Minnesota Title V MCH Needs Assessment Fact Sheets

Pregnant Women, Mothers and Infants

Infant Sleep Safety

Summer 2004

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Size of the Problem

Over 68,000 births occur annually in Minnesota and over 1,096,832 women of childbearing age (15 to 44 years) reside in the state [1]. Back to Sleep is a risk reduction initiative that has successfully reduced Sudden Infant Death Syndrome (SIDS) in infants <1 year of age. Annually, 20-28 Minnesota infants die from SIDS and forever alter the family structure of their birth or adoptive families.


Infants and mothers affected by lack of sleep safety education and “back to sleep” practice.
In 1994, the National Institute of Child Health and Human Development (NICHD) and the American Academy of Pediatrics (AAP) launched a national SIDS risk reduction campaign entitled Back to Sleep in an effort to re-duce the risk of SIDS. Minnesota’s campaign was launched and continues to be implemented by the Minnesota Sudden Infant Death Center of Children’s Hospitals and Clinics.

Prior to the Back to Sleep initiative in Minnesota, between 80-90 babies died of SIDS each year. Currently, Minnesota loses 20-30 babies to SIDS annually. Additionally, Minnesota records 16-20 infant deaths related to unsafe sleep conditions for infants such as bedsharing with adults or other children or sleeping on adult beds or with pillows or excess bedding or on other furniture not safety-approved for infant sleep. These deaths are occurring in all areas of the state, among all cultures and socioeconomic groups.

No economic impact or cost effectiveness data is available for the Infant Sleep Safety Intervention. However, the decline of the SIDS death rates indicate that up to 61 babies each year are alive as a result of the interventions enacted since 1994.

Minnesota Sudden Infant Death Syndrome (SIDS) Rates, 1990-2002
  Deaths per 1,000 Live Births
Year Infant Mortality Rate SIDS Death Rate

The Minnesota SIDS death rate is 2-3 times greater for African Americans and 3-5 times greater for American Indian infants than for white infants [2].

Of the 16-20 Minnesota bedsharing infant deaths that occur annually, populations of color and American Indians experienced a disparate number of these deaths [3].


Recommendations for interventions have been identified by national organizations including the NICHD, AAP, the Maternal and Child Health Bureau, the Association of SIDS and Infant Mortality Programs (ASIP), and the SIDS Alliance. Infant Sleep Safety Education interventions include the following [4,5]:

  • Always place a baby to sleep on his/her back-even at naptime
  • Don’t smoke around baby
  • Don’t smoke if you’re pregnant
  • Place a baby on a firm mattress, such as in a safety-approved crib
  • Remove soft, fluffy bedding and stuffed toys from a baby’s sleep areas
  • Keep blankets and other coverings away from baby’s nose and mouth
  • Don’t put too many layers of clothing or blankets on a baby
  • Make sure everyone who cares for a baby knows that infants should be placed to sleep on their backs and the other ways to reduce SIDS risk

Another important intervention was state legislation. Minnesota legislation in 2001 required all child care providers to be trained in SIDS risk reduction. The Minnesota SID Center developed an education curriculum and provides risk reduction education to child care providers statewide.

Effectiveness of Interventions
The Minnesota SIDS incidence declined substantially after the infant sleep safety initiative was implemented [6,7]. Since infant sleep safety training was required in the 2001 legislation, the SIDS rate in licensed childcare fell to 3% in 2002 compared to 23% in 2000. This is the most dramatic decrease in SIDS occurring in childcare in the 20 years of data collection [7].


Minnesota Resources
Minnesota Department of Health in partnership with the Minnesota SID Center and other agencies have implemented programs and strategies including:

  • Culturally appropriate risk reduction materials have been developed nationally and broadly distributed in the African American community (Babies Sleep Safest on their Backs) and in the American Indian community (Face Up to Wake Up).
  • Minnesota’s Infant Death Investigation Guidelines were revised in 2002 to facilitate uniform investigation and determination of cause of death for sudden unexplained infant deaths.
  • In January 2001, MDH established population screening for MCAD, a genetic metabolic disorder that can result in sudden infant death, as a part of the expanded newborn bloodspot screening program.
  • MDH used state funds (2002) from the Infant Mortality Reduction Initiative (IMRI) to pilot a project in partnership with the MN SID Center, The Infant Sleep Safety and Baby Bed Project. Cribs and a folder of infant sleep safety education materials were provided to public health, tribal, and community agencies throughout Minnesota for families in need. Although state funding for cribs is no longer available, the folders continue to be distributed to agencies statewide.
  • The Division of Indian Work in Minneapolis has recently developed and disseminated posters for community education to reduce SIDS in the American Indian population.

Community Awareness
No specific studies of Minnesota community awareness of the Back to Sleep initiative are available. National surveys have indicated growing community awareness of Back To Sleep and other sleep safety education. The MN SID Center sends a quarterly newsletter to thousands of Minnesotans every year and staff from the Center make presentations to various groups statewide every year. The dramatic reduction in SIDS deaths is evidence that community awareness overall is high.


1. MDH. Minnesota Center for Health Statistics 2002.
2. MDH. Eliminating Health Disparities: Infant Mortality-Sudden Infant Death Syndrome (SIDS). March 2001.
3. MDH. Minnesota’s Infant Sleep Safety and Baby Bed Project Summary.2002.
4. American Academy of Pediatrics, Task Force on Infant Sleep Position and Sudden Infant Death Syndrome. Pediatrics 105(3):650-656. May 2000.
5. Back to Sleep Campaign, National Institute of Child Health and Development, the Maternal and Child Health Bureau, the American Academy of Pediatrics, the SIDS Alliance, and the Association of SIDS and Infant Mortality Programs.
6. Data from the Minnesota SID Center and the Minnesota Center for Health Statistics. 2002.
7. MDH. SIDS Report to the Legislature. 2004