The vital importance of understanding infant sleep safety measures

March 30, 2023

The conversation is etched in pediatrician Anna Morad’s memory.

“I was talking to a mom about safe sleep practices for her newborn. She was aware of what to do but kept her baby in the bed with her. I asked her why, and she didn’t hesitate to tell me that it was most important to protect the baby from gun violence that plagued her community,” recalled Morad, MD, director, Newborn Nursery at Monroe Carell Jr. Children’s Hospital at Vanderbilt. “She could move her baby faster if she heard gunshots.”

There are many reasons why an infant is placed in unsafe sleep circumstances, said Morad.

Her patient’s story is an example of an ever-increasing statistic not just in Tennessee, but across the country.

While the overall rate for infant sleep-related deaths has dropped, there is a significant and long-standing racial disparity that continues to worsen among Black infants.

According to Tennessee’s 2022 Child Fatality Annual Report, over the past five years, white infants accounted for most of the sleep-related infant deaths in Tennessee, but Black infants were three times more likely to suffer a sleep-related fatality.

Every year there are about 3,400 sleep-related deaths among infants in the United States.

In 2020, there were 115 infant sleep-related deaths in Tennessee, up from 103 in 2019, but a decrease from 2018, which saw 128 deaths.

“Our numbers in the state continue to be high, particularly since these deaths are potentially preventable,” said Morad, an associate professor of Pediatrics at Monroe Carell.

“We continue to see a larger percentage of deaths among Black infants. We don’t know why, and it’s been a problem we have struggled with for years.”

Morad wants to sound the alarm for more awareness about safe sleep practices.

Of the cases she has reviewed, she has noted babies who are left asleep in swings, co-sleep with parents or siblings, or have additional items in their sleep area that may have led to suffocation.

“This is a community issue, and education about safe sleep practices needs to be more widespread. We need to be talking about it before a child is born, during well-child checkups, at church, at day cares, at community centers, at schools … wherever there are infants, there needs to be discussion about how to safely put a child to sleep. No one thinks it will happen to them,” Morad said.

At Monroe Carell, Quality Improvement Analyst Melissa Hill, RN, leads a safe sleep quality improvement project that constantly checks infant beds in the nurseries, makes adjustments in real time, and has a discussion with the parent or caregiver in the room, said Morad.

Education and a book about safe sleep are also provided in multiple languages.

“Another concerning issue is unplanned co-sleeping after a late-night/early-morning feeding,” said Morad. “We work really hard to address that practice and even ensure that once a baby leaves the hospital that they have a separate and safe place to sleep.”

The ABCs of safe sleep mean babies are sleeping Alone, on their Backs and in a Crib.

Data from Tennessee’s 2022 report showed the main reasons for sleep-related deaths included unsafe bedding or toys in the sleeping area (86%), infants not sleeping in a crib or bassinet (69%), and infants not sleeping on their backs (56%).

In 2020, Tennessee’s infant mortality rate of 6.3 deaths per 1,000 live births exceeded the national rate of 5.6 deaths per 1,000 live births, according to the Tennessee Department of Health.

Sleep-related deaths account for approximately 20% of all infant deaths each year, with unsafe sleep environments being the third leading cause of infant death in Tennessee.

VUMC release