In my last blog I discussed the latest AAP recommendations regarding SIDS and other sleep-related infant deaths (SUIDS) and recommended having a discussion with new parents about SUIDS risk factors instead of just giving instructions. But you may still be wondering what can you do about the disproportionate number of black, Native American and Alaska native infants that die from these causes each year.

To understand the current situation, we must first look to the past. The Back to Sleep campaign has been successful overall.  Parents have received the message that infants should be placed in a supine position when sleeping — these rates increased from 13% to 72% from 1992 to 2001. Since 2001, the rates have increased only slightly to 75% and have remained relatively stable. 

Another advance has been the significant reduction in the number of deaths from SIDS from during this same time period from 120 per 100,000 to 56 per 100,000. Interesting, from 1996 to 2006, rates of accidental suffocation and strangulation in bed (ASSB) have increased from 3.8 per 100,000 to 13.8 per 100,000.  Some of the increase is likely due to the reclassification of some ASSB deaths that might have been labeled SIDS in the past.

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Unfortunately, statistics from black, Native American and Alaska native populations tell a different story.  In 2006, SIDS rates in black infants was 103.8 per 100,000, and for Native Americans and Alaska natives the numbers were even worse at 119.4 per 100,000.

Similarly, ASSB rates among blacks in that same year were 32.4 per 100,000, and 44 per 100,000 among Native American and Alaska natives.

Supine sleeping rates are also much lower among black infants (53%) compared with white infants (75%), and bed sharing – a known SUIDS risk factor – is more prevalent among blacks.

Here is where the opportunity lies. Be sure to take the time to listen to what your patients are saying about how and where they put their infants to sleep, and how and where nighttime feeding occurs. As healthcare providers we are responsible for reaching out to patients that belong to these racial and ethnic groups, discussing sleep environments and busting prevalent myths about healthy sleeping.

One of the barriers in promoting supine sleeping positions for infants is the misconception that it increases the risk for choking and aspiration. This is the reason that many people who had children before 1992, myself included, placed their infants to sleep on their bellies. Reassure your patients that studies have since demonstrated that the supine position does not increase choking risk, even in infants with gastroesophageal reflux. Remember that the previous compromise position of “side-lying” is not recommended, as it is easy for the infant to roll into the prone position.  

Many parents think that their baby is more comfortable, sleeps better and sleeps longer in the prone position. Although infants do arouse less often when placed on their bellies, the ability to arouse from sleep is a protective physiologic response that the supine sleeping assures will happen if something goes wrong.

Other parents worry that using a pacifier as a sleep aid can lead to dental problems later in their child’s life. However, the American Academy of Pediatric Dentistry states that pacifiers can be recommended for children younger than 3 years, as nonnutritive sucking is normal in these infants and will not cause long-term dental problems in this age group. Encourage parents to wait to introduce the pacifier until breastfeeding is well established, usually three to four weeks, the AAP recommends.

Hopefully you can assist not just parents in these higher risk groups, but all parents, identify ways they can increase the safety of their infants’ sleep environment, while at the same time fostering optimum feeding and attachment.

Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.


American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome.  “SIDS and other sleep-related infant Deaths: Expansion of recommendations for a safe infant sleeping environment.” Pediatrics. 2011; 128: e1341 -e1367.