By Michelle Barry, Parent-advocate with Safe Infant Sleep
What is safe sleep?
Safe sleep for infants is a series of guidelines put out by health organizations specializing in infant safety. The two most known organizations are the American Academy of Pediatrics and the National Institute of Health.
Many have heard of the “ABCs of Safe Sleep,” which contain the most basic recommendations of the safe sleep movement.
A is for Alone – Nothing in the baby’s sleep space but a fitted sheet and a pacifier. Nothing attached to the sleep space that did not come with it. No items hanging off of it.
B is for Back – Babies should be placed flat on their backs for each sleep up to at least 12 months of age.
C is for Crib – Only a crib, bassinet, or play yard that passes the necessary safety standards should be used for each and every infant sleep. The space should not be attached to an adult bed, nor too close to the adult bed, in order to reduce the risk of items getting into the sleep space. Items such as in-bed or sidecar car cosleepers are often used to try and safely bedshare but can carry the same risks as bedsharing.
In addition to these guidelines are the lesser-known recommendations:
Reduce the risk of overheating – Babies who are too warm are at an increased risk for SIDS. Dress your baby so that their chest or back feel warm but not hot or sweaty. It is safer to have your baby be on the slightly cooler side.
Ensure that your baby’s arms are free once they show signs of rolling, or they reach 8 weeks of age. Studies have shown babies who have rolled with their arms swaddled as early as 2 months, therefore being proactive will help reduce the risk of suffocation or entrapment.
The mattress you choose for your child’s crib should be above all FIRM. The AAP has found that a firm mattress will not conform to the baby’s head and thus will help to prevent instances of suffocation or positional asphyxiation. Positional asphyxiation occurs when the position the infant is in interferes with their ability to breathe. Most often it occurs when the baby falls into a chest to chin position and their trachea is pinched shut.
Home consumer-grade respiratory monitors do not protect against SIDS. These items are often used to ease parental anxiety, unfortunately, studies do not show that they do any such thing and instead can make anxiety worse due to false alarms and incidences of babies being burned by the devices. If a medical condition requires your baby to be monitored, they should be prescribed a medical-grade monitor and be closely followed by a physician.
How much of this really matters?
Let’s look at the terms SIDS and SUID:
SIDS is categorized as a sudden and unexpected death of an infant found to have no known reason following a full investigation.
SUID is the sudden and unexpected death of an infant. SUID includes SIDS, as well as Accidental Suffocation and Strangulation in Bed, Positional Asphyxiation, Accidental Overlay, Sudden Natural Death, and Unknown Cause.
Ninety percent of sleep-related infant deaths had AT LEAST one unsafe sleep factor, meaning the guidelines listed above were not being followed in at least one way.
When the guidelines above are followed the risk of a SIDS or unsafe sleep-related event is extremely rare. The ABCs reduce the risk of SIDS up to 99%.
If a SIDS event occurs while following these measures, other intrinsic factors such as prematurity, low birth weight, etc. are often also in play. The more factors, the greater the risk, and even more reason to follow safe sleep guidelines to ensure caregivers are doing everything you can to minimize risk.
Safe Sleep Myths:
- Babies with reflux can’t sleep flat.
A baby with reflux should still follow all safe sleep guidelines. There has been no increase in choking since the “Back to Sleep” campaign started. When a baby lays supine, their trachea is positioned above their esophagus, lessening the chances of choking as gravity is working in their favor. Inclines have not been shown to help reflux but instead can exacerbate the issue, as the feet to stomach position can cause fluids to back up into the esophagus in this position.
If your baby is uncomfortable due to reflux, work with your doctor to keep them comfortable and hold them upright after feeding for at least 20 minutes.
- Sleeping on their back will cause a flat head.
While there has been some increase in incidences of flat head since the back to sleep campaign started, often times this can be prevented due to limiting the time baby spends on their back or in sitting devices while they are awake. Plenty of tummy time and safe babywearing when possible will help to limit incidences that had no other attributing factors.
- You can’t breastfeed without bedsharing.
While it may provide more sleep to the mothers who take this route, it also provides unnecessary risk. Not bedsharing has not discouraged breastfeeding. In a study done on 3,000 mothers, 58.2% of exclusively breastfeeding mothers reported that they room shared without bedsharing. Those who did so stated that it was due to being informed of safe sleep practices. The more sources that the parent heard this information, the greater the chances that they followed it.
Having your baby in the same room but in a separate safe sleep space can help facilitate breastfeeding while still keeping the baby as safe as possible.
- It’s OK to follow unsafe sleep practices as long as I’m supervising during that time.
There is no evidence that you will be able to tell If a SIDS event or other unsafe sleep injury is occurring. Things like positional asphyxiation can occur in less than a minute and the baby can look like a normal sleeping baby. It is imperative to follow all the safe sleep guidelines at all times to lessen these risks.
Far too many parents have lost their babies to unsafe sleep situations. It is imperative that we display and promote safe sleep everywhere. Parents learn by what they see, and as social media becomes even more popular it is our duty to display only safe sleep materials in order to ensure other parents are aware of this life-saving information.
Sources
http://pediatrics.aappublications.org/content/pediatrics/early/2016/10/20/peds.2016-2940.full.pdf
http://www.naspghan.org/files/documents/pdfs/position-papers/FINAL%20-%20JPGN%20GERD%20guideline.pdf
http://www.childcarequarterly.com/pdf/summer15_licensing.pdf
https://pediatrics.aappublications.org/content/pediatrics/134/2/e406.full.pdf
https://www.ncbi.nlm.nih.gov/books/NBK513399/
https://www.ncbi.nlm.nih.gov/books/NBK513386/
https://www.cdc.gov/sids/data.htm
https://www.cdc.gov/nchs/nvss/births.htm
https://pubmed.ncbi.nlm.nih.gov/20156907/
