Ky.gov
Effective: 2/17/2025

C3.8 Safe Sleep

Legal Authority

Introduction

​According to the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP), about thirty-five hundred (3500) infant deaths occur annually from sudden unexpected infant death (SUID). The term SUID is used to describe the sudden and unexpected death of a baby less than one (1) year old in which the cause was not apparent before investigation. These deaths often happen during sleep or in the baby’s sleep area. SUID includes sudden infant death syndrome (SIDS), accidental suffocation or strangulation in a sleeping environment, and other deaths from unknown causes. SIDS is a subcategory of SUID and is a cause assigned to the death of an apparently healthy infant under age one (1) that cannot be explained after a thorough case investigation. 

CDC data from 2020 indicate SUID cases were reported as shown below:
  • Sudden infant death syndrome (41%)
  • Unknown cause (32%)
  • Accidental suffocation and strangulation in bed (27%)
According to the CDC, as of 2020, Kentucky’s rate of SUID annually is among the ten (10) highest in the nation.  
An abundance of research shows some steps can be taken to reduce the risk of SUID. Advocating for and educating caregivers about safe sleep practices may be the single most impactful thing that staff can do to prevent infant deaths in Kentucky.  


Practice Guidance

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  • Staff should be familiar with the ABCD of safe sleep:
    • A stands for ALONE – Babies should always sleep alone. Babies need their own safe sleep space. Sharing a room or sleeping close to the caregiver is encouraged during the first six (6) months, but babies should not share a bed with an adult or other children. Bedsharing places the baby at high risk for suffocation or overlay. 
    • B stands for BACK – Babies should be placed in their sleep space on their back every time, including naps. Since 1992, the American Academy of Pediatrics (AAP) has recommended that babies sleep on their backs until they are capable of rolling over on their own. The rate of SIDS deaths decreased drastically in the 1990s following this change in recommended sleep positions.  
    • C stands for CRIB – Babies should always sleep in a crib or other firm, flat sleeping surface designed for sleeping infants and approved by the Consumer Product Safety Commission. This may include a safety-approved bas​sinet, pack-and-play, or other baby equipment designed specifically for infant sleep. The safest place for a baby is in the same room as the parents but alone in a separate sleep area. The crib mattress should have nothing other than a tight-fitted sheet. This means there should not be any soft bedding such as blankets, pillows, or bumper pads. This also means the sleep space should be free of toys and other items.
    • D stands for DANGER – It is important to know the caregiver-related factors that increase the risk of SUID death in infants. Drowsiness, exhaustion, or being under the influence of alcohol or drugs (even some prescriptions) impairs one’s ability to care for a baby thus making bedsharing and other unsafe sleep practices more dangerous. 
  • According to the AAP, other measures that reduce the risk of SUID include:
    • Feeding human milk (which may not be possible for all families);
    • Offering a pacifier to infants over one (1) month of age at naptime and bedtime;
    • Avoiding exposure to smoking, vaping, and nicotine;
    • Abstaining from use of alcohol, marijuana, and other illicit drugs while caring for an infant;
    • Avoiding overheating or covering the head of an infant while sleeping;
    • Supervised tummy time daily while the infant is awake to facilitate development;
  • Failure to follow safe sleep guidelines as the only allegation does not support a neglect/abuse finding. 


Procedure

​​The SSW:

  1. Reviews What DCBS Workers Need to Know About Safe Sleep document;
  2. Assesses for safe sleep practices when the family or household includes any infant(s) age one (1) and younger.
    1. When speaking with the family, specifically ask where the child sleeps both at night and during naps; 
    2. Request to observe the child’s sleep space; and  
    3. Discuss the importance of safe sleep practices and provide information if the family is not already aware.
  3. Discusses the ABCDs of safe sleep as part of an initial assessment with the family, utilizing the What does safe sleep look like? pamphlet;
  4. Assesses for nighttime and naptime safe sleep practices on an ongoing basis at monthly home visits when a family has an open case when the infant remains in the home;
  5. Assesses for nighttime and naptime safe sleep practices on an ongoing basis at monthly home visits at the placement setting when an infant under the age of one (1) is placed in OOHC;
  6. Re-educates on safe sleep utilizing the provided resources any time an issue with safe sleep is identified;
  7. Reports any concerns with OOHC providers following safe sleep practices to the approving or licensing agency; and
  8. Encourage parents of infants to talk to any alternate care providers about safe sleep practices as well.  

The R&C Worker: 

  1. Reviews the What DCBS Workers Need to Know About Safe Sleep and Safe Sleep Guidance for Foster Parents documents;
  2. Before placement of an infant age one (1) or younger, assesses the plan for safe sleep practices for the infant:
    1. When speaking with the family, specifically ask where the infant will sleep both at night and during naps;
    2. Request to observe the child’s sleep space if an appropriate sleep space for an infant has not previously been observed before placement; and
    3. Discuss the importance of safe sleep practices and provide information if the family is not already aware.
  3. Discusses the ABCDs of safe sleep as part of an initial assessment with the family and provides the Safe Sleep Guidance for Foster Parents and What does safe sleep look like? pamphlets;
  4. Assesses for nighttime and naptime safe sleep practices on an ongoing basis at quarterly home visits if the family cares for infants;
  5. Re-educates on safe sleep utilizing the provided resources any time an issue with safe sleep is identified;
  6. Completes a foster home review in accordance with SOP 12.17​ if concerns about safe sleep practices persist following re-education attempts; and
  7. Encourages foster parents of infants to talk to any alternate care providers about safe sleep practices as well. 
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Documents

Revisions