Safe Sleep for Your Baby

As parents, our number one job is to keep our children safe.

One of the best things we can do for our children as infants is to follow these simple steps: the ABC’s.

A Stands for ALONE. Have your baby sleep in his or her own area, such as a flat bassinet, a crib, or portable crib. Only allow for one fitted sheet in the crib or bassinet with no blankets, bumpers, stuffed animals, or pillows. Keep your baby in the same room with you, but NOT in the same bed with you.

B stands for BACK. Evidence strongly supports that placing your baby on his or her back to sleep lowers the risk of Sudden Unexpected Infant Death (SUID, also known as SIDS) and other sleep-related deaths. Whenever baby is being placed in the crib for a rest, ALWAYS place them on their back. Babies are less likely to suffocate or choke when they are placed on their backs. Lastly, dress your baby in light sleep clothing and do not use a loose swaddle blanket. Keep the room at a comfortable, cool temperature.

C stands for CRIB. Your baby should ALWAYS sleep on a flat surface on a firm mattress with a tightly fitted sheet. Babies should NEVER sleep on a sofa, armchair, or couch. Only bring your baby into your bed when you are feeding or comforting, but place him or her back in their crib when you are ready to sleep.

In addition to the ABCs of safe sleep is the letter D.

D stands for “Don’t Smoke.” Keeping baby in a smoke-free environment is also proven to reduce the incidence of SIDS.

These points, while simple, can be hard, especially when family or friends tell you things like “my baby sleeps so much better when they’re on their tummy.” Or “if your baby has reflux, you should elevate the head of the crib.” Proper sleeping habits for babies is something that we MUST be talking about, despite it being a very sensitive topic. To date, there is no evidence to support that elevating the head of the crib decreases the incidence of infantile reflux. Have you tried elevating the head of the crib? This is no easy task, let me tell you. Without therapeutic positioning aids, a baby whose head of the crib is elevated will inevitably roll or slide down to the bottom of the crib. Also, when you elevate the head of the crib for a newborn, you encourage cervical flexion, or a “chink tuck”, which actually could make it more dangerous for a baby with (or without) reflux. When a baby’s head of the crib is elevated and they fall into this “chin tuck”, it makes it harder for the baby to turn their head or to achieve a neutral cervical spine, thus increasing their risk for aspiration. Likewise, if a baby is placed prone to try and remedy reflux, anatomically speaking, you are just inviting aspiration for the baby as well. Some people believe that babies will choke on their backs. But when placed on the stomach, the trachea (airway) is below the esophagus (food pipe). Anything that is spit up will be pushed back down by gravity to the lowest point. When placed on the stomach, it is easier to aspirate into the lungs.

Commonly asked questions and myths debunked from a healthcare provider:

“My baby sleeps longer on his tummy or his side.”  While babies may seem to sleep longer on their stomachs or side, recognize that it is dangerous to place them in these positions. Things you can do to help a baby sleep comfortably include:

• Start with back to sleep from the very beginning

• Know that it is completely normal for babies to wake frequently

• Try swaddling the baby for comfort. Stop swaddling when the baby is 3-4 months old, or once the baby tries to roll over (swaddled or unswaddled), whichever comes first. A safe sleep swaddle recommendation is embé®. Learn more at embebabies.com.

“I’m worried that my baby will develop a flat head if he sleeps on his back.”. Here’s a few tips to avoid a flat head or a flat spot on one side of the back of the head (brachycephaly and plagiocephaly, respectively):

• Rotate the head to face a different direction each day. For example, on Monday, I face my baby’s head to the left and on Tuesday, I face my baby’s head to the right.

• Get your baby off their backs whenever they are awake. Tummy time starts right away! Tummy time starts in the fetal position on your chest, then gradually while supervised on a firm surface, such as a play mat.

“Should my baby use a pacifier? I don’t want him to get used to having one.” Yes! You should offer a pacifier for sleep time once breastfeeding has been established. Studies have shown a large reduction in the risk of SIDS among babies when a pacifier is used during sleep. If the pacifier falls out, you can leave it out. There is no need to replace it.

“I’m afraid my baby might get cold at night, so I want to bundle her.” Babies require one more layer of clothing than adults, typically. I generally tell parents to put their baby in a cotton onesie or cotton pajamas and swaddle accordingly.

Written by:
Dr. Roper
NICU Physical Therapist