The Safe To Sleep message has supplanted the “Back to Sleep” message over the past decade as the drop in sudden unexpected infant deaths (SUID) has plateaued and the importance of sleep location has been clearly linked to the risk of infant death. Getting parents to follow the ABCs of safe sleep by placing infants to sleep Alone, on their Back, and in a Crib has been a challenge, with many parents struggling to follow the guidance of the American Academy of Pediatrics recommendations. In this month’s Pediatrics, (10.1542/peds.2021-053935) we are early releasing an article by Bryan et al from Seattle present results from a national survey of parents of infants and report on what parents do after infants wake up in the middle of the night.
I would characterize their findings as a mixed picture. The good news is that around 70% of parents report putting their infant to sleep on their back, in their own sleep location, and on an approved surface. Rates significantly higher than prior National Infant Sleep Position (NISP) Study results in the past. Unfortunately, only 44% of participants met all three safe sleep practices at sleep onset, 39% of infants had a secondary sleep position, and only 9% of them met all 3 criteria at both sleep onset and after a night wakening. Even more concerning, parents under 25 years of age, first time parents, parents of infants who were born preterm, and those with a smoker in the home had a lower adjusted prevalence of meeting all three safe sleep criteria at sleep onset – compounding multiple risk factors for SUID.
So where do we go from here? Our messaging needs to continue to evolve. We have progressed from “back to sleep” to “safe to sleep” but that might not be enough. We need to help parents problem solve and come up with strategies to put infants back into safe sleep environments after waking in the middle of the night. We will need more research to determine what messages and strategies work to help parents follow safe sleep guidance. Additionally, we will need to really focus on families with multiple risk factors such as those with tobacco exposure and young parental age. The bottom line is all pediatricians need to help empower families to reduce the risk factors for SUID at every visit from birth to age 1.
