Can we Stick to the Message of Safe Sleep and Prevent Infant Deaths?

Unintentional suffocation is the leading cause of injury and death among infants < 1 year old in the United States with 82% being attributable to accidental suffocation and strangulation in bed.  Understanding the circumstances surrounding these deaths may inform prevention strategies. 

Pediatrics; May 2019

Understanding the circumstances of infant and child deaths has been prominent in my work as the executive director of a Child Advocacy Center, the director of a victims services organization and as a public health consultant.  Over the past 15 years, I have served on a national expert Child Fatality Review Team, a member of a local county team, an advisor to the New York City Council as they developed legislation requiring child death reviews which was signed into law by Mayor Michael Bloomberg, and as a consultant for a developing Fetal/Infant Mortality Review Team.  The mission of all of these initiatives has been to understand the circumstances of infant and child deaths to prevent future deaths.  Reviews are often excruciatingly detailed including the brief lives and relationships, and tragic losses of lives; the understanding never ceases to be heartbreaking.

Reviews I have participated in over the years have included babies who had died from suffocation while in the care of family members, neighbors, friends of the parents.   I have often found myself wide awake late into the night and early morning hours struggling with how these tragic deaths could be prevented.  The American Academy of Pediatrics, the CDC, state departments of health, hospitals and health care providers provide information and training for parents.  The A, B, C’s of Safe Sleep has been promoted in videos, brochures, and on bus stop kiosks.  New parents receive information in hospitals after the birth of their baby; perhaps not the most teachable moment as parents celebrate their baby’s birth, but also adjust to many life changes.  These forms of Safe Sleep education have had varying degrees of success.  But how does this education reach other people who will care for babies?  Grandparents, aunts, uncles, cousins, babysitters, neighbors, friends?  There have been cases of babies placed on a soft sofa, a babies in a bed with another child, babies who died with their faces against a teddy bear or other soft toy.  

In the early morning hours of a recent sleepless night, I came downstairs to my computer and started researching articles and statistics and mostly just thinking about how we as public health professionals could provide education for anyone who would ever care for a baby.  It seemed overwhelming.  At some point I realized that general information, public service announcements, social media, those bus kiosks might not be the answer.  I had the thought that parents needed a tool to educate, remind, inform caregivers and as I glanced around my own desk, my own office and in various places in my house I realized how I remind myself and provide information to others:  sticky notes.  I had several on my desk about bills to pay and other “to do”s, on my refrigerator as a reminder that I was low on milk, and one on the front door to remind visitors to not let the cats out.  Sticky notes with Safe Sleep information could be stuck on a refrigerator, on a wall near where the baby would be sleeping, on a diaper bag.  I had a pang of embarrassment that I was thinking about a tool for parents to protect their babies by using something so simplistic as sticky notes to share Safe Sleep information, but I pushed through that and went to an online print service and bullet pointed the basics, organized the information on a 3×4 sticky note and placed the order.  When they arrived I shared them with several public health colleagues.  Good idea, too small.  I increased the size to 4×6 and organized the information in the A, B, C’s of Safe Sleep and sent it off to where David, the company president not only cleaned up my format removing extraneous punctuation, but gave me a discount on printing.

Besides the basics of Safe Sleep parents leaving their baby will want to assure that the baby is not exposed to second hand smoke, that there is a fire exit, that there are no drugs, weapons, or other dangers in the home.  The Safe Sleep stickies cannot protect against all dangers.  Certainly from my participation in infant death reviews too many and too tragic, I know that saving lives can be complex and requires large scale interventions, medical science and technology, but I also know that saving lives can be accomplished by simple behavioral changes: wearing a seat belt, wearing a mask, throwing away that pack of cigarettes, applying sunscreen, washing our hands for 20 seconds singing Happy First Birthday twice to all babies.  Hopefully a caregiver having a sticky note with the A, B, C’s reminding them to put a baby to sleep alone, on their back and in a crib or firm surface can save lives.  

The bottom of the message on the sticky note states:  

My baby will grow to be a happy, healthy child with your love and kindness.

If you want to reach me or have questions, please call me at_____________________


If you would like a sample of the Safe Sleep Sticky you may contact me at 

Karel R. Amaranth, MPH, MA

Amaranth Advocates for Public Health