Teaching Safe Sleep

by Liz Marshall, ICCE

In 1991, when I was expecting my first child, I attended childbirth education classes with my husband. In the last class, we learned the basics of newborn care. I listened very carefully as our childbirth educator told us how to position the baby in the crib to reduce the risk of SIDS. Then, several weeks later when our daughter was born, I positioned her exactly as I had been taught. On her stomach. The thought of it now makes me shiver. But it wasn’t until 1994 that the American Academy of Pediatrics recommendation changed to what we know now: Babies should sleep on their backs to reduce the risk of SIDS. I share that experience when I teach today, but not immediately. Instead, I ask the expectant parents to share what they already know about SIDS and safe infant sleep. There’s usually a lot to talk about! As the conversation unfolds, I make sure I’m careful to distinguish between SIDS deaths (those that lack an explanation) and deaths due to accidental suffocation. We describe surfaces that are unsafe for babies: pillows, blankets, sheepskin rugs, water beds, chairs, and especially couches. Since sleeping in the family bed can be less safe or more safe, the ICEA Position Paper on Safe Infant Sleep carefully describes how to educate parents on safer bedsharing. It also strongly recommends baby-proofing the family bed “even if they have no plans to bedshare.” Then I guide us back to the subject of SIDS. I make sure they know that breastfeeding and room-sharing contribute to safe sleep. I also explain that babies who live in households where someone smokes are at an increased risk of SIDS. (Yet another great reason to quit smoking and I always make sure that I have cessation resources on hand.) I distribute fact sheets, like those made available by the “Safe to Sleep” campaign of the National Institute of Child Health and Human Development. Finally, I tell my story. I want my students to understand that when their mothers were young and pregnant they were probably taught to place baby on the stomach. Why? To avoid spitting up and choking. Those women may have sat in a room just like this one, decades ago, and been taught by a childbirth educator who spoke just as earnestly as I speak today. But we know now that the advice that was given was wrong. And when we know better, we do better. How will you talk to your mother-in-law about putting the baby down for a nap? I ask. Will you bring up her occasional cigarette? Together we’ll role play. I’ll help them find the right words to use. Do they feel comfortable sharing the handouts with their family members? What about extending an invitation to attend a well-baby visit so that family members can hear advice about safe sleep directly from the doctor? I emphasize that if any older family members are going to be caring for their baby, they need to be brought up-to-date regarding safe sleep recommendations. When it comes to safe sleep, it’s not enough to teach expectant parents the important concepts. Today’s parents must be able to address all the aspects of safe sleep with their own parents–and aunts and grandparents and any other older adult who may be caring for the baby.


American Academy of Pediatrics, Task Force on Infant Sleep Position and Sudden Infant Death Syndrome. (2000). Changing concepts of sudden infant death syndrome: Implications for infant sleeping environment and sleep position. Pediatrics, 105(3), 650-656. Anderson TM, Lavista Ferres JM, Ren SY, et al. (2019). Maternal Smoking Before and During Pregnancy and the Risk of Sudden Unexpected Infant Death. Pediatrics, 143 (4), 2018-3325. Bombard JM, Kortsmit K, Warner L, et al. (2018). Vital Signs: Trends and Disparities in Infant Safe Sleep Practices — United States, 2009–2015. MMWR Morb Mortal Wkly Rep 2018;67:39-46. DOI: http://dx.doi.org/10.15585/mmwr.mm6701e1external icon. Centers for Disease Control and Prevention. (2018). About 3,500 babies in the US are lost to sleep-related deaths each year. Retrieved Sept. 28, 2020, from https://www.cdc.gov/media/releases/2018/p0109-sleep-related-deaths.html Moon RY, Hauck FR, Colson ER. (2016). Safe Infant Sleep Interventions: What is the Evidence for Successful Behavior Change? Current Pediatric Reviews. 12(1).DOI : 10.2174/1573396311666151026110148 Smith LJ. Safe Infant Sleep. ICEA Position Paper. (2018). Task Force on Sudden Infant Death Syndrome. (2016). SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics, 138 (5) e20162938; DOI: 10.1542/peds.2016-2938

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