According to a new article in Pediatrics, many parents still aren’t following safe sleep guidelines with their babies—even though those guidelines have been shown to help prevent Sudden Infant Death Syndrome, or SIDS. Researchers at Penn State University set up video cameras with 160 families in central Pennsylvania and recorded their babies throughout the night at one month, three months and six months of age. The study was originally designed to look at where infants are put to sleep, how often their mothers picked them up, and the effects that had on mothers’ mental health and their marital relationships. But once the researchers started watching the night-vision videos they’d gathered, they noticed widespread unsafe behaviours, like putting infants to sleep with loose blankets, crib bumpers, pillows, sleep positioners and stuffed animals in the crib or bassinet; babies being placed on their sides and stomach instead of on their backs; and infants who were moved after a wakeup and ended up in a swing, car seat, or bed-sharing with a parent. The proportion of parents allowing bumpers, blankets, pillows, and stuffies in the crib or bed was particularly alarming across all three age groups: 91 per cent of parents of one-month-olds, 87 per cent of the three-month-olds, and 93 per cent of the six-month-olds were sleeping with these non-approved, dangerous items.
We spoke with paediatrician Ian Paul, one of the study co-authors, about his safe sleep findings.
What was so surprising about the video evidence you saw?
Compared to studies that use self-reporting, a picture says 1,000 words. The videos are pretty disturbing—you see a one-month-old sleeping on its belly with loose blankets and stuffies. You see mothers and babies bed-sharing, with the baby’s face smushed up against her.
Isn’t it pretty common, especially in the first few weeks and months, for moms to bring the baby into bed with them for night nursing sessions? Even if you’re not a dyed-in-the-wool, devoted co-sleeping family, it’s really hard not to doze off with the baby in your arms during that 5 a.m. feed.
True. But I would say that bed-sharing—or babies who are being moved into a parent’s bed in the middle of the night—wasn’t the most overwhelming or most alarming thing we saw. When we looked at the first sleep surface, at bedtime, almost all of them had unsafe items in the sleep environment: 84 per cent of one-month-olds have loose bedding; 24 per cent of them have crib bumpers; 16 per cent of one-month-olds have stuffed animals in the crib or bassinet.
Some people use crib bumpers to keep the pacifier from falling between the crib rails, or to keep their infant’s arms and feet from getting stuck, or because they think their babies will roll around and bump their heads.
Well, in 18 years as a pediatrician, I’ve never seen a baby get an injury from a crib rail. I think it’s more of a cosmetic thing—parents like how the crib bumpers look in the nursery.
You definitely see crib bumpers in catalogues as part of a bedding set, and they’re popular on design blogs, for sure. So why aren’t parents getting the message? Or are we knowingly disobeying expert safe sleep recommendations?
I think there are a few reasons. One, there could be a knowledge deficit. Two, parents know the rules, but they don’t think SIDS will happen to them. Three, different settings—including the hospital and retailers like Babies R Us—aren’t modelling safe sleep behaviours, either. I’ve seen newborns placed to sleep on their sides in hospital bassinets, maybe because they’ve been spitting up. And four, it could be that parents just desperately want their baby to sleep and wind up doing whatever works.
If loose blankets are so dangerous for newborns, why do hospitals send new parents home with those free receiving blankets? It’s confusing.
Those receiving blankets should be used to swaddle, not as loose bedding. In our study, swaddling did not count as loose bedding, and neither did sleep sacks. Sleep sacks are OK.
Now that we know how widespread unsafe sleep practices likely are, what needs to happen next?
Parents need to take these recommendations more seriously. And paediatricians need to do a better job of explaining safe sleep guidelines, clearly and repeatedly, at every doctor’s visit. And we need to help parents. Parents want—and need!—their babies to sleep. A lot of things that help the baby sleep have been taken away from parents because of safety, but we haven’t given them alternatives. We’ve told them what not to do, but not what they should be doing. The American Academy of Pediatrics and the Canadian Paediatric Society have position statements about SIDS and what’s dangerous, but no evidence-based summary of what works. We need to do a better job of helping parents get their babies to sleep safely.
What if my baby is a tummy sleeper, and stays asleep longer in that position, even though I know it goes against safe sleep recommendations?
You should still put your baby down for the night on his or her back. If your infant is rolling onto her tummy on her own in the night, and she can flip from her back to her front and from her front to her back independently, you don’t have to keep flipping her. You can let her roll onto her on her stomach [Ed note: and discontinue swaddling, if you’re swaddling]. The head and neck control required for rolling from front to back and back to front usually becomes more developed by about five months.
Lots of parents use infant swings. Are they safe, and is there a difference between using the swing at night versus using it for daytime naps?
It’s definitely not OK to put your baby in a swing at night, when the parent is asleep. [Ed note: An infant’s head can fall forward, obstructing his or her airway.] It’s safer for daytime sleep, if the parent is awake and checking on the baby. We found that only three per cent of one-month-olds were being put to bed in a swing initially, but of one-month-olds who were moved to a second location in the night, 13 per cent of them ended up in a swing.
At what age CAN you allow stuffed animals in the crib and transition your baby from sleep sacks to actual blankets?
Most doctors would say that after age one, SIDS is uncommon, and you can allow a comfort blanket in the crib. After a child is two, you can even have a pillow.
DID YOU KNOW?
- SIDS (sudden infant death syndrome) accounts for about 2.8 percent of infant deaths in Canada.
- SIDS, suffocation, and accidental strangulation are not the same thing, but they are closely connected. Creating a sleep safe environment reduces the risk of all three.
- The Public Health Agency of Canada and Canadian Paediatric Society recommend putting your baby to sleep on her back in a crib, bassinet or cradle that meets Health Canada safety standards, in the same room as her parents for the first six months.
- Stuffed animals, blankets, pillows, crib bumpers (even the mesh ones marketed as “breathable”) and sleep positioners should not be allowed in the crib or bassinet. (Wedges placed under the crib mattress to create an incline and ease reflux symptoms are OK, however.)
- Velcro or snap swaddles, and receiving blankets used as swaddles, are fine; they do not count as loose bedding.