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Advice from Doctor Mom: The ABC's for infant safe sleep

Posted 12/3/2014 by UHBlog

Erin Frank, MDErin Frank, MD, Pediatric Hospitalist at UH Rainbow Babies & Children's Hospital and mom to a vibrant two year old girl.

Expectant parents spend months decorating and outfitting the perfect nursery for their new bundle of joy, while friends and family shower the newborn with handmade blankets and nursery accessories. Who can forget the excitement welcoming a new baby into the special space you worked so hard to prepare?

Unfortunately the beautiful and cozy nursery essentials can be dangerous for newborns. Every year we lose far too many babies to sleep-related deaths from suffocation or entrapment, as well as Sudden Infant Death Syndrome (SIDS). Many parents in these cases were unaware of the risks associated with soft bedding, a shared sleeping space or placing their infant on their tummy to sleep. A recent study published in the journal Pediatrics found that nearly 55 percent of infants nationwide are put to bed with soft blankets or covered by a comforter. Each of these scenarios has been shown to increase the risk of infant death in the first year of life.

To prevent a tragedy and ensure a safe sleeping environment, I tell new parents to follow the ABCs:

  • Alone: Lay baby to sleep in their own crib, bassinet or pack-n-play. Co-sleeping, also called bed sharing, is one of the most significant risk factors in sleep-related deaths. The American Academy of Pediatrics recommends young infants share a room with their parents but have their own dedicated sleep surface.
  • On their Back: Placing babies on their back to sleep has proven to decrease the rates of SIDS. This reduces the risk of suffocation as the baby’s mouth and nose have no contact with the mattress or bedding. In this position, infants are better able to regulate their level of arousal and respond to changes in their environment.
  • In a bare Crib: Infants should be placed in a crib with a firm mattress and tightly fitted sheet. All other materials should be removed from the sleep space as they represent a suffocation risk. This includes all blankets, pillows, stuffed animals and bumper pads. Infants should sleep in a warm sleeper or wearable blanket such as a HALO sleep sack. Other items such as swings, bouncers and car seats should not be used for sleep time in the home.
  • In a Smoke-free home: Secondhand smoke exposure before birth and during the newborn stage have been linked to increase risk of SIDS.

Parents often express concerns their baby will not be warm enough at night without blankets. A good rule to follow for temperature control is to have your baby dressed in one layer more than an adult in the room. The nursery should be kept at a comfortable temperature, and with snug-fitting infant sleep sacks, the use of additional blankets isn’t necessary. Infants generally enjoy being swaddled, and the infant sleep sacks are designed to fit snuggly and prevent bunching of material near the infant’s face. Sleep sacks are a great option for children who are not yet close to rolling over or unwrapping the swaddled blanket.

Additionally, new families often fear they will be unable to hear and respond to their child should a problem arise overnight. Sharing a room with your infant during the early months, while having a separate sleep surface for your baby, allows you to attend to your infants needs quickly while maintaining a safe sleep routine. A good monitor, either video or sound, can allow you to check in on baby even if they are sleeping in another room. Pacifier use has also been shown to decrease the rate of SIDS, and many infants enjoy using a pacifier, as sucking is soothing for babies. For breastfed babies, pacifiers should be introduced only after breastfeeding is well established.

Once parents learn and become comfortable with a safe sleep routine, it’s important to educate other caregivers who play a role in the infant’s first year of life. Grandparents in particular are often unfamiliar with the current safe sleep guidelines and are inclined to place the baby on their tummy or use blankets for sleep as those were familiar to them. Sharing safe sleep information with anyone who will be caring for your baby ensures that they are kept safe and sound even when you are not able to be with them. Remember, safe sleep rules should be followed whenever the child is placed to sleep, including nap time!

Nothing is more important than the health and well-being of your newborn baby. As parents we need to change our vision of what a comfortable infant’s crib looks like and focus on a new vision of a safe sleep environment. Even if the image isn’t as cozy, waking up to a healthy and thriving infant makes the nursery the warmest place in the home.

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