Safe sleep tips

I remember running into the Emergency Room and seeing nothing but tears: tears from the nurses and staff, tears from a distraught mother, and then tears clouding my own vision when I saw the lifeless form of the 6-month-old boy.

I was as close with his family as I had been with any family as their pediatrician. I was present at his birth, provided his well-child care and cared for his sister through an illness and subsequent rehabilitation.

Everything was perfect until that night, when I signed his death certificate.

He died in his sleep, and the autopsy showed no abnormality or disease. The medical examiner ruled his death to be Sudden Infant Death Syndrome, or SIDS. He had slept in bed with his parents, and they found him unresponsive at 4 a.m. He was fine the day before, and then he was gone.

According to the U.S. Centers for Disease Control and Prevention, about 3,500 infants die of SUID (Sudden Unexpected Infant Death) each year, and about 40 of those happen in Oregon. Of those deaths, about 25 percent are the result of identifiable occurrences during sleep, including smothering and suffocation from blankets, pillows or other people. The rest have no clear explanation, and are classified as either Sudden Infant Death Syndrome (SIDS), or unexplained. In 1992, the American Academy of Pediatrics (AAP) recommended that all infants less than 1 year of age be placed on their back for sleep, followed by the Back to Sleep campaign in 1994. As a result of those recommendations, we have seen a decrease in deaths from SIDS of approximately 70 percent in the last 30 years. Those recommendations can be found here and are also listed at the bottom of this blog post.

While we know what works to help ensure that babies sleep safely, it can be challenging for parents to adhere to best practice. Living with a newborn is exhausting, terrifying and, worst of all, unremitting: night after night, for months on end – it is completely understandable why parents may choose to bed share with their infants.

Sociocultural pressures and beliefs, coupled with concerns like spitting up, lead parents to choose to co-sleep with their babies, or to allow them to sleep on their stomachs. As the parent of three kids (meaning I myself have survived having three infants), I have memories of the sleep deprivation. However, I am sure I have repressed most of the true memories of the absolute exhaustion that our children wreaked upon us.

As a pediatrician, I spend hours every week discussing safe sleep with families, reviewing the recommendations that prevent tragic deaths from SIDS and suffocation. Many families acknowledge that they are following best practice. Many more families confide that following the guidelines is a challenge; they often feel the infant prefers sleeping on her stomach, that the baby will not sleep alone in her bassinet or crib or that they are uncomfortable being separated from their baby.

Tragically, many families may also be forced into unsafe situations due to space or financial restrictions.

Last month, pediatricians at Penn State published a brilliant study using video surveillance among participating families to show that most infants were sleeping in unsafe ways. Many babies were put to sleep in dangerous places, on their sides or bellies, and most had dangerous items in their sleep spaces. Moreover, when babies awoke during the night, many were moved to an unsafe sleep environment.

I must admit, I am not totally shocked by this study, and it confirms what every parent knows: Getting your baby to sleep, and making sure that parents are also able to sleep, is a huge issue for everyone. People do what they feel like they must do just to get through the night. It is survival mode for parents. The tragedy lies in the fact that survival for parents can be critically dangerous for babies.

What I take away from this study is a humbling reminder that it is hard to be a parent. It’s easy for me to talk about things and provide recommendations based on the best available science. People will take that information and do what they need to in order to make it through a day and night. Armed with this information, I can help acknowledge the challenges, and help parents do the best they can as a part of an honest conversation, as opposed to a sermon.

I often think back to that night in the ER, to the sadness and powerlessness I felt as a physician, and as a person, to prevent the senseless loss of a beautiful baby. As I reflect on that, I also reflect on the fact that every year, more children die from sleep-related deaths (most of which are associated with unsafe sleep practices) than they do from all of childhood cancers combined. Crazy, right?

We know what we should do, but we also, sadly, know what actually happens sometimes. I encourage you to read through the recommendations below and share them with your friends and family members.

What you can do, as recommended by the American Academy of Pediatrics:

  • Place your baby to sleep on his back for every sleep.
  • Place your baby to sleep on a firm sleep surface.
  • Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the crib.
  • Place your baby to sleep in the same room where you sleep but not the same bed.
  • Breastfeed as much and for as long as you can.
  • Schedule and go to all well-child visits.
  • Keep your baby away from smokers and places where people smoke.
  • Do not let your baby get too hot.
  • Offer a pacifier at nap time and bedtime.
  • Do not use home cardiorespiratory monitors to help reduce the risk of SIDS.
  • Do not use products that claim to reduce the risk of SIDS.

For details and additional tips to reduce the risk of SIDS, visit or talk with your family’s provider.


Ben Hoffman, M.D. 
Medical Director, OHSU Doernbecher Tom Sargent Safety Center
Professor of Pediatrics
OHSU Doernbecher Children’s Hospital


3 responses to “Safe sleep tips

  1. While I appreciate the comments in this article and the helplessness the physician feels, as a SIDS parent who was holding her sleeping daughter who died in my arms in a public place, and saw what happens during a SIDS “event”, none of these sleep techniques would have prevented the death of my child. SIDS is a mystery. Its root causes unknown and is a diagnosis of exclusion. It remains important to do what you can, but ultimately there is nothing anyone can do at this point in time to prevent SIDS.

    1. Hi Cara – here’s a note from the blog’s author, Dr. Ben Hoffman:

      I am so sorry for your loss. Absolutely tragic. Sadly, there are many babies who die and we never know why, or have a sense of what could have been done to prevent it. As you know, SIDS is the name given to a death of an infant that cannot be explained after a thorough investigation. SUID is a broader category, and includes the death, explained or unexplained, that occurs in infancy.
      We know that many of these deaths are related to sleep, and we also know what is effective in preventing many sleep-related tragedies.
      The helplessness that health care providers feel is nothing compared to that of a parent who has lost a child. I cannot imagine what you have gone through. I know that we will not prevent every such tragedy, but I feel compelled to do everything possible to prevent those that we can.
      Again, my deepest sympathies for your experience.

  2. Thank you, Ben. I will never forget the look and the tears rolling down the face of the kind and caring physician’s face who delivered the news to my husband and I that sad day so many years ago. I commend you for doing everything you can, and remaining a compassionate provider when a parent is faced with such unfathomable loss.

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