<p>Sleep-related deaths are a preventable cause of infant mortality. Pediatricians can promote infant safe sleep practices; however, communication barriers may arise, especially for patients of color. This study examined how patient race and ethnicity relate to the length and quality of safe sleep discussions with pediatric residents. Sixteen pediatric residents completed questionnaires on safe sleep knowledge and attitudes. Observations were conducted during 102 well-baby visits to measure time spent discussing safe sleep and frequency of effective communication skills used by residents. In descriptive analyses, residents spent less time discussing safe sleep with Black and other patients of color compared to White patients. In multivariate models, caregiver receptiveness, rather than client race and ethnicity, predicted time discussing infant safe sleep. However, when receptiveness was removed from the model, caregiver race and ethnicity did predict time discussing infant safe sleep such that providers spent less time talking to Black caregivers and caregivers of color. Race and ethnicity did not predict resident use of MI skills. Residents may experience communication challenges when discussing infant safe sleep, particularly with patients of color. Client receptiveness and race appear to be important variables with regard to patient-provider communication about infant safe sleep.</p>