Safe Sleep Practices for Infants

The principles of applied behavior analysis can be used to teach parents to create a safe sleeping environment for their infants. This was explored in a study published in the year 2020 by Carrow, Vladescu, Reeve, and Kisamore.

Sadly, there are over 3,000 sleep related infant deaths each year in the United States (Carrow,, 2020). To attempt to reduce these numbers, the medical and child development fields have placed efforts in teaching parents to utilize safe sleeping methods for their babies.

Behavioral skills training, or BST, is an evidence-based training method for helping teach parents and children new skills. The study by Carrow and his colleagues used BST to teach parents safe sleeping arrangements for their infants.

Some examples of environmental arrangements or setting events that could put an infant at risk of harm include (Carrow, et. al., 2020):

  1. sleeping on their tummy which could increase the chances of overheating or breathing in expressed gases
  2. sleeping on a soft bed which could increase the changes of suffocation
  3. having physical items in the sleeping area which could increase the chances of strangulation or entrapment
  4. bed sharing which could lead to the infant’s airway being blocked if the other person obstructs their airway in some way

As Carrow and colleagues discuss, the American Academy of Pediatrics (2011) presented their recommendations for creating a safer sleep situation for infants. Their recommendations include:

  1. Having the baby lay on their back facing upward when sleeping
  2. No soft bedding in the sleeping area/Having a firm bed surface
  3. Having a fitted sheet for the bed/sleep space
  4. Not having objects in the sleeping area

In the “Back to sleep: Teaching adults to arrange safe infant sleep environments” study, the researchers taught parents to create a safe sleep environment for babies by using BST.

This included using the following steps:

  • Instructions: The parent was given instructions on creating a safe sleep environment.
  • Modeling: The research showed parents how to create a safe sleep environment.
  • Rehearsal: The parent was given an opportunity to practice creating a safe sleep environment.
  • Feedback: The researcher gave positive and corrective feedback.

Based on the training provided in the Back to Sleep study, parents were able to correctly create a safe sleep environment for babies.

It is noteworthy that the intervention only took 18 minutes. It only took 18 minutes to train parents on creating a safe sleep environment. Additionally, the skills gained were maintained over time as parents were still able to demonstrate what they learned when they were assessed 16 weeks after the training.

The study by Carrow and colleagues is an extremely important step forward in research on helping parents to ensure the safety and well-being of their children as well as to give parents accurate information and skills to parent with more peace of mind.


Carrow, J.N., Vladescu, J.C., Reeve, S.A. and Kisamore, A.N. (2020), Back to sleep: Teaching adults to arrange safe infant sleep environments. Jnl of Applied Behav Analysis. doi:10.1002/jaba.681