Are Your Hospital’s Website Images Safe-Sleep Friendly?

Infant safe sleepCreating a safe sleep environment for an infant can be confusing to families, especially when they don’t hear consistent information from their peers or health providers. Moreover, pictures of infants sleeping in unsafe positions are all over the internet and social media platforms, which adds to the mixed messaging.

Considering that approximately 3,500 babies die annually due to sleep-related causes, promoting consistent images and messaging about safe sleep is critical. That’s why the New York State Department of Health’s (NYSDOH) New York State Perinatal Quality Collaborative (NYSPQC) is encouraging birthing hospitals across New York State (NYS) to review and update their websites to ensure all messaging and images promote infants sleeping in a safe environment.

“It’s very important that hospitals set a positive example for families,” says Marilyn Kacica, MD, MPH, Medical Director of the NYSDOH Division of Family Health, and Executive Director of the NYSPQC. “Along with educating about and modeling safe sleep to families during the birth hospitalization, we encourage hospital staff to model safe sleep environments in their public facing resources, such as websites. The images families see when they visit hospital websites should reflect behaviors that we’re encouraging them to use at home, behaviors that will keep more babies safe.” 

Kacica oversees the NYSPQC’s work on two NICHQ-led national initiatives focused on reducing sleep-related infant deaths: the Safe Sleep Infant Mortality Collaborative Improvement and Innovation Network (Safe Sleep IM CoIIN) and the National Action Partnership to Promote Safe Sleep and Healthy Breastfeeding (NAPPSS-IIN). NICHQ leverages its expertise in infant mortality reduction to provide technical assistance, and quality improvement expertise to state and hospital-based teams on these initiatives.

Over the past few months, the NYSPQC has conducted a review of all 123 birthing hospitals in NYS. Using NAPPSS-IIN’s checklist for safe sleep and safe breastfeeding images—which provides clear guidance for reviewing photos—they evaluated images on each hospital’s website. Of the 123 websites that were audited, just over 20 percent included content that portrayed unsafe sleeping environments for infants. Now, they’re reaching out to hospitals, explaining which images are unsafe and why, and sharing recommendations on how to provide consistent safe sleep messages.

Response to the NYSPQC’s outreach has been positive. Hospital staff have expressed appreciation to the NYSPQC for bringing images depicting unsafe sleep environments to their attention, and for raising awareness of the importance of considering the facility’s digital influence.

Interested in reviewing your hospital’s website? Or, do you work for an organization or health department that is interested in reviewing hospital websites in your state? The NAPPSS-IIN checklist can help you evaluate images. Keep reading for recommendations on making your review as effective as possible.  

Recommendations for Improving Hospital Websites to Promote Infant Safe Sleep

1. Check safe sleep language, as well as images, in your audit

While reviewing birthing hospital websites, check each website for inclusion of safe sleep recommendations, whether recommendations are accurate and up-to-date, and that all links are connected to up-to-date resources. Identifying where hospitals should include safe sleep recommendations on their website is nearly as valuable as correcting misinformation, says Katie Potestio, MPH, RD, Health Program Coordinator for the NYSPQC. 

“Along with department pages, we reviewed course descriptions of classes where infant safe sleep information would be included—such as infant safety, breastfeeding, and baby care basics classes. If safe sleep language was absent from the course descriptions, we suggested highlighting that aspect of the class so that safe sleep recommendations would reach more families.”

If possible, recommendations posted on the hospital’s website should be available in different languages commonly spoken in your state or community.

Culturally appropriate language and images are critical for efforts looking to address the disparities in unsafe sleep deaths, explains NICHQ Project Director Stacy Scott, PhD, MPA, who is a co-director for NAPPSS-IIN. Images should reflect the communities your hospitals serve so that all families can identify with the images they see.

2. Review all relevant website pages

Websites can also help ensure that families receive consistent information across the healthcare spectrum, from prenatal care to pediatrics.

“The siloes in hospital structures are often reflected on website department pages,” explains Potestio. “Different departments often share different information, and that can be confusing for families. We found that if a hospital’s website did have information about safe sleep, it was only included on the maternity department’s webpage but missing from the pediatric department’s webpage. We’re suggesting that hospitals include safe sleep information across obstetrics and pediatrics webpages, including the neonatal intensive care unit (NICU). We’re also making recommendations for all relevant departments—maternity, labor and delivery, obstetrics and gynecology, pediatrics, emergency department, and the NICU—to ensure all photos of sleeping infants reflect a safe sleep environment.”

3. Offer outreach to key influencers

The NYSPQC shared its recommendations directly with hospital staff involved in infant care—the chiefs of pediatrics and neonatology, directors of nursing, nurse managers, etc.  It’s also important for providers to connect with their marketing and communications departments: those responsible for what appears on the website.

If providers connect with their hospital’s communications staff and help them understand the importance of infant safe sleep images and messaging, marketing and communications departments can then help ensure continued consistency on the website and all other communications materials, such as social media and email marketing messages. Providers should be encouraged to provide communications staff with safe sleep resources, such as the safe sleep images checklist, free image galleries like those provided by NICHQ or the U.S. National Institute of Child Health and Human Development (NICHD), free graphics, and any other resources your state has available.

Following the NYSPQC’s outreach, some hospitals immediately contacted their colleagues in web design, quality, marketing, or public relations to correct the issues brought to their attention.

4. Include recognition for excellence in infant safe sleep practices and policies (i.e. Cribs for Kids® Safe Sleep Certification), if eligible

Hospitals that have achieved recognition for excellence or improvements in infant safe sleep should display the achievement on their website. For example, the National Safe Sleep Hospital Certification Program created by Cribs for Kids® is endorsed by leading health and safety organizations. Hundreds of hospitals across the country have achieved this certification, and NYS has grown their certified hospitals from five to 25 in the past two years alone. Accredited hospitals receive a logo to signify their certification, which they can display on their website.

Similarly, hospitals may also have received other state-based awards and recognitions, all of which are important to promote. In New York State, Potestio noted, 72 birthing hospitals in the NYSPQC Safe Sleep Project received the NYSPQC Safe Sleep Project’s 2017 Quality Improvement Award. This award was given in recognition of the hard work and dedication of the facilities’ staff to improve safe sleep practices for infants.

As participants in the NYSPQC Safe Sleep Project, the facilities worked to increase: documentation of caregiver safe sleep education during the birth hospitalization; modeling of a safe sleep environment during the birth hospitalization; and infant caregivers’ understanding of safe sleep educational messages. Participating hospitals received an award certificate regarding the achievement, and the NYSPQC sent a letter to each birthing hospital’s CEO.

By highlighting national and state-based credentials and certifications on their websites, hospitals gain another tool for drawing family’s attention to safe sleep information and guidelines.

“These recommendations can help hospitals across the country improve how they display safe sleep images and information,” says NICHQ Executive Project Director Pat Heinrich, RN, MSN, CLE, who leads NICHQ’s work for the Safe Sleep CoIIN and NAPPSS-IN.  “Imagine if all hospital websites across the country had consistent safe sleep messages? Fewer families would be confused, and that can save more babies’ lives.”

In six months, the NYSPQC plans to review the websites again and determine if additional recommendations are needed. Interested in keeping up with their work? Visit and sign up for NICHQ news to stay informed.