Safe Sleep 101
As someone who suffers from postpartum anxiety, safe sleep and all the rules were kind of stressful. I didn’t know what I didn’t know! So this blog’s purpose is really here to educate you so you have the knowledge to make safe sleep choices for your family in your home.
We will cover safe sleep from newborns to toddlers….
But, first we need to touch on what SIDS is because that’s the whole purpose of safe sleep and everything the AAP recommendations (SIDS reduction! This topic can get pretty heavy, but it it is an important one to discuss.
What is SIDS?
SIDS and SUID. SUID (Sudden Unexpected Infant Death) is a broad term that encompasses all sudden and unexpected deaths in infants younger than 1 year of age whose cause of death is not immediately obvious prior to investigation.
This includes:
SIDS (Sudden Infant Death Syndrome)
accidental deaths (such as suffocation, entrapment and strangulation)
sudden natural deaths (such as those caused from infections, cardiac or metabolic disorders, metabolic and neurological conditions)
trauma (accidental or otherwise)
Some use the term to refer to deaths that are unexplained, as opposed to unexpected.
Sudden Infant Death Syndrome (SIDS)
SIDS is the leading cause of death in children between 1 month and 1 year of age. The majority of SIDS deaths occur when babies are between 2 and 4 months of age.
We don’t know yet exactly what causes SIDS (current research is focusing on brainstem abnormalities, genetics and a link with respiratory infection). There have been cases where no risk factors were present and a SIDS death still occurred. Therefore, we cannot prevent SIDS completely.
However, SIDS rates have fallen 50% since the "Back to Sleep" campaign, it's clear that we are moving in the right direction!
The “Back to Sleep” campaign was launched in the 90’s as part of the safe sleep campaign when SIDS deaths were on the rise. It significantly lowered the rate of SIDS death from then on. Therefore, it is important to always place your infant on their back to sleep for the first 12 months.
Now, what are the actual safe sleep recommendations? Based on years of research from The American Academy of Pediatrics, they have developed a very easy way to remember the safe sleep rules for your little ones with the ABC’s of safe sleep!
A- Alone
B- on their Back
C- in their Crib (or safe sleep approved bassinet or pack-n-play)
WHAT ARE SAFE SLEEP RECOMMENDATIONS (ages >1):
A- Alone:
Alone means without anything else in their sleep space! The crib should be empty. Keep soft objects, toys, and loose bedding out of the baby’s sleep area. Don’t use pillows or crib bumpers. There's no need for a mobile and make sure any cords from monitors are out of reach.
Never place the baby to sleep on pillows, quilts, sheepskins, or other soft surfaces (couches, loungers like dockatots or snuggle me, etc.)
A good rule of thumb is that anything that attaches to the crib is unsafe to use as they risk entrapment, suffocation, or strangulation. According to a study in the journal Pediatrics, “the number of babies who died because of bumpers tripled in the last seven years of data available. From 1983 to 2012, bumpers may have been involved in 77 deaths.” So yes, even mesh bumpers can pose a risk for little ones.
B- Back:
Always place your baby on his or her back for sleep! If your baby has learned to roll, still place baby on their back to sleep, once they can independently roll on their stomachs, you can leave them. According to this study out of Australia, https://health.usnews.com/health-news/family-health/sleep/articles/2011/03/03/research-uncovers-clue-to-sids, found that babies who sleep on their belly have lower levels of oxygen in their brain than babies who sleep on their back!
C- Crib:
Do you remember buying your baby’s mattress and it having two sides? It has an infant side and a toddler side. The infant side is used for 12-15 months; it is more firm than the toddler side! Place your baby on a firm sleep surface, covered by a tightly fitted sheet.
A crib with a firm sleep surface and tight, fitted sheet that meets the safety standards of the Consumer Product Safety Commision (CPSC) is the safest surface for your little one to sleep on.
A mattress that is too soft or indents when you place them on it can make it difficult to get in and out of positions if they needed and can cause positional asphyxiation (where their airway is blocked due to their chin resting on their chest)..
As someone who travels often with their babies, I found pack and play sheets to be too loose. A pro tip is to make sure you buy a fitted sheet that goes with the pack and play you have, this will ensure it fits appropriately.
Other considerations for Safe Sleep:
Overheating:
Keep the room at a temperature that is comfortable for an adult! Dress your baby in light sleep clothing. The best way to check your baby’s temperature is to check the back of their neck or chest! If they are sweaty, remove a layer of clothes. If they are cold, use a sleep sack NOT a blanket!
Smoking: Do not allow smoking around the baby inside your home.
Bed sharing/Roomsharing/Cosleeping: Room sharing is recommended not bedsharing as there is no way to make bedsharing as safe as the ABC’s. Be sure to use a safe, sleep approved bassinet, crib or packnplay. Room sharing is recommended for the first 6-12 months of your baby’s life. Room sharing is simply sharing your room with the baby- it is not the same as sharing a bed with your baby. Your baby should still have their own separate sleep surface such as a crib or bassinet.
(want more information about bedsharing? Check out this blog!)
Breastfeeding: Breastfeeding is recommended. However, not breastfeeding does NOT increase your risk of SIDS!
Safe Sleep For Toddlers:
The American Academy of Pediatrics recommends:
No pillows before age 2, a small firm pillow (only in a toddler bed, not a crib because most manufacturers say not to add ANYTHING to the crib)
Rails are safe on a toddler bed
Keep beds away from windows, drapery, and electrical cords.
A toddler bed is safe after 15 months
Cribs are safe until they are 3 feet tall according the manufacturer due to the risk of falling out/climbing out
It is safe to use a top bunk after 6 years of age
When working with parents of toddlers who are transitioning from crib to toddler bed I always recommend to anchor all furniture to the wall and consider putting a gate on the door! This is not to punish your toddler but to keep them safe and ensure they will not wander the house in the middle of the night when everyone else is sleeping!
Common FAQs about Safe Sleep:
Are Pacifiers Safe for Safe Sleep?
Yes. You can offer a clean, dry pacifier when placing the baby down to sleep, but don’t force the baby to take it. Wubbanubs or anything that is attached to the pacifier wouldn’t be considered safe for sleep.
Is Swaddling Safe for Sleep?
Yes! Your baby can go into his or her crib on his or her back in a swaddle! You should stop swaddling when they show their first sign of rolling! The doctor that heads the SIDS task force for the AAP recommends dropping the swaddle by 8 weeks as the incidence for accidental rolling has occurred at that age and no one wants to find their swaddled baby on their belly.
Honestly, from a developmental standpoint, the sooner the better anway!
Is it Safe to Sleep in the Car?
According to research from Red Nose, do not let your baby sleep in a car seat any longer than is necessary for travel.
https://rednose.org.au/news/new-research-shows-risks-posed-by-leaving-infants-to-sleep-in-car-seats
How to have safe sleep when baby is rolling?
As soon as your baby is showing signs of rolling, stop swaddling them.
When baby shows signs of rolling transfer them from the bassinet to a crib if your bassinet recommends that (always go by weight or abilities according to the manufacturer; whichever limit they meet FIRST).
When Is It Safe to Sleep With a Pillow/Blanket?
According to the AAP, pillows and blankets should be given to a child when he or she is at least 2 years of age!
Is it Safe to Baby on Back to Sleep when they have Reflux:
Babies automatically swallow or cough up fluid that they spit up or vomit—it’s a reflex to keep the airway clear.
Red Nose https://rednose.org.au/article/will-baby-choke-if-he-she-vomits-while-sleeping-on-the-back
Has a great visual to show what happens when your baby is on their back and experiences reflux!
Studies show no increase in the number of deaths from choking among babies who sleep on their backs. In fact, babies who sleep on their backs might clear these fluids better because of the way the body is built.
We get it— safe sleep rules are tough especially if you have a not so great sleeper. If you’re really struggling with sleep AND safe sleep, reach out for a 1:1 consult!
