Does Your Baby Practice Safe Sleep?

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Researchers in infant medicine have had much to be proud of over the years. So many new treatments have saved little lives and improved health for our youngest patients. Yet there was one important discovery that decreased by more than half the number of cases of the most common cause of infant death outside the newborn period. It didn’t involve a medical procedure, a medication, or even an immunization; rather, it led to a recommendation for parents to make one little life-saving change in their baby’s care.

We are, of course, talking about placing babies on their backs to go to sleep. It was after the American Academy of Pediatrics (AAP) rolled out the “Back to Sleep” campaign in 1994 that the rate of sudden infant death syndrome (SIDS) began its sharp decrease.

Even so, one SIDS death is too many, and 3700 cases of sleep-related death (which includes SIDS and accidental death; the two are now part of a larger category known as sudden unexplained infant death, or SUID) still occur each year. Because of this, investigations into causes continue. Over time, new findings are discovered and reported to health care providers and, from there, to families and other caregivers.

Such was the case recently when the AAP published results of a new study on sleep-related deaths. This time, they focused on babies who were places in a sitting device to sleep, most commonly a car seat, swing or bouncer. Tragically, 338 infants had a sleep-related death in these or similar devices between 2004 and 2014.

While these devices when used properly (say, a car seat for transportation) are appropriate, the AAP concluded they are risky proposition when used at home for sleeping. (The majority of deaths did occur while the seat was being used at home.) What are the risks? Among the many, let’s talk about a few. First off, babies can’t always maintain a good head position to get air in and out. In addition, whether or not the infant is restrained, there are other risks. Restrained babies may not have breathing room, whereas unrestrained babies may get themselves into a position (such as on their stomach) where they can’t breathe as well.

What about devices designed for sleeping more upright? There’s not good news here either. Use of one brand resulted in 32 deaths, leading the Consumer Product Safety Commission to order a recall of the devices. And just this past week, legislation was introduced in Congress to ban other upright infant sleepers.

Based on the recent study, it seems likely that the AAP will go on record in the future as officially recommending that all infants sleep in a crib or bassinet. Their last set of recommendations on safe sleep, which did mention avoiding upright devices, was published in 2016. The full list is available here, but it’s worth noting a few of the important points:

  • Put babies on their back (stomach up) to go to sleep every time.
  • Use a firm sleep surface.
  • No soft objects or loose bedding should be in the bed.
  • It’s safer for parents (or other caregivers or siblings) not to sleep in the bed with the infant. (Having the infant in the parents’ room in their own crib or bassinet, however, is OK and even desirable.)
  • (Perhaps some good news here:) Use of a pacifier may be helpful.

Now, this blogger realizes that neither he nor the researchers are at home with the parents and the baby, who seems much calmer in that swing or car seat. That said, the research on safe sleep in preventing infant death is there, and has undoubtedly saved many lives. Let’s wrap up by talking about alternatives to a risky sleep position:

  • Younger infants may respond well to a variety of calming measures, many of which are performed while the baby is awake. Can you spend some time holding and rocking her? Whether or not she falls asleep during that activity, it often has a soothing effect, as does some music, or even the (easily obtainable through technology these days) sound of a heartbeat. Infants under 4 to 6 months generally can’t be spoiled by a little extra attention.
  • Older infants are a little more of a challenge, as they will try and stay awake at times. Having a set bedtime, perhaps with a little ritual (such as a song) is sometimes helpful.

Finally, a couple of additional considerations. While infants under one year of age should generally be placed on their back to go to sleep, those that can and do roll over onto their stomach can be left there. (If you have to pick your baby up for some reason, return him to the crib backside down.) And there are a few—a very few—medical reasons for babies to not sleep in the recommended position. That’s always worth a talk with your provider. (It’s worth noting, however, that the on-the-back position is still considered the safest for most spitty babies, including those that have been diagnosed with gastroesophageal reflux.)

Infant sleep is yet another challenging subject, and each pediatric provider may have their own bag of tricks. However, the safe sleep recommendations have now been around for over a generation and, as we’ve seen, continue to be refined. While we keep following the research, please know that as a parent you have the power to keep your little one safe and healthy.

Stan Sack
Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.

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