By Jennifer Fernandez
Every three days, a North Carolina baby dies in an unsafe sleep environment. That’s more than 100 babies every year.
Less than two weeks into 2026, a Cary infant was found dead after falling asleep in a baby lounger, according to media reports.
Baby loungers, which are often soft, contoured pillows with a dent in the middle for the baby, are one culprit in infant deaths. They are not meant to be used for sleeping, and in 2024, the Consumer Product Safety Commission issued a new rule to address concerns about such devices.
Educating parents — and even health care providers — about what constitutes an unsafe sleeping situation is the core mission of Safe Sleep NC, a program of the UNC Collaborative for Maternal and Infant Health.
However, the organization’s efforts are currently limited by a lack of funding. Safe Sleep NC gets $97,000 annually through a federal block grant for maternal and child health.
More money would mean getting the message out to more people and allowing Safe Sleep NC to provide support to counties.
“The infrastructure is there, and the desire for it is there, and the need for it is there,” said Megan Canady, one of two coordinators for the program. “It’s just having that support from the legislators saying, ‘Yes, we also would like to reduce our infant mortality rate.’”
North Carolina ranks near the bottom in the U.S. when it comes to infant mortality, reporting 6.9 deaths per 1,000 live births in 2023. The U.S. average infant mortality rate was 5.6 deaths per 1,000 live births that year. New Hampshire has the lowest infant death rate, with only 2.93 infant deaths per 1,000 live births. If North Carolina’s infant mortality rate was the same as New Hampshire’s, 480 more babies would survive their first year annually.
Unsafe sleeping is one of the leading causes of infant mortality, something Safe Sleep officials want to impress on parents and caregivers. Canady said that data shows even parents who have had children need to be reminded, as well as family members and child care and health care workers who either take care of children or share information with parents.
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‘No reason for that to happen’
From 2015 to 2023, unsafe sleep environments claimed the lives of 1,135 North Carolina infants, according to state data shared by the North Carolina Child Fatality Task Force.
“When we look over time, those are classrooms full of North Carolina kids that we don’t have,” Canady said.
“To even say, ‘Oh, 130, that’s not that much.’ That is a lot,” she continued. “Those are healthy babies, for the most part, who came home, and there was no reason for that to happen.”
For babies under a year old, sleeping on a soft surface, like a couch or adult mattress, can be unsafe because the baby can suffocate in the soft cushions. Sleeping with toys, blankets, pillows or crib bumpers also pose risks of suffocation, strangulation or entrapment. In addition, it’s unsafe for babies to sleep on their stomachs or on an inclined surface.
Co-sleeping, also known as bed sharing, where the baby sleeps alongside adults, accounts for the majority of infant deaths attributable to unsafe sleep in North Carolina every year, state data show. In 2023, co-sleeping caused 86 of the state’s 125 infant deaths due to unsafe sleeping conditions.
Babies placed to sleep on their stomachs are more likely to breathe in their exhaled breath, which can lead to carbon dioxide build-up and low oxygen levels. Sleeping prone also makes it easier for an upper-airway to become blocked, making it harder to breathe. Sleeping on their stomachs can also cause babies to overheat, preventing oxygen from getting to the brain.
“Some babies, if they fall into too deep of a sleep, if they get in a position that they need to wake up from, they can’t,” Canady said.
Multiple funding requests
The North Carolina Child Fatality Task Force has recommended that Safe Sleep NC get more money almost every year for more than a decade. The task force, a legislative study group of volunteer experts, state agency leaders, community leaders and state legislators who research child health issues, makes policy and spending recommendations to the General Assembly.
The group, which recently released its 2026 recommendations, is urging lawmakers to give the Safe Sleep program an additional $250,000 every year to expand its reach.
The General Assembly returns this week for its short legislative session.
Supporters say more money would allow Safe Sleep NC to broaden its messaging beyond parents and caregivers. Information on safe sleep practices could be reinforced with health care providers to help ensure that consistent, accurate messaging is shared repeatedly — not just when parents take their newborns home.
A 2017 study in Pediatrics showed that mothers who were told that babies should sleep on their backs were less likely to report placing their infant on their stomach to sleep.
Safe sleep education emphasizes six steps for correctly placing a baby to sleep:
- Sleep the baby ALONE
- Sleep the baby on their BACK
- Sleep baby in a CRIB
- Put nothing in the baby’s sleep area
- Do not overdress the baby
- Do not smoke anything around the baby
The researchers also found that mothers whose social norms supported babies sleeping face down were much more likely to do so compared with those who felt that their social norms only supported back sleeping for babies.
“These beliefs persist and are potentially modifiable,” the study’s authors wrote, “so they should be considered an important part of any intervention to change practice.”
Examples of unsafe sleep by Jennifer Fernandez
Public health issue
Safe Sleep NC got more funding for the program in the 2024 and 2025 fiscal years. That extra money allowed North Carolina to pilot a multifaceted approach, which was modeled after the Safe Sleep Baby Education program in Sacramento County, California, Canady said.
Sacramento County reduced its overall sleep-related infant deaths by more than half from 2012 to 2019, data shows. The disparity between Black infant deaths and all other infant deaths was reduced by 60 percent, according to a news release issued by the county in 2023.
In North Carolina, Black infants are twice as likely as white infants to die in unsafe sleep environments, according to data shared by the N.C. Child Fatality Task Force. (The racial disparity in overall infant death rates is even worse — Black babies die at three times the rate of white babies in the state.)
Families may not understand that unsafe sleeping conditions are a leading contributor to infant deaths in North Carolina, Canady said.
“Other times when there’s been a public health crisis, we as a state, we as a country, have really faced it head on,” she said.
Today, people understand the importance of transporting babies in car seats, Canady said, but families probably have stories of a parent or grandparent holding a baby while driving home from the hospital.
Sleep-related infant deaths also don’t make the news like when a baby dies in a fire or car crash, she said. There’s not as much reinforcement about the risks of unsafe sleep conditions, she said.
“It’s just one of those public health issues that we haven’t properly addressed how critical it is.”
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