Infant Sleep Safety

Every two to three days in Michigan, an infant dies due to being placed to sleep in an unsafe environment. Sleep-related infant deaths are the third leading cause of all infant death in Michigan and the leading cause of death among infants 1 month to 12 months old. They are considered the most preventable type of infant death. It is critical that MIHP beneficiaries are educated on infant sleep safety and are supported in providing a safe sleep environment for their infant throughout their participation in MIHP. Infant sleep safety should be discussed at every MIHP visit using a conversation style that is non-judgmental, non-confrontational and strength-based. Having an appropriate sleep environment prepared for the infant prior to arrival home from the hospital is essential. The majority of infant deaths due to unsafe sleep occur while the baby is under 4 months old, so safe sleep must begin the first day home from the hospital. All staff should be familiar with the most recent American Academy of Pediatrics guidelines for infant sleep safety issued in October, 2016 (below) and providers should review these with the beneficiary, family members and anyone who is going to provide care for the infant.

  • Back to sleep for every sleep.
  • Use a firm sleep surface. A crib, bassinet, portable crib or play yard that conforms to the safety standards of the Consumer Product Safety Commission (CPSC) is recommended. A tight-fitting, firm mattress and a fitted sheet designed for the particular product should be used. If the infant falls asleep in a car seat, stroller, swing, infant carrier, sling or other sitting device, the infant should be moved to a firm sleep surface and placed on his or her back as soon as possible.
  • Breastfeeding is recommended.
  • It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first 6 months.
  • Keep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment and strangulation.
  • Consider offering a pacifier at nap time and bedtime. For breastfed infants, pacifier introduction should be delayed until breastfeeding is firmly established.
  • Avoid smoke exposure during pregnancy and after birth.
  • Avoid alcohol and illicit drug use during pregnancy and after birth.
  • Avoid overheating and head covering in infants.
  • Pregnant women should obtain regular prenatal care.
  • Infants should be immunized in accordance with recommendations of the AAP and Centers for Disease Control and Prevention.
  • Avoid the use of commercial devices that are inconsistent with safe sleep recommendations.
  • Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly.
  • There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS. Swaddling can be an effective calming strategy. If infants are swaddled, they should always be placed on the back while following all other safe sleep guidelines. When an infant exhibits signs of attempting to roll, swaddling should be discontinued.

The guidelines can be accessed at: additional education, a free online training course can be accessed at: Nurses and Social Workers can receive continuing education credit for course completion.

Anticipate areas where beneficiary may have difficulty in following the infant safe sleep guidelines and assist her in developing a plan for success. Guide her in enlisting support from family members and help to educate all caregivers in the home on infant sleep safety. Common myths and barriers should be discussed. Provider should assess the infant’s sleep setting, position, clothing and environment. This needs to be done frequently as parent’s adherence to safe sleep guidelines typically varies due to what is happening in the home, i.e. if parent is very exhausted, she may not lay baby to sleep in crib, but instead bring baby to bed with her, or if parent is living at a different location and there is not space for a crib or pack and play in the new location, etc. Videos and other resources can be accessed at: Free brochures, posters, decals and DVDS can be ordered at: For questions or for additional information, please contact the Michigan Department of Health and Human Services Infant Health Unit at 517-335-8955.

2-16-17