Sudden unexpected infant death claimed the lives of about 3,400 babies in the United States in 2024. Despite decades of public health efforts to promote safer sleep, these deaths remain a major cause of mortality during infancy. A new report from the U.S. Centers for Disease Control and Prevention found that nearly three-quarters of these deaths examined from 2020 through 2024 involved unsafe sleep factors. That means there are steps parents and caregivers can take. The first one is knowing about a safe sleep environment looks like. I spoke with CNN wellness expert Dr. Leana Wen to learn what parents and other caregivers do to reduce an infant’s risk. Wen is an emergency physician and clinical associate professor at George Washington University. She previously served as Baltimore’s health commissioner and is the mother of two young children. CNN: What did a new CDC report find about sudden unexpected infant death? Dr. Leana Wen: Sudden unexpected infant death, or SUID, is a general term for the sudden and unexpected death of a baby younger than 1 year. It includes sudden infant death syndrome, or SIDS, as well as accidental suffocation and strangulation in bed, and infant deaths for which the cause remains unknown. For this report, the CDC analyzed 4,861 SUID cases that occurred between 2020 and 2024 in 31 jurisdictions around the country that participate in its case registry. This registry provides detailed information about the circumstances surrounding deaths that is not available from death certificates alone. The main finding is that 73 per cent of the deaths were classified as having unsafe sleep factors. Looking at specific characteristics of the sleep environment, 78 per cent involved soft bedding; 75 per cent occurred on a sleep surface other than a crib or bassinet; 59 per cent involved sharing a sleep surface with another person or animal; and 46 per cent of infants were found sleeping on their stomach or side rather than their back. (These categories overlap, so an infant could have had several of these risk factors.) There were also substantial racial disparities. Black infants accounted for 38 per cent of the deaths in the registry, and the CDC noted that sudden unexpected infant death disproportionately affects Black and American Indian or Alaska Native infants. The reasons are complex and can include differences in access to resources in order to consistently implement safe sleep practices. CNN: What should a safe sleep environment look like? Wen: The American Academy of Pediatrics recommends babies be placed on their backs for every sleep, including naps. The sleep surface should be firm, flat and designed for infant sleep, such as a crib, bassinet or portable crib that meets current federal safety standards. The crib should be empty or nearly empty. Use a firm mattress covered by a fitted sheet, without pillows, blankets, quilts, bumper pads or other soft objects. If parents are concerned about their baby being cold, they can use a wearable blanket or other well-fitting sleep clothing rather than putting a loose blanket in the crib. The AAP recommends room-sharing without bedsharing, ideally for at least the first six months. That means the baby’s crib or bassinet can be next to the parents’ bed, which makes feeding and comforting easier, but the baby should sleep on a separate surface. Babies should always be placed on their backs to sleep. Tummy time is important for developing strength and motor skills, but it should take place only when the baby is awake and being actively supervised. Once babies can roll from their backs to their stomachs and back again on their own, parents do not need to keep repositioning them during sleep, but they should still place them on their backs at the beginning of every sleep. These recommendations apply every time and everywhere the baby sleeps. It is not enough to have a safe crib at home if the baby sleeps differently at a grandparent’s or babysitter’s house. Everyone caring for an infant should follow the same practices, and families should stick to the practices when travelling. CNN: Why are soft bedding and sharing a bed with an infant dangerous? Wen: Young infants have limited ability to move their heads and bodies if something interferes with their breathing. Soft bedding poses a particular danger because a pillow, blanket or other object can cover a baby’s nose and mouth, and the infant may not be able to reposition themselves to breathe. Sharing a sleep surface creates additional risks. An adult, child or animal can unintentionally roll onto the baby or otherwise obstruct the baby’s airway. Infants can also become wedged between a mattress and a wall, headboard or other object. This is why adult beds are not considered safe sleep surfaces for infants. Couches and armchairs can be even more dangerous. A baby can become trapped between cushions or between the sleeping adult and the furniture. The CDC data illustrate these dangers. Among the 919 deaths that investigators determined were caused by suffocation involving unsafe sleep factors, 74 per cent involved soft bedding obstructing the airway. About one in four involved “overlay,” meaning another person or animal obstructed the infant’s airway, and 8 per cent involved the baby becoming wedged between objects. Some deaths involved more than one mechanism. CNN: What other steps can parents and caregivers take to reduce the risk of sudden unexpected infant death? Wen: The most important step is to follow safe sleep practices every time the baby sleeps. That means placing the baby on their back in their own crib or bassinet, without soft bedding or other objects around them. Parents should also avoid smoking and nicotine use during pregnancy and prevent the baby from being exposed to secondhand smoke after birth. Exposure to cigarette smoke increases the risk of SIDS, so no one should smoke or vape around the baby or in the home or car. They should also avoid alcohol, marijuana, opioids and illicit drugs during pregnancy and after delivery. These substances can increase risk during pregnancy, and their use by parents and other caregivers can impair their ability to wake up and respond to an infant. In addition, AAP recommends breastfeeding and offering a pacifier at naps and bedtime, because these are also associated with a reduced risk of SIDS. Pregnant women should receive routine prenatal care, and babies should be sure to receive their recommended vaccinations. CNN: What should parents do if their baby falls asleep in a car seat, stroller, swing or baby carrier? Wen: Car seats are essential tools for protecting infants while travelling in vehicles, but they are not meant to be routine sleep spaces outside the car. Babies commonly fall asleep in car seats, strollers and baby carriers, and parents do not need to worry when that happens. Once they reach their destination, parents should move the baby to an appropriate surface designed for infants. The main worry is the baby’s position. Young infants have relatively large heads and limited head and neck control. On an inclined or sitting surface, their heads can fall forward or their bodies can shift into a position that compromises breathing. As far as swings, parents should be wary if it’s promoted as something that helps sleep. A product being sold for infants does not mean that it is appropriate for unsupervised sleep. The safest choice remains a firm, non-inclined surface that meets infant sleep safety standards. CNN: What about exhausted parents who bring a baby into bed to feed or comfort them? Wen: This is an important practical issue because nighttime feedings happen when parents are understandably exhausted. Parents can make it easier to follow safe sleep practices by keeping the baby’s crib or bassinet next to their bed. After feeding or comforting the baby, they should return the infant to this separate sleep space before going back to sleep themselves. If a parent unintentionally falls asleep while feeding the baby in bed, they should return the baby to the crib or bassinet as soon as they wake. Pillows, blankets and other soft objects should be kept away from the baby during feeding in case the parent dozes off. Katia Hetter, CNN
