What’s the “Why” behind the ABC’s anyway? by guest blogger, Dominique Johnson

October is sudden infant death syndrome (SIDS) awareness month. SIDS awareness month was created to bring awareness to the impact of SIDS across the United States, where 3,700 babies die suddenly and unexpectedly each year. SIDS is the loss of an infant under 12 months of age, where the cause of death is classified as “undetermined” after a death investigation. SIDS is the leading cause of death affecting infants under 12 months. While there is no known cause for SIDS, these deaths are related to how and where an infant is laid to sleep.

During 2024, the Unintentional Injury Prevention Initiatives team within the Patrick M. Magoon Institute for Healthy Communities at Ann & Robert H. Lurie Children’s Hospital of Chicago conducted 4 focus groups with parents across the Chicagoland area, seeking to gain a deeper understanding of existing barriers parents face when implementing the American Academy of Pediatrics (AAP) safe sleep recommendations. Over the course of these focus groups parents inquired about the “why” behind the APP guidelines. One

parent said, some time you don’t know why a recommendation is made. I read something that said don’t let a baby sleep too long in their car seat, and no reason why.” Here is our response to the over thirty parents that shared their invaluable insight on infant’s sleeping behavior and parental decisions.

Research as early as the 1960s-1970s documented the risk associated with placing infants to sleep on their stomach (prone position) as a potential cause of death for infants. Between 1983-1994, over 61,882 infants died due to SIDS. Over 60% of these deaths occurred between 1-3 months of age. During this time, the primary sleeping position for infants in the U.S was on their stomach. The 1992 AAP guidelines recommended that parents place infants on their side or back to sleep. By 1994, the American Academy of Pediatrics (AAP) Task Force on Infant Sleep Position and SIDS updated the recommendations, advising parents that the lowest position risk for infants was on their back. This shift reduced SIDS deaths by over 50% but, unfortunately, there is still so much that we don’t know.

Following the leadership of the National Institute of Child Health and Human Development (NICHD), the Back to Sleep Campaign, was created with a goal to raise awareness about SIDS and reinforce the AAP guidelines. While the goal was still the same, the campaign was renamed the Safe Sleep Campaign in 2012. The campaign was renamed to recognize all sleep related infant deaths including SIDS.

Seeking to simplify the AAP guidelines and reinforce the 2011 AAP guidelines, First Candle, a non-profit organization, simplified the strategies, using the message of the ABC’s during the nighttime and naps. This message stands for:

A: Alone

B: Back

C: Cribs

While infants are safest when they share the same room as their parent or care provider, they also need their own space. Placing infants to sleep on their back and in their own (bassinet, portable crib, or crib) bed, reduces the risk of SIDS by at least 50%. We also know that surface matters. When the space is clear, flat, without incline and the mattress is firm, with nothing but the infant, infants can sleep safely.

In the of month October, we want to recognize the number of families across the U.S who experienced these painful, unimaginable, and preventable deaths. These babies are our “why.” Each infant had a story that they did not live to tell. While there is still more to learn as we work to bring the numbers of SIDS deaths to zero, we know that environment matters.

Dominique Johnson (far left), Program Specialist, Infant Safe Sleep at Ann & Robert H Lurie Children's Hospital of Chicago, working to reduce sleep-related in Chicago communities.

When we place infants on other surfaces such as an adult bed, couch or chair for sleep, there is increased risk for suffocation, strangulation, entrapment and overheating that raises the risk for SIDS. While we recognize that caring for infants is not easy. We know that there are times when parents make decisions that may deviate from the AAP guidelines. We encourage you to talk with your pediatrician to help you make the safest decision for yourself and your infant. Here at Lurie Children’s, every time we get to celebrate the first birthday of a child in the United States, we are reminded of our “why.” Similarly, we know that for parents nothing provides a greater “why” than knowing that your child is safe.