What you say to parents and caregivers of infants does make a difference!
- Use a strength-based approach. This helps families feel valued, not judged.
- Ask for permission to share information and remember to be respectful and sensitive.
- Use open-ended questions to get the conversation going and to keep it honest.
Remember the goal is to reduce the risk by sharing information, answering questions and concerns, discussing resources, problem-solving, and
For conversations about safe sleep to be successful, parents need judgment-free conversations that encourage open and honest dialogue. Using open-ended question such as, what do you like about bed sharing? What makes it hard for you to put your baby on their back to sleep? By proactively avoiding yes or no answers, you can better understand parents’ and caregivers’ motivations and help to create solutions for each family that reduces the risk of death or injury for the infant.
Open-Ended Questions to Talk About Safe Sleep
- What have you heard about ways to keep your baby safe while they sleep?
- What worries or questions do you have about how and where your baby should sleep?
- What do others who will care for your baby know about safe sleep practices?
- What plans have you made for where your baby will sleep? (Or- Where does your baby sleep?)
- We recommend that you put your baby to sleep alone, on his or her back and in a crib. What do you think about these recommendations?
- Avoid Smoke/vape.
- Do not smoke/vape or expose yourself to others’ smoke/vape while you are pregnant and after the baby is born.
- Keep your car and home smoke-free at all times.
- Do not drink alcohol or use drugs while pregnant or after the birth.
- Get regular prenatal care to reduce your risk of having a low birthweight or premature baby.
- Have a crib, bassinet, or portable crib (pack ‘n play) with a firm mattress and fitted sheet.
- Keep pillows, quilts, comforters, bumper pads, stuffed toys and cords out of the crib. Remember bare is best! Decorate the room NOT the bed
- Make sure the baby’s room does not get too hot.
- Place your baby to sleep on his back for naps and at night. If your baby can roll from his back to his side or stomach on his own, he can be left that way.
If your baby falls asleep in a car, stroller, swing, infant carrier or infant sling move her to a crib or bassinet as soon as possible.
Breastfeed as long as you can. Studies show that breastfeeding reduces the risk of SIDS. Exclusive breastfeeding (no baby formula) is best, but any breast milk is better than none.
Make sure your baby goes to all scheduled doctor visits and gets all recommended shots. Evidence suggests that immunizations may protect against SIDS.
Offer a dry pacifier (without a string) at nap time and bedtime. This helps reduce the risk of SIDS. If breastfeeding, wait around 3- 4 weeks (until breastfeeding is established) before offering a pacifier. If baby does not take a pacifier, do not force it.
Don’t let your baby get too hot. Dress him in one layer. Use clothing designed to keep babies warm without the risk of it covering their heads. Blankets are not recommended but if you decide to use a blanket, make sure it is tucked into the crib mattress to keep it from becoming loose and covering your baby’s face. Use the “feet-to-foot” guidelines: Put the baby so his feet are near the foot of the crib. Place a lightweight blanket across the baby’s chest just under the arm pits. Tuck the blanket securely along the two sides and foot of the crib.
Do not use home breathing or heart monitors to reduce the risk of SIDS.These can be helpful for babies with breathing or heart problems. They have not been found to reduce the risk of SIDS.
Do not use products that claim to reduce the risk of SIDS. Wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS. Some infants have suffocated using these items.
Most sleep related infant deaths in North Carolina are associated with bed sharing. Many parents bed share for different reasons and it is best to find out why they are bed sharing to be better able to talk with them about how to reduce the risk. You can do this through non-judgmental communication that includes the use of open-ended questions. Some parents are intentional about their desire to bed share, others do so on accident due to exhaustion. By better understanding what is driving parents to bed share, the better able you will be to talk with them about strategies to reduce the risk for infant by this practice.
- When the infant is younger than 4 months
- If the infant was born premature or had low birth weight
- If the bed-sharer uses tobacco or if the mother used tobacco during pregnancy
- If the bed-sharer has taken illicit drugs or medicine that causes drowsiness
- If the bed-sharer has consumed any alcohol
- If the bed-sharer is not the parent
- If there are multiple bed-sharers (including other children)
- If the sleep surface is soft, such as an old mattress, waterbed, or pillow-top mattress
- If the sleep surface is a couch, sofa, or recliner
- If there is soft bedding, such as pillows or blankets, present in the bed.
You can talk with parents about their infants’ level of risk when it comes to bed sharing. It is important that parents clearly understand why this practice can be dangerous for all infants but making it personal about their infants’ risk is important. Also, although there is no 100% safe way to bed share, there are ways to reduce risks. Consider using our level of risk survey to help parents better understand their infant’s individualized risk factors regarding bed sharing.
Click HERE for information for parents about reducing the risks associated with bed sharing.
Click HERE to learn more about how to have conversations with parents about bed sharing.
Many families have questions about bed sharing and breastfeeding. Click HERE to read more about how to engage parents on this topic.
It is important that parents also are sure that anyone who cares for their baby follows safe sleep practices. A study found that while parents and licensed childcare providers are catching on about safe infant sleep practices, friends, relatives, and babysitters often do not know how to help prevent sleep-related infant death.
In North Carolina, licensed child care facilities are required to follow strict safe infant sleep practices. Click HERE to read more about these policies. It is North Carolina law and childcare licensing rules require that in childcare settings.
- Licensed childcare providers are taking important steps to be informed about reducing the risk of SIDS and other sleep related infant deaths and are working to help your baby sleep safely. North Carolina has important legal and licensing requirements designed to reduce the risks of SIDS/ SUIDS in childcare settings.
- When considering a childcare provider ask if the childcare provider is ITS-SIDS certified and look for the ITS-SIDS symbol. Ask to see the provider’s “Safe Sleep” policy.
- You can read the Safe Sleep Rules for Caregivers to see how caregivers are helping keep babies safer while they sleep and the steps they are taking to keep SIDS from happening.
- North Carolina law and childcare licensing rules require that in childcare settings:
- Place babies, 12 months of age or younger, to sleep on their back. A waiver may apply under certain circumstances.
- Childcare providers must have a written safe sleep policy and must explain it to parents before the baby is enrolled.
- Providers must complete the Infant/Toddler Safe Sleep and SIDS Risk Reduction in Child Care(ITS-SIDS) training.
The North Carolina Child Care Health and Safety Resource Center offers a toll free number ( 1-800-367-2229 ) as well as an online form that parents and anyone working in the child health and child care communities can use for more information.
Encourage parents to talk with everyone that cares for their baby about safe sleep.
Encourage them to ask the following questions:
- What sleeping arrangements they already use for infants in their care.
- Ask to see what they already have for sleeping arrangements or if you should provide your own.
- Ask to see what they already have for sleeping arrangements or if you should provide your own.
- Ask them what they would do if your baby were to fall asleep in the car seat, in a swing, or in a bouncy seat.
- Ask them how they put babies to sleep (babies should only be placed on their backs–not their side or stomach).
- Ask about tummy time, and ask to see where tummy time takes place.
- Ask if they or anyone who comes to the childcare location smokes/vapes, or if your baby will ever be around anyone who smokes/vapes while in their care.
- Ask if they use blankets, stuffed animals, or bumper pads in the crib.
Encourage parents to share the following safe sleep information:
- Always put baby to sleep on his or her back.
- Always put baby to sleep in a crib or bassinet with a firm and flat mattress.
- Remove all blankets and pillows from the crib.
- Remove any other objects that could be hazardous, including stuffed animals, toys, and bumpers.
- Do not sleep on the same surface (bed, couch, etc.) with baby.
- Do not smoke or vape around baby
The North Carolina Safe Sleep Advisory Committee recently created a statement about baby boxes for both community leaders and parents. Click HERE to read the statement.
Baby boxes are sturdy cardboard boxes with a firm mattress, a waterproof cover, and a fitted sheet that are intended to serve as a safe sleep area when a traditional and recommended sleep area, like a crib, is not available. A baby box may be a great alternative for many families that need a place for their infant to sleep when used safely.
• Babies should only sleep in the box for the first 3-4 months of life (or until they can turn over). After 4 months or when they can turn over, you will need another safe sleep space for your baby, such as a crib or pack-n-play.
• Make sure the baby box, like all sleep spaces for infants, does not contain any fluffy bedding, pillows, blankets, stuffed animals, or extra padding.
• The box is designed to be placed on the floor. It should not be placed on a bed, dresser, table, couch, counter, or any other unstable or high surface.
Parents often have questions about safe sleep and the recommendations. Here are some examples of common questions and examples of how to answer those questions. Note how the answers encourage feedback from parents.
A) That is great that you are breastfeeding! Can you tell me what you like about bed sharing for breastfeeding? (listen to the answer) I see, by bed sharing you are able to easily breastfeed. That makes sense and you are right having the baby nearby does help to promote and maintain breastfeeding. Unfortunately, bed sharing is related to high rates of infant death especially with infants less than 4 months like yours. Can I share with you some other ideas about how to breastfeed and be sure that your baby is sleeping safe?
One idea is to put your baby’s crib near your bed so that you can easily pick them up for feedings during the night and then return them to their crib for sleeping. What do you think about this idea?
If the parent is unwilling to change their practice of bed sharing, discuss what factors put infants at higher risk when bed sharing. Further, discuss how to reduce risk by making sure that baby always sleeps on their back, that there is no soft bedding near the baby (blankets, pillows, etc.), that the bed is pulled away from the wall, and that the mattress is firm (not a soft pillow top, water bed, or air mattress).
A. I understand that happens to many parents. Caring for a newborn is exhausting and I know you are doing your best. I am glad you asked me about this.
Can I share with you some ideas ?
Ask others to help you, such as your partner, parent, or adult, to move the baby back to her crib if they see that you have fallen asleep with the baby. Another idea is to set an alarm for yourself to wake up and move your baby back to their crib. We all get sleepy, but one really important thing is to not care for your baby on the couch or recliner because that is a very risky place to fall asleep with your baby. Another tip is to keep your bed area clear of all bulky bedding and pillows in case you accidentally do fall asleep. What do you think about these suggestions?
A. Great question, a lot of parents wonder about this. Actually, no. Healthy babies naturally swallow or cough up fluids. It’s a reflex all people have to make sure the airway is always open. Infants are actually less likely to choke when placed on their backs. When your baby is on their stomach, anything spit up can block the windpipe and cause choking or breathing problems. Even if your baby has reflux or GERD (gastroesophageal reflux disease) it is still safest for them to sleep on their backs. What do you think about this? What other questions do you have about infant sleep?
A. I am so glad you asked. Babies who usually sleep on their backs but who are then placed to sleep on their stomachs are at higher risk of Sudden Infant Death Syndrome (SIDS). So, it is important for everyone who cares for your baby to use the back sleep position for all sleep times—for naps and at night. How do you feel about talking to your parents or caregiver about this? What else can you tell me about how your infant is sleeping.
You can’t assume that others know about and follow safe sleep practices. So be sure to talk with everyone who cares for your baby about how and where your baby should sleep. What are your thoughts about doing that? (Continue to talk to parent about how to talk to caregivers about safe sleep)
A. A lot of babies do sleep better on their stomachs, but that is actually part of the problem. When babies sleep on their stomachs they are less reactive to noise, they can experience sudden decreases in blood pressure and heart rate control, and they can experience less movement and have longer periods of deep sleep. These things can put a baby at higher risk of SIDS. I know you want your baby to sleep well, but stomach sleeping is not safe. Putting your baby to sleep on their back really helps to lower the risk of SIDS. What do you think about that suggestion?
A. I am really glad you asked. I know there are a lot of things to know when it comes to taking care of a new baby. Can you tell me what you know about safe sleep and questions you have?
Thanks for sharing. A good way to think of a safe sleep environment is to remember A, B, C
A is for alone. This means that a baby sleeps in alone (not with another person, or sibling, or pet).
B is for back. This means the baby sleeps on their back for every sleep.
C is for crib. This means they sleep in a crib (or bassinet or pack n play) without anything else in the crib but a tight fitted sheet on a mattress. No blankets, stuffed animals, pillows. This also means the baby doesn’t sleep on a couch or adult bed because they can be unsafe. I know that was a lot to hear. What other questions do you now have about your baby and sleep?
A. It sounds like you want to make a safe and comfortable place for your baby to sleep. But what we know is that having extra stuff around the baby when they sleep is not safe. They can easily get covered by a blanket or stuffed animal and not be able to breathe. Bumper pads seem like a good idea and you see them everywhere, but babies are much safer without them because they can get caught up in them and this can cause them to suffocate or be strangulated. Crib slats (bars) should be narrow enough that a can of soda won’t fit through the space between them. Your infant is safer without the bumper pads. There is very little chance they would hurt their arms, legs, or head because of the crib bars, but they could get hurt because of the bumper pads.
What other questions do you have about your babies crib or sleeping?
A. I am glad you asked me. What other places do you have available that your baby can sleep at night? I understand that sometimes we just want our baby to sleep wherever it works, but unfortunately, car seats and other sitting devices aren’t safe. It is best for infants to sleep alone on a firm flat crib or pack and play mattress.
Sitting devices, such as car seats, strollers, swings, and infant carriers are not recommended for routine sleep. Its also important to know that car seats and sitting devices are not stable on a crib mattress or other elevated surfaces. Infants sleep safest on a flat surface and infants should not be left unattended in car seats and similar products or with the straps unbuckled or partially buckled. Do you have another place that your baby could sleep? Can I share with you some other ideas to keep your baby safe when they sleep?