Infant Sleep Safety: An Update

Dr. Karen Sokal-Gutierrez, M.D., M.P.H.

Pediatrics

Over the past decade, the “Back to Sleep” campaign for infant sleep safety has cut the rate of Sudden Infant Death Syndrome (SIDS) in half, saving thousands of babies’ lives. However, SIDS is still the leading cause of death in infants after the first month of life.

Although we do not know all of the causes of SIDS, research continues to identify factors that place babies at risk for it. In November 2005, the American Academy of Pediatrics updated its recommendations for infant sleep safety, in the first year of life, to reduce the risk of SIDS:

• Put your baby to sleep on his back every time he sleeps—for naps and at night. It is not safe to put a baby to sleep on his tummy, or face down, because he can smother in the bedding. Also, it is not safe to put a baby to sleep on his side because he can easily roll over into a face down position.

• Put your baby to sleep on a firm cot mattress covered by a tight-fitting sheet. Never put your baby to sleep on a sofa or sofa chair, or on soft materials such as pillows, quilts, comforters or sheepskins. Your baby can smother in them.

• Keep soft objects and loose bedding out of the cot. Remove pillows, quilts, comforters, sheepskins and stuffed toys. If you use bumper pads around cot rails, they should be thin, firm, well-secured and not “pillow-like.” It is safest not to use a blanket and instead dress your baby in a sleeper outfit or an infant sleep sack. If you use a blanket, be sure to cover your baby only up to his chest, leaving his face uncovered, and tuck in the blanket under the mattress to secure it.

• Do not smoke during pregnancy. Doing so puts your baby at risk for SIDS as well as low birth weight and other health problems. Don’t expose your baby to second-hand smoke either, since this can also cause many health problems. (For more information on quitting smoking, see the article “Smoking and Pregnancy” on this website: www.fisher-price.com

• Your baby should sleep separately from you, but nearby. It is safest to put your baby to sleep in a cot, bassinet or cradle that meets the safety standards for Consumer Product Safety Commission and ASTM. Place the cot or bassinet close to your bed to make it easier to breastfeed and comfort your baby. Co-sleeper infant beds that attach to adult beds have not yet been approved for safety. Although many families enjoy sharing their bed with baby, studies have found that this can increase the risk of SIDS and suffocation. It is considered safe to bring the baby into bed temporarily to breastfeed or comfort him, but afterward he should be returned to his cot or bassinet for sleep. However, bringing the baby into bed is not recommended if parents are overtired or have been using sleep medications, alcohol or other drugs that can impair their alertness, because they could fall asleep, roll onto and smother the baby.

• Consider offering the baby a dummy at nap and bedtimes. Studies have shown that sleeping with a dummy for the first year of life can significantly reduce the risk of SIDS. For breastfed babies, wait until 1 month of age to start the dummy to make sure nursing is established and the baby won’t be confused by a different nipple. Don’t coat the dummy in any sweet solution. Offer it to him, but don’t force him to take it. Give it to him for falling asleep, but if it falls out of his mouth during sleep, it is not considered necessary to reinsert it. Also, be sure to wash the dummy frequently.

• Don’t overheat your baby. Heat the bedroom to a temperature that’s comfortable for you, and dress your baby as warmly as you are dressed. Don’t over-bundle your baby. He should not feel hot to the touch.

• Avoid commercial devices marketed to reduce SIDS. None of the devices developed to maintain sleep position or to reduce the risk of “rebreathing” has been tested sufficiently to show that it is effective or safe.

• Do not use home monitors to prevent SIDS. Some babies have unstable breathing or heart function and may benefit from electronic cardio-respiratory monitors, if recommended by the pediatrician. But studies have not shown that these monitors significantly decrease the risk of SIDS.

• Change your baby’s head position to avoid head flattening. When a baby spends too much time with his head in one position on a firm surface, his skull can become flattened. This is especially true for babies who are born prematurely or have developmental or neurological problems. To help prevent head-flattening, change your baby’s orientation in the cot from one day to the next: place him to sleep with his head on the right side of the cot one day, and on the left side of the cot on the next day. Limit the amount of time your baby spends in car seats and bouncers, which also can flatten his head. Be sure to spend time every day holding your baby upright in your arms, and giving him “tummy time” on the floor when he’s awake. (For more information, see the article “Preventing Flattening of Your Baby’s Head” at www.fisher-price.com.

• Talk with family members and childcare providers about “Back to Sleep.” Studies have shown that if parents put a baby to sleep on his back but the childcare provider doesn’t, the baby is at a much higher risk for SIDS. It is important that everyone who cares for your baby—grandparents, childcare providers, babysitters—follow the same safety recommendations to prevent SIDS.