Safe Infant Sleep: A Refresher for Sleep Health Professionals

by | Nov 26, 2025 | News

By: Robyn Woidtke, MSN-Ed, RN, RPSGT, CCSH, FAAST

According to the most recent CDC data,1  (Sept 2024), in 2022, there were 3,700 infant deaths, which consisted of:

  • 1,529 deaths from SIDS.
  • 1,131 deaths from unknown causes.
  • 1,040 deaths from accidental suffocation and strangulation in bed.

What is SUID?

Sudden Unexpected Infant Death (SUID). According to a recent Stat Pearls article2, “SUID includes SIDS, accidental suffocation/asphyxia, and deaths due to uncertain circumstances.” The peak incidence of SIDS occurs at 2-4 months. A definition of SIDS is “the sudden unexpected death of an infant < 1 year of age, with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation, including performance of a complete autopsy and review of the circumstances of death and the clinical history.”3

A long-held model, the Triple-Risk model by Dr. Kinney et al., posits that distinct factors interact. One of the factors is the environmental/extrinsic component, which is probably the most modifiable (Figure 1). As noted in the figure, there is likely a combined risk when all the factors intersect, the critical development period, intrinsic, and extrinsic factors. Recent research has also demonstrated that material obesity may be a previously unconsidered risk factor.4 A 2025 review paper posits that intermittent hypoxemia is a primary pathologic mechanism for SIDS.5

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The Safe Sleep Initiative

The safe sleep initiative for infants is well known6; however, at times, individuals tasked with educating and training new parents and families may not be up to date with current recommendations. Although not all sleep centers or offices may have direct involvement in safe sleep initiatives, it is essential to have the most recent information to engage with the community when the opportunity arises. One of the most important things to consider is that these babies may die in their sleep, but the cause of death could be suffocation, wedging, or over-laying.

As healthcare professionals, particularly in the sleep health space, there is nothing more important than ensuring safe sleep practices for infants and reducing the risk. A,B,C , it’s as simple as that. Well, not really, but these are the main components. The American Academy of Pediatrics (AAP) guidelines provide the necessary information for discussing safe sleep with parents and other caregivers, as well as the community at large.

AAP general recommendations are below7, Table 1 elaborates on additional recommendations and can be accessed with this link.

  • Place infants on their backs for sleep in their own sleep space with no other people. 
  • Use a crib, bassinet or portable play yard with a firm, flat mattress and a fitted sheet. Avoid sleep on a couch or armchair or in a seating device, like a swing or car safety seat (except while riding in the car). 
  • Keep loose blankets, pillows, stuffed toys, bumpers, and other soft items out of the sleep space.
  • Breastfeed if possible and avoid smoking.

A Bit of History

Initially, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) promoted the “back to sleep” campaign, which started in 1994, when data from 1992, originating from Australia, Tasmania, and England, showed that sleeping on the stomach contributed to infant deaths. The term “Safe Sleep” emerged as a more encompassing term in 2012. 8

Numerous organizations and partners contribute to education and training to prevent this horrible event from happening. Both public and private, not-for-profit groups work together to educate health care providers and the community regarding safe sleep. A list of collaborators can be found here.

What can we, in the field of sleep, do to help?

It’s about lowering the risk. Safe Sleep! As professionals in the sleep health profession, we hold credibility with our knowledge of sleep, the importance of good quality and quantity of sleep, and the potential for associated sleep disorders; therefore, it should go without saying that providing your community with this information can be an excellent opportunity to reduce the risk of infant death.

A full complement of AAP recommendations is listed in Table 1.

Table 1 AAP Recommendations9

In our field, we do have contact with sleep-deprived patients, in particular, new parents may exhibit significant sleep deprivation. This article, Safe Sleep Tips for Sleep-Deprived Parents by the AAP is a helpful tool for sleep professionals to provide tips and also to refer new parents to.

In summary, as healthcare professionals, particularly in the field of sleep health, we have a fiduciary duty to be part of the larger medical community regarding safe sleep education and recommendations. Although sleep centers may not regularly engage with new parents and caregivers, we can still make meaningful contributions to this important matter.

If you are interested in a free, vetted presentation on this topic, please reach out to the California Sleep Society. This lecture is a members-only offering. Robyn Woidtke, completed her certification in safe infant sleep in October 2025. The KIDS Network certifies Safe Sleep Instructors (SSI) through their National SSI Certification program. The KIDS Network manages and is responsible for the curriculum which is based on the American Academy of Pediatrics (AAP), National Institute of Child Health and Human Development (NICHD), Centers for Disease Control (CDC) and Safe Kids guidance and recommendations. The SSI certification is endorsed by the Association of Maternal Child Health Programs (AMCHP) as a Best Practice and supported by the Kansas Department of Health and Environment (KDHE) Bureau of Family Health and Health Promotion and Safe Kids Kansas.

References:

  1. US Centers for Disease Control and Prevention. Data and Statistics for SUID and SIDS. https://www.cdc.gov/sudden-infant-death/data-research/data/index.html
  2. Kim H, Pearson-Shaver AL. Sudden Infant Death Syndrome. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560807/
  3. Horne RS, Harrewijn I, Hunt CE. Physiology during sleep in preterm infants: Implications for increased risk for the sudden infant death syndrome. Sleep Med Rev. 2024;78:101990. doi:10.1016/j.smrv.2024.101990
  4. Tanner D, Ramirez J, Weeks WB, Lavista Ferres JM, Mitchell EA. Maternal Obesity and Risk of Sudden Unexpected Infant Death. JAMA Pediatr. 2024;178(9):906–913. doi:10.1001/jamapediatrics.2024.2455
  5. Hegyi, T., Ostfeld, B.M. Reducing the risk of sudden unexpected infant death: the caffeine hypothesis. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02333-x
  6. Trachtenberg FL, Haas EA, Kinney HC, Stanley C, Krous HF. Risk factor changes for sudden infant death syndrome after initiation of Back-to-Sleep campaign. Pediatrics. 2012;129(4):630-638. doi:10.1542/peds.2011-141
  7. American Academy of Pediatrics. Safe Sleep https://www.aap.org/en/patient-care/safe-sleep/
  8. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health. Safe Sleep for Babies Campaign History. https://safetosleep.nichd.nih.gov/campaign/history
  9. Moon RY, Carlin RF, Hand I; TASK FORCE ON SUDDEN INFANT DEATH SYNDROME AND THE COMMITTEE ON FETUS AND NEWBORN. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics. 2022;150(1):e2022057990. doi:10.1542/peds.2022-057990