AAP Voices Blog

Is Safe Sleep a Luxury? Lessons From My Bronx Clinic 

Last week, a new mother sat in my exam room, cradling her newborn while her 3-year-old son curiously explored my exam room and her 5-year-old daughter played games on the phone. Eyes heavy with exhaustion, she recited the safe sleep rules perfectly — “alone, on the back, in a crib, no toys or loose blankets” words she had heard at the hospital, in her prenatal classes and even read in the discharge packet from the hospital. Impressed by her recall, I started to address other healthcare aspects when she sighed and said softly, “There’s no room for a crib; I share the room space with another family to make ends meet.”

That moment has stayed with me.

In my Bronx clinic, I meet families every day who want to follow the American Academy of Pediatrics’ (AAP) safe sleep guidelines but face real barriers in doing so. Sleep deprivation, housing insecurity, overcrowding, and the absence of family support often make co-sleeping feel like the only practical option. The difference between knowing what’s safe and being able to do it now becomes two very different realities. 

As a pediatrician, I am deeply grateful for AAP’s Back to Sleep campaign as it helps to dramatically reduce sudden infant deaths, but the benefits haven’t reached everyone equally. In 2022, Black infants in the United States were more than twice as likely to die from sudden unexpected infant deaths as white infants. In the community where I practice, infant mortality remains the highest in New York City. This sheds light on an all-too-common reality; safety isn’t just about education; it is about circumstance.

As the sole pediatrician at NYC Health + Hospitals/Gotham Health/ Tremont, my goal is not only to teach safe sleep, but to make it possible. I use my time wisely to suggest research grants and community-based resources. I was fortunate to be able to connect families to state-run free crib distribution programs and worked to receive a book grant from Charlie’s Kids Foundation, which provides bilingual safe-sleep storybooks during well-child visits. For many families, these small books are the first ones they have ever owned. This encourages parents to create safe sleep environments while also nurturing early literacy. Mothers share pictures of their babies asleep in these cribs, the book open in their hands. These serve as my reminder that education, when paired with access, can save lives.

These experiences are my constant teachers. Meeting families where they are - respecting cultural traditions while reinforcing the safety of separate sleep spaces - is possible. I’ve learned that my role as a pediatrician doesn’t end when I give advice; it continues as I help families navigate systems built without them in mind. Expanding awareness and connecting families to state-based programs is imperative. These resources remain underutilized simply because families don’t know they exist. As our community’s fiercest advocates, we must stand for policies that weave these supports into Medicaid coverage, housing programs, and maternal-child health initiatives.

Young physicians like myself are uniquely positioned to see both the progress and the persistent gaps. It is our role to bridge medical knowledge with community realities and bring practical solutions to our families. We can and must do better.

Safe sleep should not be a privilege earned through socioeconomic advantage, zip codes, or circumstance; it should be a universal right supported by community systems and policy.

These small interventions ripple into lasting change. It reminds me that advocacy doesn’t always begin with sweeping reform—it often starts with a single book, a safe crib, a single conversation, and an act of trust.

*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.