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What’s New with Safe Infant Sleep?

By Sharon Hitchcock MSN, RNC

What’s New with Safe Infant Sleep?

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.

 

Safe sleep effects on families

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.

 

New safe infant sleep guidelines

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:

  • Baby must be on their back only—not their side or tummy
  • Swaddle should be snug (but not tight) around the chest and hips

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:

  • Keep blankets, comforters, and pillows away from baby in case you fall asleep
  • Put baby back in their own safe crib or bassinet as soon as you get drowsy; if you doze off, put baby in their own bed as soon as you wake up
  • Consider setting an alarm when you begin to nurse baby at night

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:

  • Sleeping with an infant younger than 4 months of age
  • Sleeping with a baby born preterm or with low birth weight
  • Sleeping with a parent who smokes or is impaired by alcohol or drugs—even prescription or over-the-counter medications
  • Sleeping together on a soft surface such as a couch, sofa or arm chair, or with loose bedding

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.

 

Share these recommendations to protect baby

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.

 

Put your baby to sleep safely every time: AAP’s safe sleep recommendations

  1. Get regular prenatal care during pregnancy—this gets baby the best possible start.
  2. Baby on their back to sleep for all sleep, starting at birth. Side and stomach positions are unsafe
  3. Baby sleeps on a firm sleep surface, such as a firm infant mattress in a safety-approved crib, playyard, or basinet
  4. Breastfeeding is protective; exclusive nursing is best, but any amount is better than none
  5. Room-share without sharing a sleep surface: Couches and armchairs are more dangerous than an adult bed. No bed-sharing situations have been found safe.
  6. No blankets, pillows, and other loose items in baby’s sleep area
  7. Pacifiers are protective
  8. Don’t smoke during or after pregnancy and baby’s birth
  9. Avoid alcohol and illicit drugs during pregnancy and after baby is born
  10. Baby sleeps in a cool room: Avoid overheating baby and covering baby’s head during sleep
  11. Ensure baby gets all scheduled immunizations according to current recommendations
  12. Skip monitors or devices marketed to reduce the risk of SIDS
  13. Avoid commercial products, such as wedges or positioners, which are inconsistent with the safe sleep recommendations. These are not proven safe and have created hazards for baby.
  14. Provide “tummy time” when the baby is awake and supervised

 

Highly dangerous bed-sharing situations

  1. Baby is 4 months old or younger
  2. Baby was born premature or with low birth weight
  3. You or your partner smokes
  4. You smoked during pregnancy
  5. You or your partner take drugs
  6. You or your partner take medications that cause drowsiness
  7. If you or your partner have drank any alcohol
  8. If your partner is not a parent
  9. The sleep surface is soft, such as an old mattress, waterbed, or a pillow-top mattress
  10. The sleep surface is a couch, sofa, or armchair
  11. There is soft bedding, like pillows or blankets, in the bed

 

Sharon Hitchcock MSN, RNC, is faculty for the University of Arizona College of Nursing in Tucson, AZ.


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