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Health Indicator Report of Safe Sleep

Placing babies on their backs to sleep reduces the risk for Sudden Infant Death Syndrome (SIDS) and other sleep-related infant deaths.
This is Healthy New Jersey 2020 Objective MCH-6.

Data Source

Pregnancy Risk Assessment Monitoring System, Maternal and Child Health Epidemiology, Division of Family Health Services, New Jersey Department of Health, []


Self-reported practice of putting infants on their backs to sleep


Number of mothers who put their infants on their backs to sleep


Number of mothers who responded to the survey

Healthy People Objective: Increase the proportion of infants who are put to sleep on their backs

U.S. Target: 75.8 percent
State Target: 80.0 percent

Other Objectives

'''Healthy New Jersey 2020 Objective MCH-6''': Increase the proportion of infants who are put to sleep on their backs to 80%.

How Are We Doing?

Putting infants on their backs for every sleep is associated with a lower rate of sleep-related infant deaths including SIDS. This practice increased 23% in the period from 2003-2014, from 57.8% to 70.9% Mirroring the pattern in the other states that participate in the Pregnancy Risk Assessment Monitoring System (PRAMS), there are population group disparities in the placement of infants on their backs. In 2011 and 2012, the Healthy New Jersey 2020 (HNJ2020) target of 80% for back to sleep was met or exceeded by White infants, and in 2014, it approximated the goal at 79.1%. For Asian infants, the target was exceeded in both 2013 and 2014. The target has not yet been reached in Black or Hispanic infants. However, from 2003 to 2014, the practice increased by 42% for the former and by 46% for the latter. The practice of an infant usually sleeping in a shared bed is another major risk factor for sleep-related infant deaths. This practice fell to its lowest level of 18% in 2014. Again, population group disparities were evident with the privately insured group least likely to engage in this risk-elevating practice. However, although usual bed sharing was more evident in both the Medicaid and Uninsured groups, from 2003-2014 it declined by 30% in the former and by 40% in the latter. Sudden Unexpected Infant Death (SUID), which is comprised of Sudden Infant Death Syndrome (SIDS), accidental suffocation and strangulation, and ill defined and unknown causes, is a major contributor to infant mortality. SUID is now used as the main analytic statistic due to diagnosis shifts among its three components, and it is now a health indicator for Healthy People 2020. All three sleep-related infant deaths share similar risk elevators, including non-supine sleep and bed sharing. The safe to sleep guidelines of the American Academy of Pediatrics (AAP) pertain to all sleep-related infant deaths. From 1999-2001, the earliest period in which the current International Classification of Diseases 10th Revision of the Procedure Coding System (ICD-10) was used, to 2012-2014, the era with the most recently available data, the SUID rate in New Jersey declined by 28.4% from 0.67 per 1,000 live births to 0.48 in contrast to a decline in the national SUID rate of only 7.4%, from 0.94 to 0.87. In the period 2012-2014, New Jersey's SUID rate was lower than that of all states and equaled only by one. The 2012-2014 New Jersey SUID rates for non-Hispanic White, non-Hispanic Black, and Hispanic infants also were among the lowest in comparison with national rates (0.31 vs. 0.84, 1.33 vs. 1.73, and 0.41 vs. 0.51, respectively). However, while New Jersey rates are favorable relative to other states, racial disparity exists here and nationally and differences in the use of supine sleep are a focus of risk reduction efforts. According to the 2013 NJ PRAMS data prepared by the NJDOH MCH Epidemiology program, 85% of New Jersey mothers recalled being told by a doctor, nurse, home visitor, or other health care provider about safe infant sleep. The difference in the use of the recommended safe sleep practices is therefore less likely to be about a variance in knowledge and more likely about other population-specific risks and barriers that affect practice such as cultural patterns.

What Is Being Done?

In 1994, the "Back to Sleep" campaign was enacted encouraging parents to place babies on their backs to sleep. This practice is associated with a reduction in SIDS and other sleep-related infant deaths such as accidental suffocation. This campaign was based on the evidence-based recommendations the American Academy of Pediatrics (AAP) began issuing in 1992 to reduce the risk of SIDS. The most recent guidelines were published in 2016. The current campaign, "Safe to Sleep," describes the safest sleep environment for infants from birth to 12 months of age. In addition to placing infants on their backs to sleep, the guidelines recommend that caregivers avoid having the infant bed share with a sleeping adult or child, avoid using a sofa or chair for infant sleep, remove loose bedding, pillows, quilts, soft objects, and bumpers from the infant's sleep area, use a firm mattress that fits the crib space and is covered only with a tightly fitted sheet, avoid overheating the infant, and avoid exposure to tobacco smoke. Although bed sharing is not recommended, room sharing with the baby is advised so that the parent can be close by the infant. Breastfeeding is also recommended. While parents may bring the infant into bed for feeding and comforting, the AAP recommends that the infant be returned to the near-by safety-approved crib once the parent is ready to sleep. The AAP recommends that parents consider using a pacifier but should wait one month if breastfeeding and should avoid the use of clips or strings to attach a pacifier to the infant's clothing as these pose a strangulation risk. Tummy time when the infant is awake and supervised is also recommended to facilitate motor development. The AAP recommends the use of cribs, bassinets, and portable cribs that meet current standards of safety. These standards can be obtained from the Consumer Product Safety Commission ( or 800-638-2772). The AAP urges all caregivers to discuss these guidelines and any challenges to achieving them with their infant's health care providers. These guidelines are all evidence-based and include the research of the SIDS Center of New Jersey (SCNJ). The policy statement can be accessed through the following link provided by the AAP: []. Disparity in outcomes among racial/ethnic groups is associated in part with disparities in social determinants of health, including measures of socioeconomic status and access to healthcare, disparities in prematurity and low birth weight, as well as disparities in infant care practices that elevate the risk of SIDS. Measures of low income are significantly associated with lower compliance and with higher SUID rates. Cultural and generational patterns of care also contribute to the variance in safe sleep practices. The SIDS Center of New Jersey (SCNJ) serves the state's missions to provide bereavement support, to study risk factors associated with SUID, and to provide multi-lingual and culturally, racially, and ethnically-sensitive risk-reducing education on safe infant sleep to caregivers and health and social service providers and institutions. The SCNJ collaborates with physicians, nurses, social service providers, child care providers, health care systems, including hospitals and clinics, licensing systems, social service organizations, government agencies, community groups, and educational institutions with allied public health missions. It identifies barriers to compliance and addresses these. Two of its initiatives are Nurses LEAD the Way, which is presented at all birthing hospitals and has resulted in improvements in knowledge about safe sleep and in education policies and procedures related to the provision of this information to families, and Neighborhoods LEAD the Way which reaches into communities at highest risk to address the challenges of racial disparity. The SCNJ provides educational materials in English, Spanish, Arabic, Haitian Creole, and Hindi with other languages available as requested. Educational videos, hospital tool kits, webinars and other message facilitating material are distributed and also available on the SCNJ website. Public health campaigns have included safe sleep bulletins along the NJ Turnpike. Current programs include school-based education. In addressing the major risk of household smoke exposure, the SCNJ collaborated with Mom's Quit Connection to extend the penetration of knowledge and interventions. The SCNJ also targets specific groups of caregivers, such as grandparents, and works with faith-based communities to reach caregivers at community levels. New initiatives to address challenges and improve outcomes include a statewide conference on racial disparity.

Available Services

Sudden Infant Death Syndrome Center of New Jersey (SCNJ) Hotline: 800-545-7437 Visit [] or call the hotline to obtain Hospital Safe Sleep Tool Kits, the American Academy of Pediatrics safe infant sleep guidelines, and SIDS Center safe sleep materials. To arrange an education program, call the hotline. NJ Department of Children and Families: [ NJ Safe Sleep]

Health Program Information

SIDS Center of New Jersey: [] National Institutes of Health "Safe to Sleep" campaign: [] NJDOH Sudden Infant Death Syndrome (SIDS) information: [] NJ Dept of Children and Families: []
Page Content Updated On 02/23/2018, Published on 05/02/2018
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Content updated: Tue, 4 Sep 2018 05:00:56 EDT