Pregnancy Risk Factors

Pregnancy risk factors ___ Did mom smoke during pregnancy

___ Did mom receive regular prenatal care (defined as more than 6 visits)

___ Did mom wait 18 months between pregnancies

Sleep environment ___ Contains a crib/bassinet/Pack ‘n Play (should have a firm sleep surface with tight fitting sheet)

___ Includes a sleep surface free of soft bedding, bumper pads, pillows, blankets and stuffed animals

___ Smoke-free, including smoking outside

___ Infant is placed on the back to sleep, for every sleep

___ Utilizes a fan in the sleep environment, but not blowing directly at infant

Protective factors ___ Infant is breastfed

___ Infant is sleeping in the same room as caregiver(s)

___ Infant is offered a pacifier for sleep

___ Infant has supervised, awake tummy time

Children’s Health Alliance of Wisconsin www.chawisconsin.org