AAP Voices Blog

Safe Sleep Programs Work—We Cannot Afford to Lose Them 

I still remember the look in her eyes. My grandmother—my own beloved “Nanny”—once told me about her firstborn son, who died of sudden infant death syndrome in the 1950s. Even though decades had passed, the pain in her voice and the weight of that loss were unmistakable.

As a child, I didn’t have the words for it, but I understood one thing clearly: no one should have to endure that kind of grief without answers or support.

That conversation never left me. Years later, when I was a resident physician—seven months pregnant with my first child—I experienced my first infant death in the emergency department. An unresponsive baby arrived during a 24-hour shift. The team worked with quiet urgency, trying everything. Just outside the room, the baby’s family waited, their voices rising and falling in a way I can only describe as grief taking shape. I remember the moment my attending called the time of death. I remember the stillness that followed, the weight of what had been lost. And I remember the quiet ache in my own body, carrying life while witnessing its end.

Those two moments—linked across generations—have shaped my career and my purpose. They drive my passion for safe infant sleep research, public education, and the belief that no family should face such loss without knowledge, resources, and support.

As a pediatric emergency medicine physician and child health researcher, I have dedicated my career to preventing sleep-related infant deaths. Each year, thousands of families in the United States experience the unimaginable loss of an infant—often during sleep and frequently preventable. I have cared for some of those families and witnessed how the right education and support can alter the trajectory for others.
Many of us in the maternal and child health community were alarmed to learn about significant reductions in staff and programming at the Centers for Disease Control and Prevention (CDC), particularly in areas that support safe infant sleep research and public health initiatives. While details are still emerging, it is clear that the timing of these changes presents a genuine threat to the progress we've achieved in reducing infant deaths.

According to the CDC, approximately 3,400 infants die each year from Sudden Unexpected Infant Deaths (SUID) in the United States. These deaths include those from Sudden Infant Death Syndrome (SIDS), accidental suffocation in bed, and unknown causes. Since the launch of the Back to Sleep campaign in 1994 (now known as Safe to Sleep®), we have seen dramatic declines in SIDS deaths—by more than 50% over the last three decades. However, overall rates of SUID have plateaued since 2000, and racial disparities have persisted or worsened.

Black and American Indian/Alaska Native infants are more than twice as likely to die from sleep-related causes compared to white infants. These disparities reflect not only differences in access to resources but also structural and systemic inequities that must be addressed through focused and sustained public health efforts.

That’s why the CDC’s role has been so critical. The Maternal and Infant Health Branch, part of the Division of Reproductive Health, has long supported work to reduce SUID through public health messaging, epidemiologic surveillance, and program development. The CDC has helped fund and sustain the SUID Case Registry, which collects detailed data on infant deaths in participating states to improve our understanding of risk factors, disparities, and prevention opportunities.

This work has established a foundation for evidence-based guidance and targeted interventions. For instance, findings from registry data have shaped public campaigns and informed updates to the American Academy of Pediatrics policy statement on safe sleep.

In our pediatric emergency department, we implemented a program based on this data: screening caregivers of infants under six months for unsafe sleep practices and, when needed, providing both education and direct-to-home delivery of portable cribs and wearable sleep sacks. Families often tell us they want to follow recommendations but face real barriers such as limited income, multiple caregivers across households, or a lack of familiarity with the risks. Many report previously using adult beds, couches, or loose blankets to keep babies warm. These choices are often made out of necessity, not neglect.

Our initial findings are encouraging. One month after receiving supplies, families in our program reported notable improvements in safe sleep practices: reduced co-sleeping, decreased use of soft bedding, and increased utilization of designated safe sleep spaces. These outcomes align perfectly with the goals of public health programs like Safe to Sleep, which aim to replicate success on a larger scale.

Without sustained CDC support, these efforts may stall or vanish. Programs that provide education, distribute cribs, and tailor safe sleep messaging to the needs of diverse communities often depend on technical guidance and funding partnerships originating from federal initiatives. With workforce reductions and shrinking resources, entire prevention systems are now at risk—just as we face renewed urgency in addressing rising infant mortality in some regions.

We understand that safe sleep messaging alone is insufficient. What proves effective is a combination of education, resources, and community engagement, bolstered by research and data infrastructure. This is especially true in emergency care environments like ours, where we frequently reach families who may lack consistent access to pediatric primary care.

As clinicians and advocates, we must continue to emphasize the importance of these programs—not just in name, but in impact. We urge agencies and stakeholders at every level to prioritize safe sleep efforts as a core strategy for addressing infant mortality and health equity. The NIC’s Safe to Sleep® campaign, SUID Case Registry, and maternal and infant health initiatives have established a strong foundation—we must safeguard and enhance that progress.

Every baby deserves a safe place to sleep, every caregiver deserves the knowledge and tools to follow through, and every community deserves a public health infrastructure that meets its needs with respect, evidence, and action.

Safe sleep saves lives. Let’s ensure that this work continues.

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