The medical examiner, after discussion with the state Child Death Review Team, is asking child-care professionals across the commonwealth to educate parents that some sleep environments are very unsafe.

The Back to Sleep Campaign and more recent recommendations from the American Academy of Pediatrics that describe a safe sleep environment for infants have been responsible for cutting cases of Sudden Infant Death Syndrome in half, from approximately 1 per 1,000 infants, to 1 in 2,000 children. Although rare, the loss of even one child is too many if it were preventable.

Despite the safe sleep environment recommendations, an alarming number of infants continue to sleep in beds with their parents or in an otherwise unsafe setting. Some parents do this because it is part of their cultural heritage. Many breast-feeding advocates believe that breast-feeding is more successful when infants share their mother's bed and that breast-feeding protects those infants from SIDS.

Having an infant sleep with their parents, however, has been shown to be hazardous. Accidental smothering can occur when a sleep-deprived parent or sibling rolls over on an infant for the baby's face is covered by soft bedding or pillows.

What is a safe sleep environment and what can parents do to protect their infants?

The guidelines clearly state that infants under 6 months of age should be put down to sleep on their backs, on a firm surface, and without blankets, pillows or stuffed toys. Soft bedding is a risk to infants. Sleeping on a soft couch can be a particular danger, as can sleeping in a parent's arms, if both are sleeping soundly.

A child left asleep unattended for a prolonged period in a car seat may also be at risk. The SIDS rate also increases in the presence of secondhand smoke, so a tobacco-free environment is safer for everyone.

Although numerous studies have explored this sleeping issue and reached no firm conclusions regarding safety, parents may sleep better and children more safely when placed on a firm sleep surface next to the parents in a crib, cradle, or "co-sleeper bed extender."

While co-sleeping related infant deaths are rare occurrences, a child's death is devastating and thinking that it might have been prevented changes families' lives forever.

Additional information that allows parents and families to make well-informed decisions can be found by contacting your pediatrician or online at www.aap.org.

Feel free to contact me at NSMC North Shore Children's Hospital, 57 Highland Ave., Salem, MA 01907 or at ebailey@aap.org with your questions or comments.

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Dr. Edward Bailey is chairman of pediatrics at NSMC North Shore Children's Hospital, on staff at Massachusetts General Hospital for Children, and a father of three.