As a nurse, I am all about prevention. The latest safe infant sleep recommendations are based on what experts have learned and are known risk-factors for sleep-related infant deaths. As a mom, I also get the need for sleep.
During my second pregnancy, I worked full time, chased around a two-year-old, and developed insomnia! Prior to going into labor, I was exhausted. I went home with my newborn even more exhausted, and I stayed that way for a long time. I understand the desperate need for sleep parents feel.
For families, some of these recommendations can create gut-wrenching dilemmas as not all of the guidelines are easy to follow, and babies don’t always cooperate.
Nevertheless, one fact keeps me passionate about promoting safe sleep: Every year in the US, 3,500 infants die suddenly and unexpectedly while sleeping. Many of these deaths are due to sudden infant death syndrome (SIDS), accidental suffocation, entrapment, and strangulation. This is almost 10 babies a day.
While some SIDS cases can’t be prevented, most sleep-related deaths occur in unsafe sleep environments—and these deaths are preventable. As a parent, there’s so much you can do to help your baby sleep safely. Most of the time, the parents I counsel simply don’t know all of the recommendations, or understand the reasons for them.
In October 2016, the American Academy of Pediatrics (AAP) published updated safe sleep recommendations and guidelines that acknowledge the realities and dilemmas parents face. We’ve got the full list of recommendations in this article and here’s an overview of the changes since perhaps your last childbirth education or parenting class:
Back to sleep: This is still the most important safe sleep “rule.” Studies have proven babies don’t choke more on their backs because their feeding tube (esophagus) is positioned below/behind the airway tube (trachea). Thus, when a baby on their back regurgitates fluid, it will pool next to the esophagus, not the trachea.
The opposite is true when babies are on their tummies. And side-positioning isn’t recommended because infants may roll over too soon when put to sleep in this position. They may not be strong enough yet to move themselves out of danger, such as from blankets.
Swaddling: is considered safe and can help calm baby as they fall asleep on their back. It can also be dangerous if not done correctly. Safe swaddling includes these actions:
Once baby is trying to roll over, stop all swaddling—this can happen as early as age 2 months. You can purchase swaddle sacks; they’re a good alternative to swaddling with a thin blanket (as done in many hospitals).
Breastfeeding: Nursing your baby is shown to reduce infant death risks—experts can’t emphasize and recommend breastfeeding strongly enough. Breastfeeding can reduce the risk of SIDS by as much as 50%! Exclusive breastfeeding is best, but some is better than none.
Skin-to-skin: Going skin-to-skin with your little one is safe and highly encouraged as it promotes breastfeeding. Just make sure to return baby to his own sleep-space when you first begin to get sleepy. It’s not safe if you fall asleep with your baby skin-to-skin.
Room-sharing: Parents—you’ve got a new roommate. This is actually a recommendation that continues from previous advice—that baby should sleep in their own safe infant bed in your room, such as a safe crib, bassinet or play yard. Many parents tell me the play yard is more useful than a bassinet as they can accommodate a sleeping child up to age 1 and they’re portable, making room sharing easier.
Room sharing offers the same benefits as bed-sharing, is safer than baby sleeping alone in their own room or nursery, safer than bed-sharing (or sharing the same sleep surface, such as on a bed, couch or armchair), and room sharing decreases the risks of all sleep-related deaths by 50%!
The Consumer Product Safety Commission (CPSC) has recently published safety standards for some of the new bedside sleepers that attach to the adult bed, though the AAP does not advise about their use.
In-bed Sleepers: These products, which are designed to give baby their own space in your bed, are still questionable. They haven’t been thoroughly studied and the CPSC hasn’t created safety standards for their use. In time, we may learn more about whether in-bed sleepers are a safe option.
Bed-sharing: is still a controversial topic that I find many parents would rather not discuss. What makes this topic confusing is the mix of research results. There is strong evidence that bed-sharing is not safe, and so the AAP recommends against it. There is also research that shows bed-sharing is good for bonding and comforting, and makes nighttime feeding easier.
Most healthcare providers agree, however, that the risks of bed-sharing outweigh the benefits. While some parents will choose to sleep with their baby because of the benefits, research has shown that many will bed-share unintentionally by accidentally falling asleep with baby in bed.
It’s so hard not to fall asleep with your baby when feeding at night. The experts at the AAP recognize this and offer the following advice anytime you’re feeding your baby at night and you might fall asleep: Feeding baby in your bed is much safer than on a couch or armchair, both of which are highly dangerous.
To reduce the risks of bed-sharing, then, make sure your bed is as safe as possible for baby:
Studies show that the longer you are asleep with your baby in your bed, the more dangerous it is. See the AAP’s list here of highly dangerous bed-sharing situations that should be avoided at all times:
Pacifier: Research supporting using pacifiers to reduce SIDS death is only growing stronger. Studies show that using pacifiers can decrease an infant’s SIDS risk by 50-90%! How pacifiers protect babies from SIDS isn’t fully known, but to gain the benefits, offer a pacifier as soon as possible after birth, or after breastfeeding is going well, which is usually within the first 3-4 weeks of baby’s life. During sleep, once a pacifier drops from baby’s mouth, there’s no reason to put it back in place.
Soft or loose bedding: Infants rolling into, or getting covered by soft or loose bedding continues to be a common cause of death, especially in infants older than three months, when they are beginning to roll over. Make sure to continue to keep the crib empty of bumper pads and all soft, loose, or fluffy items until the infant is 12 months old.
Infant seats or recliners: Finally, while no one is fond of disturbing a sleeping baby, infant gear including car seats, strollers, swings, bouncy chairs and slings aren’t recommended for routine sleep, especially for babies ages 4 months or younger. The pediatricians at AAP advise that if your baby falls asleep in one of these devices, move them to an infant crib or bassinet as soon as safe and practical.
As a nurse, mom, and new grandma, I want to do everything in my power to teach parents about safe infant sleep—and keep that conversation going, even when it’s controversial.
Do your friends and family know the recommendations and steps they can take to reduce a baby’s risk for sleep-related infant death? While some parents would rather not discuss the topic, the more we talk and help each other problem-solve unsafe sleep situations, the more deaths we can prevent.
Thankfully, the goal of the AAP has remained unwavering, and that is to ultimately eliminate sleep-related deaths entirely.