Sudden Infant Death Syndrome (SIDS) and Unsafe Bedding
Author: NIH/National Institute of Child Health and Human Development
Published: 2014/12/03 - Updated: 2025/02/04
Publication Type: Informative
Peer-Reviewed: Yes
Topic: Youth and Disability - Publications List
Page Content: Synopsis - Introduction - Main
Synopsis: Nearly 55% of U.S. infants are placed to sleep with bedding that increases risk of sudden infant death syndrome or SIDS.
Why it matters: This article provides a comprehensive overview of Sudden Infant Death Syndrome (SIDS) prevention strategies and crib safety guidelines, tailored to support caregivers, including those with disabilities or mobility challenges. It outlines evidence-based recommendations for reducing SIDS risks, such as sleep positioning and environment modifications, while addressing adaptive tools and techniques to assist parents or guardians who may require specialized equipment. The resource also emphasizes accessible, clear explanations of medical guidance, making it practical for diverse audiences, including seniors or individuals with disabilities involved in childcare. By combining actionable advice with inclusive solutions, it serves as a valuable reference for fostering infant safety in households facing unique physical or situational challenges - Disabled World (DW).
Introduction
Nearly 55 percent of U.S. infants are placed to sleep with bedding that increases the risk of sudden infant death syndrome, or SIDS, despite recommendations against the practice, report researchers at the National Institutes of Health, the Centers for Disease Control and Prevention, and other institutions.
Main Item
Soft objects and loose bedding - such as thick blankets, quilts, and pillows - can obstruct an infant's airway and pose a suffocation risk, according to the NIH's Safe to Sleep campaign. Soft bedding has also been shown to increase the risk of SIDS Infants should be placed to sleep alone, on their backs, on a firm sleep surface, such as in a mattress in a safety-approved crib, covered by a fitted sheet. Soft objects, toys, crib bumpers, quilts, comforters, and loose bedding should be kept out of the baby's sleep area.
Based on responses from nearly 20,000 caregivers, the researchers reported that, although such potentially unsafe bedding use declined from 85.9 percent in 1993-1995, it remained high, at 54.7 percent, in 2008-2010.
"Parents have good intentions but may not understand that blankets, quilts, and pillows increase a baby's risk of SIDS and accidental suffocation," said the study's first author, Carrie K. Shapiro-Mendoza, Ph.D., M.P.H., senior scientist in the CDC's Division of Reproductive Health in Atlanta.
The current study analyzes data from the National Infant Sleep Position Survey (NISP), which collected information on the influence of infant sleep position and other safe sleep recommendations on infant care practices. Funded by the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the survey collected information by telephone from a random sample of more than 1,000 caregivers in U.S. households from 1992-2010.
"Parents receive a lot of mixed messages," said study author Marian Willinger, Ph.D., special assistant for SIDS at the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development. "Relatives may give them quilts or fluffy blankets as presents for the new baby, and they feel obligated to use them. Or they see magazine photos of babies with potentially unsafe bedding items. But babies should be placed for sleep on a firm, safety-approved mattress and fitted sheet, without any other bedding."
Drs. Shapiro-Mendoza and Willinger analyzed with colleagues at CDC, the Yale School of Medicine in New Haven, Connecticut, the Boston University School of Public Health, and the Boston University School of Medicine. The study was published online in Pediatrics.
In 1992, the AAP recommended that infants sleep on their backs. Two years later, the NICHD and its partners launched the Back to Sleep campaign, later renamed Safe to Sleep. The SIDS rate in the United States has fallen 50 percent since 1992. However, since 2000, the SIDS rate has declined slowly, and researchers have reported an increase in other unexpected infant deaths resulting from such causes as accidental suffocation, entrapment in bedding material, or other causes. These accidental suffocation deaths have increased from 7.0 per every 100,000 live births in 2000 to 15.9 in 2010.
As part of the survey, caregivers were asked whether infants were placed to sleep on such items as blankets, bean bag chairs, rugs, sheepskin, cushions, or pillows. Caregivers were also asked whether the infant was covered with such bedding materials as a blanket, quilt or comforter, sheepskin, or pillow. The Safe to Sleep campaign advises against blankets or other coverings and recommends sleep clothing, such as a one-piece sleeper, and keeping the room at a comfortable temperature.
"Bedding use for infant sleep remains common despite recommendations against this practice," the study authors wrote.
By 2007-2010, most respondents reported following these Safe to Sleep recommendations:
- Placing the infant to sleep in a crib or bassinet,
- Placing the infant on their back,
- Not sharing a sleep surface with the infant.
However, the use of bedding was consistently 50 percent or higher for each of these years.
From 1993-1995 to 2008-2010, covering with thick blankets declined from 56 percent to 27.4 percent, and covering with quilts or comforters declined from 39.2 percent to 7.9 percent. However, the authors did not see significant declines in such bedding materials placed under infants, with 25.5 percent-31.9 percent reporting placing blankets under infants and 3.1 percent-4.6 percent placing cushions under infants.
"Interestingly, we also observed a greater decline in bedding use over the infants (quilts/comforters and thick blankets) compared with bedding (blankets) under infants," the study authors wrote. "This finding raises a concern that parents may incorrectly perceive the recommendations as only about items covering or around the infant, and not include items under the infant."
The researchers speculate that mothers used bedding to provide warmth and comfort or prevent falls from an adult bed or sofa by using pillows as a barricade. They noted that a study of images from popular magazines targeting women of childbearing age found that more than two-thirds of these images showed infants sleeping with potentially hazardous bedding such as blankets and pillows.
"Seeing images such as these may reinforce beliefs and perceptions that having these items in the infant sleep area is not only a favorable practice but also the norm," the researchers wrote.
The authors also found that caregivers of Hispanic and African-American infants were more likely to use potentially hazardous bedding than caregivers of white infants. In addition, younger mothers were more likely to use this bedding than older mothers, as were non-college-educated mothers compared to college-educated mothers.
The NICHD sponsors research on development before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation.
Attribution/Source(s): This peer reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by NIH/National Institute of Child Health and Human Development and published on 2014/12/03, this content may have been edited for style, clarity, or brevity. For further details or clarifications, NIH/National Institute of Child Health and Human Development can be contacted at nih.gov NOTE: Disabled World does not provide any warranties or endorsements related to this article.