CE/CME

Infant Safe Sleep

Welcome to the training on Infant Safe Sleep provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).

Credit Hours: 1.50 CE

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Overview
Appendix/Resources

Goal

The goal of this module is to equip Texas Health Steps providers and others to recognize risk factors for sudden infant death syndrome (SIDS) and other forms of sleep-related infant death, promote protective factors and collaborate with parents and caregivers to support safe-sleep practices and environments.

Target Audience

Texas Health Steps providers and other interested health care professionals.

Specific Learning Objectives

After completing the activities of this module, you will be able to:

Detect risk factors for sleep-related infant death and promote protective factors to help prevent it.
Formulate and deliver clear and consistent messages about safe-sleep practices and collaborate with parents and caregivers to support such practices.

NOTE ON TERMINOLOGY: "SUPINE" AND "PRONE"

The medical literature about infant safe sleep often refers to the supine and prone sleeping positions. The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) use such terminology, as do some other public health advocacy entities. This module also uses supine and prone when referring to the sleep positioning policy and clinical guidance from such organizations.

However, the terms supine and prone can be confusing to new parents and tired caregivers, so it is best to avoid using those words when guiding families about the safest sleeping position for their infant. Say “on the back” instead of supine and “on the tummy” instead of prone.

Remember to keep it simple by saying a baby should always sleep on its back and never on its side, stomach or tummy.

Please note this module expires on 8/22/2025.

This module was released on 8/22/2022.

References

Featured

Aarnivala, H., Vuollo, V., Harila, V., Heikkinen, T., Pirrtiniemi, P., Holmström, L., & Valkama, A. M. (2016). The course of positional cranial deformation from 3 to 12 months of age and associated factors: a follow-up with 3D imaging. European Journal of Pediatrics, 175(12): 1893–1903.
Aarnivala, H., Vuollo, V., Harila, V., Heikkinen, T., Pirrtiniemi, P., & Valkama, A. M. Preventing deformational plagiocephaly through parent guidance: a randomized, controlled trial. (2015). European Journal of Pediatrics, 174(9): 1197–1208.
American Academy of Pediatrics. (2022). Policy Statement: Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment.
American Academy of Pediatrics. (2022). Technical Report: Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths.
American Academy of Pediatrics, healthychildren.org. (2022). How to Keep Your Sleeping Baby Safe: AAP Policy Explained.
American Academy of Pediatrics. (2021). Three Out of Four Sudden Unexpected Infant Deaths Happen in Unsafe Sleep Environments. (News release).
American Academy of Pediatrics, HealthyChildren.org. (2021). Monitoring the Situation.
American Academy of Pediatrics, healthychildren.org. (2021). Facts For Parents About E-Cigarettes & Vaping.
American Academy of Pediatrics, healthychildren.org. (2021). Pacifiers and Thumb Sucking.
American Academy of Pediatrics, healthychildren.org. (2020). Swaddling: Is it Safe?
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Centers for Disease Control and Prevention. (2018). Beyond the Data—Safe Sleep for Infants Video.
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Gaydos, L. M., Blake, S. C., Gazmararian, J. A., Woodruff, W., Thompson, W. W., & Dalmida, S. G. (2015). Revisiting safe sleep recommendations for African-American infants: why current counseling is insufficient. Maternal and Child Health Journal, 19(3): 496-503.
Gibbs, K., Collaco, J. M., & McGrath-Morrow, S. A. (2016). Impact of Tobacco Smoke and Nicotine Exposure on Lung Development. Chest, 149(2): 552–561.
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Hauck, F., Thompson, J., Tanabe, K., Moon, R., & Vennemann, M. (2011). Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics, 128(1): 103-110.
Hauck, F., Signore, C., Fein, S., & Raju, T. (2008). Infant Sleeping Arrangements and Practices During the First Year of Life. Pediatrics, 122(Supplement 2): S113 -S120.
Hauck, F., Omojokun, O. O., & Siadaty, M. R. (2005). Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics, 116(5): e716-723.
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Hirai, A. H, Kortsmit, K., Kaplan, L., Reiney, E., Warner, L., Parks, S. E., . . . Shapiro-Mendoza, C. K. (2019). Prevalence and Factors Associated With Safe Infant Sleep Practices. Pediatrics, 144(5):e20191286. (Abstract)
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Iruka, I. U., & Carver, P. R. (2006). Initial results from the 2005 NHES Early Childhood Program Participation Survey. U.S. Department of Education, National Center for Education Statistics.
Joyner, B. L., Oden, R., Ajao, T. I., & Moon, R. Y. (2010). Where Should My Baby Sleep? A Qualitative Study of African-American Infant Sleep Location Decisions. Journal of the National Medical Association, 102(10): 881–889.
Joyner, B., Gill-Bailey C., & Moon, R. (2009). Infant Sleep Environments Depicted in Magazines Targeted to Women of Childbearing Age. Pediatrics, 124(3): e416-e422.
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Landa-Rivera, J. L., Pérez-Pérez, J., del Pilar González-Núñez, M., & Gil-Miralles, R. A. (2022). Population-Based Survey Showing That Breastfed Babies Have a Lower Freq2uency of Risk Factors for Sudden Infant Death Syndrome Than Nonbreastfed Babies. Breastfeeding Medicine, 17(2): 182–188.
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Malloy, M. H. (2002). Trends in postneonatal aspiration deaths and reclassification of sudden infant death syndrome: impact of the “Back to Sleep” program. Journal of Pediatrics, 109(4): 661–665.
McKenzie, L. B., Klein, E. G., Roberts, K. J., & McAdams, R. (2020). When Social Media Images and Messages Don’t Match: Attention to Text versus Imagery to Effectively Convey Safety Information on Social Media. Journal of Health Communication, 25(2), 1–6.
Mitchell, E. (2009). SIDS: Past, Present and Future. Acta Paediatrica, 98(11): 1712-1719.
Moon, R. (2019). Investigation of Sudden Infant Death Syndrome, Section 6, Chapter 27: Child-Care Environment. Cambridge University Press.
Moon, R. Y., & Hauck, F. R. (2016). SIDS Risk: It’s More Than Just the Sleep Environment. Pediatrics, 137(1): e20153665.
National Action Partnership to Promote Safe Sleep. (2016). National Action Plan to Promote Safe Sleep Improvement and Innovation Network (NAPPSS-IIN).
National Institute for Children’s Health Quality. (2022). It’s Past Time to Prevent SIDS and Sleep-Related Infant Deaths.
Ostfeld, B., Esposito, L., Perl, H., & Hegyi, T. (2010). Concurrent Risks in Sudden Infant Death Syndrome. Pediatrics, 12(5): 447-453.
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Parks, S. E., Erck Lambert, A. B., Hauck, F. R., Cottengim, C. R., Faulkner, M., & Shapiro-Mendoza, C. K. Explaining Sudden Unexpected Infant Deaths, 2011-2017. Pediatrics, 147(5):e2020035873.
Paruthi, S., Brooks, L. J., D’Ambrosio, C., Hall, W. A., Kotagal, S., Lloyd, R. M., Malow, B. A., . . . Wise, M. S. (2016). Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine, 12(6): 785–786.s
Pease, A. S., Fleming, P. J., Hauck, F. R., Moon, R. Y., Horne, R. S.C., L’Hoir, M. P., Ponsonby, A. L., & Blair, P. S. (2016). Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics, 137(6): e20153275.
Rapaport, L. (2015). Infant sleep safety still misunderstood by many caregivers. Reuters Health, Sept. 18.
Ramirez, J-M., Ramirez, S. C., & Anderson, T. M. (2018). SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future. University of Adelaide Press.
Scheers, N. J., Woodard, D. W., & Thach, B. T. (2016). Crib Bumpers Continue to Cause Infant Deaths: A Need for a New Preventive Approach. The Journal of Pediatrics, 169: 93-97.
Schnitzer, P., Covington, T., & Dykstra, H. (2012). Sudden Unexpected Infant Deaths: Sleep Environment and Circumstances. American Journal of Public Health, 102(6); 1204-1212.
Stiffler, D., Yares, B., Fauvergue, C. & Cullen, D. (2018). Sudden Infant Death and Sleep Practices in the Black Community. Journal for Specialists in Pediatric Nursing, 23(2): e12213. (Abstract)
Stiffler, D., Mukasa Matemachani, S., & Crane, L. (2020). Considerations in Safe to Sleep Messaging: learning from African American Mothers. Journal of Specialists in Pediatric Nursing, 25(1): e12277.
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Texas Department of State Health Services. (n.d.). Pregnancy Risk Assessment Monitoring System (PRAMS) Survey website.
Texas Department of State Health Services. (2019). Pregnancy Risk Assessment Monitoring System: Sleep Position.
Texas Department of State Health Services. (2018). Texas Child Fatality Data and Recommendations.
Texas Health Steps. Anticipatory Guidance Provider Guide.
Texas Health Steps. Periodicity Schedule.
Texas Department of State Health Services. (2015). A Parent’s Guide for Raising Healthy, Happy Children.
Texas Health and Human Services Commission. (2012). Breastmilk Counts website: Breastfeeding 101.
Texas Department of State Health Services. (n.d.). Safe Sleep for Babies: Community Training Guide.
Texas Health and Human Services Commission. Maternal & Child Health Epidemiology Reports. (2018). Regional Analysis of Maternal and Infant Health in Texas.
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U.S. Congress. Safe Sleep for Babies Act of 2021 (signed into law in 2022).
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U.S. Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2013). Safe to Sleep Public Education Campaign.
U.S. Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2012). Safe Sleep for Your Baby: Reduce the Risk of Sudden Infant Death Syndrome (SIDS) and Other Sleep-Related Causes of Infant Death (African American Outreach) [brochure].
U.S. Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2012). Safe Sleep for Your Baby: Questions and Answers for Health Care Providers [brochure].
U.S. Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2010). The usual position in which mothers place their babies to sleep: data from the national NISP telephone survey for years 1992–2010.
U.S. Department of Health and Human Services Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2010). Timely Advice on Safe Infant Sleep: Research on Sudden Infant Death Syndrome (SIDS).
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Zero to Three. (2017). Infant-Toddler Child Care Fact Sheet.

Medical Definitions

The medical definitions provided in this module were adapted or obtained from American Academy of Pediatrics, American Physical Therapy Association, Boston Children’s Hospital, Free Dictionary’s Medical Dictionary, Healthline Media, KidsHealth from Nemours, NHS, Texas Council for Developmental Disabilities and Texas Health and Human Services Commission.

Accreditation Statements

Continuing Medical Education

The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.

The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development

The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of Nursing Continuing Professional Development by the American Nurses Credentialing Center’s Commission on Accreditation.

Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hours of Nursing Continuing Professional Development.

Social Workers

The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 hours of credit.

Certificate of Attendance

The Texas Department of State Health Services, Continuing Education Service has designated 1.50 hour(s) for attendance.

Certified Community Health Worker

The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.50 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.

Disclosures

General Disclosure

One of the requirements of continuing education is disclosure of the following information to the learner:

Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support.
Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).

The following are policies and definitions of terms related to continuing education disclosure:

The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.

All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.

Glossary of Terms

Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.

Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.

Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).

Browser Requirements

Texas Health Steps courses are best viewed using a current browser. If you are using an out-of-date browser or a version of Internet Explorer less than 11, lesson progress and interactive features may not function properly.

Health-Care Providers

Aarnivala, H., Vuollo, V., Harila, V., Heikkinen, T., Pirrtiniemi, P., & Valkama, A. M. Preventing deformational plagiocephaly through parent guidance: a randomized, controlled trial. (2015). European Journal of Pediatrics, 174(9): 1197–1208.

Academy of Pediatric Physical Therapy. Fact sheet about causes and interventions for infant head shape deformities, including statistics.

American Academy of Pediatrics. (2022). Policy Statement: Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment.

American Academy of Pediatrics. (2022). Technical Report: Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths.

American Academy of Pediatrics. Safe Sleep and Your Baby: How Parents Can Reduce the Risk of SIDS and Suffocation brochure.

American Academy of Pediatrics, healthychildren.org. (2022). Back to Sleep, Tummy to Play.

American Academy of Pediatrics. HealthyChildren.org. A parent-oriented website offering parents comprehensive information on safe sleep, addressing common parent concerns such as infant comfort, and videos and short articles about putting baby to bed safely.

American Academy of Pediatrics, HealthyChildren.org. Monitoring the Situation.

Breastfeeding: See separate resource section below.

Caregivers: See separate resource section below.

Charlie’s Kids Foundation. Started by Sam and Maura Hanke after they lost their son, Charlie, to SIDS. This nonprofit raises awareness about infant safe sleep with the goal of reducing deaths from SIDS.

Collaborative Improvement & Innovation Network to Reduce Infant Mortality (IM CoIIN). A collaboration of public and private agencies, professionals and communities to reduce infant mortality.

Consumer Product Safety Commission. News release: CPSC Approves Major New Federal Safety Standard for Infant Sleep Products. Press release with links to standards and recall information.

Consumer Product Safety Commission. Safety Education for Infants. A compendium of CPSC safe sleep product information, including recalled products.

Consumer Product Safety Commission. Searchable database of all federal regulations, mandatory standards and bans. It offers a pull-down menu by general product name, such as “mattresses,” or by a specific product’s name.

Cribs for Kids. A national nonprofit that provides portable cribs and education to families who are unable to purchase a safe crib. Search for a local partner by clicking the website’s “Partners” button.

Culturally Effective Health Care: See separate resource section below.

Edison Research, the Research Moms’ archives. A compilation of studies and information from 2011 to 2021 about staff findings and related content about mothers’ use of media.

First Candle. A national nonprofit committed to the elimination of SIDS and other sleep-related infant deaths through education, while providing support for grieving families who have suffered a loss. Toll-free grief line: 800-221-7437.

National Center for Education in Maternal and Child Health. Building on Campaigns with Conversations. Online modules for health-care and other professionals about how to help families embrace safe sleep and breastfeeding.

National Institute for Children's Health Quality. Video: How Safe Sleep Savvy Are You? A video quiz that engages caregivers in conversations about safe sleep recommendations.

Pathways.org. Tummy Time. Offers information about approaches to tummy time, developmental advantages and tips for overseeing tummy times as well as Tummy Time activities.

Safe Kids Worldwide. Sleep Safety and Suffocation Prevention Tips. Printable safe sleep fact sheet.

Social Media: See separate resource list below.

Swaddling: See separate resource list below.

Swansea University, U.K. Should Babies Sleep Through the Night video. An educational video clip for parents about normal infant sleep and night waking.

Texas Department of Family and Protective Services. Get Parenting Tips website. A compilation of safe sleep guidance, including videos and tips about unsafe sleep surfaces. In Spanish.

Texas Department of State Health Services. Information for Parents of Newborn Children pamphlet, which contains the required information that health-care professionals must provide to pregnant women and to parents at childbirth. It includes information about SIDS and current recommendations for infant sleeping conditions. Page 16 of this pamphlet covers strategies to calm a baby. In Spanish.

Texas Health Steps, Anticipatory Guidance Provider Guide. Age-appropriate anticipatory guidance topics for children ages birth through 20 years.

Texas Health Steps. Periodicity Schedule.

The Period of PURPLE Crying. The PURPLE program is designed to help parents of newborns understand the developmental period of infants ages 2 weeks through 3 months. It provides education about the normal crying curve, soothing techniques and the dangers of shaking a baby.

Tobacco: See separate resource section below.

U.S. Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Infant Sleep Position and SIDS: Questions and Answers for Health Care Providers. A booklet designed for health-care providers to share with parents and caregivers.

Myths and Facts about SIDS and Safe Infant Sleep web page.

Questions and Answers for Health Care Providers: Sudden Infant Death Syndrome (SIDS) and Other Sleep-Related Causes of Infant Death. This booklet for health-care providers answers common questions about SIDS and other sleep-related causes of infant death.

Safe Sleep for Your Baby, a general outreach brochure available for order from NICHD. This brochure has also been adapted for African American, American Indian/Alaskan Native, and Spanish-speaking audiences and is available for download as a PDF.

Safe Sleep for Your Baby video. A video available in English and Spanish.

Safe Sleep for Your Grandbaby: Reduce the Risk of SIDS and Other Sleep-Related Causes of Infant Death. This booklet explains the latest safe sleep recommendations to grandparents and other trusted caregivers so they can help reduce the risk of SIDS and other sleep-related causes of infant death, such as accidental suffocation. Available for order in English and Spanish.

What does a safe sleep environment look like? Reduce the Risk of SIDS and Other Sleep-Related Causes of Infant Death. A single-page handout shows a safe sleep environment for infants and explains ways parents and caregivers can reduce the risks of SIDS and other sleep-related causes of infant death. Available for order in packets of 25.

Breastfeeding Resources:

Academy of Breastfeeding Medicine. Bedsharing and breastfeeding resources. Evidence-based resources regarding the benefits and risks of bedsharing for mother-infant pairs who have initiated breastfeeding and are in home settings.

Academy of Breastfeeding Medicine. (2019). Bedsharing and Breastfeeding Protocol #6. Provides guidelines for assisting breastfeeding mothers and infants.

Human Milk Banking Association of North America.

National Action Partnership to Promote Safe Sleep Improvement and Innovation Network (NAPPSS-IIN). A coalition of more than 70 organizations committed to supporting infant safe sleep and breastfeeding.

National Institute for Child Health and Human Development. Breastfeed Your Baby to Reduce the Risk of SIDS video. A simple, animated Breastfeeding and Safe Sleep video for sharing with caregivers.

Texas Health and Human Services Commission. Breastmilk Counts website. Developed to help families get off to a successful start with breastfeeding.

U.S. Department of Health and Human Services, National Institute of Child Health and Human Development. (2012). Safe Sleep for Your Baby Video.

World Health Organization and UNICEF. Ten Steps to Successful Breastfeeding. Created to motivate all facilities providing maternity and newborn services to support breastfeeding.

Child-care Provider Resources for Safe Sleep:

American Academy of Pediatrics. A Child Care Provider's Guide to Safe Sleep. A fact sheet for child-care providers that explains the AAP’s recommendations for creating a safe sleep environment.

Centers for Disease Control and Prevention. Safe Sleep for Babies. Resources for health-care providers to use in counseling parents and caregivers about safe sleep.

Centers for Disease Control and Prevention. Sudden Unexpected Infant Death and Sudden Infant Death Syndrome: Parents and Caregivers web page. The CDC’s summary of infant safe sleep recommendations for parents and caregivers.

Texas A&M AgriLife Extension. Safe Sleep: Reducing the Risk of Sleep-Related Infant Death in Child Care. A $12 two-hour online training for child-care providers.

Culturally Effective Health Care Resources:

Centers for Disease Control and Prevention, Gateway to Health Communication website. Includes a section about key principles of inclusive communication that provides appropriate word choices for oral and written communications.

Centers for Disease Control and Prevention. (2021). Social Determinants of Health: Know What Affects Health.

Emergency Medical Services for Children Innovation and Improvement Center. Cultural Competency Toolkit, for culturally and linguistically appropriate pediatric care and other resources.

Kaiser Family Foundation. (2018). Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity.

National Action Partnership to Promote Safe Sleep. Module 4: Discussion Points on Cultural Beliefs and Family/Societal Perspectives. Covers discussion points for cultural beliefs and family and societal perspectives about safe sleep.

U.S. Department of Health and Human Services. Social Determinants of Health.

U.S. Department of Health and Human Services, National Institute of Child Health and Human Development. Healthy Native Babies Project Workbook Packet. This packet includes the Healthy Native Babies Project Workbook, Healthy Actions for Native Babies Handout, Toolkit Disk and Toolkit User Guide. Describes ways to reduce the risk for SIDS among American Indian/Alaska Native babies.

U.S. Department of Health and Human Services, Health Resources & Service Administration. Health Literacy web page. Covers health-care provider role in promoting health literacy, reasons for low health literacy and how an individual may have difficulty as a result.

U.S. Department of Health and Human Services. Think Cultural Health website, offers many resources, including free, accredited online continuing education programs such as A Physician’s Practical Guide to Culturally Competent Care.

Social Media Resources:

National Institute of Child Health and Human Development. Using Social Media to Raise Awareness About Infant Safe Sleep. The institute has developed tips about social media use; videos; and other materials that providers can post about infant sleep recommendations, safe sleep and breastfeeding. Also offers an image gallery of reviewed safe sleep and breastfeeding images.

U.S. Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development. Safe Infant Sleep Social Media Block Party.

U.S. Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development. SIDS Awareness Toolkit. Printable and shareable resources, including photos, flyers and social media photo frame.

Swaddling Resources:

American Academy of Pediatrics, healthychildren.org. (2020). Swaddling: Is it Safe?

International Hip Dysplasia Institute. Infant & Child – Hip-Healthy Swaddling. Information and guidelines for safe swaddling, including how-to videos and recommendations about products considered to be ‘hip-healthy’

Tobacco Cessation Resources:

Texas Department of State Health Services. Tobacco Prevention and Control Program.

Texas Department of State Health Services. Texas Tobacco Quit Line Referral Form. Providers can use the form to assist families in receiving a call from the Texas Tobacco Quit Line to develop a plan for smoking cessation.

Texas Department of State Health Services. Tobacco Use and My Baby brochure. Downloadable brochure about the risks of smoking during pregnancy and benefits to cessation for mother and baby.

Texas Department of State Health Services. Tobacco cessation fact sheets and flyers available as PDFs, including several in Spanish. Materials are targeted to youth or to adults.