Public health initiatives have reduced infant sleep-related deaths in the U.S. since 1990, yet approximately 3,700 such deaths were reported in 2022. This study examines the demographics of mothers from the 2016-2022 Missouri PRAMS cohort to understand their adherence to safe sleep practices for infants. Using a scoring system based on American Academy of Pediatrics guidelines, the study analyzed maternal characteristics and healthcare provider advice.

Results showed that 49.2% of mothers consistently followed safe sleep recommendations. Factors associated with lower adherence included being unmarried (36.3%), under 20 years old (30.3%), never breastfeeding (43.8%), living in rural areas (42.5%), and having less than a high school education (33.3%). Provider advice on placing infants “back to sleep” emerged as a significant predictor of safe sleep practices.

The findings indicate that targeted public health messaging is critical to address the needs of demographics less likely to follow safe sleep guidelines. Despite many mothers receiving education on safe sleep, a considerable number do not comply. Future efforts should focus on understanding barriers to safe sleep practices to promote behavioral change effectively.