Introduction

Sudden infant death syndrome (SIDS) rates have declined significantly in the United States (US) as a result of the “Back to Sleep” campaign. Despite this and many state and local risk reduction campaigns, rates still remain high in the African American and American Indian/Alaska Native populations. The American Academy of Pediatrics (AAP) recently released (2016) updated guidelines and recommendations for a safe sleep environment (12). However, certain recommendations, especially the advice against infant bed sharing, continue to be controversial and are not followed by some groups. Further research on the reasons for non-adherence and identification of culturally acceptable and safe alternatives that address parental concerns are needed to help in targeting educational interventions in high-risk populations. In this chapter, we will address SIDS from a US perspective, covering rates and trends, interventions to reduce risk, the bed-sharing controversy, and current laws and regulations in the US.

SIDS Rates in the US

Sudden unexpected infant death (SUID), also known as sudden unexpected death in infancy (SUDI), is defined as the sudden and unexpected death of an infant regardless of cause (1). The largest proportion of SUID deaths among all racial/ethnic groups is attributed to sudden infant death syndrome (SIDS). SIDS, a subset of SUID, is defined as “the sudden and unexpected death of an infant under 12 months of age that remains unexplained after a review of the clinical history, complete autopsy and death scene investigation” (1) (p. 681). In 2014, there were approximately 3,500 SUID deaths in the US, and 44% of them (1,500 deaths) were attributed to SIDS (2). Despite continued efforts to promote safe sleep, the SIDS mortality rates in the US have plateaued.

Trends

In 1994, in response to studies from Europe and Australia, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) initiated the “Back to Sleep” campaign to help educate millions of caregivers in the US on ways to reduce the risk of SIDS (3). The campaign promoted placing babies on their back to sleep. In 2012, the NICHD expanded the campaign to emphasize safe sleep environments and back sleeping as ways to reduce SIDS and other sleep-related deaths, renaming it the “Safe to Sleep” campaign.