Sleep Position

Sleep Position in United States

United States

Every year 3,500 infant deaths are reported in the United States as a result of sleep-related problems. The Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend putting babies to sleep on their backs to reduce the risk of sudden unexpected infant deaths. Putting a baby to sleep in a facedown or side sleep position is the most significant contributing factor in sudden unexpected infant deaths.

Mothers at a disproportionate risk for not placing an infant to sleep in a face-up position include:

• Those with a high school education or less compared with those with education beyond high school.
• Those who lack health insurance or have Medicaid compared with those with private insurance.
• Those with a provider who did not advise mothers on sleep position or who may believe or have been poorly advised that a facedown sleep position prevents infant choking or that it is the best position for infant comfort. Mothers who received correct advice from their providers were 28% more likely to use the correct back sleep position.

Non-Hispanic Black mothers, who are more than twice as likely to place infants in a face-down position than their white counterparts.

The American Academy of Pediatrics has identified sleep-related recommendations to reduce the risk of sudden unexpected infant death. These include:

• Placing infants face-up for sleep on a firm, flat surface until age 12 months unless the infant has a medical reason to sleep in a different position.
• Avoiding soft objects, loose bedding and crib bumpers in the infant's sleeping area.
• Sleeping in the same room as the infant, but not in the same bed.
• Avoiding overheating.

Increased education on the recommended guidelines is needed for new and expecting mothers to keep infants safe during sleep, especially mothers at high risk of not placing their infant to sleep in a face-up position. It is also critical to ensure pediatricians and other health care providers are educated on safe sleep practices and communicate the correct recommendations to parents.

A Healthy People 2030 objective is to increase the percentage of infants sleeping face-up.

Bombard, Jennifer M., Katherine Kortsmit, Lee Warner, Carrie K. Shapiro-Mendoza, Shanna Cox, Charlan D. Kroelinger, Sharyn E. Parks, et al. 2018. “Vital Signs: Trends and Disparities in Infant Safe Sleep Practices — United States, 2009–2015.” MMWR. Morbidity and Mortality Weekly Report 67 (1): 39–46. https://doi.org/10.15585/mmwr.mm6701e1.

Hirai, Ashley H., Katherine Kortsmit, Lorena Kaplan, Erin Reiney, Lee Warner, Sharyn E. Parks, Maureen Perkins, Marion Koso-Thomas, Denise V. D’Angelo, and Carrie K. Shapiro-Mendoza. 2019. “Prevalence and Factors Associated With Safe Infant Sleep Practices.” Pediatrics 144 (5): e20191286. https://doi.org/10.1542/peds.2019-1286.

Moon, Rachel Y., Rebecca F. Carlin, and Ivan Hand. 2022. “Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment.” Pediatrics 150 (1): e2022057990. https://doi.org/10.1542/peds.2022-057990.

Moon, Rachel Y., Marit Kington, Rosalind Oden, Joana Iglesias, and Fern R. Hauck. 2007. “Physician Recommendations Regarding SIDS Risk Reduction: A National Survey of Pediatricians and Family Physicians.” Clinical Pediatrics 46 (9): 791–800. https://doi.org/10.1177/0009922807303894.

Von Kohorn, Isabelle, Michael J. Corwin, Denis V. Rybin, Timothy C. Heeren, George Lister, and Eve R. Colson. 2010. “Influence of Prior Advice and Beliefs of Mothers on Infant Sleep Position.” Archives of Pediatrics & Adolescent Medicine 164 (4). https://doi.org/10.1001/archpediatrics.2010.26.