SIDS prevention: How to get a good night of safe sleep

By Dr. Natasha Agbai

Every day in my office I see loving moms and dads bring in their newborns for their first doctor’s visit with their pristinely clean car seat and a diaper bag filled with everything a newborn could possibly need, except maybe an extra pair of pants… you live and you learn. A few weeks later they come for the one month visit. The car seat might have a little dried spit up on it, the diaper bag has been thinned out, and it definitely has a second pair of pants.  

One thing remains constant though no matter how seasoned a parent. It is the fear of SIDS, particularly in the first 6 months of age when SIDS is most likely to occur. So many of us parents can relate to waking up in a panic and checking to verify that the baby is still breathing.  Some families find that worry keeps them awake. Some families have been given well meaning gifts for their babies that are actually dangerous or have unknowingly purchased something that has been linked to an increased risk of SIDS. My goal as a pediatrician and a parent is to try to make sure that all parents can have easy access to current SIDS prevention recommendations.  

The American Academy of Pediatrics (AAP) has a SIDS task force that reviews and summarizes new studies and forms SIDS prevention recommendations. These recommendations, along with practical tips, can be found at http://sidsrisk.org. The AAP comes out with updated recommendations every 5 years (the next update is in 2021). Here are some of their science-backed peer-reviewed SIDS prevention recommendations.  

Prenatal:

✅ Pregnant women should obtain regular prenatal care.
✅ Avoid smoke exposure during pregnancy and after birth.
✅ Avoid alcohol and illicit drug use during pregnancy and after birth.

Setting up the nursery:

✅ It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first 6 months.
✅ Keep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment, and strangulation.

Once baby is born:

✅ Infants should be placed for sleep on the back (face up) for every sleep until age 1
✅ Infants should be placed on a firm sleep surface (eg, mattress in a safety-approved crib)
✅ Aside from a fitted sheet, all other bedding should be avoided
✅ No soft objects in the sleep space
✅ If able, breastfeed exclusively until 6 months.  
✅ Use a pacifier
✅ Avoid overheating and head covering/hats in infants.
✅ Infants should be immunized in accordance with recommendations of the AAP and Centers for Disease Control and Prevention.
✅ Avoid the use of commercial devices that are inconsistent with safe sleep recommendations.
✅ Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS

Setting up a safe sleep environment for your baby should be fun and rewarding. You can create a cozy, nurturing environment that is also safe.  Most people use a bassinet for the first 4 months of age and then change into a larger crib. If your baby needs a blanket I encourage the use of swaddles for newborns or sleep sacks (also called wearable blankets) for infants.  

I urge you to ignore magazine ads showing babies sleeping peacefully with unnecessary (and unsafe) things like stuffed animals, bumpers (even mesh bumpers), quilts, positioners, and pillows. There are also a variety of “sleepers” that are sold regularly in stores that are unsafe sleep surfaces. Things like rockers, recliners, hammocks, and loungers often say “safe for supervised sleep”.  As a pediatrician and SIDS expert let me unequivocally translate this for you. “Safe for supervised sleep” means it is not safe for sleep. I hope in the future the labeling becomes more clear. Until that time we have to rely on savvy parents like you to outwit the marketers and remember the safe sleep principles.

Sometimes friends and family aren’t aware of the updated sleep recommendations. With the best of intentions people may tell you stories of how their child slept on X (insert an unsafe environment) and did just fine. Of course they did. Just like some of our ancestors kids rode in the car without a seatbelt and did just fine. But also some died. My response to this is simple, we make the best decisions we can to protect our children with the information we have at the time. As new information arises recommendations are updated. When it comes to SIDS we can’t yet predict who will end up just fine and who won’t wake up. For this reason, I recommend protecting all infants as best we can.

I also think it is important to recognize the level of sleep deprivation that comes with having a newborn. Sometimes parents need to make difficult choices. Some sleeping surfaces are riskier than others (the couch for example is one of the most dangerous places for an infant to sleep).  If you want to see how certain behaviors influence an infant’s risk for SIDS, check out my Risk Calculator available at http://sidsrisk.org/risk-calculator/   

Having an infant is exhausting, messy, and amazing all at once. Every parent that I have met wants the best possible future for their baby. My hope is that by adopting safe sleep practices our community as a whole will get to experience the joy that comes with more 1st birthdays!

:::

Natasha Agbai, MD, FAAP is a pediatrician at Palo Alto Medical Foundation and creator of SIDSRisk.org, a website dedicated to safe sleep and SIDS prevention.  She is the proud mom of two sons. You can follow her on twitter @AFitterFamily