Dr. Bob: I have been reading a lot about arrangements for infant sleeping. My parents want to buy bumper pads and cute pillows for the crib for our new baby boy due soon. My reading tells me that we should not have those in the crib. And I also read that I should not have the baby sleep with me if he has trouble falling asleep. What are your recommendations?
Answer: I understand that there is a fair amount of confusion about sleeping arrangements for new babies. Things have changed during my career after medical school, now almost 50 years ago. In retrospect, both of my sons had sleep conditions that were less than safe. But the changes are for the better and I enthusiastically endorse them. Change can be difficult to accept but should always be accepted when those changes improve the lives of children, decreasing their risk of death and enhancing their health.
The important thing to remember about the recommended changes is that they were derived from data that dramatically documents the decreased risk of sudden infant death or crib death. Any steps to decrease such a dread outcome are certainly worth taking.
So, let’s review some of the steps –
- Babies should sleep on their backs. Period. Now, some folks especially grandparents will say that when the baby vomits or spits up, they will choke or aspirate. That does not happen because the anatomy of the throat and the voice box (their built-in gag reflex) are designed to stop that. They are actually more likely to choke or aspirate when sleeping on their stomach.
- The baby should be on a firm surface. The crib, bassinet, portable crib or play yard should have a mattress that is firm and covered with a fitted sheet. A loose sheet might come loose and become a source of suffocation.
- No other items should be in the crib. Bumper pads, pillows, stuffed animals and blankets should not be in the crib as these items could shift and pose a suffocation risk. I unfortunately have seen this happen. Cute things can be placed in the room but not in the crib.
- The crib (or alternate bed) should be safety approved. There are safety standards that can be checked to be sure. And make sure that the installation is correct and matches the instructions.
- Never sleep with the baby. This point cannot be overemphasized. Room share but do not bed share. The surface of a bed is too soft, and the covers might shift over on the baby. Co-sleeping is downright dangerous. The parent can easily roll over on the baby. This has happened even when parents have been convinced that could never happen.
- If the baby falls asleep in your arms or on the couch, move them to a safe sleep surface, on their back. This is very important. Infants have fallen asleep and accidentally suffocated when the parent or caregiver also fell asleep on a couch or recliner.
More sleep advice is available on the American Academy of Pediatrics website (healthychildren.org) and on this YouTube video (https://youtu.be/NXmjGbBLP60).
Good luck with your new baby. Make sure that their sleeping environment is as safe as possible.
Dr. Saul is Professor of Pediatrics (Emeritus) at University of South Carolina School of Medicine – Greenville and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.