I heard the grieving young mother recount through gentle sobs how she had awakened during the night to comfort her crying six-week-old infant and then fallen asleep with the baby on the couch. This mother woke up in the morning to find her baby wedged next to her, face down and not breathing.

The child was dead long before the futile ambulance rush to Children's Hospital. I watched the emergency doctor try to comfort the devastated family members, and he mentioned Sudden Infant Death Syndrome as a possible cause.

As we physicians left the room, the grandmother followed.

"So the baby really was smothered, wasn't she?"

It was more a statement than a question.

I nodded yes, and we both blinked back tears.

In the first three weeks of June, four infants were brought to the Emergency Department of Children's Hospital of Pittsburgh already dead. Another infant had died in similar circumstances in May; two infants have died since. All were essentially healthy babies, all less than three months old, all normal when they fell asleep and all sleeping on couches or in adult beds.

The June clustering of cases prompted some attention by local news media. But the story is not a new one: It's been happening at every pediatric hospital in every city for years. Healthy babies are put to sleep and never wake up. Many, if not most, are dying of suffocation.

Of course, everyone has heard of SIDS, described as a mysterious and unexplained killer of sleeping infants. Twenty years ago, some 8,000 deaths each year were attributed to SIDS.

Around that time, researchers realized that fewer babies died in their sleep while sleeping on their backs. The American Academy of Pediatrics and public health agencies began the wonderfully named "back to sleep" campaign, educating parents that babies should not be put to sleep face down. The number of reported SIDS cases plummeted to current levels of about 2,000 cases a year (although changing definitions also affected the statistics).

SIDS remains not fully explained, with complex diagnostic criteria and probably various causes. But when the focus is on unexpected "sleep-related infant deaths," the data are dramatic and the conclusions inescapable.

Most of these infants were sleeping face down, and/or sleeping on couches or adult beds, and/or sleeping with other persons. Many, perhaps most, died of suffocation. Reasons include "rollovers" by adults, smothering in soft mushy surfaces and rebreathing of depleted air from enclosed air pockets. Something blocked the babies' ability to breathe.

Every new parent now knows the "safe sleep" drill. Birth hospitals throughout the Pittsburgh area provide a movie for new parents to watch, and many families receive a safe-for-sleeping pack-n-play from by the SIDS Foundation of Western Pennsylvania.

Parents generally know the recommendations. But many repeatedly ignore them. Somehow, loving parents do not truly believe that harm can come from doing something as natural as sleeping with their babies.

Unsafe infant sleep practices are a major problem. In the 30 months from January 2008, 41 infants in Allegheny County have died in their sleep with investigations finding no injury or disease. Thirty-five were not in cribs or appropriate sleep settings. Seventeen were asleep in adult beds and 14 were asleep on couches.

Safe sleep practices are simple. Infants should be in their own safe environment (crib, bassinet, pack-n-play), be on their backs and have no loose blankets or toys which can get near their mouths. Parents need to keep away anything that could interfere with breathing.

A good analogy is the car seat. It used to be common for adults to hold infants on their laps in the car. Practically everyone now knows that this is highly unsafe.

This is not an argument against co-sleeping families -- once children are old enough. After all, child experts strongly recommend frequent close physical contact between infants and parents. And as long as parents are awake, cuddling their babies, awake or asleep, is ideal.

This is a plea for safety for very young infants. The risk to sleeping babies declines as they grow and mature; the risk goes down considerably after the age of six months or so.

Some demographic groups should be especially careful. The Allegheny County Health Department finds that African-American infants in our community have a 10-fold increased risk of dying a sleep-related death. Exact reasons are unclear.

Heroic leaders such as Dr. Jerome Gloster of Alma Illery Medical Center and Rev. Brenda Gregg of Project Destiny have volunteered countless hours trying to improve the situation -- joining health department educators in meeting with pastors and congregations of predominantly African-American churches to explain the issues and explore the answers.

It is not easy to talk about babies suffocating when they are found dead in their sleep. We use euphemisms, and remind ourselves that you can never know for sure what happened in a single unwitnessed tragedy. But the patterns are unmistakable.

Parent must know the risks and have them explained without sugar coating.

Babies need a safe place to sleep. On their backs. With no blankets, pillows, cushions or loose objects nearby which could obstruct their breathing.

It's all about being able to breathe.

Cartoonist Rob Rogers does "Rob's Rough," an early look at his work and his creative process, exclusively at PG+, a members-only web site of the Pittsburgh Post-Gazette. Our introduction to PG+ gives you all the details.