[Trigger warning: This article discusses sudden unexpected infant deaths.]
Over the past two decades, infant health in the U.S. has steadily improved. Between 1999 and 2022, overall infant mortality rates declined by 24%, thanks to advancements in obstetric management, neonatal advancements, and preterm labor prevention.
But a new study published in JAMA Pediatrics (Jan. 27, 2025) reveals a concerning shift: while overall infant mortality has gone down, sudden unexpected infant deaths (SUID) are rising.
Between 2020 and 2022, sudden unexpected infant death (SUID) rates increased by nearly 12%, reversing years of stability, according to researchers at Virginia Commonwealth University. SUID refers to the sudden, unexplained death of an otherwise healthy baby under one year old, including cases of sudden infant death syndrome (SIDS), accidental suffocation, and deaths from unknown causes.
It’s a troubling trend—one that researchers say isn’t just about where babies sleep, but why some parents are struggling to create safe sleep environments in the first place.
Related: 14 science-backed ways to lower SIDS risk in babies
Why are SUID rates rising?
It’s tempting to assume that more education is the only answer. But the reality is, many parents already know the guidelines—they just can’t always follow them.
Most conversations about SUID focus on where babies sleep—cribs versus couches, bassinets versus adult beds. And yes, safe sleep environments matter. The study specifically examined SUID trends and noted possible contributing factors.
According to lead researcher Elizabeth Wolf, M.D., M.P.H., associate professor of pediatrics at Virginia Commonwealth University (VCU) School of Medicine and pediatrician at Children’s Hospital of Richmond, “It’s difficult to pinpoint exact causes, but COVID-19 and parental opioid use are two potential factors. “
[The study notes that COVID-19 or other respiratory illnesses may have played a role in the rise of SUID deaths, but it does not specify how. Further research is needed to determine the extent of this impact.]
Dr. Wolf adds, “Social media may also be playing a role. In social media posts, infants can be seen in unsafe sleep positions, for example on their stomach instead of on their back, and in unsafe sleep environments such as adult beds, couches and baby swings.”
This isn’t just a passing trend—it’s shaping how parents perceive infant sleep safety. Viral images often normalize unsafe setups, making them seem harmless despite well-documented risks. A 2023 study found that 86% of infant sleep photos in a Facebook moms’ group showed setups that didn’t follow AAP guidelines—highlighting how misinformation spreads. While the sample size was small, the findings underscore the need for clearer, evidence-based guidance on safe sleep.
SUID disproportionately affects Black and Indigenous babies—here’s what the data shows
The study found that Black infants are 10 times more likely to die from SUID compared to Asian infants and three times more likely than white infants. American Indian and Alaska Native infants had SUID rates nearly 9.6 times higher than Asian infants.
While the study identifies disparities, it does not draw conclusions about the root causes. Dr. Wolf notes that more research is needed to understand the role of sleep environment, prematurity, tobacco exposure, and feeding practices.
However, these disparities aren’t just about individual parenting choices—they reflect larger systemic inequities.
Related: If we want to end racial disparities for moms and babies, we need to invest in our children—today
Safe sleep isn’t just about parenting—it’s about access
The study underscores an increase in SUID deaths, but it does not explore in depth why parents may struggle to follow safe sleep practices. However, broader research on maternal and infant health suggests several key barriers:
Lack of Paid Leave
The study does not examine parental leave, but experts in maternal health have long pointed to the role of economic stress and exhaustion in shaping infant sleep environments.
The U.S. remains one of the only developed nations without guaranteed paid maternity leave. This means many new parents—especially those in low-wage or hourly jobs—return to work within weeks of giving birth.
Newborns wake every two to three hours, meaning exhausted parents are operating on fragmented, minimal sleep while trying to keep up with work and family responsibilities. A mother working an overnight shift with a newborn at home isn’t ignoring safe sleep recommendations when she accidentally dozes off while holding her baby—she’s exhausted and out of options.
Sleep deprivation isn’t just difficult—it’s a safety risk.
Gaps in Healthcare Access
The study highlights racial disparities in SUID rates but does not examine healthcare access as a contributing factor. However, other research shows that early pediatric visits provide safe sleep education, yet families without consistent healthcare may miss these crucial touchpoints.
A baby with regular check-ups may receive reinforced safe sleep guidance, access to social programs, and early intervention—but families facing insurance barriers, transportation challenges, or systemic healthcare inequities may lack these same opportunities.
Unsafe Products Still on the Market
Public health experts have long warned that misleading marketing and unsafe infant sleep products put babies at risk.
Parents are bombarded with infant sleep products that claim to be safe but don’t meet AAP guidelines—like inclined sleepers, sleep positioners, and padded crib bumpers.
- In 2022, the Safe Sleep for Babies Act banned the sale of dangerous inclined sleepers and padded crib bumpers—but unsafe products continue to be marketed.
- Many caregivers aren’t even aware that some of these products have been linked to suffocation deaths.
- Better enforcement of safety regulations could prevent families from unknowingly purchasing hazardous products.
This isn’t about parents not caring about safe sleep—it’s about a system that isn’t setting them up to succeed.
Preventing SUID requires more than just education—it requires policy change
Dr. Wolf and her research team emphasize that preventing sleep-related deaths will take more than just education—it will take system-wide reform.
“Expanding health insurance access and providing support for mothers pre- and postnatally could reduce infant mortality,” Dr. Wolf says.
Public health advocates argue that these additional changes could further reduce SUID rates:
- Paid family leave—so that exhausted parents aren’t forced into unsafe sleep situations.
- Expanded healthcare access—so that all parents receive equal levels of postpartum and pediatric care.
- More funding for safe sleep programs—to ensure cribs and bassinets are accessible to every family.
- Stronger regulations on misleading infant sleep products—so parents aren’t left guessing which items are safe.
- Increased lactation support—to help more families establish and sustain breastfeeding, which research links to a lower risk of SIDS.
AAP-backed safe sleep guidelines every parent should know
While changes need to happen at the policy level, parents can take immediate steps to reduce SUID risk.
The JAMA Pediatrics study underscores the continued importance of following the American Academy of Pediatrics (AAP) safe sleep guidelines, which include:
- Always place your baby on their back to sleep (face up), as it significantly reduces the risk of suffocation.
- Use a firm, flat sleep surface like a crib or bassinet, free of soft bedding, pillows, or toys.
- Keep your baby’s crib or bassinet in your room for at least the first 6–12 months, but avoid bed-sharing.
- Avoid allowing your baby to sleep in a swing, car seat, or other non-flat surfaces. These can lead to airway obstruction and increase the risk of SIDS.
- Keep the sleep area free of blankets, bumpers, and stuffed toys. Soft objects can increase the risk of suffocation.
- Refrain from smoking or using alcohol or drugs during pregnancy or while caring for your baby.
- Dress your baby lightly and avoid head coverings to prevent overheating. Overheating is a known risk factor for SIDS.
- Offer a pacifier at sleep times. Studies suggest that using a pacifier during naps and nighttime sleep is associated with a reduced risk of SIDS, even if it falls out after the baby falls asleep.
- Research shows that breastfeeding, even for a short duration, is linked to a lower risk of SIDS.
Related: Any amount of breastfeeding for 2 months cuts SIDS risk in half, says study
The bottom line: It’s time to change the narrative
SUID rates are rising, and this isn’t just a parenting issue—it’s a policy issue.
We can’t talk about safe sleep without talking about paid leave, affordable healthcare, and economic inequality. Telling exhausted, overworked parents to simply “follow the guidelines” without giving them the structural support to do so isn’t a solution—it’s a failure of public policy.
The study presents the data—but it’s up to policymakers, healthcare providers, and society to act on it.
If we truly want to reduce SUID rates, we need to stop asking “Why aren’t parents following safe sleep rules?” and start asking, “What would it take to ensure every parent can?”
Because every baby deserves a safe place to sleep—and every parent deserves the support to provide it.
Sources
- Infant mortality declines, but SUID rises. JAMA Pediatrics. 2025. “Sudden Unexpected Infant Death and Disparities in Infant Mortality in the US”
- Updated guidelines on sleep-related deaths. American Academy of Pediatrics. 2022. “Photos Shared on Facebook in the Context of Safe Sleep Recommendations: Content Analysis of Images”
- Infant mortality declines, but SUID rises. Children’s Hospital of Richmond at VCU. 2024. “Infant mortality rates declining, but Sudden Unexpected Infant Death is on the rise”
- Examining sleep-related death prevention strategies. JMIR Pediatrics and Parenting. 2024. “Photos Shared on Facebook in the Context of Safe Sleep Recommendations: Content Analysis of Images”
- Investigating the rise in sudden unexpected infant death. Children’s Hospital of Richmond at VCU. 2024. “What’s behind the rise in Sudden Unexpected Infant Death?”
- Relationship between pacifier use, breastfeeding and infant safety. Curtin University. 2012. “Pacifier Use, Breastfeeding and Sudden Infant Death Syndrome.”
- Breastfeeding and its impact on SIDS prevention. National Institute of Child Health and Human Development. 2018. “Breastfeed Your Baby to Reduce the Risk of SIDS.”
- Review of SIDS risk reduction strategies. BMC Pediatrics. 2021. “Sudden infant death syndrome prevention.”
