Overview to Infant Safe Sleep and SIDS

Why is Infant Safe Sleep Important?

From 2010-2014, more than 125 North Carolina babies died each year related to sleeping. While sleep-related deaths due to Sudden Infant Death Syndrome (SIDS) have decreased greatly over the years, deaths from other sleep-related causes have increased. Some of these deaths could have been prevented. Sleep-related death rates for non-Hispanic, Black and American Indian infants remain higher than the rest of the state’s population.

Definition of Sleep-Related Infant Death:

Death of a baby linked to how or where the baby slept. Causes include:

  • Suffocation – Something blocks air from entering the baby’s lungs like soft bedding, blankets, pillows, crib bumpers or overlay (when a person rolls onto the baby).
  • Strangulation – When something cuts off the baby’s airway, like when a cord or piece of fabric gets wrapped around the baby’s neck.
  • Entrapment – A baby gets trapped or wedged in a small space or between two objects.

Definition of SIDS:

Sudden Infant Death Syndrome (SIDS) is the sudden death of an infant under one year of age that remains unexplained after a thorough case investigation, including a complete autopsy, examination of the death scene and review of the baby’s medical history.


  • Mostly occurs before six months of age (90%), but can happen later
  • Claims slightly more boys than girls
  • Occurs at a higher rate among African American babies than White babies
  • Is not preventable (but the risk can be reduced)

According to the Centers for Disease Control and Prevention, the overall rate of SIDS in the United States has declined by more than 50% since 1990. It is believed that better investigations of unexpected infant deaths and greater adoption of safe sleep practices have contributed to fewer SIDS deaths.

Why Does SIDS Happen?

The cause of SIDS remains unknown. It is known that some risk factors can make a baby more vulnerable to SIDS. Some of these risk factors include brain abnormalities (which may impact a baby’s ability to control breathing, heart rate, waking, etc.), being born premature or low birthweight, having a respiratory infection, stomach or side sleeping, sleeping on a soft surface or co-sleeping with an adult or other child.

What are Sleep-Related Risks?

Research has identified factors that can put a baby at risk for SIDS or a sleep-related death:

  • Tummy or side sleeping
  • Sleeping on a soft sleeping surface (couch, adult mattress, chair)
  • Cluttered sleeping area (crib bumpers, pillows, fluffy blankets or stuffed animals in crib)
  • Sleeping with parents or anyone else
  • Not sleeping in a crib or bassinet
  • Overheating or excessive swaddling
  • Baby’s exposure to secondhand smoke or a mother who smokes while pregnant
  • Premature birth (born before 37 weeks gestation)
  • Low birthweight (born less than 2,500 grams, or 5 lbs. 8 oz.)
  • Multiple births (twins, triplets, etc.)
  • Not breastfeeding
  • Women using alcohol or illicit drug use during pregnancy and after birth
  • Pregnant women not getting regular prenatal care

After a Baby Dies Unexpectedly

An unexpected infant death is usually investigated to find the cause. An autopsy is done by a medical examiner or coroner. The baby’s health history is reviewed. Law enforcement examines the place where the baby died.

In North Carolina, counselors are available, at no cost, through local health departments. Counselors are trained in grief counseling and can help families deal with their loss. Counselors can:

  • Provide support and answer questions
  • Collect information about the baby’s health history and death
  • Follow-up with the medical examiner’s office
  • Help families understand the autopsy report
  • Link the family with other local resources

Prevent Sleep-Related Infant Deaths and Reduce SIDS

Is the room safe where your baby sleeps?

Find out here. Learn what you can do to make the room your baby sleeps in is as safe as it can be.

Mom – Before Baby is Born

  • Do not smoke or expose yourself to others’ smoke while you are pregnant and after the baby is born.
  • Do not drink alcohol or use drugs while pregnant or after the birth.
  • Get regular prenatal care to reduce your risk of having a low birthweight or premature baby.

Recommended Safe Sleep Practices

  • Place your baby to sleep on his back for naps and at night. If your baby can roll from his back to his side or stomach on his own, he can be left that way.
  • If your baby falls asleep in a car, stroller, swing, infant carrier or infant sling move her to a crib or bassinet as soon as possible.
  • Breastfeed as long as you can. Studies show that breastfeeding reduces the risk of SIDS. Exclusive breastfeeding (no baby formula) is best, but any breast milk is better than none.
  • Make sure your baby goes to all scheduled doctor visits and gets all recommended shots. Evidence suggests that immunizations may protect against SIDS.
  • Offer a dry pacifier (without a string) at nap time and bedtime. This helps reduce the risk of SIDS. If breastfeeding, wait at least 4 weeks (until breastfeeding is established) before offering a pacifier. If baby does not take a pacifier, do not force it.
  • Don’t let your baby get too hot. Dress him in one layers. Use clothing designed to keep babies warm without the risk of it covering their heads. Blankets are not recommended.*
  • Do not use home breathing or heart monitors to reduce the risk of SIDS. These can be helpful for babies with breathing or heart problems. They have not been found to reduce the risk of SIDS.
  • Do not use products that claim to reduce the risk of SIDS. Wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS. Some infants have suffocated using these items.
  • *If you decide to use a blanket, make sure it is tucked into the crib mattress to keep it from becoming loose and covering your baby’s face. Use the “feet-to-foot” guidelines: Put the baby so his feet are near the foot of the crib. Place a lightweight blanket across the baby’s chest just under the arm pits. Tuck the blanket securely along the two sides and foot of the crib.

Create a Safe Sleep Environment (for naps and nighttime)

  • Always place your baby to sleep in a safe crib, bassinet or portable crib.
  • Never let your baby sleep on a sofa, water bed, chair, cushion, car seat or anywhere else.
  • A safe crib must meet all requirements outlined below:
    • Have a firm mattress that is the correct size
    • Be less than 10 years old
    • Have slats that are no more than 2 3/8 inches (60 mm) apart
    • Be assembled using the manufacturer’s instructions
  • All cribs sold after June 28, 2011 meet current safety standards.
  • Cribs should NOT have:
    • Missing, broken or loose parts
    • Chipped, cracked or peeling paint
    • A drop side
    • Bumper pads (crib bumpers)
    • Corner posts that extend above the sides of the crib
    • Cut-out designs in the headboard or footboard
  • Keep soft objects, loose bedding, bumper pads, pillows, quilts, comforters, sheepskins, and stuffed toys out of the crib. These items can cause your baby to suffocate.
  • Place your baby to sleep in the same room where you sleep but not in the bed. Keep the crib or bassinet within an arm’s reach of your bed. Babies who sleep in the same bed as their parents are at greater risk of sleep-related death.
  • Keep your baby away from people who are smoking and places where people smoke. If you smoke, try to quit. Keep your car and home smoke-free. Do not smoke anywhere near your baby and don’t let others either – even if you are outside.
  • Do not let your baby get too hot. Keep the room where your baby sleeps at a comfortable temperature.

Choosing Safe Child Care

Before Going to Child Care

If you plan to enroll your infant in child care make sure that the place you are considering is licensed by the state of North Carolina. Licensed childcare providers are taking important steps to be informed about SIDS and are working to help your baby sleep safely. North Carolina has important legal and licensing requirements designed to reduce the risks of SIDS/ SUIDS in childcare settings.

Ask Your Caregiver


When considering a childcare provider ask if the childcare provider is ITS-SIDS certified and look for the ITS-SIDS symbol. Ask to see the provider’s “Safe Sleep” policy.

You can read the Safe Sleep Rules for Caregivers to see how caregivers are helping keep babies safer while they sleep and the steps they are taking to keep SIDS from happening.

Know the NC Prevent SIDS Law

North Carolina law and childcare licensing rules require that in childcare settings:

Know the Law

North Carolina law and childcare licensing rules require that:

  • Help prepare your baby by making sleep time in child care easier:
    • Teach your baby to sleep on his or her back from the beginning
    • Use a crib, bassinet or playpen instead of a car seat, swing or infant carrier as a sleeping place
    • Allow your baby to comfort himself instead of teaching him or her to depend on a stuffed animal or blanket as a comfort aid when falling asleep
    • Talk with the childcare provider about your baby’s sleep patterns and sleep safety
    • Give your awake baby tummy time for exercise, for play and for healthy development
    • For ideas on how to make your baby’s awake tummy time interactive and fun, download your copy of See How We Grow (plain text version.)

Multimedia Resources for Infant Safe Sleep

We want you to know how to lower the risk of Sudden Infant Death Syndrome (SIDS) and Infant Sleep Related Deaths. In this section you can learn what steps to take by watching our webisodes, downloading our podcast (coming soon) on safe sleep and then test your knowledge with one of our interactive games.


Safe Sleep Webisodes

  • Webisode #1
    What is an infant safe sleep space? (242 MB)
    Although Sudden Infant Death Syndrome or SIDS cannot be prevented, there are some things you can do to reduce the risk. The most important thing is to provide your baby with a safe sleep environment. This video outlines many of the things that parents can do at home to reduce the risk of SIDS. See what an infant safe sleep space should look like.
  • Webisode #2
    How to overcome the challenges of infant back sleeping (241 MB)
    If we know back to sleep reduces the risk of SIDS, why doesn’t everyone put their baby on their back? This video describes some of the challenges to back sleeping and dispels some of the misunderstandings related to it. Find out how you can overcome some of these challenges.
  • Webisode #3
    Where should your baby sleep? (271 MB)
    Babies need their own separate sleep space: “A crib or bassinet protects your baby best”. Learn more about what you can do to make your baby’s sleep space safer.
  • Webisode #4
    Introduction to BESST flipchart (257 MB)
    Whether you are new to educating about infant safe sleep or it’s been awhile since you attended the Baby’s Easy Safe Sleep Training (BESST), this video details how to effectively use the BESST flipchart.
  • Webisode #5
    FAQ’s about safe sleep (494 MB)
    This video answers many of the questions that anyone might have about SIDS and infant safe sleep. It will be particularly helpful for SIDS educators/BESST trainers, but provides valuable information for anyone interested in infant safe sleep practices.
  • Webisode #6
    Sharing safe sleep messages with Latina moms (397 MB)
    In this webisode, we share some tips about reducing SIDS and other infant sleep related deaths in relation to working with Latina moms. We provide background on Latino culture and traditions and some phrases in Spanish to help you communicate with Latina moms.
  • Webisode #7
    What is an infant safe sleep space? (291 MB)
    This webisode in Spanish provides Latino parents and caregivers information about SIDS and how to set up a safe sleep environment for their baby.

Podcasts – Coming soon to iTunes

  • Presently, access the audio “Baby’s Safe Sleep – a message about keeping your baby safe ” English or Spanish (Total run time: 5:59)

Is Your Baby’s Crib a Safe Sleep Environment?

See if you can remove all the unsafe items in “Our Crib”

Safe Sleep Crossword Puzzle

Test your knowledge of safe sleep for a baby. (Printable PDF)

PSA “Danger”

Keep your baby safe. Learn more about how to reduce the risk of SIDS. (View on YouTube)

Publications and Websites for Infant Safe Sleep


  • My Baby’s Safe Sleep Checklist
    Lower your baby’s risk of Sudden Infant Death Syndrome (SIDS) and infant sleep related death.
    PDF version – English (154KB)
    PDF version – Spanish (184KB)
    Plain text version
  • Baby’s Safe Sleep poster
    Steps to follow to safely put a baby to bed.
    PDF version – English (72 KB)
    PDF version – Spanish
    Plain text version – English and Spanish
  • Keeping Baby Safe at Home
    Safe sleep tips for babies from Neonatal Intensive Care Units.
    PDF version (161 KB)
    Plain text version
  • Oh Baby! We want to keep you safe from secondhand smoke.
    Tips for dealing with secondhand smoke
    PDF version (247 KB)
    Plain text version
  • If You Smoke and Are Pregnant
    Self-help, quit smoking guide for women who are pregnant or thinking about pregnancy.
    PDF version (254 KB)
    Plain text version
  • Say No to Bumper Pads
    New research shows that bumper pads can be dangerous and cause babies to suffocate.
    PDF version – English
    PDF version – Spanish
  • Say No to Bumper pads flyer
    A flyer that explains the dangers bumper pads can cause with ABC’s of Babies safe sleep
    PDF version – English
    PDF version – Spanish