A Pediatrician’s Guide to Safe Sleep

Remember, your baby does not know how to call for help or lift their head up when they are born which means they cannot get themselves out of potentially dangerous situations. Every year, we lose 3,400 babies to Sudden Infant Death Syndrome (SIDS) or suffocation/strangulation while sleeping.  This is why the AAP (American Academy of Pediatrics) has a specific set of recommendations based on evidence to help reduce the risk of SIDS in infants up to age 1.

The most important practices to implement so that your baby is safe when sleeping include:

1.     Placing your baby to sleep on their back, even for naps. This makes sure your baby does not roll over in a position that blocks their airway and also prevents spit-up from going down the wrong pipe to irritate their lungs or causing them to choke. If your baby rolls over, place them back on their back until your baby is able to roll both ways.

2.     Sleeping on a flat, firm surface, like in their crib or bassinet. Do not let them sleep in their car seats, strollers, slings, loungers, nursing pillow, couch, or sofa as they can compromise their airway.

3.     Making sure your crib or bassinet meets the Consumer Product Safety Commission (CPSC)’s safety standards.

4.     Do not have anything besides the firm mattress itself. The mattress itself should be firm and not indent when your baby is placed on it. You can use a firmly fitted sheet made for that mattress specifically.

5.     Do not place pillows, blankets, teddy bears or soft objects, or loose bedding, crib liners or bumpers in the crib with your baby. If you think your baby may be getting cold, try a wearable blanket.

6.     If you choose to swaddle your baby, make sure it is not too tightly so they are able to move their hips and can breathe but not yet escape the swaddle. You can stop swaddling around 2 months of age.

7.     Breastfeeding is shown to reduce the risk of SIDS while smoking increases the risk.

8.     Pacifier use is also known to reduce the risk of SIDS.  

9.     Bed-sharing is highly discouraged but room-sharing is helpful. Keep your baby’ sleep area in your own sleep area for the first 6 months to 1 year.

10.  Have tummy time to play when they are awake to develop their neck and upper body muscles and prevent a flat head.

11.  Do not rely solely on heart rate monitors, pulse oximeters, or breathing monitors to track the health of your baby. If you are worried about you child, consult your pediatrician.

12.  Remember to go to all your well-child visits so your pediatrician can monitor your baby’s progress and answer any question you have, including safe sleep practices.

Are crib liners or bumpers recommended?

Both crib liners and bumpers are commonly found in baby aisles. As pediatricians, we strongly advise against using either. Using bumpers and liners is a more dated practice that we have learned a lot about.  In fact, we do not recommend using anything besides a firm mattress itself for safe sleeping in babies. The mattress itself should be firm enough to not indent when your baby is placed on it.  

That means no pillows, blankets, teddy bears, soft objects, or loose bedding. And, no crib liner or bumpers either. These extra objects in the crib or sleep area can be hazards that can increase the chance of suffocation, strangulation, and Sudden Infant death Syndrome (SIDS) in babies. 

The baby industry is a highly prolific and very lucrative market. Often times, many products have not been studied for safety or efficacy and are unregulated, including even some over-the-counter medications. The landscape is ever-changing with new products every time you go to the store. It can be such a confusing world to navigate for parents. We understand how overwhelming this can be. This is why we always recommend reaching out to your pediatrician for advice on what to use and what to avoid as well as to check what is safe to use at what age for your child. It is our job to provide you with explanations, recommendations, and evidence so that you can be empowered to make the best, most-informed decision when it comes to your child.

What can I do to prevent crib-related limb injuries?

In general cribs that meet CPSC standards, like most new cribs, are made to have small spaces between slats to minimize the chance of your baby’s limbs from getting stuck. Though it can happen, the majority of these occurrences are typically minor and do not cause serious injury or fracture. Most of the time, it is just uncomfortable for your baby.

Try to use a crib that does not have cut outs. Make sure the mattress fits snugly to prevent any limbs from getting caught in between the mattress and the side of the crib. Ensure your crib meets the CPSC safety standards, which makes sure that the space between bars is the optimal size to prevent your child’s head, neck, or body from getting stuck. If they do get their arm or leg stuck, gently help them get “un-stuck” (which may involve taking out a slate and putting it back in) and comfort them till they are soothed.

We hope these tips help ease your anxiety as you adjust to having your newborn at home. We know this is a difficult time for parents, but also one of the most life-changing as you bond with your little one. Being worried is TOTALLY okay. In fact, to us, it is a sign you are a good parent! As always, don’t hesitate to talk to your pediatrician about anything on your mind. That is what we are here for!