The Maternal and Child Health Bureau (MCHB) Title V Maternal and Child Health Services Block Grants to States Program has established 15 National Performance Measures for the 2015-2017 grant cycle. Performance Measure 5 is the percent of infants placed to sleep on their backs. This evidence brief points to a selection of resources for state MCH programs about infant safe sleep, with emphasis on evidence-based information.
The Title V Maternal and Child Health Services Block Grant to States Program guidance1 defines the significance of this goal as follows:
Sleep-related infant deaths, also called Sudden Unexpected Infant Deaths (SUID), are the leading cause of infant death after the first month of life and the third leading cause of infant death overall. Sleep-related SUIDs include Sudden Infant Death Syndrome (SIDS), unknown cause, and accidental suffocation and strangulation in bed. Due to heightened risk of SIDS when infants are placed to sleep in side (lateral) or stomach (prone) sleep positions, the AAP has long recommended the back (supine) sleep position. However, in 2011, AAP expanded its recommendations to help reduce the risk of all sleep-related deaths through a safe sleep environment that includes use of the back-sleep position, on a separate firm sleep surface (room-sharing without bed sharing), and without loose bedding. Among others, additional higher-level recommendations include breastfeeding and avoiding smoke exposure during pregnancy and after birth. These expanded recommendations have formed the basis of the National Institute of Child Health and Development (NICHD) Safe to Sleep Campaign®.
Read More about Performance Measure 5
Performance Measure 5
Percent of infants placed to sleep on their backs
To increase the number of infants placed to sleep on their backs.
Numerator: Mothers reporting that they most often place their baby to sleep on their back (Excludes multiple responses of back and combination with side or stomach sleep positions)
Denominator: Live births
Healthy People 2020 Objectives
Identical to Maternal, Infant, and Child Health (MICH) Objective 20: Increase the proportion of infants placed to sleep on their backs (Baseline: 69.0%, Target: 75.9%)
Data Sources and Data Issues
Pregnancy Risk Assessment Monitoring System (PRAMS)
Data and Statistics
- Pregnancy Risk Assessment Monitoring System (PRAMS). State-specific, population-based data on maternal attitudes and experiences before, during, and immediately following pregnancy. PRAMS is a surveillance project of the Centers for Disease Control and Prevention (CDC) and state health departments. Forty states and New York City currently participate in PRAMS. View a map and contacts for participating states.
To access data collected through PRAMS surveys, use CDC's PRAMS Online Data for Epidemiologic Research (CPONDER) V2.0. Go to the search page. Choose a state, year, and topic: Sleep Behaviors. Click on Go. Choose one of four sleep-related questions to get your results.
- Healthy People 2020: Maternal, Infant, and Child Health. One objective addresses safe sleep:
Objective MICH-20: Increase the proportion of infants who are put to sleep on their backs. See Healthy People 2020 Structured Evidence Queries for an automated search of published literature indexed in PubMed and related to this objective.
- Centers for Disease Control and Prevention (CDC): Sudden Unexpected Infant Death Initiative. Activities to standardize and improve data collected at infant death scenes and to promote consistent classification and reporting of cause and manner of death for SUID cases. Includes a reporting form, training materials, and information about the SUID Case Registry (SUID-CR) and the SUID-CR pilot program.
- Maternal and Child Health Bureau. 2013. Child health USA. Rockville, MD: Maternal and Child Health Bureau. View narrative, graphs, and data about SIDS/SUID and about safe sleep behaviors.
- Association of State and Territorial Health Officials (ASTHO): Safe Sleep. Resources and promising state practices and programs to reduce the rates of SUID/SIDS and sleep-related infant death.
Safe infant sleep. (2014). This fact sheet includes strategies for state and territorial health agencies to reduce the rates of SIDS and other sleep-related infant deaths. Topics include laws and regulations, Cribs for Kids, safe sleep campaigns, WIC messaging, and public health recommendations.
Safe sleep roundtable report. (2014). This report includes a summary of best practices and recommendations and next steps for federal partners, state health departments, community organizations, and others.
- Collaborative Improvement and Innovation Network to Reduce Infant Mortality (CoIIN). A public-private partnership developed by the Maternal and Child Health Bureau to reduce infant mortality and improve birth outcomes. Participants learn from one another and national experts, share best practices and lessons learned, and track progress toward shared benchmarks. Promoting infant safe sleep practices is one of five priorities selected by CoIIN participants.
- National Action Partnership to Promote Safe Sleep (NAPPSS). Engages a coalition of over 50 organizations, professional associations, faith communities, business groups, and federal partners to develop and implement a practical action plan to make safe infant sleep a national norm.
Evidence base for safe sleep interventions. (2014).
- National Resource Center for Health and Safety in Child Care and Early Education (NRC). Each state's child care licensing and regulation information that includes those involving safe sleep environments for infants. Publications include
Safe Sleep Practices and SIDS/Suffocation Risk Reduction. (2012). This compilation presents 27 health and safety standards on sleep safety from Caring for Our Children: National Health and Safety Performance Standards—Guidelines for Out-of-Home Child Care, 3rd ed (2011). The guidelines were developed by the American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education in consultation with panels of experts.
- Safe to Sleep Campaign®. National campaign aimed at health professionals, child care providers, and families about ways to reduce the risk for SIDS and other sleep-related causes of infant death. Includes outreach materials in English and Spanish and online curricula for nurses and pharmacists. Includes information about outreach activities in specific communities that is informed by research and experience. The Eunice Kennedy Shriver National Institute of Child Health and Human Development directs and manages the campaign with support from collaborating organizations.
- Sudden Unexpected Infant Death (SUID) and Sudden Infant Death Syndrome (SIDS) Gateway. Resources for states, communities, health and social services professionals, child care providers, and families to reduce SUID and SIDS, promote healthy outcomes, and cope with grief when losses occur. Resources related to infant sleep environments include a resource page, research bibliographies, a links to current research, a training toolkit, and the following:
Infant safe sleep campaigns and materials. (2013).
Resources to support AAP's policy statement on SIDS and other sleep-related infant deaths. (Updated 2012).
What works: Changing knowledge and behavior to reduce sudden unexpected infant death. (Updated 2013).
- Johnson K. From Evidence to Improved Policy and Program Practices: Safe Sleep. 2014. National Center for Education in Maternal and Child Health. Georgetown University: Washington, DC.
- Adkins M, Frank S, Hawkins H, O'Neil ME, Stampfel C, Williams L. 2012. Data-driven decisions: Using surveillance data to inform infant safe sleep programs. Lansing, MI: Association of SIDS and Infant Mortality Programs.
- Hauck FR, Tanabe KO, McMurry T, Moon RY. 2014. Evaluation of bedtime basics for babies: A national crib distribution program to reduce the risk of sleep-related sudden infant deaths. Journal of Community Health 2014 Oct 21. [Epub ahead of print]. View citation.
- Moon RY. 2014. Safe infant sleep interventions: What is the evidence base? [White paper in process].
- Rodriguez M, Horton B, Bammarito K. 2012. Toolkit for community health providers: Engaging ethnic media to inform communities about safe infant sleep. Washington, DC: National Center for Cultural Competence.
- Treadway NJ, Diop H, Lu E, Nelson K, Hackman H, Howland J. 2014. Using surveillance data to inform a SUID reduction strategy in Massachusetts. Injury Epidemiology 1:e12.
- Voos KC, Terreros A, Larimore P, Leick-Rude MK, Park N. 2014. Implementing safe sleep practices in a neonatal intensive care unit. Journal of Maternal-Fetal & Neonatal Medicine 2014 Sep 29:1-4. [Epub ahead of print]. View citation.
- California Department of Public Health, Maternal, Child and Adolescent Health Program, Sudden Infant Death (SIDS) Program. 2013. Guidance for local health jurisdictions and communities addressing infant safe sleep environments. Sacramento, CA: California Department of Public Health.
- Gittelman M, Denny S, Southworth H, Arnold MW. 2014. Ohio AAPs comprehensive approach to addressing Ohio's infant safe sleep. American Academy of Pediatrics, Ohio Chapter. [Presentation].
- Maternal and Child Health Bureau. 2013. Moving beyond Back to Sleep to Safe to Sleep. Rockville, MD: Maternal and Child Health Bureau. [Webinar].
- National Association for the Education of Young Children. 2014. Program administrator's guide to evaluating safe sleep and SIDS reduction practices: Criterion 5.A.12. Washington, DC: National Association for the Education of Young Children.
Related NCEMCH Resources
1Health Resources and Services Administration. 2014. Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, Appendix F, p. 78.
Safe Sleep: Evidence Brief, 1st ed. (November 2014).
Author: Susan Brune Lorenzo, M.L.S., with contributions from Jolene Bertness, M.Ed., CHES, Beth DeFrancis, M.L.S., Olivia K. Pickett, M.A., M.L.S., NCEMCH