Safe Sleep for Babies
Since October is SIDS Awareness Month, I am starting with an article about safe sleep guidelines, rather than nutrition. This topic is so important to me, not simply as a pediatrician, but as one who has volunteered for years with the Oklahoma County Health Department as a member of their Fetal and Infant Mortality Review Committee. Each quarter we review all the infant deaths (preterm through one year) across multiple counties. Sadly every quarter, 30-40% of the cases or more are preventable deaths, primarily due to unsafe sleep practices. The goal of these meetings is to ultimately create systemic change to improve infant outcomes and reduce infant mortality in the state of Oklahoma and elsewhere.
An example of an infant sleeping safely in their crib.
SIDS, or sudden infant death syndrome, has different terminology, SUID, or sudden unexpected infant death. SIDS deaths have no identifiable cause. SUID includes SIDS and sleep-related deaths, of which many are due to unsafe sleep. Preterm infants are at greater risk than term infants.
SIDS significantly decreased when we had babies sleep on their backs instead of their tummies. This simple change, issued by the American Academy of Pediatrics (AAP) in 1994, was a success story, dropping the incidence of SIDS by 60%! The data was dramatic. Unfortunately, the numbers haven’t continued to decrease since the 1990s, with a plateau since the year 2000.
The Back to Sleep campaign is now named Safe to Sleep. There are still cases of SIDS that occur, but more deaths occur due to unsafe sleep practices.
According to the CDC, about 3,500 sleep-related deaths occur each year. This number includes both SIDS and unsafe sleep. So many of these deaths are preventable if parents will heed the recommendations.
Parents need their sleep too...just out of baby's bed.
Having experienced many sleepless nights after several children, I understand the temptation to bring your baby to bed with you, or to let them sleep on your chest on the sofa, or to want to have a blanket or toy in bed with them, or to want to cushion their sleep surface, or to have an older sibling in bed with them - please don’t! These can be deadly, and I have reviewed many cases with these scenarios.
No. No. No.
These photos all depict unsafe sleep practices - tummy sleeping, toys in bed, pillows and blanket in crib, sleeping with parent, and baby on adult bed with pillows.
I’ve reviewed so many cases of an infant smothered by a parent or older sibling who rolled over on them during the night, or an infant that suffocated, wedged between the mattress and wall or sofa cushions, or an infant placed on a pillow or blankets that ended up face down and unable to breathe, and way too many others. Parents can be desperate to sleep and will try anything to get their baby to do so. Crying is not dangerous to an infant, but sleeping anywhere other than on a firm mattress, alone in their bed, without other objects, can be lethal.
Current safe sleep guidelines from the AAP include:
Place your baby on their back on a firm sleep surface for ALL sleep times - naps and night sleep. The bed can be a crib, bassinet, or portable crib with a firm, flat mattress, and a tightly fitted sheet. Parents shouldn’t use any products not marketed, specifically for sleep.
Keep everything out of their sleep area - soft bedding, blankets, pillows, bumper pads, toys, etc., and people.
Room sharing is advised, for the first six months, BUT NOT BED SHARING. Bed-sharing is not recommended, in any circumstance, due to the risk of injury or death. A baby can be in a bassinet in the parent’s bedroom or in a co-sleeper that attaches to their bed - providing a separate space for the infant. The risk of sleep-related death increases 67 times when an infant sleeps with another person on a bed, couch, or recliner, especially if the baby is under four months.
Having baby in the parent's room, in their own bed is recommended for the first 6 months.
4. Devices such as strollers, swings, infant carriers, baby seats, etc., are not recommended for routine sleep.
5. Avoid smoking around an infant or exposure to smoke. Infant risk of SUID is doubled if mom smoked during pregnancy and second-hand smoke increases the risk of SIDS.
6. The use of any devices that claim to reduce the risk of SIDS or improve safe sleep, such as heart and respiratory monitors, have no proven evidence and may give a false sense of security. These are not endorsed.
7. Awake tummy time is encouraged but under supervision by an adult. Tummy time helps prevent the skull from developing flat spots. If your infant falls asleep, turn them over on their back.
Tummy time when awake helps build neck strength and prevent flat spots on the head.
8. A swaddled infant should always be on their back. Swaddling does not reduce the risk of SIDS. Once a baby starts to roll, stop the swaddle. The AAP does not recommend weighted swaddles or clothing.
9. Pacifier use at night is associated with a decreased risk.
The AAP also advocates breastfeeding (if possible) for at least the first two months (longer is better) since this is associated with a reduced risk of sleep-related deaths.
Despite 90% of SIDS cases occurring before six months, safe sleep practices should continue for the entire first year.
It is simple but not always easy.