Behavioral Safe Sleep Training (BeSST) teaches caregivers how to arrange infant sleeping spaces

Whereas bedsharing was once denounced entirely, it is becoming increasingly recognized as a behavior that many parents will engage in, especially when breastfeeding. So, health advocates are shifting focus to how to do so safely. For some examples see ABM, NCEMCH, and NAPPSS-IIN.

Image courtesy of the Safe to Sleep® campaign, for educational purposes only; Eunice Kennedy Shriver National Institute of Child Health and Human Development,; Safe to Sleep® is a registered trademark of the U.S. Department of Health and Human Services.

The CDC reports that there are about 3,400 sleep-related deaths among babies in the US each year. 

Jason C. Vladescu, Ph.D., BCBA-D, NCSP, LBA(NY) is a professor in the Department of Applied Behavior Analysis and Clinical Supervisor at the Center for Autism and Applied Behavior Analysis at Caldwell University, and he and his colleagues developed the Behavioral Safe Sleep Training (BeSST)—a practice-based approach—to teach caregivers to arrange the infant sleeping area. The BeSST team consists of researchers from three Mid-Atlantic Universities and has reached about 60 caregivers in Philadelphia since 2019.

Infant feeding is not a primary focus of their training, but Vladescu explains, “We recognize that this is an area that is not unrelated to safe infant sleep in that feeding of human milk (note here I intentionally didn’t specify breastfeeding, as work here has not always distinguished between feeding at the breast vs. expressed human milk) is recommended by the American Academy of Pediatrics (AAP) as it has been associated with a reduced risk of sudden infant death syndrome (SIDS).”   

He goes on to explain that BeSST training was designed to align with APP infant sleep environment recommendations: policy statement and  technical report.

The recommendation “includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating.” 

Vladescu comments, “This recommendation is made because there is five times greater risk for infant death when bedsharing. The hope is that by room sharing (rather than bedsharing), caregivers can still feed and comfort their infant with relative ease, without increasing the risk of sleep-related death. By addressing the AAP recommendations in our work, we provide caregivers with information and training, as well as rationales for the recommendations provided in the training, with the end goal of minimizing risk and working to ensure caregiver needs and those of their infant are met.” 

The AAP recommendations differ from approaches like those of Durham University and the greater UK which acknowledges the reality that many babies will be in bed with parents and is against the ‘just say no’ approach, as Healthy Children Project’s Karin Cadwell points out. 

Currently, the BeSST team is deploying their training in a maternal residential substance use treatment program. 

“This is particularly exciting work given the emerging evidence that infants born to mothers with opioid use disorder are at increased risk of sleep-related deaths,” Vladescu begins.  “Some of the variables at play for this population of infants are unique (for example, healthcare personnel may utilize practices that do not align with the AAP recommendations to improve neonatal opioid withdrawal symptoms, which caregivers may imitate outside of the hospital). Such unique variables need to be considered when developing interventions to promote safe infant sleep with this population. In the context of this work,

we will be evaluating an initial attempt to evaluate the influence of a contingency management program based on caregiver responding across the night.” 

At the moment, the BeSST program is available in Philadelphia, Pa. through partnerships with community health centers, but Vladescu says he hopes by developing a network of partnerships with colleagues and professionals, they can increase the scale of their work. 

You can reach out to Vladescu directly at  for more information or to engage with their programming. 

Check out these recent publications for more on the topic

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