Better Baby Sleep: Infant Sleep Safety
by
Jane Stockly
Illustrated by Ellen Surrey
Cover photo by Chemistry / Getty Images
Smashwords Edition
“Better Baby Sleep”
Copyright © 2010 by Jane L. Stockly
Information about “Better Baby Sleep” is available at the author’s website:
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Acknowledgments
Numerous people have offered their support and assistance in developing “Better Baby Sleep.” This book would not be as strong without their input. A special thank you goes to the faculty in the Family and Consumer Science Department, California State University, Northridge, and to my Parent Education colleagues at Glendale Community College. I also thank the many parents and professionals who provided thoughtful evaluations of this booklet. I am especially grateful to Carol Bloodworth, Anne Crump, Roberta Vadman, Jan Vunder, whose critical and timely feedback was invaluable.
A special acknowledgement goes to Ellen Surrey, whose illustrations make the book more inviting. I thank all of my family and friends on both sides of the Atlantic, who have always shown an interest in my work and given me constant support and encouragement, particularly my husband, Ed, and my daughters, Lauren and Katherine, who made it possible for me write this booklet with the additional understanding of what it is like to be a mum. That is invaluable!
Disclaimer
“Better Baby Sleep” contains information intended to help parents and caregivers understand infant sleep; however, the author is not a healthcare professional and the information provided cannot substitute for the medical expertise and advice available from a pediatrician or primary healthcare provider. The author assumes no responsibility or liability for any outcomes that result after reading this book. Parents and caregivers are encouraged to discuss their infants’ sleep with a qualified physician or healthcare professional.
Better Baby Sleep: Infant Sleep Safety
By Jane Stockly
Infant Sleep Safety
The infant death rate in the United States is 6.8 per 100,000, one of the highest in the developed world. Parents can take steps to reduce their baby’s risks. The back-sleeping position must be used every time your baby is laid down for sleep: bedtime, nighttime, at home, away from home, in childcare, with a baby sitter or with relatives. It is also of critical importance to have a safe sleep environment for your baby. Infants die every year from being laid down to sleep in hazardous places. Babies can die from falling, entrapment, entanglement, wedging, overlaying and suffocation. Infant death rates from these causes have been rapidly increasing.
Sudden Infant Death Syndrome
Sudden Infant Death Syndrome (SIDS) is the unexplained, sudden death of an infant under the age of one year, usually occurring while the infant is sleeping. The thought of it naturally terrifies parents. I am guessing the majority of new parents spend some time hovering over their sleeping babies checking to see if they are still breathing. I know I did. When babies are in deep sleep, they can seem to be so still.
The risk for SIDS peaks in infants between the ages of two and four months, with death rates dropping significantly after six months of age. The chances your baby will die from SIDS are extremely low if the baby is a healthy full-term infant, if the mother was over the age of 20 during pregnancy, if she did not smoke while pregnant, and if the baby is not exposed to secondhand smoke. SIDS rates are higher among infants born prematurely.
Since 1992 SIDS death rates in America dropped approximately 50% as parents began to put their babies to sleep on their backs, following the “Back to Sleep Campaign” sponsored by the American Academy of Pediatrics and the National Institute of Child Health and Human Development (see the section on Helpful Web Sites in the Appendices).
American Academy of Pediatrics Infant Sleep Guidelines
In 2005, the AAP issued guidelines to reduce the risk of SIDS and sleep-related, accidental infant deaths, such as suffocation. Infants’ re-breathing their own air has been determined to be the cause of some suffocation deaths. This occurs when a baby’s nose and mouth have only a small airspace around them, because their face is either loosely covered or pushed up very close to something, stopping them from breathing in new, fresh air. The baby ends up breathing stale air they have already breathed out, loaded with higher levels of carbon dioxide and a lot less oxygen.
The following is based on AAP guidelines and should be taken very seriously by parents and anyone caring for an infant. These guidelines are based on careful, scientific research building on the lessons learned from actual cases where babies have died.
Babies must be placed on their backs when laid down to sleep. No side or stomach sleeping is recommended at bedtime or naptime. Tell this to everybody caring for your child.
Babies should sleep in their own space. This means separate from the parents or any other children, but close enough to be monitored. An infant crib, cradle, or bassinet that is certified by the Juvenile Products Manufacturer Association (JPMA) to meet current safety standards should be used (see the section on Helpful Web Sites in the Appendices). Look for one of these symbols on the products:
JPMA Logos: Previous, left, and current.
In addition, check with the Consumer Product Safety Commission (CPSC) to see if there is a recall notice for any crib or baby product you intend to use, including those purchased new or used, or received as a gift (see the section on Helpful Web Sites in the Appendices).
CPSC Logo.
To prevent suffocation and entrapment, never put a baby to sleep on a waterbed, air mattress, sofa, or armchair, and never sleep with an infant in such a location. Babies may be brought into a parent bed for nursing, feeding, or comforting, but should be put back in their own crib before the parent falls asleep. At no time should an infant be brought into the parent’s bed if the parent is using medications or substances that may impair their alertness or if the parent is very sleepy.
Babies should sleep on firm surfaces only. A firm crib mattress covered by a fitted sheet is ideal. Soft items such as pillows, comforters, quilts, or sheepskins should not be placed under infants. Soft, loose bedding and objects such as stuffed toys should not be put in the crib. If bumper pads are used, they should not be pillow-like, but should be thin, firm, well secured, and designed for that purpose. These should be removed before a child can pull himself up to a standing position.
Make the sleep surroundings safe. Remove all cords (such as from window blinds), ties, or strangulation hazards from around the sleeping area. If traveling and you are not sure of the sleep environment, consider taking an infant-safe, portable crib with you.
Babies should wear comfortable sleep clothing. There should be no head coverings. All-in-one sleeper outfits may be worn instead of having a blanket, as loose blankets may be dangerous. If blankets are used, they should be tucked in firmly, anchored under the foot of the mattress, and not reach up higher than the infant’s chest. To prevent the baby wiggling down under the covers, he may be placed in bed with his feet touching the bottom of the crib.
The bedroom temperature should not be too hot or too cold. A lightly clothed adult should feel comfortable. Consider a thermostatically controlled, nonflammable heat source for maintaining a comfortable temperature in the sleep area. Avoid overheating the baby by not over-bundling. An infant should never feel hot to the touch or sweaty.
Do not expose your baby to any secondhand smoke. Never directly expose your baby or his environment to cigarette smoke. If you are a smoker, never exhale in your baby’s face, even when not smoking, as your baby may breathe in toxins. Smoke outside and consider changing your shirt afterward, before holding your baby. Becoming a parent may be a good motivator to quit. Doctors are always willing to be supportive of this process.
Be a wary consumer. Avoid commercial products that claim they are designed to reduce the risk of SIDS, or state they keep a baby sleeping on their back. None have been fully tested to show efficiency or safety. There is no evidence that commercial electronic home monitoring systems reduce the risk of SIDS. Do some research before you buy any products. Use infant equipment that conforms to the safety standards of the Consumer Product Safety Commission (see the section on Helpful Web Sites in the Appendices).
Pacifiers may be used. A pacifier may be used when putting a baby down to sleep but should not be reinserted once the infant falls asleep. Research shows pacifier use may reduce the risk of SIDS, although experts are not sure why. Pacifiers should not be forced on a baby, and must be cleaned often, replaced regularly, and never coated in any solution. For breast-fed babies, pacifiers may be introduced after one month.
The Safest Sleep Environment for Your Baby
Whether you’re planning on designing a new nursery, or simply making space for a crib in your bedroom, you can create a safe and comfortable sleep environment for your baby.
The Room
The safest place for a baby to sleep is in a crib near the parents’ bed. The AAP recommends a crib near the bed for at least the first few months of life.
• The room your baby sleeps in should be smoke-free, even when your baby is not there. Parents should not smoke and the baby should be kept away from people who are smoking. There should be no smoking inside your home. You should insist on a smoke-free zone around your baby.
• The temperature in the room should be comfortable, never too warm or too cold. If needed, I recommend the kind of thermostatically controlled portable heater that does not have an open heat source. The room should be comfortable for a lightly clothed adult.
• Room darkening curtains and/or blinds can be helpful in the summer, when it gets dark later and light earlier.
• There should not be cords from curtains or blinds anywhere near the crib, as these create a strangulation hazard.
• Any mobile or hanging decorations should be well out of the reach of a toddler standing up in a crib. Remember, your baby will grow! When your child reaches 35 inches (89 cm) in height, he has outgrown the crib and should sleep in a bed.
The Crib
Your baby’s crib should meet CPSC safety standards and it should bear the JPMA logo, indicating that model has been tested and was found safe. You should also check the model at the CPSC website to be sure it has not been recalled. This is of particular importance if you are using an older crib or one that was purchased second hand (see the section on Helpful Web Sites in the Appendices).
• For as long as you use the crib, it should have no loose, missing or broken slats and should have no missing or broken hardware.
• The width of the space between the crib’s slats should be no more than 2 3/8" (60 mm, about the width of a soda can).
• The corner posts should be flush, or no more than 1/16 of an inch (1.5 mm) higher than the rails, headboard and footboards. Not all cribs have corner posts. If the corner post is more than 16" inches (40 cm) above the rails that is also acceptable.
• The mattress should be firm and designed for use with that crib.
• The crib’s mattress should fit tightly in the crib. The mattress is too loose if you can fit more that two finger widths between the edge of the mattress and the crib side.
• The mattress should have a tight-fitting bottom sheet. Do not use an adult sheet with a crib mattress. Use a sheet that is made for crib mattresses.
• Do not use plastic bags or coverings on the mattress.
• There should be no pillows, quilts, comforters, sheepskins, stuffed toys, bumper pads, or any other soft, padded or plush products in the crib.
• Avoid devices, pads or wedges that prop a baby on her side, or claim to “prevent SIDS” and suffocation. These devices have not been tested to show if they reduce or increase the SIDS risk and have not been proven safe. The back sleeping position is best way to minimize the risk of SIDS for your baby.
When you travel, you need to be prepared to create a safe environment wherever you go. If you’re going to use cribs provided by hotels, ask them for the make and model number and check the CPSC website to make sure that their crib meets the standards and has not been recalled. If you are not sure of the sleep environment, consider bringing an infant-safe, portable crib along.
The Baby
When babies are sleeping they should be on their backs. If they are sleeping in a stroller, car seat or are placed in a baby carrier, make sure the baby is not in a scrunched position with their chins on their chests. Babies’ airways are soft and necks should be extended when they sleep to ensure there is no compression of the airway.
• Your baby should sleep in a sleeper or similar sleep clothing, these are preferable to blankets.
• If you choose to use a blanket, use a thin blanket tucked snugly around sides and foot of the crib mattress. For sleep, place your baby on her back with her feet near the foot of the crib, so she can't slide down under the blanket. The blanket should reach only as far up as your baby’s chest.
• Make sure your baby’s head will always remain uncovered during sleep.
• Before putting your baby to sleep, remove any bibs, ribbons, necklaces and anything else that may cause a strangulation hazard.
• If you use a pacifier, do not use anything to tie it to your baby’s wrist or neck.
• Avoid overheating. Your baby should not be sweating or feel hot to the touch, especially at the hands.
Babies are Not Adults
Sometimes when adults see babies sleeping on their backs, with no pillow or blankets, they may wonder if the baby is comfortable, since they themselves wouldn’t be in that position or environment. Babies become accustomed to sleeping on their backs without soft pillows or fluffy padding, and they sleep quite comfortably that way. Some parents or caregivers may even decide not to use the back-sleeping position because they think it may increase the risk of choking or “it just looks awkward.” The National Institute of Health found that back-sleeping babies have not been shown to have increased problems with choking; healthy babies automatically swallow or cough-up fluids. So don’t be tempted to offer your baby a “cozy” comforter or pillow or lay them in another sleep position. This can be very dangerous for your baby. You should make sure that anyone caring for your baby understands this.
Maximizing Safety if You Sleep With Your Baby
Choosing whether or not to sleep in the same bed as your infant is a controversial topic. Those in favor of parents and babies sleeping in the same bed, “the family bed,” say it promotes bonding and breast-feeding, and is a traditional practice carried out in many of the world’s cultures. I believe parents can bond with their babies and breast-feed successfully with each sleeping in their own space.
The AAP recommends having babies sleep in a crib near their parents’ bed. Adult sleep arrangements in Western cultures are dangerous for infants, and experts agree that the absolute safest sleep environment for an infant is in a crib or bassinet close enough to the parents’ bed to be monitored. The AAP guidelines reflect the potential dangers of adult Western beds. Babies should be laid down for sleep in a crib near the bed.
Parents who smoke should never sleep in the same bed with their infants, as this may increase an infant’s exposure to smoke components. Smokers, even when they are not actively smoking, exhale potentially harmful toxins that their babies breathe in when lying face-to-face with them in bed. Some European studies show direct contact with smokers increases an infant’s risk for respiratory infection and SIDS.
For those who choose bed sharing, measures need to be taken to prevent infant suffocation, wedging, entrapment, strangulation, falling, or overlaying.
Consumer Product Safety Commission Baby-doll Illustrations
Below are photos of dolls depicting dangerous situations in order to show how hazardous adult beds can be for babies. In many cultures where bed sharing is customary, the mattress is placed directly on the floor and away from the wall.
A doll is used to illustrate the danger of furniture placed too close to the bed.
Here the doll illustrates the danger of the bed being placed too close to a wall.
The doll shows how a baby can become trapped in an adult bed’s footboard. Headboards and footboards are not built to the same standards as a crib and can be hazardous to an infant.
The Family Bed
If you feel strongly that you want to bed share with your baby, then here are some safety tips to consider:
• Bed mattresses should be firm and placed directly on the floor so babies cannot fall from a height. Sleeping directly on the floor is the norm in many world cultures that bed share.
• Bed mattresses should be pulled away from the wall and nearby furniture so there is no chance of an infant getting wedged between them.
• Use a tightly fitted sheet over the mattress.
• Remove all nearby clutter, and raise any hanging cords from blinds or curtains out of reach.
• Secure furniture, such as dressers, to the wall. This is particularly important if you live in an earthquake zone.
• The entire bedroom should be childproofed since it takes the place of the crib. Remember, babies learn to roll, crawl, climb, and walk sometimes sooner than we expect. Be prepared in advance.
• Headboards, footboards, and side rails should be removed (including those designed to prevent children from falling out of bed). These may entrap an infant.
• Remove any unsafe bedding and keep any pillows out of the baby’s way and away from the floor around the bed.
Even if you follow all these steps, the safest place for your baby to sleep is still in a crib next to your bed. You may consider co-sleeping products. These are low-sided, bassinette-type baby beds designed to be placed directly in the parents’ bed (a king-size bed may be needed to use these comfortably). These are only for newborns and infants unable to roll over. Before purchasing check-in with the Consumer Product Safety Commission to verify there are no reported safety problems connected with these co-sleeping products (see the section on Helpful Web Sites in the Appendices).
Avoiding a “Flat-Headed” Baby!
When it is time for sleep, always lay your baby on her back in a safe sleep environment, but during the day, when she is awake, vary your baby’s position. Have her lie on her stomach to prevent a misshaped head and to encourage muscle development and build strength.
Infants spend a lot of time lying on their backs while they are asleep. In the years since the AAP began recommending infants be put to sleep on their backs, there has been an increase in babies developing plagiocephaly, also known as positional molding of the head. The skull becomes flattened due to lying in the same position so much. If you have any concerns your child has an odd-shaped head or any flattened areas, you should discuss them with your pediatrician.
To prevent a “flattened head,” vary your baby’s sleep position by turning his head to different sides when you lay him down to rest, or place the baby with his head at the foot of the bed. Turning the crib around or changing its position in the room may help.
When your baby is awake, do not always have him in a sitting position, in a baby seat or car seat. Allow him to play on the floor. Place your baby on his tummy for supervised “tummy time” every day. This should be done from early on as babies not used to being placed on their stomachs may complain when they are a little older. You can try laying your baby on his tummy across your lap, or it may help for you to sit on the floor with your baby at first. You can then lay your baby across your legs on his stomach, so he can peek over your thighs. The baby’s head will be raised slightly so he is better able to see any toy you may show him on the ground. Your baby may like some tummy time after a bath, when you can rub some baby lotion on his back and provide a gentle massage.
Another benefit of putting your baby on her stomach every day and varying positions is this helps her to strengthen and develop the different muscles in her body and encourages a full range of neck rotation. This promotes the optimum development of her motor skills, body control, and movement. Research indicates babies who are not placed in a variety of different positions, spending much of their time on their back, may be slightly delayed in learning how to roll, crawl, and walk.
Don’t Panic if Baby Rolls Over in Bed
Sometimes, after you put your child down to sleep on his back, you may find him rolled over onto his stomach. If this does occur, you do not need to change his sleep position, which may wake him. If he has the ability to roll all the way from his back to his front himself, he has developed the strength and ability to cope with this position. But remember; always lay him down to sleep on his back, regardless of what sleep position he ends up in.
Helpful Web Sites
American Academy of Pediatrics (AAP):
AAP Policy on Infant Sleep Environment and Sleep Position: aappolicy.aappublications.org/cgi/content/full/pediatrics;105/3/650
Consumer Product Safety Commission:
Telephone Hotline: 1-800-638-2772
Crib Information Center: www.cpsc.gov/cribs
Healthy Child Care America Campaign:
Centers for Disease Control and Prevention: Infants:
Cribs for Kids:
First Candle:
Juvenile Products Manufacturers Association:
Crib Safety:
National
Institute of Child Health & Human Development’s Back to Sleep
Campaign Website: 
The National Sleep Foundation: Children and Sleep:
Further Reading
Brazelton, T. Berry & Sparrow, Joshua D. (2003). Sleep the Brazelton Way. Reading, Massachusetts: Perseus Books.
Brazelton, T. Berry (1992). Touchpoints. Reading, Massachusetts: Perseus Books.
Cohen, G. (1999). American Academy of Pediatrics: Guide to Your Child’s Sleep. New York: Villard Books.
Ferber, R. (2006). Solve Your Child’s Sleep Problems. New York: Simon & Schuster.
Weissbluth, M. (2003). Healthy Sleep Habits, Happy Child. New York: Ballantine Books.
References
American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome Policy Statement (2005). The changing concept of sudden infant death syndrome: Diagnostic coding shifts, controversies regarding the sleep environment, and new variables to consider in reducing risk. Pediatrics 116(5), 1245-1255.
Barr, R.(1998). Colic and crying syndromes in infants. Pediatrics 102.
Graham, J. (2006). Tummy time is important. Clinical Pediatrics 45 119-121.
Mesich, H. (2005). Mother-infant co-sleeping. The American Journal of Maternal Child 30(1), 30-40.
About the Illustrator
Ellen Surrey is currently an illustration student at Art Center College of Design in Pasadena, California. Ellen’s artwork is largely inspired by American culture from the 20th century, including music, movies, television, fashion, and events of the period. With her artwork Ellen hopes to evoke a nostalgic feel for the subjects depicted.
About the Author
Jane Stockly has spent her entire career working with families and children in one capacity or another, including as a nursery nurse on a maternity ward; a private nanny; a pre-school teacher; an in-home child-care provider and a parent education instructor. Born in England, Jane now resides in Southern California with her husband. She has two daughters and teaches parent education at Glendale Community College.
Webpage: www.betterbabysleep.com
Blog: BetterBabySleep.blogspot.com
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