:
- Place babies, 12 months of age or younger, to sleep on their back. A waiver may apply under certain circumstances.
- Childcare providers must have a written safe sleep policy and must explain it to parents before the baby is enrolled.
- Providers must complete the Infant/Toddler Safe Sleep and SIDS Risk Reduction in Child Care(ITS-SIDS) training.
Help Make Child Care Sleep Time Easier for your Baby
- Teach your baby to sleep on his or her back from the beginning
- Use a crib, bassinet or playpen instead of a car seat, swing or infant carrier as a sleeping place
- Allow your baby to comfort himself instead of teaching him or her to depend on a stuffed animal or blanket as a comfort aid when falling asleep
- Talk with the childcare provider about your baby’s sleep patterns and sleep safety
- Give your awake baby tummy time for exercise, for play and for healthy development
Safe Sleep Materials and Websites
- My Baby’s Safe Sleep Checklist
Lower your baby’s risk of Sudden Infant Death Syndrome (SIDS) and infant sleep related death.
PDF version– English and Spanish
- Baby’s Safe Sleep poster
Steps to follow to safely put a baby to bed.
PDF version– English and Spanish
- Oh Baby! We want to keep you safe from secondhand smoke.
Tips for dealing with secondhand smoke
PDF version – English only
- If You Smoke and Are Pregnant
Self-help, quit smoking guide for women who are pregnant or thinking about pregnancy.
PDF version – English only
- healthychildren.org: a parenting website
From the American Academy of Pediatrics (AAP). Includes general information related to child health plus more specific guidance on parenting issues.
- National Institute for Child Health and Human Development
National Safe-to-Sleep Campaign with resources for parents, caregivers, and health and childcare providers.
- Healthy Child Care America
Safe Sleep Campaign with resources for parents and childcare providers.
- Consumer Products Safety Commission
Information about safe bedding products for infants