In the last two decades, the health of infants in the U.S. has shown a consistent upward trend. From 1999 to 2022, the overall infant mortality rates dropped by 24%, attributed to improvements in obstetric care, neonatal technology, and the prevention of premature labor.
However, a new study published in JAMA Pediatrics (Jan. 27, 2025) indicates a troubling trend: while the overall infant mortality rate has declined, cases of sudden unexpected infant deaths (SUID) are on the rise.
Between 2020 and 2022, sudden unexpected infant death (SUID) rates surged by nearly 12%, reversing previous years of stability, as reported by researchers from Virginia Commonwealth University. SUID encompasses the sudden and unexplained death of an otherwise healthy infant under one year of age, including instances of sudden infant death syndrome (SIDS), accidental suffocation, and fatalities of unknown origins.
This trend is alarming—researchers emphasize that it’s not solely about where infants sleep but also why some parents find it challenging to establish safe sleep conditions in the first place.
Reasons behind the rise in SUID rates
One might think that merely enhancing education is the solution. Yet, many parents are already aware of safe sleep guidelines but struggle to implement them.
Discussions surrounding SUID often center on the locations where babies sleep—cribs versus couches, bassinets versus adult beds. While safe sleeping arrangements are crucial, the study specifically explored trends in SUID and identified several potential contributing factors.
According to lead author Elizabeth Wolf, M.D., M.P.H., associate professor of pediatrics at Virginia Commonwealth University (VCU) School of Medicine and pediatrician at Children’s Hospital of Richmond, “It’s challenging to determine exact causes, but COVID-19 and parental opioid use might be influencing factors.”
[The study suggests that COVID-19 and other respiratory illnesses may have contributed to the increase in SUID cases, though it does not clarify how. More research is warranted to assess the extent of this influence.]
Dr. Wolf further notes, “Social media possibly has an impact as well. On social platforms, it’s common to see infants in unsafe sleep positions, such as on their stomachs instead of their backs, or in inappropriate sleep settings like adult beds, couches, and baby swings.”
This is not merely a fleeting phenomenon; it affects parents’ views on safe infant sleep. Viral content can normalize unsafe arrangements, leading to misperceptions about their safety despite well-established dangers. A 2023 study indicated that 86% of baby sleep photos in a Facebook group for mothers depicted setups conflicting with AAP guidelines, highlighting the spread of misinformation. Though the study’s sample size was limited, the findings stress the importance of precise, evidence-based recommendations on safe sleep practices.
Disparities in SUID rates affect Black and Indigenous infants—data insights
The study reveals that Black infants are 10 times more likely to succumb to SUID than their Asian counterparts and three times more likely than white infants. Additionally, American Indian and Alaska Native infants experience SUID rates nearly 9.6 times those of Asian infants.
Although the study highlights these disparities, it does not examine the underlying causes. Dr. Wolf emphasizes the necessity for further research to uncover the contributions of sleep environment, prematurity, exposure to tobacco, and feeding practices.
Importantly, these disparities extend beyond personal parenting practices—they reflect broader systemic inequalities.
The importance of safe sleep transcends parenting—it’s about accessibility
The study highlights the rise in SUID deaths, but does not thoroughly investigate why parents may struggle to adhere to safe sleep guidelines. Nevertheless, broader research into maternal and infant wellness indicates several significant obstacles:
Lack of Paid Leave
Although the study did not delve into parental leave, experts in maternal health have long acknowledged how economic stress and exhaustion affect infant sleep environments.
The U.S. stands out as one of the few developed countries without guaranteed paid maternity leave. As a result, many new parents—particularly those in low-income or hourly positions—are compelled to return to work just weeks after childbirth.
Newborns typically wake every two to three hours, meaning that weary parents operate on minimal, fragmented sleep while balancing work and family demands. A mother who works night shifts with a newborn at home isn’t disregarding safe sleep recommendations when she inadvertently drifts off while holding her baby—she’s likely overwhelmed and short on viable options.
Sleep deprivation poses not just a challenge; it can also endanger safety.
Healthcare Access Inequalities
While the study emphasizes racial disparities in SUID rates, it does not explore healthcare access as a cause. However, other research indicates that routine pediatric appointments are crucial for educating families about safe sleep, yet families lacking consistent healthcare may miss these vital opportunities.
Infants who have regular check-ups receive ongoing safe sleep education, along with access to social services and early intervention. In contrast, families facing barriers related to insurance, transportation, or systemic healthcare biases might not receive the same level of care.
Unsafe Products on the Market
Public health experts have long raised alarms about how misleading marketing and dangerous sleeping products put infants at risk.
Parents are inundated with infant sleep items that purport to be safe but do not conform to AAP guidelines, such as inclined sleepers, sleep positioners, and padded crib bumpers.
- In 2022, the Safe Sleep for Babies Act prohibited the sale of harmful inclined…
- Despite the known dangers associated with certain products like sleepers and padded crib bumpers, they are still being advertised.
- A significant number of caregivers remain unaware that some of these items are associated with risks of suffocation fatalities.
- Enhancing the enforcement of safety regulations could help ensure families do not inadvertently buy dangerous products.
This issue doesn’t stem from a lack of parental concern regarding safe sleep; it reflects a system that is not effectively equipping them for success.
Addressing SUID demands more than education—it requires policy transformation
Dr. Wolf and her team of researchers assert that tackling sleep-related fatalities requires comprehensive reforms, rather than solely educational efforts.
“Improving access to health insurance and offering assistance to mothers before and after childbirth could help decrease infant mortality rates,” Dr. Wolf affirms.
Proponents of public health advocate that additional initiatives may further lower the rates of SUID:
- Paid family leave—to prevent fatigued parents from resorting to unsafe sleep practices.
- Increased healthcare access—to guarantee all parents receive similar standards of postpartum and pediatric care.
- Enhanced funding for safe sleep initiatives—to make cribs and bassinets available to all families.
- Stricter regulations on deceptive infant sleep products—to eliminate the confusion for parents about which products are safe.
- Greater lactation assistance—to support more families in initiating and maintaining breastfeeding, which studies have connected to a reduced risk of SIDS.
Safe sleep principles endorsed by AAP that every parent should be aware of
While systemic changes are necessary, parents can take prompt actions to lower the risk of SUID.
The study published in JAMA Pediatrics highlights the ongoing necessity of adhering to the safe sleep guidelines set forth by the American Academy of Pediatrics (AAP), which include:
- Always place your baby on their back to sleep (face up), which significantly diminishes the risk of suffocation.
- Utilize a firm, flat sleeping surface such as a crib or bassinet, devoid of soft bedding, pillows, or toys.
- Keep the crib or bassinet in your room for at least the first 6–12 months, but refrain from sharing your bed.
- Avoid allowing your baby to sleep in a swing, car seat, or on other non-flat surfaces, as these can obstruct the airway and elevate the risk of SIDS.
- Ensure the sleep environment is clear of blankets, bumpers, and stuffed animals, since soft objects could increase the risk of suffocation.
- Avoid smoking, alcohol, or drug usage during pregnancy or while caring for the baby.
- Dress your baby lightly and forgo head coverings to avert overheating, which is a recognized SIDS risk factor.
- Introduce a pacifier at sleep times. Research indicates that using a pacifier during sleep is correlated with a reduced risk of SIDS, even if it falls out after the baby has fallen asleep.
- Studies demonstrate that breastfeeding—even for a limited duration—is associated with a decreased risk of SIDS.
The key takeaway: It’s time to alter the discussion
The increase in SUID rates highlights that this concern transcends mere parenting—it is also a policy issue.
We cannot discuss safe sleep without considering aspects such as paid leave, accessible healthcare, and economic disparity. Advising fatigued parents to simply “adhere to the guidelines” without providing adequate structural aid is not a solution; it represents a failure in public policy.
The study lays out the facts—but it is imperative that policymakers, healthcare professionals, and society respond accordingly.
If we genuinely strive to lower SUID rates, we must pivot from questioning “Why aren’t parents following safe sleep guidelines?” to asking, “What resources can we provide to ensure every parent can do so?”
Because every infant deserves a secure sleeping environment—and every caregiver deserves the necessary support to create one.
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