Sudden unexpected infant death (SUID) is the term used to describe the death of an infant who is less than 1 year old in which the cause of death was not obvious before investigation. SUID often occurs in the baby’s sleep area and includes sudden infant death syndrome (SIDS). The most current data (2014–18) reveal that 42% of infant deaths are now attributed to SUID. Almost 3,500 infants die from SUID in the United States each year, an average of nine babies every day. The U.S. Centers for Disease Control and Prevention tracks these numbers and there has been no decline in SUID rates in over two decades. Nationally, rates of SUID demonstrate significant racial and ethnic disparities with American Indian/Alaska Native and non-Hispanic Black infants experiencing 2x the rate of SUID compared to non-Hispanic White infants.
Safe sleep practices for infants are crucial to preventing SUID. Consistently, the sleep environment has been shown to be a risk factor in these cases. The Safe to Sleep Campaign, a public education effort led by the National Institute of Child Health and Human Development, highlights that learning about safe infant sleep is important for all caregivers, not just for parents.
In this month’s Voices of Child Health in Chicago report, we explore infant sleep practices in Chicago. We asked 692 Chicago parents who had a child between 0–5 years old about their youngest child’s sleep practices when the child was an infant (12 months old or younger), as well as other family demographic and health questions.
More than half of Chicago parents (58%) reported engaging in one or more unsafe sleep practices
with their infants. These included putting the baby to sleep in unsafe locations, such as in the parent’s own bed or the bed of another person (37%) or in a car seat or bouncy seat (6%). Parents also reported putting their babies to sleep with unsafe objects including a loose blanket (46%), a pillow (31%), a stuffed animal or toy (26%), a quilt or comforter (18%), a crib bumper (9%) or a wedge (3%). Some parents put their babies down in less safe sleep positions; 17% said they put their baby down on their side and 8% said on their stomach.
Among the safe sleep practices that parents reported were putting their baby to sleep in recommended locations such as a crib (64%), a portable crib (10%) and a bassinet (10%), and putting their baby to sleep swaddled (22%), in a sleep sack (20%) or with a pacifier (30%). The majority of parents reported putting their baby down on his or her back (75%), the safest position for infant sleep.
We found differences in sleep practices by parent race/ethnicity but not by parent age or gender. Latinx parents (67%) were the most likely to engage in at least one unsafe infant sleep practice (67%), followed by Black parents (65%), Asian/Other-race parents (56%) and White parents (46%).
Additionally, we found that parents with a high school education or below were most likely to engage in one or more unsafe infant sleep practices (68%), followed by those with some college or technical school (58%) and those with a college degree or higher (50%). Infant sleep practices also differed by household income — parents with low household income (<100% federal poverty level [FPL], in 2021, the FPL for a family of four was $26,500) were most likely to engage in unsafe infant sleep practices (72%) followed by those with middle income (100–399% FPL; 64%), and those with high income (400%+ FPL; 45%).
We asked parents where they received advice about how to help their baby sleep through the night. The most common sources of advice were a doctor or nurse (70%), family (58%), social media/blogs/websites (30%), book or pamphlet (27%), friends or neighbors (22%) or WIC programming (13%).
We asked parents how much they trusted the infant sleep information they received from the sources they selected. The most trusted sources of information were noted respectively as WIC programming (73% said they trusted the information from this source “very much”), doctor or nurse (69%), family (50%), book or pamphlet (38%), friend or neighbor (24%) and lastly, social media/blogs/websites (17%).
We also asked parents how easy it was to implement the safe infant sleep recommendations from these sources. Recommendations that were the easiest to implement came from WIC programming (69% said it was “very much” easy to implement the recommendations from this source), a doctor or nurse (57%), a friend or neighbor (38%) or social media/blogs/websites (26%), with the hardest recommendations to use coming from a book or pamphlet (26%).
The following recommendations are from the National Institutes of Health's Safe to Sleep guidelines and can help infants under one year of age sleep safely:
Always place the baby on their back to sleep.
Place the baby to sleep alone, on a firm, flat surface. The mattress can have a fitted sheet, but there should be no other bedding in their sleep space.
Keep the baby’s sleep space free from toys, crib bumpers, stuffed animals or other soft objects.
Consider giving the baby a pacifier for sleep.
Avoid overheating and overbundling the baby.
Make sure the baby gets regular care from a healthcare provider.
Do not smoke during pregnancy, and do not allow smokers around the baby.
Breastfeed if it is possible for you.
Share your room (but not your bed) with your baby until at least 6 months of age.
The Fussy Baby Network is a group that serves parents and families who are struggling with their baby’s crying, sleeping or feeding. Learn more at: https://www.erikson.edu services/fussy-baby-network/ or call 888.431.2229.