It’s important that the more than 61,496 babies in Colorado today are surrounded by parents, family, friends, neighbors, licensed and unlicensed child care providers, health care professionals and communities working to create environments for infants to thrive and sleep safely.2
Safe Sleep for Every Baby Everywhere
All families deserve to have the support they need to create environments at home and in the community for their infants to sleep safely.
The ABC’s of safe sleep are simple and easy. Babies should be Alone on their Backs and in a Crib.
You don’t need any fancy equipment to make sure a baby is sleeping safely, just a firm, flat surface, separate from adults or others without any bumpers, soft bedding, or stuffed toys.
Avoid Inclined Infant Sleepers
Things like swings and bouncy chairs with padding and soft sides, as well as crib bumpers, can cause a baby to suffocate. New federal safety standards for infant sleep products will help make smart choices to keep kids safe easier, whether you are preparing for a new baby yourself or shopping a baby registry.
American Academy of Pediatrics Updates Safe Sleep Recommendations: Back is Best
In June 2022, the American Academy of Pediatrics (AAP) updated Safe Sleep Recommendations.
To reduce the risk of sleep-related infant death, the AAP recommends:
The baby should sleep on a firm, flat non inclined surface that, at a minimum, adheres to the June 2021 Consumer Product Safety Commission’s rule that any infant sleep product must meet existing federal safety standards for cribs, bassinets, play yards, and bedside sleepers. Parents should not use products for sleep that aren’t specifically marketed for sleep.
- Sitting devices, such as car seats, strollers, swings, infant carriers, and infant slings, are not recommended for routine sleep in the hospital or at home, particularly for infants younger than 4 months.
- Breastfeeding reduces the risk of sleep-related infant deaths, and while any human milk feeding is more protective than none, 2 months of feeding at least partial human milk feeding has been demonstrated to significantly lower the risk of sleep-related deaths. The AAP recommends exclusive human milk feeding for 6 months, with the continuation of human milk feeding for 1 year or longer as mutually desired by parent and infant.
- AAP recommends that parents sleep in the same room – but not in the same bed as a baby, preferably for at least the first six months.
- Avoid parent and infant exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs.
- Make sure the baby receives routine immunizations.
- Pacifier use is associated with reducing risk.
- Avoid the use of commercial devices that claim to reduce the risk of SIDS or other sleep-related deaths. There is no evidence that any of these devices reduce the risk of these deaths. Notably, the use of products claiming to increase sleep safety may provide a false sense of security and complacency for caregivers. Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.
- Supervised, awake tummy time is recommended to facilitate infant development and to minimize the development of positional plagiocephaly. Parents are encouraged to place the infant in tummy time while awake and supervised for short periods beginning soon after hospital discharge, increasing incrementally to at least 15 to 30 minutes daily by 7 weeks of age.
- There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS. If infants are swaddled, always place them on the back. Weighted swaddles, weighted clothing or weighted objects on or near the baby are not safe and not recommended. When an infant exhibits signs of attempting to roll (which usually occurs at 3 to 4 months but may occur earlier), swaddling is no longer appropriate, as it could increase the risk of suffocation if the swaddled infant rolls to the prone position.
Prevention is Possible
We know we need to do more than educate EVERYONE taking care of an infant on safe sleep practices to ensure no family experiences the unimaginable loss of an infant.
The good news is most recent results related to infant sleep position and environments among families in Colorado indicate that most families in Colorado are practicing safe sleep. 10
The Pregnancy Risk Assessment Monitoring System (PRAMS) collects jurisdiction-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy. This information is critical to reducing health problems among mothers and babies, including SUID.
%
Non-Hispanic white mothers reported that they most often lay their infants down to sleep on their backs.
%
Mothers in Colorado reported they most often lay their infants down to sleep on their backs.
%
Black mothers reported that they most often lay their infants down to sleep on their backs.
%
Non-Hispanic in Colorado reported usually placing their infant to sleep in a crib, bassinet, or portable play yard in the last two weeks.
%
Mothers in Colorado reported usually placing their infant to sleep in a crib, bassinet, or portable play yard in the last two weeks.
%
Black mothers in Colorado reported usually placing their infant to sleep in a crib, bassinet, or portable play yard in the last two weeks.
Infant mortality is an important indicator of overall health and well-being of our nation, the State of Colorado, tribal sovereign nations within our region and local communities.
Heartbreaking Loss of an Infant's Life
Sudden unexpected infant death (SUID) describes deaths of infants under age 1 that occur suddenly and unexpectedly, whether explained or unexplained. 3
These deaths often occur during sleep. The term includes the tragic loss of life due to:
Accidental Suffocation and Strangulation in Bed (ASSB)
Accidental Suffocation and Strangulation in Bed, or ASSB, occurs when something limits a baby’s breathing, like when soft bedding or blankets are against their face or when a baby gets trapped between two objects, such as a mattress and wall.4,5
Sudden Infant Death Syndrome (SIDS)
Sudden infant death syndrome (SIDS) is assigned to deaths that cannot be explained after a thorough investigation including a death scene investigation, autopsy and review of the clinical history. 6
Undetermined Causes
Assigned to infant deaths when the cause is unknown. This may occur when the requirements for a SIDS classification are not met.7
The Colorado Child Fatality Prevention System (CFPS) is a statewide, multidisciplinary, multi-agency effort to prevent child deaths housed at the Colorado Department of Public Health and Environment in the Violence and Injury Prevention – Mental Health Promotion Branch of the Prevention Services Division.
Download the CFSP 2021 Annual Legislative Report
Download the data brief analysis of sudden unexpected infant death (SUID) data from
CFPS.
Sudden unexpected infant death (SUID) is the leading cause of infant mortality in the United States and third leading cause of death for Coloradans under age 18. 8
- From 2015-2019, the Colorado Child Fatality Prevention System identified 237 infants who died by SUID, 14.3% of all infant deaths under age 1 in Colorado. 14.3%
Of the 237 infants who died tragically by SUID during these years, none slept in a space that met all of the American Academy of Pediatrics’s Recommendations for a safe infant sleeping environment. 9
Chronic Stress Leads to SUIDS
When a person is stressed, their body releases stress hormones, including epinephrine, adrenaline, and cortisol, which normally act to protect the body.
However, experiencing chronic stress causes these hormones to continuously pump into the body, no longer protecting the individual and instead causing damage.12
These biological processes attributed to chronic stress are associated with negative birth outcomes, including low birthweight and preterm birth.
These risks increase the likelihood of the sudden unexpected death of an infant. 13
Some families more than others experience community inequities associated with increased infant mortality, such as food insecurity.14, 15, 16, 17, 18
%
Non-Hispanic White people in Colorado lack reliable access to affordable, nutritious food.
%
Non-Hispanic American Indian or Alaska Native people in Colorado lack reliable access to affordable, nutritious food.
%
Black people in Colorado lack reliable access to affordable, nutritious food.
Racial segregation leads to neighborhood disadvantage by concentrating neighborhood poverty
Increasing exposure to environmental stressors such as air pollutants
Creating barriers to and fewer opportunities for a healthy lifestyle
housing and food insecurity 19
Driven largely by discriminatory federal, state, and local policies, such as redlining, that create unjust geographic divisions among racial and ethnic groups, neighborhood poverty, racial residential segregation can determine infant mortality.20,21, 22, 23
Social, economic, and environmental inequities in Colorado explain why Colorado communities are experiencing significant infant mortality rate disparities.
Upstream prevention strategies are needed to address social and structural inequities to reduce Sudden unexpected infant death in Colorado, in addition to continued education for parents, family, friends, neighbors, licensed and unlicensed child care providers, health care professionals to practice safe sleep at home and in the community.
The American Academy of Pediatrics (AAP) provides recommendations for a safe infant sleeping environment to help reduce the risk of SUID. In addition to these recommendations, the Colorado Child Fatality Prevention System also recommends expanded safe sleep education, modeling, and discharge safety screening at birthing hospitals in your community.28
Birthing hospitals play a vital role in supporting and educating caregivers and families about safety in the home, including the need to practice infant safe sleep.
Health care providers and hospital staff are sources of trusted information for new parents. We are missing an opportunity to help families thrive, even after a family has left the hospital, by focusing on safe sleep in these precious first few days together.
Encourage Hospitals and Health Care Facilities Commit to Practicing and Modeling Safe Sleep
At least six states require hospitals and health care providers to give parents and caregivers educational materials and
information on infant safe sleep practices within health care settings, during a hospital stay or at discharge.30, 31 The depth and breadth of safe sleep practices and policies at Colorado’s birthing hospitals is not widely or easily known.
Encourage hospitals and health care facilities to commit to practicing and modeling safe sleep by participating in the Cribs for Kids National Safe Sleep Hospital Certification program.
Hospitals participating in this no-cost program receive resources and support in drafting safe sleep policies for their organization, training for all health care providers in safe sleep, safe sleep educational materials for families and caregivers, and support for modeling safe sleep in all settings (labor and delivery, NICUs, etc.) and messaging around safe sleep in alignment with the AAP’s recommendations.
Cribs for Kids also provides a step-by-step hospital certification toolkit that guides organizations through certification requirements at the bronze, silver, or gold levels depending on their commitments, policies, and practices related to infant safe sleep.
Of all the hospitals in Colorado, only one is currently certified by Cribs for Kids: Valley View Hospital in Glenwood Springs, which is certified at the gold level.29
Get Involved in Colorado
The mission of the Colorado Infant Safe Sleep Partnership is to support families, providers, organizations and policymakers to increase infant safe sleep practices and address related barriers and disparities, through education, practice change and systems improvement.
Community Education & Awareness
>> Sign up to receive the Illuminating safe sleep newsletter to receive monthly highlighted tools for safe sleep awareness, updates from the ISSP and ideas for ways parents, caregivers, organizations and communities can create safe sleep for every baby everywhere.
Start Planning Your October #SafeSleepSnap Activities
Infant safe sleep and SIDS awareness month is a great time to talk about how to practice safe sleep with the little ones in your life and create change in your community to prevent the heartbreaking loss of an infant’s life.
Safe Infant Sleep & Breastfeeding
Share videos to help explain ways to practice safe infant sleep and breastfeeding. Available in English & Spanish.
Get Information and Materials
Get Safe to Sleep® materials to share with parents, grandparents and health care providers.
Explore the Campaign
Safe to Sleep® started in 1994 as Back to Sleep to teach people about reducing the risk of SIDS. Learn more about the Safe to Sleep® campaign.
Citations
- Colorado Health Information Dataset (CoHID), Live Birth Statistics, Counts, 2020 Colorado Department of Public Health and Environment retrieved on August 2021 from https://cohealthviz.dphe.state.co.us/t/HealthInformaticsPublic/views/COHIDLiveBirthsDashboard/LiveBirthStatistics.
- Colorado Health Information Dataset (CoHID), Live Birth Statistics, Counts, 2020 Colorado Department of Public Health and Environment as of August 2021 https://cohealthviz.dphe.state.co.us/t/HealthInformaticsPublic/views/COHIDLiveBirthsDashboard/LiveBirthStatistics.
- Child Fatality Prevention System; Sudden Unexpected Infant Death Data, 2014-2018, Colorado Department of Public Health and Environment, 3.
- Moon, R. Y., & Task Force on Sudden Infant Death Syndrome. (2016). SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics, 138 (5), e2-e34.
- Shapiro-Mendoza, C. K., Kimball, M., Tomashek, K. M., Anderson, R. N., & Blanding, S. (2009). U.S. infant mortality trends attributable to accidental suffocation and
strangulation in bed from 1984 through 2004: are rates increasing?. Pediatrics, 123 (2), 533-539. - Willinger, M., James, L. S., & Catz, C. (1991). Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatric Pathology, 11(5), 677- 684.
- Schnitzer, P. G., Covington, T. M., & Dykstra, H. K. (2012). Sudden unexpected infant deaths: sleep environment and circumstances. American Journal of Public Health, 102(6), 1204-1212.
- Colorado Child Fatality Prevention System. (2015-2019). Colorado Department of Public Health and Environment.
- Child Fatality Prevention System. (2021). Child Fatality Prevention System Annual Legislative Report. Colorado Department of Public Health and Environment, 40.
- Pregnancy Risk Assessment Monitoring System Data: 2018. Center for Health and Environmental Data, Colorado Department of Public Health and Environment.
- Williams, R., & Mohammed, S. A. (2013). Racism and health I: Pathways and scientific evidence. American behavioral scientist, 57(8), 1152-1173.
- Grimm, , & Cornish, D. L. (2018). Infant Mortality and Racism in the United States. International Journal of Undergraduate Research and Creative Activities, 10(1), 2.
- Bartick, , & Tomori, C. (2019). Sudden infant death and social justice: A syndemics approach. Maternal & child nutrition, 15(1), e12652.
- Office of Health Equity, Colorado Department of Public Health and Environment, Health Inequities Fact Sheet 2019: American Indian & Alaska Native Coloradans Fact Sheet. Retrieved from drive.google.com/file/d/1unUSRd37yCMzGQY2Lhco7KzPDRoSMOri/view.
- Office of Health Equity, Colorado Department of Public Health and Environment, Health Inequities Fact Sheet 2019: Black/African American Coloradans Fact Sheet. Retrieved from drive.google.com/file/d/1s0dh56JHqKpbduwjh0_9MUVY_EfBysrg/view.
- Anthopolos, R., James, S. A., Gelfand, A. E., & Miranda, M. L. (2011). A spatial measure of neighborhood level racial isolation applied to low birthweight, preterm birth, and birthweight in North Carolina. Spatial and Spatio-Temporal Epidemiology, 2(4), 235-246.
- Holzman, C., Eyster, J., Kleyn, M., Messer, L. C., Kaufman, J. S., Laraia, B. A., …Elo, I. T. (2009). Maternal weathering and risk of preterm delivery. American Journal of Public Health, 99(10), 1864-1871.
- Child Fatality Prevention System; Sudden Unexpected Infant Death Data, 2014-2018, Colorado Department of Public Health and Environment, 8.
- Bailey, Z. D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the S.A.: evidence and interventions. The Lancet, 389(10077), 1453-1463.
- Office of Health Equity, Colorado Department of Public Health and Environment, Health Inequities Fact Sheet 2019: American Indian & Alaska Native Coloradans Fact Retrieved from drive.google.com/file/d/1unUSRd37yCMzGQY2Lhco7KzPDRoSMOri/view.
- Office of Health Equity, Colorado Department of Public Health and Environment, Health Inequities Fact Sheet 2019: Black/African American Coloradans Fact Sheet. Retrieved from drive.google.com/file/d/1s0dh56JHqKpbduwjh0_9MUVY_EfBysrg/view.
- Anthopolos, R., James, S. A., Gelfand, A. E., & Miranda, M. L. (2011). A spatial measure of neighborhood level racial isolation applied to low birthweight, preterm birth, and birthweight in North Spatial and Spatio-Temporal Epidemiology, 2(4), 235-246.
- Holzman, , Eyster, J., Kleyn, M., Messer, L. C., Kaufman, J. S., Laraia, B. A., …Elo, T. (2009). Maternal weathering and risk of preterm delivery. American Journal of Public Health, 99(10), 1864-1871.
- Child Fatality Prevention System; Sudden Unexpected Infant Death Data, 2014-2018, Colorado Department of Public Health and Environment, 9.
- Child Fatality Prevention System. (2021). Child Fatality Prevention System Annual Legislative Report. Colorado Department of Public Health and Environment, 41.
- Child Fatality Prevention System. (2021). Child Fatality Prevention System Annual Legislative Report. Colorado Department of Public Health and Environment, 41.
- Health Promotion Branch, Prevention Services Division.. (2020). The Role of Policies and Systems in Child Deaths in Colorado. Colorado Department of Public Health and Environment.
- Child Fatality Prevention System. (2021). Child Fatality Prevention System Annual Legislative Report. Colorado Department of Public Health and Environment, 41-42.
- National Conference of State Legislatures (NCSL). (2015). Sudden unexpected infant death legislation.
- The Network for Public Health Law. (2017). SUID Prevention, Infant Safe Sleep Law Table: Legal Provisions Relating to SUID Prevention in 5 States. Research conducted for the Colorado Department of Public Health and Environment. To access: https://drive.google.com/file/d/1NcPJerdHa1QrENg4nAdB2BPXqOeqJ8nl/view?usp=sharing
- Child Fatality Prevention System. (2021). Child Fatality Prevention System Annual Legislative Report. Colorado Department of Public Health and Environment, 41-42.
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Social Needs Influence Health Outcomes
To create environments at home and in the community for infants to sleep safely, we need to look at the conditions in which parents and caregivers are raising their new babies known to have a major impact on people’s health, well-being, and quality of life.
The stress brought on by the impact of these social needs can overload parents and caregivers, negatively influencing health outcomes for families and their infants.