Meg Frizzola, DO, Interim Chair of Pediatrics & Division Chief, Critical Care Medicine at Nemours/ Alfred I. duPont Hospital for Children in Wilmington, Del, co-authored this blog post.
Much of a baby’s early life is spent sleeping. In fact, many newborns snooze anywhere from 11 to 18 hours a day, which is vital to their health, growth and development. It’s important that sleeping hours be just as safe as those spent awake. This is because Sudden Unexpected Infant Death Syndrome (SUID) is a leading cause of death in infants 1 month to 1-year-old. Statistics show the number of babies dying from accidental suffocation and strangulation in bed skyrocketed 184% between 1999 to 2015. Most of these deaths occur in the first six months of life.
While sleep-related infant deaths are not 100% preventable, there are many simple steps you can take to reduce the risk and protect your baby. While many new parents receive education on safe sleep environments in birthing hospitals or during early newborn pediatric care, data shows there is still room to improve knowledge and beliefs about safe sleep practices. Here are the top tips to keep in mind to ensure that your baby’s sleep environment is as safe as possible.
1. Keep your baby in your bedroom – but not your bed.
The American Academy of Pediatrics (AAP) recommends room-sharing (as in bedroom-sharing). This is when an infant sleeps in the same bedroom as their parents (but not the same bed) for at least their first six months.
The reason sharing a bed (also called “bed-sharing”) is not recommended is that parents can accidentally roll onto or push their baby off the bed. Bed-sharing significantly increases your baby’s chance of sleep-related infant deaths due to overheating or by suffocation. A much safer alternative is room-sharing. This is when your baby sleeps in a crib, bassinet, or portable crib/playpen in your bedroom, but not in your bed.
Room-sharing allows your little one to be near enough to hear, smell, and sense you – and for you to be more aware and ready to help if your baby is in distress – but without the dangers of bed-sharing.
Room-sharing also makes it easier for moms to breastfeed, which (on its own) has been shown to decrease sleep-related infant death risk by 70%. Just remember to always return your baby to their own sleep space (outside of your bed) after breastfeeding.
2. Swaddle your baby safely.
Swaddling (wrapping a baby snugly in a cloth or light blanket) can help calm babies and soothe them to sleep. And some babies respond well to swaddling. However, research has suggested that incorrectly swaddling may increase infants’ risk of sleep-related infant deaths by about one-third, sparking a national conversation about infant sleep safety.
The thing is, when performed correctly (and at the right age and stage), swaddling can be very effective – and safe. Babies should not be swaddled after 2 months, as this is when some babies can start to roll over even while swaddled.
Sleep sacks are recommended for infant safe sleeping and come with and without swaddling options.
And now, for the standard infant sleep safety recommendations all parents of infants should follow…
3. Place your baby on the back to sleep.
Never place your baby to sleep on the stomach or side. Babies put to sleep on their sides are likely to roll onto their stomachs. And babies who sleep on their tummies are at an increased risk of sleep-related infant death.
Why? Well, some think this puts pressure on the baby’s jaw, which narrows the airways. Others think that the baby re-breathes exhaled carbon dioxide in this sleeping position. We don’t know a lot about this mysterious cause of death. But we do know that infants who are placed to sleep on their stomachs or sides have a much higher risk of sleep-related infant death.
Of course, babies often begin rolling over between 4 and 6 months old (and some may start as early as 2 months). If your baby rolls over onto the belly during sleep, you don’t need to roll them back over. But when first placing your down for a nap or at night, do continue to place your infant to sleep on the back until age 1 year. Your baby may still turn over during sleep – and that’s okay.
4. Buy a crib (or other sleep furniture) that meets safety standards.
Full-sized mattresses, couches, and armchairs are no place for babies to sleep – ever. Proper sleep furniture should meet Consumer Product Safety Commission (CPSC) standards. So make sure your infant is always sleeping in a safe:
Choose a sturdy one with fixed side rails (not adjustable) and slats that are 2 3/8 inches apart so your baby can’t fall out or get stuck.
Portable crib/playpen/play yard
Set up properly according to the manufacturer’s instructions and only use the mattress pad provided. Don’t add any extra padding.
Check that the bassinet has been approved by the Juvenile Products Manufacturers Association (JPMA) and is marked with their seal.
And one more important item…
Inclined products and equipment such as strollers, car seats, swings, bouncers, infant carriers, and slings are not safe places for infants and babies to sleep. Babies are safest sleeping flat on their backs. This keeps their head, neck, and jaw from flexing and collapsing downward.
5. Buy new when you can, and double-check old.
Baby merchandise isn’t exactly cheap. So if you need to borrow or buy second-hand baby furniture and products, make sure to check the CPSC for safety recalls. But try to avoid hand-me-down or used cribs and other infant furniture/equipment that are more than 10 years old.
6. Find a firm, fitting mattress.
It should be firm because infants don’t have the strength to push away from a surface that’s soft and can block their breathing. Also, make sure to use:
- a mattress that fits snugly in your baby’s crib, bassinet, or portable crib/play yard/playpen. Don’t use a mattress that’s too big or too small – it should fit just right. A mattress that doesn’t fit the frame of the crib or sleeping furniture can allow for the infant to become trapped between the two.
- sheets that snugly fit the exact size of the mattress. Never use sheets that are too big (and too loose) or too small (and too tight).
7. Remove everything from your baby’s crib but the mattress and a snugly fitted sheet.
Your baby’s sleep environment should be completely bare. That means no pillows, blankets, stuffed animals, and/or toys – all of which could potentially suffocate your baby or block breathing. Also steer clear of products like positioners and wedges that are marketed to prevent sleep-related infant deaths – these have not been proven to be safe or effective.
And, years ago, baby bumpers were considered a must-have for new moms’ registries. But those have now been deemed dangerous, too. So what you used for an older child may no longer be considered safe for a new baby.
8. Keep potential hazards out of your baby’s reach.
Place the crib, bassinet, etc. away from the window and any wall hangings (e.g., curtains, blinds, picture frames) that could be pulled down and could strangle or fall on your baby.
None of this means that you have to make the baby’s room look bland and plain. You can decorate the walls in a safe way with fixed shelving and nursery wall decals, so they have a bright and cheerful room.
Nemours Children’s Health System is dedicated to keeping babies healthy and safe and is a certified Cribs for Kids® hospital; that means that the hospital can identify infants in need of safe sleep environments and refer a family to local resources and programs. For hospitalized babies and children, Nemours has implemented a safe sleep policy. KidsHealth.org educational materials providing guidance on safe sleep practices have also been developed to ensure families have all of the information they need to support safe sleep.
The birth of a baby is one of life’s greatest joys. Preserve the joy and prevent the tragedy by practicing safe sleep with your baby.
Learn More About SUID Prevention
If you have any questions or concerns about your baby’s sleeping safety, talk to your child’s primary care doctor and/or check out these handy resources:
- Bed-Sharing (Nemours’ KidsHealth.org)
- Choosing Safe Baby Products: Cribs (Nemours’ KidsHealth.org)
- How to Keep Your Sleeping Baby Safe: AAP Policy Explained (AAP’s Healthychildren.org)
- Safe to Sleep Campaign (National Institute of Child Health and Human Development)
- Safe to Sleep: Crib Information Center (Consumer Product Safety Commission)
- SIDS (Nemours’ KidsHealth.org)
- Sleep Safety and Suffocation (Safe Kids)