ABCs of Safe Sleep Education Reduces Sleep-Related Infant Deaths in Tennessee

Posted April 12, 2016 by Cindy Hutter

Tennessee Safe Sleep Poster
Tennessee's safe sleep guide contains the basic information that all parents and caregivers need to know about safe sleep behaviors.

Through a multi-faceted statewide campaign, which includes teaching new parents and hospital staff the ABCs of safe sleep practices, Tennessee has seen a 25 percent reduction in sleep-related infant deaths since 2014.

"With a concerted effort and the awareness and actions of all of us who care for infants, we don't have to lose another baby to a preventable sleep-related death," said Tennessee Department of Health Commissioner John Dreyzehner, MD, MPH, in a press release. "These deaths can be stopped with consistent, persistent safe sleep practices."

Tennessee’s successful safe sleep strategy has focused on teaching and modeling safe sleep behaviors—both in the hospital setting and directly with parents—using the primary message, “Remember the ABCs of Safe Sleep.” There are three critical elements to a safe sleep environment:

  • "A" is for Alone: always let the baby sleep alone, never in a bed with another person where the baby could be smothered and never with pillows or blankets.
  • "B" is for on the baby's Back: an infant should be placed to sleep on his or her back, not on his or her side or stomach.
  • "C" is for Crib: always put your child to sleep in a crib with only a firm mattress and tight-fitting sheet. 

"Parents go home and model the sleep behavior they see in the hospital," says Rachel Heitmann, MS, section chief, Injury Prevention and Detection, Tennessee Department of Health (TDH). "We thought if we could get our hospitals modeling the right behavior, and teach parents, that we could decrease sleep-related deaths."

The assumption was right. A hospital safe sleep project that started in 2014 at all 65 birthing hospitals in the state led to a 45.3 percent decrease in unsafe sleep environments in the hospital based on quarterly crib audits. At the heart of the project was the requirement of each hospital to have a safe sleep policy. Once the policy was implemented, hospitals received enough Sleep Baby Safe and Snug board books to give to new parents for an entire year, along with educational products and a certificate from the commissioner. All 65 birthing hospitals in Tennessee now have a safe sleep policy and 12 have received the Cribs for Kids National Safe Sleep Certification.

To reach families in a different way, TDH worked with its Women, Infants and Children’s program to develop educational online modules for parents. All Tennessee parents that are eligible for WIC benefits are required to complete certain educational online modules to get vouchers. Modules include topics like healthy snacks, kitchen safety and newly added ones on breastfeeding and safe sleep. Pre and post-module tests measures parents’ intent and knowledge around the topics. 

TDH also partnered with first responders to educate parents through the Direct On-Scene Education (D.O.S.E.External Link) program. First responders have distributed hundreds of safe sleep informational packets to parents. 

"Unfortunately there is no single project or no single group that can prevent sleep-related infant deaths. We believe that our success has come as the result of our multi-pronged approach and partnership with a variety of stakeholders," says Michael Warren, MD, MPH, the Tennessee Maternal and Child Health director.

Learn more about the ABCs of safe sleep at Link.


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