An infant laying on mothers lap with her hands supporting the head.
A mother holds her baby's head. Credit: shutterstock

When the American Academy of Pediatrics recommended that babies be placed on their back to sleep in the 1990s, the number of sleep-related infant deaths declined for a period of time but have plateaued since then. 

Today, unsafe infant sleep is the leading cause of preventable death for children under the age of 1 in Colorado and nationally.

Within a five year span (2017 to 2021) in Colorado, 241 babies passed away from Sudden Unexpected Infant Death, said Amanda Abramczyk-Thill, an injury prevention and outreach specialist for Children’s Hospital Colorado

Sudden Unexpected Infant Death includes Sudden Infant Death Syndrome, otherwise known as SIDS, which is the sudden and unexplained death of an infant younger than 1 year old.

Accidental suffocation and strangulation in bed, ill-defined deaths and undetermined causes also fall under the umbrella of Sudden Unexpected Infant Death. 

Over half of the deaths within the five year period involved an asphyxiation risk, an adult or another individual rolled on top of the baby while sleeping or the baby was wedged between two objects, said Abramczyk-Thill. 

With no guaranteed way to prevent SIDS, a safe sleep environment will help lower the risk of all sleep-related infant deaths.  

What research shows

In the United States, nearly 3,500 infants die each year of sleep-related infant deaths, according to the American Academy of Pediatrics updated 2022 policy statement

Children’s Hospital Colorado states between 50 to 80 babies have died from SIDS each year in Colorado since 2004. 

Additionally, most deaths occur in babies between two and four months of age and the rate of SIDS tends to increase during the colder months, according to Children’s Hospital Colorado. 

Multiple sources have said African American babies are twice as likely and Native American babies are about three times more likely to die of SIDS than white babies. 

Although there has been research into SIDS, doctor’s don’t know the exact reason why SIDS affects infants. However, there are factors in a baby’s sleep environment that can put them at higher risk. 

“What we’re finding with further investigation of the actual circumstances is that a lot more cases involve that accidental suffocation and strangulation,” said Abramczyk-Thill. “They’re also finding that it may be undetermined.”

The single largest risk factor for SIDS is stomach sleeping. Some researchers believe that the sleeping position puts pressure on the baby’s jaw, narrowing the airway and therefore, making breathing more difficult. 

Other possible theories provided by Children’s Hospital Colorado include that the position would increase the baby’s risk of “rebreathing” exhaled air. When a baby breathes in exhaled air, the available oxygen level in the body decreases. 

Another theory suggests there could be an abnormality in the part of the brain that controls breathing and helps the baby wake up during sleep. 

According to the American Academy of Pediatrics, the risk of sleep-related infant death can be up to 67 times higher when a baby sleeps with someone on a couch, soft armchair or cushion. 

Other factors that put babies at a higher risk for SIDS include but are not limited to overheating from excessive sleepwear or blankets, covering the baby’s head and low birth weight. 

Expert recommendations and tips

Experts encourage parents, caregivers and grandparents to follow the ABCs of safe sleep. 

A is for alone. Don’t sleep in the same bed as the baby, instead, place a crib next to the bed.

B is for back. Place the baby on their back to sleep, which includes naps. 

“It also helps their lungs expand to the way they’re supposed to,” said Abramczyk-Thill. “So they can get the necessary oxygen and air so they can breathe while they are sleeping.”

Babyies can be placed on their tummy for supervised play time. 

As every baby is different, Abramczyk-Thill said it is important to speak with your pediatrician about those guidelines and timelines for your baby’s development. 

C is for crib. Experts say to use a crib or a bassinet that meets current safety standards of the Consumer Product Safety Commission at 

Within the crib, provide the baby with a firm sleep surface and keep the crib empty. Remove loose bedding, bumpers, blankets and toys as they can be a choking, suffocation or strangulation hazard. 

Abramczyk-Thill recommends alternatives to blankets, such as onesies or what is called a sleep sack. 

“That helps them maintain warmth while they’re sleeping without it potentially being a blanket that can get loose and can move up to their mouth and become a suffocation hazard,” said Abramczyk-Thill. 

Also, with the holidays approaching, Abramczyk-Thill encourages those traveling somewhere to ensure they have the infant’s separate sleep space, whether it’s a pack and play, crib or bassinet. 

When an infant is in a properly installed car seat in the vehicle, it’s safe for the infant to be in the car seat for up to an hour and a half to two hours. Take breaks at regular intervals to allow the baby to be removed from the car seat and held. 

“The car seat is not a safe sleep space outside of the vehicle,” said Abramczyk-Thill. 

The American Academy of Pediatrics recommends that if a baby falls asleep in a car seat, stroller, swing or sling, to remove the baby to a firm sleep surface on their backs as soon as possible. 

In addition to avoiding smoke exposure around the baby, alcohol and illicit drug or substance use, breastfeeding has shown to decrease the risk of SIDS. 

While it is not entirely clear why breastfeeding reduces the risk of sleep-related infant death, research in an American Academy of Pediatrics article suggests that breastfed infants are more easily aroused from sleep, the maternal responses to infant cues may be stronger and it improves baby’s immune systems. 

Additional resources

The American Academy of Pediatrics has put together tools and resources to help guide parents and caregivers on infant safe sleep. 

Detailed information can be found at

They have also partnered with the National Institute of Children’s Health Quality, the National Center for Fatality Review and Prevention and Sharp Insights, LLC to create a prevention program that is aimed to reduce the overall rates of Sudden Unexpected Infant Death. 

The Children’s Hospital Colorado website has a Safe Sleep Checklist created by the Colorado Infant Safe Sleep Coalition that can be found here. (En español aquí.

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