Safe Infant Sleep

https://www1.nichd.nih.gov/sts/news/downloadable/Pages/environment2_image.aspx

Sudden Infant Death Syndrome (SIDS) is the most common cause of death in children between 1 and 12 months of age.  The majority of SIDS deaths occur between 2-4 months, with the rate of SIDS decreasing subsequently, especially after 6 months.  The cause of the death remains unexplained in SIDS cases despite a thorough investigation. 

 

What Causes SIDS?

SIDS is thought to be caused by a variety of biological and environmental factors.  For example, infants born prematurely or at a low birth weight face a heightened risk for SIDS.  Other biological risk factors likely play a role but are not fully understood.  Importantly, a number of environmental risk factors for SIDS – risk factors that are avoidable - have been identified. Among the most important modifiable risk factors are infant sleeping position and maternal smoking during pregnancy. 

If expecting mothers did not smoke during pregnancy, it is estimated that the SIDS rate would drop by 1/3.  After birth, keeping your home a smoke free environment further protects your infant. The Back to Sleep campaign, launched in Canada in 1999, encouraged caregivers to put babies to sleep on their backs rather than on their tummies.  Between 1999 and 2003, there was a 50% drop in SIDS rates in Canadian infants.  It is highly likely that the Back to Sleep campaign significantly contributed to this observed decline.

 

Among the most important modifiable risk factors are infant sleeping position and maternal smoking during pregnancy. 

 

Once infants can roll from their backs to stomachs or sides, it is not necessary to reposition them onto their backs.  Supervised tummy time when babies are awake helps provide infants with the opportunity to strengthen their neck muscles and helps prevent flat spots from developing on the back of the baby's head, a condition known as “positional plagiocephaly”.

In addition to back sleeping and avoiding smoking during pregnancy, there are other ways to modify an infant’s environment to reduce the risk of SIDS.  Ensure that everyone who cares for your baby including relatives, friends and child care workers are both aware of - and practice - safe sleep when minding your child.

 

Here are ADDITIONAL WAYS you can decrease your baby’s risk of SIDS:

(1) Share your room, not bed with baby:

-Have baby sleep in the same room as you but on a separate sleeping surface - at least for the first 6 months of life

-Sharing a sleeping surface with a parent, caregiver or child increases an infant’s risk for SIDS

-Bed sharing is particularly risky for SIDS if a baby is born premature and/or baby's mother smoked during pregnancy

-The risk of bed sharing also increases if the bed-sharer currently smokes or has consumed alcohol, used sedating drugs/medications, or is very tired

-There is evidence to suggest that bed sharing is particularly risky during the first 3-4 months of life

(2) Ensure baby's sleeping space is safe:

-Safe sleeping environments include cribs, cradles or bassinets that meeting current safety regulations

-Car seats, swings, strollers, bouncy-chairs are not meant for sleep - baby's airway can become blocked if his or her head tips downwards

-Put baby to sleep on a flat and firm sleep surface with a tight-fitting sheet

(3) Keep the sleeping environment bare:

-This includes no soft objects (e.g., stuffed animals), loose bedding (e.g., pillows or blankets) or other items (e.g., toys, crib bumpers including “breathable” bumper pads)

(4) Avoid baby overheating:

-Put baby to sleep in fitted clothing and/or a sleep sack that is comfortable at room temperature

-Don’t cover a baby’s head as this is an important place for baby to get rid of extra bodily heat

-Ideal room temperature is likely between 16-20°C

(7) Breastfeed as often and for as long as you can:

-Breastfeeding helps decrease the risk of SIDS by up to 50%

(8) Consider using a pacifier:

-Pacifier use may help lower the risk of SIDS

-If breastfeeding, consider waiting until breastfeeding is well established (usually around 3-4 weeks) before introducing a pacifier

-Offer the pacifier for every sleep period

-If the pacifier falls out, you do not need to reinsert it for your infant's mouth

-Don’t attach the pacifier to the sleeping environment or to baby as this poses a strangulation risk

(9) Tend to baby's general health:

-Attend all recommended well child visits and have your child immunized 

 

What doesn’t protect against SIDS

Home cardiorespiratory (apnea) monitors have not been shown to reduce the risk of SIDS and are not recommended unless otherwise stated by your child’s health care provider.  In general, use caution when purchasing products marketed for crib use including those advertised as reducing the risk of SIDS (e.g., “breathable bumper pads”, positioners, wedges).  Before purchasing these items, discuss their safety with your child’s health care practitioner.

 

Final words for tired parents

Adding a newborn to the household can be exhausting!  Some parents end up sharing a bed with their infant inadvertently or out of tired desperation.  I know I, myself, dozed off with my babies during exhausting nights of caregiving.  I recall waking up with a start, fearful for their safety. 

The most dangerous place for an infant to sleep is on a sofa or armchair given the increased risk for entrapment and suffocation.  If you think that you might accidentally fall asleep with your infant, I suggest feeding the child on a safe sleeping surface.  

 

Adding a newborn to the household can be exhausting!  Some parents end of sharing a bed with their infant inadvertently or out of tired desperation.

 

Ways to increase the safety of a shared sleeping surface include:

(1) Use a very firm mattress with a well-fitted sheet

(2) Remove the mattress from the frame, placing it directly on the floor and away from walls

(3) Do not use side rails

(4) Use minimal pillows and blankets that are kept well away from the infant

(5) Do not share the bed with other children or pets

(6) Never leave the baby alone on the bed

 

Importantly, try to get some rest during the day.  As a parent, I know this is easier said than done!  But, if possible, rest when your baby sleeps and see if a family member or friend can watch your baby as you get some much-needed sleep yourself.

 

References:

AAP, “Policy Statement: SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment,” Pediatrics 128 (2011): 1030-9.

Caring for kids, "Preventing flat heads in babies who sleep on their backs", accessed July 12, 2018, https://www.caringforkids.cps.ca/handouts/preventing_flat_heads.

Callahan, Alice. Where should your baby sleep? In: Callahan, Alice, The Science of Mom A Research-Based Guide to Your Baby’s First Year. Baltimore, Maryland: Johns Hopkins University; 2015.

Caring for Kids, “Schedule of well-child visits,” accessed May 18, 2018, https://www.caringforkids.cps.ca/handouts/schedule_of_well_child_visits

Government of Canada, “Cribs, cradles and bassinets,” accessed May 18, 2018, https://www.canada.ca/en/health-canada/services/safe-sleep/cribs-cradles-bassinets.html.

Nova Scotia Department of Health and Wellness, “Routine Childhood Immunization Schedule,“, accessed May 18, 2018, https://novascotia.ca/dhw/cdpc/documents/13151_ChildhoodImmunizationSchedule_En.pdf.

Public Health Agency of Canada, “Joint Statement on Safe Sleep: Preventing Sudden Infant Deaths in Canada,” accessed May 18, 2018, http://www.phac-aspc.gc.ca/hp-ps/dca-dea/stages-etapes/childhood-enfance_0-2/sids/pdf/jsss-ecss2011-eng.pdf.

Public Health Agency of Canada, “Safe Sleep for Your Baby brochure”, accessed May 18, 2018, https://www.canada.ca/en/public-health/services/health-promotion/childhood-adolescence/stages-childhood/infancy-birth-two-years/safe-sleep/safe-sleep-your-baby-brochure.html.