Safer sleep practices for babies can be a matter of life or death, CDC data shows

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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 US 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.

New ‘heartbreaking’ study reveals racial disparities in neonatal deaths

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% of the deaths were classified as having unsafe sleep factors. Looking at specific characteristics of the sleep environment, 78% involved soft bedding; 75% occurred on a sleep surface other than a crib or bassinet; 59% involved sharing a sleep surface with another person or animal; and 46% 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% 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 traveling.

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% involved soft bedding obstructing the airway. About one in four involved “overlay,” meaning another person or animal obstructed the infant’s airway, and 8% 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 traveling 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.

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2024 年，美国约有 3400 名婴儿因猝死而丧生。尽管几十年来公共卫生部门一直在努力推广更安全的睡眠，但这些死亡仍然是婴儿死亡的主要原因之一。

美国疾病控制与预防中心的一份新报告发现，在 2020 年至 2024 年期间调查的这些死亡案例中，近四分之三都与不安全的睡眠因素有关。

这意味着家长和监护人可以采取一些措施。首先，他们需要了解安全的睡眠环境应该是什么样的。

我采访了CNN健康专家莉娜·温博士，了解父母和其他照护者如何降低婴儿的风险。温博士是乔治·华盛顿大学的急诊医生和临床副教授。她曾担任巴尔的摩市卫生局局长，也是两个孩子的母亲。

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CNN：美国疾病控制与预防中心（CDC）的一份新报告对婴儿猝死综合症（SND）发现了什么？

莉安娜·温博士：婴儿猝死综合征（SUID）是指1岁以下婴儿突然意外死亡的总称。它包括婴儿猝死综合征（SIDS）、意外窒息和勒死，以及死因不明的婴儿死亡。

在本报告中，美国疾病控制与预防中心（CDC）分析了2020年至2024年间发生在全国31个参与其病例登记系统的司法管辖区的4861例婴儿猝死综合征（SUID）病例。该登记系统提供了仅凭死亡证明无法获得的详细信息，包括死亡的具体情况。

主要发现是，73%的死亡案例被归类为存在不安全睡眠因素。具体分析睡眠环境特征发现，78%的案例涉及柔软的床上用品；75%的案例发生在婴儿床​​或摇篮以外的睡眠表面；59%的案例涉及与他人或动物共用睡眠表面；46%的婴儿被发现俯卧或侧卧而非仰卧。（这些类别存在重叠，因此一名婴儿可能同时存在多种风险因素。）

种族差异也十分显著。登记在册的婴儿死亡案例中，黑人婴儿占38%，美国疾病控制与预防中心（CDC）指出，婴儿猝死综合征对黑人、美洲印第安人和阿拉斯加原住民婴儿的影响尤为严重。造成这种现象的原因很复杂，可能包括不同群体在获取资源方面存在差异，从而难以持续有效地实施安全睡眠措施。

CNN：安全的睡眠环境应该是什么样的？

温：美国儿科学会建议，婴儿每次睡眠，包括小睡，都应该仰卧。睡眠表面应坚实、平坦，并专为婴儿睡眠设计，例如符合现行联邦安全标准的婴儿床、摇篮或便携式婴儿床。

婴儿床内应保持空旷或几乎空置。使用结实的床垫，铺上贴身的床单，不要放置枕头、毯子、被子、床围或其他柔软物品。如果父母担心宝宝着凉，可以使用可穿戴的毯子或其他合身的睡衣，而不是在婴儿床里铺上松散的毯子。

美国儿科学会建议，理想情况下，至少在婴儿出生后的前六个月，应与父母同室但不同床。这意味着婴儿的婴儿床或摇篮可以放在父母的床边，这样便于喂奶和安抚，但婴儿应该睡在单独的床上。

婴儿睡觉时应该始终仰卧。俯卧时间对于发展婴儿的力量和运动技能很重要，但只能在婴儿清醒且有人主动照看的情况下进行。一旦婴儿能够自主地从仰卧翻身到俯卧，父母就不需要在睡眠中不断调整他们的睡姿，但每次入睡前仍然应该让他们仰卧。

这些建议适用于婴儿睡眠的任何时间和地点。如果婴儿在祖父母家或保姆家的睡眠习惯不同，即使家里有安全的婴儿床也无济于事。所有照顾婴儿的人都应该遵循相同的做法，家庭在旅行时也应坚持这些做法。

CNN：为什么柔软的床上用品和与婴儿同床睡眠很危险？

温：婴幼儿如果呼吸受到阻碍，头部和身体的活动能力有限。柔软的床上用品尤其危险，因为枕头、毯子或其他物品可能会盖住婴儿的口鼻，导致婴儿无法调整呼吸姿势。

共用睡眠表面会带来额外的风险。成人、儿童或动物可能会无意中翻身压到婴儿，或者阻塞婴儿的呼吸道。婴儿也可能被卡在床垫和墙壁、床头板或其他物体之间。这就是为什么成人床不被认为是婴儿安全睡眠表面的原因。沙发和扶手椅可能更加危险。婴儿可能会被卡在靠垫之间，或者卡在熟睡的成人和家具之间。

美国疾病控制与预防中心（CDC）的数据印证了这些危险。在调查人员确定的919例因不安全睡眠因素导致的窒息死亡案例中，74%的案例涉及柔软的床上用品阻塞呼吸道。约四分之一的案例涉及“重叠”，即其他人或动物阻塞了婴儿的呼吸道，8%的案例涉及婴儿被卡在物体之间。有些死亡案例涉及不止一种窒息机制。

CNN：父母和监护人还可以采取哪些其他措施来降低婴儿猝死的风险？

温：最重要的一步是每次宝宝睡觉时都要遵循安全的睡眠习惯。这意味着要让宝宝仰卧在自己的婴儿床或摇篮里，周围不要有柔软的床上用品或其他物品。

父母在孕期应避免吸烟和使用尼古丁，并在婴儿出生后防止其接触二手烟。接触香烟烟雾会增加婴儿猝死综合征（SIDS）的风险，因此任何人都不应在婴儿周围、家中或车内吸烟或使用电子烟。此外，父母在孕期和产后还应避免饮酒、吸食大麻、服用阿片类药物和使用非法毒品。这些物质会增加孕期风险，并且父母和其他照护者使用这些物质会损害他们唤醒和回应婴儿的能力。

此外，美国儿科学会建议母乳喂养，并在婴儿午睡和睡前使用安抚奶嘴，因为这些做法也与降低婴儿猝死综合征（SIDS）的风险有关。孕妇应接受常规产前检查，婴儿应确保接种所有推荐的疫苗。

CNN：如果婴儿在汽车座椅、婴儿车、摇椅或婴儿背带中睡着了，父母应该怎么办？

温：汽车安全座椅是保护婴儿乘车安全的必备工具，但它们并非设计成在车外作为日常睡眠场所。婴儿经常会在汽车安全座椅、婴儿车和婴儿背带中睡着，父母不必为此担心。

到达目的地后，父母应将婴儿转移到适合婴儿的平面上。最需要注意的是婴儿的姿势。婴幼儿的头部相对较大，头部和颈部的控制能力有限。在倾斜或坐姿的平面上，婴儿的头部可能会向前倾，或者身体可能会移位到影响呼吸的姿势。

至于婴儿摇椅，如果宣传其有助于睡眠，家长就应该提高警惕。一款标榜为婴儿专用的产品并不意味着它适合无人看管的婴儿睡眠。最安全的选择仍然是符合婴儿睡眠安全标准的坚固、平整的床面。

CNN：那么，那些筋疲力尽的父母把婴儿抱到床上喂奶或安抚自己呢？

温：这是一个重要的实际问题，因为夜间喂奶时父母通常都很疲惫。父母可以将婴儿床或摇篮放在自己床边，这样更容易让宝宝睡得安全。喂奶或安抚完宝宝后，父母应该先把宝宝放回这个单独的睡眠空间，然后再自己入睡。

如果父母在床上喂奶时不慎睡着，醒来后应立即将婴儿放回婴儿床或摇篮中。喂奶时，应将枕头、毯子和其他柔软物品远离婴儿，以防父母睡着。

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