Did you know that SIDS (Sudden Infant Death Syndrome) and accidental deaths from strangulation or suffocation account for well over 3500 infant deaths in the U.S.? The irony here is that despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death that occur during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence since the early 2000s.
However daunting and scary the statistics maybe, however unpredictable the occurrence of a sleep accident maybe, there are certain things we, as parents, can do to mitigate the risks. The American Academy of Pediatrics (AAP) has put together a set of guidelines and recommendations to help us parents avoid baby sleep related accidents that can sometimes result in injuries and even death.
Babies should sleep on their backs for all sleep times – for naps and at night – at least until their first birthdays. Babies who sleep on their backs are much less likely to die of SIDS than babies who sleep on their stomachs or sides.
Newborns should be placed skin-to-skin with their mother as soon after birth as possible, at least for the first hour. After that, or when the mother needs to sleep or cannot do skin-to-skin, babies should be placed on their backs in the bassinet.
Some babies will roll onto their stomachs. You should always place your baby to sleep on the back, but if your baby is comfortable rolling both ways (back to tummy, tummy to back), then you do not have to return your baby to the back. However, be sure that there are no blankets, pillows, stuffed toys, or bumper pads around your baby, so that your baby does not roll into any of those items, which could cause blockage of air flow.
If your baby falls asleep in a car seat, stroller, swing, infant carrier, or sling, you should move him or her to a firm sleep surface on his or her back as soon as possible.
Use a firm sleep surface. A crib, bassinet, portable crib, or play yard that meets the safety standards of the Consumer Product Safety Commission (CPSC) is recommended along with a tight-fitting, firm mattress and fitted sheet designed for that particular product. Nothing else should be in the crib except for the baby. A firm surface is a hard surface; it should not indent when the baby is lying on it. Bedside sleepers that meet CPSC safety standards may be an option, but there are no published studies that have examined the safety of these products. In addition, some crib mattresses and sleep surfaces are advertised to reduce the risk of SIDS. There is no evidence that this is true, but parents can use these products if they meet CPSC safety standards.
Keep baby’s sleep area in the same room where you sleep for the first 6 months or, ideally, for the first year. Place your baby’s crib, bassinet, portable crib, or play yard in your bedroom, close to your bed. The AAP recommends room sharing because it can decrease the risk of SIDS by as much as 50% and is much safer than bed sharing. In addition, room sharing will make it easier for you to feed, comfort, and watch your baby.
Only bring your baby into your bed to feed or comfort. Place your baby back in his or her own sleep space when you are ready to go to sleep. If there is any possibility that you might fall asleep, make sure there are no pillows, sheets, blankets, or any other items that could cover your baby’s face, head, and neck, or overheat your baby. As soon as you wake up, be sure to move the baby to his or her own bed.
Bed-sharing is not recommended for any babies. However, certain situations make bed-sharing even more dangerous. Therefore, you should not bed share with your baby if:
- Your baby is younger than 4 months old.
- Your baby was born prematurely or with low birth weight.
- You or any other person in the bed is a smoker (even if you do not smoke in bed).
- The mother of the baby smoked during pregnancy.
- You have taken any medicines or drugs that might make it harder for you to wake up.
- You drank any alcohol.
- You are not the baby’s parent.
- The surface is soft, such as a waterbed, old mattress, sofa, couch, or armchair.
- There is soft bedding like pillows or blankets on the bed.
Never place your baby to sleep on a couch, sofa, or armchair. This is an extremely dangerous place for your baby to sleep.
Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the baby’s sleep area. These include pillows, quilts, comforters, sheepskins, blankets, toys, bumper pads or similar products that attach to crib slats or sides. If you are worried about your baby getting cold, you can use infant sleep clothing, such as a wearable blanket. In general, your baby should be dressed with only one layer more than you are wearing.
It is fine to swaddle your baby. However, make sure that the baby is always on his or her back when swaddled. The swaddle should not be too tight or make it hard for the baby to breathe or move his or her hips. When your baby looks like he or she is trying to roll over, you should stop swaddling.
Try giving a pacifier at nap time and bedtime. This helps reduce the risk of SIDS, even if it falls out after the baby is asleep. If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. This usually takes 2-3 weeks. If you are not breastfeeding your baby, you can start the pacifier whenever you like. It’s OK if your baby doesn’t want a pacifier. You can try offering again later, but some babies simply don’t like them. If the pacifier falls out after your baby falls asleep, you don’t have to put it back in.