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Safe Sleep Practices

Promoting safe sleep practices is a public health priority. Much research has been conducted about safe sleep practices that address sudden infant death syndrome (SIDS) and suffocation risk reduction. Simple care giving techniques can play a critical role in keeping infants safe during sleep. 

Objectives
  • Describe why safe sleep practices are important for infants.
  • Identify your role in keeping infants safe while sleeping.
  • Apply the information from this lesson to ensure that safe sleep practices are adhered to at all times.

Learn

Know

Startling Statistics

Approximately 3,600 infants die suddenly and unexpectedly each year. Sudden unexpected infant death (SUID) is a term used to describe sudden and unexpected death of an infant less than 1 year of age in which the cause was not obvious before investigation. Sudden unexpected infant death includes Sudden Infant Death Syndrome (SIDS), accidental suffocation in a sleeping environment, and other deaths from unknown causes. One-half of all SUID cases are Sudden Infant Death Syndrome.

Sudden infant death syndrome (SIDS) is the leading cause of death among infants 1 month to 12 months old and is the third-leading cause overall of infant mortality in the United States.

About one in five SIDS deaths occur while an infant is being cared for by someone other than a parent. Many of these deaths occur when infants who are used to sleeping on their backs at home are then placed to sleep on their tummies by another caregiver. Infants who are used to sleeping on their backs and placed to sleep on their tummies are 18 times more likely to die from SIDS, according to the American Academy of Pediatrics.

According to the National Resource Center for Health and Safety in Child Care and Early Education, a majority of SIDS-related deaths at child-care facilities occur in the first week that an infant starts attending a child-care program.

Sudden Infant Death Syndrome

Sudden infant death syndrome is defined as the sudden death of an infant less than 1 year of age that cannot be explained after a thorough investigation is conducted, including a complete autopsy, examination of the death scene, and review of the clinical history. Most SIDS deaths occur between 1 month and 4 months of age, however SIDS deaths can occur anytime during the first year of life.

Sudden Infant Death is NOT:

  • The same as suffocation and is not caused by suffocation
  • Caused by vaccines, immunizations, or shots.
  • Contagious
  • The result of neglect of abuse
  • Caused by cribs
  • Caused by vomiting or choking
  • Completely preventable, but there are ways to reduce the risk

Because the causes of SIDS are unknown, safe sleep practices should be used to reduce the risk of SIDS in every infant under the age of 1 year.

See

Education is the key to promoting caregiving practices that ensure infants’ well being. The American Academy of Pediatrics (AAP) provides safe sleep policy guidelines and practices.

Encouraging Safe Sleep Practices

Watch this video to see the way one program communicated safe sleep practices.

AAP’s policy guidelines say:

  • Healthy babies should always sleep on their backs.
  • Newborns should be placed skin-to-skin for at least the first hour after birth.
  • A physician’s note should be required for non-back sleepers; the note or statement should explain why the baby should not use a back-sleeping position, how the child should be placed to sleep, and a time frame for the instructions to be followed.
  • Cribs must be in compliance with 2014 U.S. Consumer Product Safety Commission and ASTM International requirements.
  • Use a firm crib mattress covered by a tight-fitting sheet designed for a safety-approved crib.
  • Keep cribs free of blankets, pillows, stuffed toys, soft objects, loose bedding and bumper pads. Nothing else should be in the crib except for the baby.
  • Bibs, necklaces, and garments with ties or hoods should be removed.
  • Dress the baby lightly for sleep. Set the room temperature in a range that is comfortable for a lightly clothed adult.

Continue to watch as a caregiver describes how her program ensures a safe sleep environment in her mixed-age infant toddler classroom.

Safe Sleep Practices in Mixed-Age Settings

Watch as a caregiver describes how they ensure a safe sleep environment in her mixed-age infant toddler classroom.

Do

Children should be placed on their backs to sleep. If children roll over onto their stomachs on their own, adults do not need to reposition the children onto their backs.

Infants who arrive at the facility asleep in car safety seats should be immediately removed and placed on their backs in a safe sleep environment.

Infants should not nap or sleep in a car safety seat, bean-bag chair, bouncy seat, infant seat, swing, jumping chair, playpen or play yard, high chair, chair, futon, or any other type of furniture or equipment that is not a safety-approved crib. If an infant falls asleep in one of these, the infant should be immediately removed and be placed on their back in a safety-approved crib.

Infants should not be swaddled according the National Health and Safety Performance Standards, 4th edition, Standard 3.1.4.2, which states “In child care settings, swaddling is not necessary or recommended, but rather one-piece sleepers should be used.” 

Supervision

The lighting in the room must allow the caregiver to see each infant's face, to view the color of the infant's skin, and to check on the infant's breathing and placement of a pacifier if used.

Infants should be directly observed by sight and sound at all times, including when they are going to sleep, are sleeping, or are in the process of waking. A caregiver trained in safe sleep practices should be present at all times when infants sleep. This caregiver should actively supervise sleeping infants including checking to make sure the infant’s head remains uncovered at all times.

Tummy Time

As a result of being placed on their backs to sleep infants may develop flattening of the skull. To minimize this, it is recommended that infants have supervised tummy time. Tummy time also encourages motor development especially the upper body muscles. During tummy time, it’s important that you actively supervise the practice of never leaving infants unattended.

Promoting Safe Sleep

Parents, family members, teachers, and all adults who care for an infant should follow safe sleep practices every nap time and every sleep time. Sleeping-related preferences may be sensitive to a family’s culture or personal preferences and beliefs. Handle discussions sensitively. Provide families A Parent’s Guide To Good Sleep (see information in Explore).

In order to ensure the safe sleep of infants and toddlers, you should be prepared to adhere to the following guidelines.

  • Know your program’s safe sleep policy and share it with families
  • Place infants on their backs to sleep every time
  • Provide firm, safety-approved crib mattresses
  • Keep soft objects and materials (toys, stuffed animals, quilts, blankets, comforters, sheepskins, and pillows) out of cribs or near sleep areas
  • Use sleep clothing (sleepers) or follow safe blanket procedures
  • Provide daily, supervised tummy time while babies are awake
  • Teach all staff, substitutes, and volunteers about safe sleep practices
  • Keep infants’ sleep areas free from hazards such as dangling cords, electric wires and window covering cords because they present a strangulation risk
  • Intervene when you observe unsafe sleep practices
  • Remove bibs, pacifier clips, or any clothing with hoods or cords before laying an infant down
  • Put infants to sleep in safe places, never in bouncy seats, play gyms or swings

Explore

As stated in the Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Settings, infants who are cared for by adults other than a parent, guardian or primary caregiver are at increased risk of dying from SIDS.

Much can be gained from learning why these risks remain. Read and study the pamphlets provided here. Respond to the questions in the Safe Sleep Risk Reduction Study Guide and share your responses with your trainer, coach, or administrator.

Apply

Visit the Healthy Children website to review safe sleep practices, including the importance of tummy time during wake time as well as other resources: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx. Then read, review, and consider using the Safe Sleep Posters below in your classroom.

Glossary

Aspiration:
The inhalation of food, liquid, or a foreign body into a person’s airway which results in choking or respiratory distress
Prone:
Lying face-down
Supine:
Lying on the back

Demonstrate

Why might SIDS-related deaths occur while an infant is being cared for by someone other than a parent, according to the American Academy of Pediatrics?
Which of the following is a safe-sleep practice?
Which of the following is a barrier to implementing safe sleep practices?
References & Resources

American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2019). Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. (4th ed.). American Academy of Pediatrics. https://nrckids.org/CFOC

American Academy of Pediatrics. (2016) How to keep your sleeping baby safe: AAP policy explained. https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx

American Academy of Pediatrics. (2016) How to keep your sleeping baby safe: AAP policy explained. https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Sleep-Position-Why-Back-is-Best.aspx

American Academy of Pediatrics. (2016) Make baby’s room safe: Parent checklist. https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Make-Babys-Room-Safe.aspx

Centers for Disease Control and Prevention. (n.d.). Sudden Unexpected Infant Death and Sudden Infant Death Syndrome. http://www.cdc.gov/SIDS/index.htm 

Centers for Disease Control and Prevention. (n.d.). SUID and SIDS: Parents and Caregivers. http://www.cdc.gov/sids/Parents-Caregivers.htm 

Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, DHHS. (2012). Safe Sleep for Your Baby: Reduce the Risk of Sudden Infant Death Syndrome (SIDS) and Other Sleep-Related Causes of Infant Death (12-7040). Washington, DC: U.S. Government Printing Office. https://www.nichd.nih.gov/publications/pubs/Documents/Safe_Sleep_Baby_English.pdf 

Eunice Kennedy Shriver National Institute of Child Health and Human Development. (n.d./Updated 2015, January 2).  Safe to Sleep Public Education Campaign. https://safetosleep.nichd.nih.gov/

Healthy Child Care America (n.d.). HCCA Safe Sleep Charlie's Story. American Academy of Pediatrics. https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Safe-Sleep-Charlies-Story.aspx

Healthy Child Care America (n.d.). Back to Sleep, Tummy to Play [Brochure]. American Academy of Pediatrics. https://healthychildren.org/English/ages-stages/baby/sleep/Pages/Back-to-Sleep-Tummy-to-Play.aspx

Healthy Child Care America. (2017). Back to sleep, tummy to play. American Academy of Pediatrics. https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Back-to-Sleep-Tummy-to-Play.aspx