Safe Sleep for Your Baby
There are many important decisions future parents make as they prepare for pregnancy, during pregnancy and after their baby is born. These decisions affect the health and safety of their infant.
One of the important decisions parents make is related to sleep. What sleep position and what sleep environment will they choose to sleep their baby in for nap and nighttime sleep.
Since 1994, health care professionals in the United States made the recommendation that healthy infants be placed on their backs to sleep. Back sleep position has helped reduce the overall incidence of SIDS by 53%. Research studies have helped identify strategies to further reduce sudden infant death syndrome and accidental causes of death. An increased effort to inform and educate parents of other risks such as unsafe sleep environments is required.
Approximately 4,500 babies die suddenly and unexpectedly every year in the United States of no obvious cause; 50 % of these infants die of sudden infant death syndrome. Other causes of sudden infant death include medical illness, injury and undetermined causes of death.
Sudden infant death syndrome (SIDS) is the sudden death of an infant under the age of one year, which remains unexplained after a complete death investigation, including autopsy, investigation of the circumstances of the death and a review of the infant’s medical history. Sudden infant death syndrome is the third leading cause of death is the first year of life, after congenital anomalies and conditions of pre-maturity, and the leading cause of death in infants one month to one year of age. Most deaths occur when babies are between 2 and 4 months of age, during a nap or nighttime period of sleep. Health care providers do not know the underlying cause of SIDS but do know risks for SIDS and ways to reduce those risks.
Risks for sudden unexpected infant death are environmental and behavioral influences, which make an infant more susceptible to sudden infant death. They are not the cause of death but learning about them increases understanding and may lead to detecting a cause. They include: infant risk factors such as pre-maturity and low birth weight, babies who sleep on their tummies or sides; overheating, and exposure to smoke. African American and American Indian and Alaskan Native babies are 2-3 times (respectively) as likely to die of SIDS as white babies. Maternal risk factors include: mothers with late or no prenatal care; low weight gain during pregnancy; smoking during and after pregnancy; alcohol and substance use. Risk factors in the sleep environment include soft bedding (mattresses, quilts, infant head covered); bed sharing on adult bed, couch, or recliner chair. Bed sharing risk increases in the presence of parental smoking, recent parental alcohol/medication/substance use, when covered by a quilt or comforter, parental tiredness and parental obesity.
In Massachusetts in 2008, 57 infants died suddenly and unexpectedly. Approximately 40 of these infants were found in compromised sleep positions and sleep environments, such as sleeping in an adult bed or on a couch.
The American Academy of Pediatrics Recommendations to reduce the risk of SIDS, reaffirmed in 2005, are comprehensive and include a recommendation concerning the risk of bed sharing. They are:
- Back to sleep: Infants should be placed to sleep in a supine position for every sleep. Side sleeping is not as safe as supine sleeping and is not advised.
- Use a firm sleep surface. A firm crib mattress covered by a fitted sheet is the recommended sleeping surface
- Keep soft objects and loose bedding out of the crib, i.e. pillows, quilts comforters, sheepskins, stuffed toys and other soft objects. Loose bedding such as blankets and sheets may be hazardous. If bumper pads are used in cribs, they should be thin, firm, well secured and not pillow-like.
- Do not smoke during pregnancy. Avoid an infant’s exposure to second-hand smoke for numerous reasons in addition to risk for SIDS.
- A separate but proximate sleeping environment is recommended. A crib, bassinette or cradle that conforms to the safety standards of the Consumer Product Safety Commission is recommended.
- Infants should not bed share during sleep; should not share a bed with other children. Infants should not sleep with anyone on a couch, armchair or pillow. Place infant’s crib near parent’s bed to allow for returning infant to the crib after breastfeeding.
- Consider offering a pacifier at nap and bedtime throughout the first year of life. For breastfed infants, delay pacifier introduction until 1 month of age to ensure that breastfeeding is firmly established. Pacifiers should be clean and not coated in any sweet solution.
- Avoid overheating. The infant should be lightly clothed and the bedroom kept comfortable for a lightly clothed adult. Over bundling should be avoided. Infants should never be placed to sleep on a couch, cushioned chair or pillow.
- Avoid commercial devices marketed to reduce the risk of SIDS
- Do not use home monitors to reduce the risk of SIDS
- Avoid the development of positional plagiocephaly (flat spots on back of baby’s head). Provide “tummy time” when the infant is awake and someone is watching. Tummy time helps your baby’s head, neck and shoulder muscles get stronger and helps to prevent flat spots on the head. Change the direction that your baby lies in the crib from one week to the next and avoid too much time in car seats, carriers and bouncers.
There are many infant care practices parents choose as they care for their infants. Parents’ choice of a safe sleep position and a safe sleep environment for their baby will help reduce the chances of sudden unexpected infant death. Parents should inform everyone who cares for their infant as to how they want their baby to sleep.
