Safe Sleeping – The Latest in Newborn Positioning and More

When speaking to a new parent, it usually takes less than two minutes before conversation turns to the topic of sleep. Not surprising, given the many issues surrounding sleep (or the lack thereof!) in the first few months of life. One of the latest pushes in safer sleep practices is awareness about the risks associated with swaddling.

Swaddling is an age old practice of tightly wrapping a sleeping baby. Why swaddle? Most swaddling advocates cite that swaddling prevents the infant from waking him/herself with jerky, startle movements that are a normal part of the sleep cycle. In hospital nurseries, newborns are swaddled to help them control their body temperature without the need for blankets, which can be dangerous in cribs. Swaddling is also one of the ways pediatricians (and grandmothers!) recommend to soothe a fussy baby. There are a few different options for swaddling. There are swaddling blankets and regular blankets as well as “wearable blankets” and “swaddle wraps.”

But a recent study of information from the Consumer Product Safety Commission (CPSC) database from 2004-2011 looked at incidents associated with swaddling in infants 3 days to 15 months of age. Here are some of the dangers they found:

• Swaddled infants rolled onto their stomachs and couldn’t breathe (positional asphyxia)
• Blankets were found over the mouth or nose of dead infants
• Teeth became snagged on zippers of wearable blankets, resulting in accidental tooth extraction.

The study acknowledged that the number of incidents (36) was relatively small given the number of infants who were swaddled in the 8 years of data collection. Still, the researchers did give one recommendation based on the information: swaddling is not a safe sleep practice beyond the newborn period (2 months).

Swaddling has also been associated with other risks, including hip dysplasia (from legs being held too tightly in an extended position), hyperthermia (overheating) or respiratory compromise.

But swaddling is just one component of safe sleeping recommendations. While I don’t want to get bogged down in terminology, safe sleeping is an important part of preventing Sudden Unexpected Infant Death (SUID). Sudden Infant Death Syndrome (SIDS) is a subcategory of SUID. The public education campaigns have made tremendous positive strides in improving statistics. The rate of Sudden Infant Death Syndrome (SIDS) has declined by more than 50% since the early 1990s. It remains, however, the 3rd leading cause of infant mortality and the leading cause of death in babies 28 days to 1 year of age.

A quick review of the other recommendations:

DO:
• Place babies on their backs to sleep. If they’re old enough to roll over (usually around 4-6 months), let them be.
• Encourage awake tummy time to promote motor development and minimize the “flat head” that comes with always sleeping on the back.
• Co-sleeping is found to be protective. This means having the infant sleep in the same room (not the same bed!) as a parent.
• Use a crib, play yard or bassinet that meets the safety standards of the CPSC, Juvenile Product Manufacturers Association and the ASTM International who advise on slat spacing, firm mattresses and no drop sides.
• Obtain regular prenatal care during the pregnancy.
• Breastfeeding is likely to have a protective effect against SIDS.
• Several studies have shown pacifier use has a protective effect against SIDS.

WARNINGS:
• No loose bedding, blankets, pillows or crib bumpers in their sleeping space.
• Do not put infants to sleep in car seats or other sitting devices (strollers, swings, slings, etc.)
• Do not bed-share. This means allowing the infant to sleep on the same surface as another person as this is associated with increased risk of SUID.
• Do not use any wedges or positioning devices.
• Do not smoke. Smoking during pregnancy and smoke in the newborn’s environment are both major risk factors for SIDS.
• Avoid alcohol and illicit drug use both during pregnancy and after.
• Avoid overheating and covering the infant’s head. SIDS seems to be less likely in a well-ventilated room with an open door, window or fan.

Life with a newborn is not easy. Sleep deprivation and the stress of being new parents can weigh heavily on moms and dads. Try to get some much needed rest while your little one does too! Hopefully, these recommendations will help us all do so safely.

• J Pediatr. 2014 Jan 30. pii: S0022-3476(13)01591-6. doi: 10.1016/j.jpeds.2013.12.045.
http://www.ncbi.nlm.nih.gov/pubmed/24507866
• SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. www.pediatrics.org/cgi/doi/10.1542/peds.2011-2285.