‘Back to Sleep’: Why Safe Sleep is Important for Babies

Protecting a baby is a full-time responsibility, even when they are asleep. In the United States, 3,400 babies die annually from sudden unexpected infant death (SUID), according to the Centers for Disease Control and Prevention.  

The CDC considers SUID deaths as SIDS (sudden infant death syndrome), unknown cause of death and accidental suffocation in a bed.  

Babies are most at risk for SIDS from birth to 1 year old.   

Throughout the years, sleeping recommendations for babies have evolved. In 2022, the American Academy of Pediatrics released an updated policy, “Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment,” to keep babies safe as they sleep.   

Ashley Ross, M.D., chief of neonatology and co-medical director for the award-winning Neonatal Intensive Care Unit (NICU) at Arkansas Children’s Hospital (ACH) in Little Rock, said safe sleep recommendations have changed over the years because health care is “dynamic.”   

"I think it's really important to understand that our understanding of science and health care is dynamic, and it changes. We have new techniques to investigate, we have new questions that we can ask and new ways to measure it. And so over time, there can be changes in recommendations, and sometimes it can be hard to keep track of that if you're a parent especially," Ross said. "So it's very important to reach out to your health care provider to understand what is the latest and greatest and best recommendation."   

Safe Sleep Tips   

Ross said there are three tips parents need to remember about safe sleeping environments for babies: 

• Do not let a baby sleep in bed with you 
• Always place a baby to sleep on their back
• Do not place anything in the crib with your baby; only a fitted sheet. 

If a baby is sleeping with you or in a crib with items like toys, stuffed animals, blankets and bumpers, they are at risk of being unable to breathe.   

"Babies are not real mobile in the very beginning, but they can scoot around, and they can get entangled in some of those items that are in the bed. They can get buried in some of those items and have difficulty breathing as a result of it. We know that babies who are not sleeping in a safe sleep situation are at an increased risk of what used to be called, 'crib death,'" now SIDS, Ross said. "And that's really the concern that we have. We know that there are things that we can do to help promote safe sleep and create the best environment for the baby to be healthy."   

The NICU care team, particularly nurses, works with families as they prepare to leave the NICU with their babies. Ross explained when a baby is in the NICU receiving 24/7 care and monitoring, some devices are present in their pod to position them in a certain way, depending on their medical condition. This changes when they are preparing to go home.   

"We start being very vocal about, 'It's time to start taking things out of the bed. It's time to start taking those positioning devices out of the bed.' And literally doing that when we're on rounds seeing patients, demonstrating what a safe sleep environment looks like for the families so they begin to have a model for what they can look at when they go home," Ross said. "Also, nurses are very important. They're the ones that are at the bedside 24 hours a day, and they spend a lot of time talking about safe sleep with families. They spend a lot of time modeling safe sleep."   

Sometimes, that means correcting myths like babies sleeping on their stomachs. Once a standard, it is now dangerous.   

"When it comes to safe sleep, we hear that. We hear that from grandparents who raised their children in a different era. And so, it's not just focusing in on the parent and making sure they understand what safe sleep is; it's really engaging the broader family, so they understand what safe sleep does as well because the recommendations have changed as we've gotten new information, new data," Ross said. "'Back to sleep' has been the standard for a number of years," since the 1990s.   

*This article was written by the Arkansas Children’s content team and medically reviewed by Ashley Ross, M.D.