Planning a Safe Place to Sleep for Baby

Throughout the first year of life, sleeping babies have died accidentally from: suffocation; smothering; wedging; being trapped under someone else while sharing a bed; being placed to sleep on a sleep surface not intended for an infant; and from Sudden Infant Death Syndrome (SIDS).

Babies sleep in many places. This is often based on cultural, traditional, or personal reasons. Regardless of where babies sleep, all babies need a safe sleep environment.

It was more than thirteen years ago that the American Academy of Pediatrics (AAP) released its first policy statement on reducing the risk of SIDS. The statement recommended that all healthy infants be placed on their backs to sleep in order to reduce the risks of SIDS.  Since then, the percentage of infants placed on their backs to sleep has increased dramatically, and the rates of SIDS have declined by more than 50 percent.  Since the AAP published its Year 2000 statement on SIDS several issues have become relevant, including the significant risk of side sleeping position. The AAP no longer recognizes side sleeping as a reasonable alternative to fully supine sleeping.

In 2005 the AAP published its most recent recommendations for infant sleep to reduce the risk of SIDS and other sudden infant deaths:

• Infants should be placed for sleep in a supine position (wholly on the back) for every sleep. Side sleeping is not as safe as supine sleeping and is not advised.
• Use a firm sleep surface: Soft materials or objects such as pillows, quilts, comforters, or sheepskins should not be placed under a sleeping infant. A firm crib mattress, covered by a sheet, is the recommended sleeping surface.
• Keep soft objects and loose bedding out of the crib: Soft objects such as pillows, quilts, comforters, sheepskins, bumper pads, stuffed toys, and other soft objects should be kept out of an infant's sleeping environment. Loose bedding such as blankets and sheets may be hazardous. If blankets are to be used, they should be tucked in around the crib mattress so that the infant's face is less likely to become covered by bedding. The bedding can be placed so that the infant's feet are able to reach the foot of the crib (feet to foot), with the blankets tucked in around the crib mattress and reaching only to the level of the infant's chest.  The infant could also be placed in a sleep sack that is designed to keep the infant warm without the possible hazard of head covering.
• Do not smoke during pregnancy: Maternal smoking during pregnancy has emerged as a major risk factor in almost every study of SIDS. Avoiding an infant's exposure to second-hand smoke is advisable for numerous reasons in addition to SIDS risk.
• A separate but proximate sleeping environment is recommended: The risk of SIDS has been shown to be reduced when the infant sleeps in the same room as the mother. A crib, bassinet, or cradle that conforms to the safety standards of the Consumer Product Safety Commission is recommended. "Cosleepers" (infant beds that attach to the mother's bed) provide easy access for the mother to the infant, especially for breastfeeding, but safety standards for these devices have not yet been established by the Consumer Product Safety Commission.
• Although bed-sharing rates are increasing in the United States for a number of reasons, including facilitation of breastfeeding, the AAP concludes that the evidence is growing that bed-sharing, as practiced in the United States and other Western countries, is more hazardous than the infant sleeping on a separate sleep surface and, therefore, recommends that infants not bed-share during sleep. Infants may be brought into bed for nursing or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep. The infant should not be brought into bed when the parent is excessively tired or using medications or substances that could impair his or her alertness. The AAP recommends that the infant's crib or bassinet be placed in the parents' bedroom, which, when placed close to their bed, will allow for more convenient breastfeeding and contact. Infants should not bed- share with other children. Because it is very dangerous to sleep with an infant on a couch or armchair, no one should sleep with an infant on these surfaces.
• Consider offering a pacifier at nap time and bedtime: Although the mechanism is not known, the reduced risk of SIDS associated with pacifier use during sleep is compelling, and the evidence that pacifier use inhibits breastfeeding or causes later dental complications is not. Until evidence dictates otherwise, the AAP recommends use of a pacifier throughout the first year of life according to the following procedures:

• The pacifier should be used when placing the infant down for sleep and not be reinserted once the infant falls asleep. If the infant refuses the pacifier, he or she should not be forced to take it.
• Pacifiers should not be coated in any sweet solution.
• Pacifiers should be cleaned often and replaced regularly.
• For breastfed infants, delay pacifier introduction until 1 month of age to ensure that breastfeeding is firmly established. 

• Avoid overheating: The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable for a lightly clothed adult. Overbundling should be avoided, and the infant should not feel hot to the touch.
• Avoid commercial devices marketed to reduce the risk of SIDS: Although various devices have been developed to maintain sleep position or to reduce the risk of rebreathing, none have been tested sufficiently to show efficacy or safety.

In October 2008 a study by Kaiser Permanente Division in Oakland, California, which is being published in the October issue of the Archives of Pediatrics & Adolescent Medicine, found that using a fan cut the risk of SIDS by 72%. The use of a fan in a room with a temperature higher than 69 degrees Fahrenheit was associated with a 94% decreased risk of SIDS compared with no fan use.

The Missouri Department of Health and Senior Services in cooperation with SIDS Resources, INC., members of La Leche League International, certified breastfeeding educators, and neonatologists developed a brochure to educate parents and caregivers on providing a safe sleep environment for their baby. The brochure titled “Safe Sleep for Your Baby” is available on the Department website at http://www.dhss.mo.gov/warehouse/e-l-gnh.html, brochure #674 or can be downloaded by clicking here.