The ABCs of Safe Sleep

Here's what parents need to know about practicing safe sleep — straight from an expert with the Oakland County Health Division.

“Just this one time.”

As a sleep-deprived parent, you might find yourself saying this at 2 a.m. when your little one refuses to rest. You may want to put your baby in bed with you and your partner, or you might think it’s OK for your baby to sleep in a bouncy seat.

However, resist the urge to put baby to bed anywhere but their crib or bassinet, says David Roth, Oakland County Health Division’s public health nursing supervisor with Community Nursing. Roth, who also works as the safe sleep coordinator and the fetal and infant mortality review coordinator, says the decision to forgo safe sleep rules can be deadly.

In 2021 alone, there were 131 sudden unexpected infant deaths (SUIDs) in Michigan, according to the Michigan Department of Health & Human Services. Between January 2021 to mid-2023, there were 30 SUIDs in Oakland County. Eighteen were residents and 12 were non-residents.

“Ninety-nine percent of these deaths are preventable,” Roth says.

Whether it’s naptime or bedtime, safe sleep practices should be in place. Here are some safe sleep rules to follow.

Dangerous misconceptions

Co-sleeping, placing baby on his or her stomach, having blankets and stuffed animals in the crib — these are just some things that can lead to a child’s death.

The American Academy of Pediatrics updated its policy statement regarding sleep-related infant deaths, offering new recommendations in July 2022. The policy recommends against co-sleeping in any circumstances.

A lot of parents think it’s OK for baby to sleep in car seat, swing or bouncy seat, Roth adds, but avoid this. It’s fine for the baby to sleep in a car seat while you’re driving because it is properly attached the base and has the right elevation, but as soon as you take the car seat off the base and put it on the floor, the angle changes and the baby’s head is more likely to come forward or roll sideways, and they can suffocate.

“As soon as you arrive at your destination, you should take the baby out and put it in a safe sleep environment,” he says.

Cradleboards are culturally appropriate infant sleep surfaces, but caregivers should be careful to not overheat the baby with excessive blankets.

Safe sleep environments are free of extra things, including pillows and blankets.

“A lot of times parents think the baby looks uncomfortable in an empty crib on its back — that they do need a pillow and a blanket, that they might get cold, and they look more comfortable on their stomach when they’re all curled up in a little ball,” Roth says. However, this could lead to suffocation. If you are worried about your baby being cold, you can put them to bed in a sleep sack, Roth suggests. The 2022 AAP guidelines warn against newborns wearing a hat or anything on their head indoors after coming home from the hospital.

Cultural influences and even health disparities can impact the decision to co-sleep or sleep baby on his or her stomach. For example, if grandma or an aunt say it’s fine, then mom is more likely to follow their advice instead of the pediatrician’s input.

“African Americans are more likely to bring their baby to bed to sleep with them, and they are more likely to sleep their baby on their stomach,” Roth says.

In addition, poverty, healthcare access and education inequities — known as the social determinants of health — play a role in safe sleep. This is why access and education are crucial — and why the Oakland County Health Division works to educate the community about safe sleep.

Creating a safe sleep environment

It’s as simple as A-B-C: alone, back and crib.

Baby should sleep alone, which means there shouldn’t be any people, toys, pillows, blankets, bumper pads, pets or stuffed animals in the crib while baby is resting.

The baby should sleep on their back — even if you have a little one who spits up often.

“They are less likely to choke on their vomit. Anatomically, if you are on your back, your esophagus is on the bottom and your trachea, which is your breathing tube, is on top. So if you spit up, it’s more likely to go back in your stomach,” he says. When they are on their stomach, their breathing tube is on the bottom and the food tube is on top, so when they vomit, the vomit is more likely to go into the lungs.

And finally, baby should always be in crib or bassinet. To further keep baby safe, Roth says he or she should sleep in your room — in their own crib or bassinet, of course — during the first six months of life, or longer, if preferred.

Everyone who is caring for the baby, whether it’s grandma, an older sibling or family friend, should follow the same safe sleep rules.

“It’s easy for me to say this is what you need to do, but it’s not easy,” Roth says. “So we ask the families to come up with a plan and that’s where a lot of education comes in.”

Plans can include how to handle safe sleep during travel, a night out with friends, visiting a family member’s house for the holidays — any scenario that could potentially change the way baby sleeps. For short-term emergency sleep situations, the AAP now says an alternative firm, flat, non-inclined surface, such as a box, basket or dresser drawer with thin, firm padding may be used temporarily.

Parents can speak to their baby’s health care provider if they have questions about how to follow safe sleep recommendations. Help is all around, Roth adds. The Oakland County Health Division provides plenty of support to families.

“We do give out pack-n-plays. We also have a nurse-on-call line. We have home visiting nurses that we can make a referral to.”

To reach the nurse on call, call 800-848-5533.

Content brought to you by the Oakland County Health Division. For more information, visit


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