Safe sleep for babies

Kids' Health
Sleeping baby
By Erin Summa, MPH

October is SIDS Awareness Month and October 15 is Pregnancy and Infant Loss Remembrance Day. Different names but highlighting the same theme — too many babies are dying.

Wait — don’t stop reading, I’m not here to scare you. The good news is that most babies thrive, despite our sometimes-imperfect parenting (in my case, imperfect might be generous). We all just want to do our best, relax, and enjoy our adorable children without being terrified that something awful is going to happen any minute. That’s not too much to ask, right?

Right! But as a mom who is also an expert in child safety, I do walk a fine line here. I don’t want you to be scared. What I want is for you to be armed with knowledge on what the real risks are, and confident that you have the skills to cut those risks down. When we take action to reduce risk, we get to set the fear aside and get back to relaxing and enjoying those cute kids.

Let’s start with an uncomfortable fact: The United States has an infant mortality problem. Our child fatality rates are among the highest in the developed world. While many are to babies who are born very sick or fragile, we are seeing an alarming trend when it comes to otherwise healthy babies.

The leading causes of death between 1-12 months of age fall into a category called Sudden Unexpected Infant Death, or SUID. SUID includes Sudden Infant Death Syndrome (SIDS) and asphyxia (suffocation) during sleep. For both categories, similar risk factors have emerged in recent years, largely around baby’s sleep environment. And that, my friends, is an opportunity for knowledge to meet behavior.

Here is what the experts recommend, up to baby’s first birthday:

  1. Take care of yourself. Start prenatal care early and go to all your OB appointments. Avoid cigarettes, alcohol and illicit drugs during and after pregnancy. If you smoke, now is the time to quit. One cigarette per day in pregnancy doubles your baby’s risk of SUID. Take a breastfeeding class and reach out to a lactation consultant if you are struggling.
  2. Set up a safe nursery. Baby should sleep in a safe crib, bassinet or pack-n-play for every sleep (naps and nighttime). Use a firm, flat crib mattress with a snugly fitted sheet. Add nothing else — no bumpers, blankets, pillows, soft toys, mattress toppers or the next viral crib accessory of the week. Place it in your bedroom, if you can, as room-sharing has shown to be protective against SIDS/SUID. But avoid bringing baby into your bed because that increases risk significantly.

What are examples of unsafe infant sleep locations?

  • Infant swings, bouncers, car seats (outside of the car), couches, chairs and adult beds
  • Being next to, or being held by, anyone who is asleep
  • On an inclined surface that elevates baby’s head
  • In anything that calls itself an infant sleeper/lounger/napper, etc. The words “crib” and “bassinet” have strict federal safety standards. When a manufacturer avoids using those specific words, that’s a sign the product does not meet those standards. (Think “Cheez Whiz” — you know that’s not real cheese, right?)
  1. Put baby to bed safely. Dress baby safely for sleep. There is no perfect temperature for baby’s room. Keep the temperature comfortable for you, and dress baby for that. Adding one more layer than you need for that temperature is a good place to start. Since loose blankets are unsafe, consider a sleep sack or footed pajamas for warmth. Swaddling is fine but stop when baby shows signs, they are ready to roll over. Leave the hat off, as babies can easily overheat when over bundled. Always place baby on their back for sleep. Older babies sometimes decide they’d rather sleep on their tummy — if they can get there on their own you can let them stay, but always start them on their back. Offer a pacifier for sleep, but don’t worry if they don’t want it or it falls out.

What if baby cries? Be responsive and gentle, but also consistent. Babies are sensitive to routine, so try to establish safe ones early. Sleep problems are easier to prevent than they are to solve, and bad habits will be even harder to break later. Accept offers of help from trusted family and friends. On that note…

  1. Teach all of baby’s caregivers about safe sleep. A disturbingly high number of sleep-related infant deaths occur at day care. I’m sorry, I know I said I didn’t want to scare you, but that fact is just downright scary. Do not assume childcare providers (or family members) are up to date on the current guidelines, and make sure they understand that following your safe sleep rules is not negotiable.

Is this new information for you? Don’t judge yourself too harshly. Safety guidelines are always a work-in-progress as data comes in and we continue to learn more. Please do not take this as a judgment on your parenting decisions so far. We are all trying to do our best. As a mom, I feel you, and I know how hard parenting is. And as a health educator, I recognize that when we know better, we do better. It is okay – and expected – to keep learning and adjust as we go. If you haven’t been following these guidelines so far, be gentle with yourself, and resolve to do better tomorrow.

If I scared you, I apologize. I was aiming for that sweet spot right before fear — let’s call it “motivation.” I just want to leave you with a sense of urgency. Urgency to act, even when it feels hard. I want for safe sleep practices to be one of those non-negotiable parenting things, like using a car seat correctly. Which reminds me, about your car seat …

Questions on safe infant sleep? Or car seats, bike helmets, life jackets, window locks? Contact the Mary Bridge Center for Childhood Safety at [email protected]