October’s Safe Sleep Awareness Month is an opportunity to educate families about sleep practices that can prevent sudden unexpected infant death. Sudden unexpected infant death (SUID), which includes sudden infant death syndrome (SIDS), is the leading cause of injury death in infancy. According to the Centers for Disease Control (CDC), approximately 3,400 infants die from SUID each year, with numbers in Oregon averaging about 40 per year.

Many parents from a range of cultural backgrounds sleep with their babies at some point during their child’s infancy. However, SUID rates for American Indians, Alaska Natives and Non-Hispanic Black infants are more than twice those of white infants, pointing to persistent racial and ethnic disparities. To address these disparities, all Oregon Department of Human Services (ODHS) Child Welfare caseworkers receive training on how to engage families in discussion about safe infant sleep in a culturally responsive manner. When appropriate, caseworkers are encouraged to connect families to culturally responsive organizations and Tribes across the state such as the Healthy Birth Initiatives, Well Mama, the Confederated Tribes of Grand Ronde and others to help parents make informed decisions and reduce risk.

“Safe sleep is a priority at ODHS Child Welfare, because education and awareness can save lives,” Child Welfare Director Aprille Flint-Gerner said. “When we work with culturally responsive community partners and build trust with families, we can be more effective in improving infant safety.”

A national public health awareness campaign sponsored by the American Academy of Pediatrics reduced sleep-related infant deaths by 60 percent in the 1990s, but decreases have plateaued since 2000. ODHS works with the National Partnership for Child Safety, as well as state and other national partners, to promote updated recommendations in the Safely to their First Birthday practice and policy brief such as breastfeeding and ensuring infants sleep on their backs separately from caregivers in a crib to prevent risk of suffocation. Bed-sharing increases the risk of infant death by five to 10 times compared to infants who sleep in their own safe space. ODHS Child Welfare case managers can provide portable cribs with bassinet attachments that allow infants to be in their own space while remaining close to caregivers. About 500 portable sleep spaces are distributed by ODHS Child Welfare every year with over 2,800 provided since 2020.

Other resources offered through ODHS partners include support for lactation counseling, information on donor milk banks, and support for substance use problems. Infants who breastfeed are less likely to die from sleep-related infant death. While reasons for this are unclear, research suggests the increased wakefulness of breastfed infants may play a role. Human breast milk is less filling than formula, causing infants to wake up more frequently to feed. This can prevent them from falling into deep sleep which makes it harder to wake up if they stop breathing.

Oregon has a cross-system approach to reviewing fatalities and has become a leader in supporting other jurisdictions across the country to promote safe sleep. Education and training have shown results, with a decrease in infant fatalities reviewed by the ODHS Critical Incident Review Team (CIRT). As of October, there have been three infant deaths assigned for review by the ODHS Critical Incident Review Team. One of those deaths involved high-risk sleep practices while the other two are still pending investigation. In 2023, eight child fatalities reviewed by the ODHS Critical Incident Review Team were infants. Of those, six had high-risk sleep practices. In 2022, all 14 infants reviewed by the CIRT had high-risk sleep practices present at the time of the infant’s death.

Key safe sleep recommendations:

• Use ABCDs of safe sleep to remember the key recommendations, which stands for babies safely sleeping: Alone, on their Back, in a Crib, and with caregivers who Don’t Smoke.
• Use a crib, bassinet or portable play yard with a firm, flat mattress and a fitted sheet. Avoid sleeping on a couch or armchair or in a seating device, like a swing or car safety seat (except while riding in the car).
• Keep loose blankets, pillows, stuffed toys, bumpers and other soft items out of the sleep space.
• Breastfeed if possible and avoid smoking.

“We strive to reduce infant fatalities, and a big part of that is sharing this information so that all families are aware of what they can do to create a safe sleep environment and prevent the tragic loss of a child,” ODHS Child Welfare Director Aprille Flint-Gerner said.

Resources

• To learn more about safe sleep practices and preventing sudden unexpected infant death, visit the Oregon Health Authority’s Safe Sleep for Babies information or the American Academy of Pediatrics website.
• Sign up for Bright by Text for prenatal and parenting tips specific to your child’s age. Text messages are available in Spanish and English.