Safe sleep





Michigan Department of Health and Human Services (MDHHS), along with our partners, works tirelessly each day to promote safe sleep practices for babies to help reduce Michigan’s infant mortality rate. Despite aggressive efforts to reduce this rate, babies are still dying. Social factors, racial disparities and economic realities all contribute to our unacceptably high infant death rate. This report seeks to paint a comprehensive picture of sleep-related infant deaths by combining data, research, and information regarding local and statewide initiatives that are making a difference in local communities across our state. TOGETHER we can:
  • provide families with the knowledge and tools needed to keep babies safe and healthy
  • make Michigan a national leader in eliminating preventable infant deaths.
  • make Michigan a place that all infants survive but thrive.
  • A baby dies nearly every other day in Michigan in an unsafe sleep environment. 
  • Unsafe sleep factors include sleeping in a position other than on the back, sleeping anywhere other than a crib, sleeping with other people, sleeping on a soft mattress, or sleeping with objects.
  • A safe sleep environment exists when babies usually sleep: on their backs, in a crib or portable, on a firm mattress, without pillows, bumpers, blankets, stuffed toys, or infant positioners and without any other person in the sleep space.
  • Data indicates that evidence-based home visiting services are associated with increased safe sleep adherence. Michigan has several home visiting programs in which a nurse, health care worker, or social worker provides support and care coordination for families to help support healthy pregnancies and positive birth outcomes.
  • The more stressful life events the mothers experienced, the less likely they were to comply with safe sleep recommendations.
  • Mothers whose babies died of SUID were less likely to have received prenatal care in the first trimester of pregnancy and were more likely to have smoked before or during pregnancy
  • Infants that are born prematurely or with low birth weight have a greater chance of dying in an unsafe sleep environment
  • While about 1 in 5 mothers in Michigan smoked before or during pregnancy, about half of mothers who experienced a SUID smoked during the same timeframe; mothers who experienced a SUID were more likely to allow smoking in their homes. Additionally, secondhand smoke exposure impairs an infant’s arousal from sleep, increasing the risk of SIDS.
  • Michigan’s infant mortality rate remains persistently high at 6.8 deaths per 1,000 live births in 2015
  • Almost 6 in 10 (57%) of sleep-related deaths occurred among infants who shared a sleep surface, the majority of which involved sharing an adult bed.
  • About 1 in 5 sleep-related deaths occurred when babies were in new or different sleep environments
  • 36% of babies that died from SUID were exposed to tobacco smoke in their home environment
  • Approximately 44% of infants who died of sleep-related causes were found on their stomach and 11% were found on their side. 

During 2010-2015:

  • Around 55% of Michigan infants who died from sleep-related causes were found on their side or stomach.
  • 23% of all babies that died from SUID were born prematurely.
  • Over 20% of infants that died of SUID were low birth weight.
  • Of all infant sleep-related deaths:
    • Almost 50% occurred in an adult bed
    • 22% of deaths occurred in a crib/bassinet
    • 15% were on a couch or chair.

Sudden Unexpected Infant Death (SUID) is a death that occurs suddenly and unexpectedly to a child younger than age 1 and whose cause of death is not immediately obvious prior to investigation. This includes accidental suffocation and strangulation in bed (ASSB), sudden infant death syndrome (SIDS) and unknown.

Despite the reference to “in bed,” ASSB also can occur on non-bed surfaces, such as an armchair or couch. Mechanisms that lead to accidental suffocation or strangulation where an infant’s airway is obstructed or breathing is restricted are further defined below:

  • Suffocation can occur when an infant is placed on a non-firm surface (e.g., water bed, pillow-top mattress, soft bedding, blanket) and the infant’s face becomes pressed against the non-firm surface or when soft bedding, such as a pillow, comforter or blanket covers the infant’s face.
  • Strangulation can occur when an object is wrapped around an infant’s neck, such as baby monitor cords or blankets.
  • Overlay is when another person, or part of another person’s body, rolls on top of or against the infant while sleeping.
  • Wedging or entrapment is when an infant is wedged between two objects (e.g., a mattress and a wall, between couch cushions)
  • Infants should be placed for sleep in the supine position for every sleep period by every caregiver until 1 year of age. Side sleeping is not safe and is not advised. Preterm infants should be placed supine as soon as possible.
  • Infants should be placed on a firm mattress covered by a fitted sheet with no other bedding or soft objects to reduce the risk of SIDS and suffocation. A crib, bassinet, portable crib, or play yard that conforms to the safety standards of the Consumer Product Safety Commission (CPSC) is recommended.
  • Breastfeeding is associated with a reduced risk of SIDS and the protective effect increases with exclusivity. Any breastfeeding is more protective than none.
  • Infants should sleep in the parents’ room close to the parents’ bed but on a separate sleep surface for at least the first 6 months of life.
  • Couches and armchairs are extremely dangerous places for infants and they should not be placed to sleep on these surfaces.
  • Keep soft objects, such as pillows, pillow-like toys, quilts, comforters, sheepskins, and loose bedding such as blankets and non-fitted sheets away from the infant’s sleep area.
  • Bumper pads are not recommended; they have been implicated in deaths attributable to suffocation, entrapment, and strangulation in bed.
  • Pregnant women should obtain regular prenatal care to lower the risk of SIDS.
  • Smoking during pregnancy, in the pregnant woman’s environment, and in the infant’s environment should be avoided.
  • Avoid alcohol and illicit drug use during pregnancy and after the infant’s birth.