Babies are dying from preventable conditions, and in the United States, the infant mortality rate (6.5 per 1000 live births) is higher than in countries that spend less money on their health care.1 In Sedgwick County, Kansas (population 498 365) the infant mortality rate remains even higher than the national average (8.1 per 1000).1 In 1994, the American Academy of Pediatrics (AAP) released guidelines for infant safe sleep to prevent sudden infant death syndrome (SIDS). Following these recommendations, the Back-to-Sleep campaign promoted placing infants supine; in the following years, a 50% reduction in SIDS deaths was observed. The AAP revised these guidelines2 in 2005 and 2011 to further emphasize environment as well as position. Current recommendations include that babies be placed on their back, in a crib with a firm mattress and fitted sheet. Bumpers, pillows, loose blankets, stuffed toys, and other potential suffocation hazards are not recommended. However, studies continue to show infant deaths related to nonsupine position and environment.3,4 For example, a review of SIDS deaths in San Diego from 1991 to 2008 found that only 5% of infants had no extrinsic risk factors at the time of death.4
The focus of our study was to develop and provide a Safe Sleep Toolkit for providers that could facilitate a consistent safe-sleep message (position, location, and environment) to caregivers of infants.