Is your baby’s safe sleep a luxury?

In my Bronx clinic, I frequently find myself across from new families who are knowledgeable about the American Academy of Pediatrics’ (AAP) safe sleep directives. Babies ought to sleep independently, on their backs, in a crib devoid of soft bedding and toys. Nevertheless, despite this understanding, numerous parents, particularly those who opt for exclusive breastfeeding, encounter genuine obstacles in adhering to these guidelines. For single mothers and those seeking shelter, co-sleeping frequently appears to be the only viable choice. Whether due to sleep deprivation, housing instability, overcrowding, or lack of familial support, these elements render “knowing” and “doing” significantly divergent tasks.

The ongoing challenge

Nationwide, the AAP’s Back to Sleep initiative (1994) has markedly decreased Sudden Infant Death Syndrome (SIDS). Nevertheless, disparities continue to exist. In 2022, the U.S. reported a SUID (Sudden Unexpected Infant Death) rate of 100.9 deaths per 100,000 live births (CDC, 2022), with non-Hispanic Black infants facing a rate of 196.9 per 100,000, compared to 85.7 for non-Hispanic white infants. In the Bronx, where I work, infant mortality rates are the highest in New York City, standing at 5.2 deaths per 1,000 live births.

This preventable catastrophe prompts some troubling inquiries:

• Is safe sleep a luxury?
• Is education the sole solution?

My responsibilities and initiatives as your pediatrician

At NYC Health + Hospitals/Gotham Health (NYCHHC) Tremont Clinic, in my role as a primary care pediatrician, my objective is not only to impart safe sleep education but to close the divide between awareness and real-life application. Because no! Safe sleep ought not to be a luxury, but a right. To tackle disparities in my community, I obtained a book grant from Charlie’s Book Foundation to distribute bilingual safe sleep literature during well-child visits. These books serve as more than educational resources; they often become the inaugural book in a family’s home, fostering literacy alongside health information. I meticulously allocate my time, researching and collaborating with community social workers while connecting families to available resources within my State. For instance, New York State’s Department of Health provides initiatives like Cribs for Kids (free portable cribs for qualifying families), in-home nursing visits, and parenting education programs (NYSDOH). These resources frequently remain underutilized simply because families lack awareness of them.

The responses I have received from families are uplifting and act as my guiding principle.

Wider advocacy and call to action

<pYoung physicians like myself are in a unique position to witness both advancements and gaps. We have observed how safe sleep campaigns have lowered infant mortality, yet we also recognize the reasons why disparities stubbornly endure. It is now our duty to merge medical knowledge with community realities and deliver practical solutions to our families.

Call to action

To avert this tragic event and establish safe sleep as a universal right, we must:

• Support families by honoring cultural practices while emphasizing the safety of crib-based sleep.
• Enhance community outreach and seek resources on behalf of our families: initiatives like Charlie’s Safe Sleep Grant, State programs like NYSDOH’s Cribs for Kids, and New York’s free portable crib distribution must be widely promoted and integrated with well-child visits.
• Advocate for legislative fairness: encourage policymakers to fortify safe sleep access by incorporating crib programs and home visits into Medicaid coverage and investing in housing policies to alleviate overcrowding.
• Empower young physicians: healthcare institutions must back pediatricians at FQHCs who innovate within the community, ensuring they are equipped with the resources and recognition to amplify their efforts.

I believe

Every infant merits a safe sleep. By recognizing the complexities families encounter and responding with concrete support, consistent communication, and policy reform, we can transform safe sleep from a mere luxury into a universal right.

Tanya Tandon is a pediatrician.