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 (supine position) to reduce the risk of sudden unexpected infant deaths (SUIDs).

Parents and caregivers at a disproportionate risk for not placing an infant to sleep on their backs include:

• Those with a high school education or less compared with those with higher levels of education.
• Those who lack health insurance or have Medicaid compared with those with private insurance.
• Non-Hispanic Black and Hispanic women compared with white women.
• Those who were not told by their provider that supine is the only safe sleep position for their infant, or who were told something different. Caregivers who received correct advice from their providers were 28% more likely to place their babies to sleep on their back.

The American Academy of Pediatrics’ recently updated guidelines for reducing sleep-related infant deaths include:

• Placing infants on their backs for sleep on a firm, flat surface until age 12 months unless the infant has a medical reason to sleep in a different position.
• Removing soft objects, loose bedding and crib bumpers from the infant's sleeping area.
• Sleeping in the same room as the infant, but not in the same bed.
• Watching for signs of overheating and avoiding overdressing infants or covering their heads. 

Increasing new and expecting parents’ knowledge of the recommended guidelines is crucial to keep infants safe during sleep. It is also critical to ensure that pediatricians and other health care providers are educated on safe sleep practices and communicate the correct recommendations to parents.

Healthy People 2030 has an objective to increase the percentage of infants put to sleep on their backs.

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.