Newborn sleep safety should be a top priority for parents as it is a leading cause of death in baby’s first year of life.
We always see horror stories on the news and on social media about sleep-related infant deaths. These stories are heartbreaking, in part because they are often 100% preventable.
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As a NICU nurse, this is a topic I care about immensely. And as a new parent, keeping your baby safe during sleep is likely paramount for you as well. You may have some of these concerns related to sleep safety:
- What exactly is safe sleep?
- What are the odds of something actually happening to my baby?
- What can I do to protect my baby during sleep?
- What positions are safe for my baby to sleep in?
- How will I remember everything when I’ve gotten no sleep myself?
- How can I make sure my babysitter knows what to do?
- What if my baby stops breathing while I’m asleep?
- Or when I’m not home?
- How will I know?
- Am I going to have to stay awake and watch my baby sleep to get some peace of mind?
There’s a lot of fear around this subject.
It’s also a hot topic that people like to debate based on personal experiences…
“That’s how we did it for years and we turned out fine” isn’t a good reason to do something.
We also didn’t always have car seats, anesthesia, or x-ray – that doesn’t mean we shouldn’t use the knowledge and technology we have now.
So, I’m here to answer these questions with facts and statistics. I want to give you some practical, research-based information to help you keep your baby safe during sleep, so you can worry less and sleep more.
These are some of the same things I teach and demonstrate for parents before baby goes home because these recommendations come directly from the American Academy of Pediatrics (AAP).
I’ll also talk about the Owlet Smart Sock since this is something I’m frequently asked about by parents. This can be found in the Peace of Mind while Baby Sleeps section further down.
*Quick note: if you’re having trouble getting your baby to sleep, you may want to also read my post on newborn sleep tips where I talk about all the things NICU nurses do to help babies sleep well!*
Safe Sleep Statistics
SUID, or sudden unexpected infant death, is a newer term used by pediatric health organizations. It includes the more commonly known SIDS (sudden infant death syndrome) as well as other unexpected causes of infant death and infant deaths occurring from suffocation or strangulation during sleep.
According to the AAP, there are about 3,500 cases of SUID in the United States every year (source).
So on average, 3,500 babies in the U.S. alone die due to unsafe sleep practices.
While this isn’t meant to scare you, it is meant to make you consider your own baby’s sleep environment.
The first few months of a baby’s life are the most dangerous in terms of sleep. Babies at this age have the highest risk of SUID. This is because of two main factors:
- Limited head/neck control
- Obligate nose breathing (unless crying)
- This means babies at this age ONLY breathe through their nose
So, let’s think about this. If baby’s nose becomes blocked by a pillow or other soft surface and they can’t turn their head away…this can lead to suffocation. And this can happen so quickly and so easily if the right steps aren’t taken to prevent it.
Safe Sleep Recommendations
*Note that while the information below is most important for the first few months, much of it will apply to babies up to one year and beyond.*
Here are the top recommendations from the AAP regarding safe sleep:
- BACK to sleep for both naps and nighttime sleep
- Firm sleep surface
- Tight-fitting sheet with no loose materials
- Avoid overheating
- Share a bedroom (but NOT bed) with parents
- Avoid smoke, alcohol, and illicit drugs
- Offer a pacifier
- Supervised, awake tummy time
- Recommended vaccines on schedule
This is a lot to keep in mind every time baby goes down to sleep, but let me explain the WHY behind each of them. I think if you understand the reasoning it’ll make them easier to remember.
BACK to Sleep
Newborns should always be placed on their back to sleep – NEVER their sides or stomach.
A baby placed on their stomach to sleep can turn their face into the mattress and suffocate if they don’t yet have the neck strength to turn away.
If an older baby with more muscle strength rolls over after being placed on their back, that’s okay (they should be able to roll themselves back over). BUT there should not be anything in the crib for baby to get stuck on if they do roll.
Side note: if you have been swaddling your baby and they learn to roll over, or can get out of the swaddle blanket, stop swaddling. They may not be able to roll back over if swaddled and the loose blanket can become a suffocation risk.
Firm Sleep Surface
Newborns should sleep in a crib or bassinet with a firm mattress and NEVER be placed on a sofa or other cushioned surfaces to sleep.
Remember, if they end up with their face on a soft surface, they may not be able to turn away and can suffocate.
Tight-Fitting Sheet with no Loose Materials
Baby’s crib should have a tight, fitted sheet and there should be NOTHING else in the bed, except a sleep-safe pacifier. This means NO loose blankets, pillows, crib bumpers, or toys (again – risk of suffocation).
Besides, we want baby to associate the crib with sleep, not play (in other words, when you put baby in bed – you want baby to know it’s time to sleep and not associate the crib with playtime).
And again, swaddling should stop if baby is able to get out of the swaddle blanket or roll over.
Overheating is a risk factor for SIDS.
The usual recommendation is that babies need one layer of clothing more than what you feel you need based on the room temperature.
NO extra blankets, especially fuzzy ones. Not only to avoid overheating but these also are a suffocation risk as mentioned before.
Watch for sweating, flushed cheeks, a heat rash, or faster-than-normal breathing as these can be signs of overheating.
Newborns should NEVER sleep on the same surface as parents, siblings, or anyone else.
Twins should each have their own bed. And yes, I know they slept together in the womb – but remember, in the womb they didn’t need to breathe.
Babies should not sleep with mom, dad, or anyone else.
This of course doesn’t mean baby can’t fall asleep in your arms or on your chest, but is important that you stay awake. If there is a chance you will fall asleep, baby should be moved somewhere safe.
Share a Bedroom (NOT BED) with Parents
It is recommended to room-share for the first year, or at least the first six months. The AAP states that room sharing has been shown to decrease the risk of SUID by up to 50%.
This could be a difficult one for some people. If you are set on having baby sleep in a nursery, I would definitely recommend some baby monitors.
(I discuss the Owlet monitor in the section on Peace of Mind)
Avoid Smoke, Alcohol, and Illicit Drugs
Cigarette smoke has been shown to increase the rate of SIDS, during pregnancy and after.
So it’s best for baby if mom doesn’t smoke and isn’t around second-hand smoke while pregnant.
Smoking should be avoided by caregivers, but if not it should at least be done outside the house and never near baby.
Alcohol and drugs can impair caregivers and increase the risk of safe sleep practices not being followed, leading to a higher risk of accidental death.
Offer a Pacifier
A pacifier can be offered to baby for nap time or nighttime sleep.
Pacifiers can actually help keep baby’s airway open.
If the pacifier falls out during sleep, it is not necessary to put it back in baby’s mouth.
Pacifiers with stuffed animals attached should not be used during sleep in this age group as they pose the same suffocation risk as a toy.
Instead, try the Phillips Avent pacifiers. They’re the ones most commonly used in hospitals and they’re very inexpensive!
Supervised, Awake Tummy Time
Tummy time helps to develop your baby’s muscles.
This includes neck muscles which can protect against sleep-related deaths, especially those related to suffocation.
Breastfeeding has actually been shown to be protective against SIDS.
Even partial breastfeeding helps decrease the risk so it’s okay if it can’t be done exclusively (source).
It’s recommended that breastfeeding (exclusive or partial) be done through at least the first six months of baby’s life because this is when baby is at the highest risk for sleep-related death.
Recommended Vaccines on Schedule
Because vaccines are given around the same time as the peak for SIDS (2-4 months), some people became worried vaccines were the cause.
This idea has been disproved with multiple studies so vaccines should still be given per the recommended schedule (source).
ABCs of Safe Sleep
Here’s a short, simple mnemonic to help you remember some of the key points above:
A – ALONE. Baby should sleep in parent’s room but not in parent’s bed. They should have no blankets, pillows, toys, bumpers, or anything other than a pacifier in their crib with them.
B – BACK. Back to sleep, tummy to play. The only position baby should ever be placed in for sleep is on his/her back. NEVER tummy to sleep.
C – CRIB. Baby should sleep in an empty crib with a firm mattress and tight-fitting sheet. No positioners should be used in the crib.
S – SMOKING. Smoking both during pregnancy and after are risk factors for SIDS. Nobody should smoke in the house.
More on Safe Sleep
Babies should never be allowed to sleep in infant swings/bouncers or car seats outside of the car.
I know it’s tempting to let baby sleep and not remove him/her from the car seat. But trust me, it’s important.
You may have seen this video that went viral on Facebook in late 2018.
WARNING: This video depicts child loss.
If you don’t want to or can’t bear to watch the video, the idea is that babies and children can suffocate or be strangled when a car seat is used outside the car. This is due to the change in the position of the car seat when sitting on a flat surface rather than in the base.
Position changes like this can cause the straps to move around the baby’s neck. It can also cause the baby’s neck to lay forward onto the chest, cutting off the airway.
This is the same reason babies shouldn’t sleep in or be left unsupervised in infant swings/bouncers.
Another important takeaway from this video is to educate ANYONE who may be watching your baby for ANY length of time. The child in the video lost her life while under the care of a licensed babysitter.
Safe sleep guidelines are vitally important to the safety and well-being of your baby. I know this post may be overwhelming and scary, but too many babies’ lives are lost to unsafe sleep practices.
I don’t sugarcoat important things like this for parents because it can be life or death.
Peace of Mind while Baby Sleeps
I’ve talked to many new parents about this topic and one thing I’m asked about time and time again is the Owlet Smart Sock. Which, for those of you who maybe haven’t heard of it, is a device that is placed on baby’s foot during sleep to monitor oxygen saturation and heart rate.
*This sounds like a dream come true for me because I am so paranoid (and am also used to being able to monitor my baby patients).*
The base monitor connects to the sock via Bluetooth and works up to 100ft away. This way, the monitor can be in your room if you choose to keep baby in a nursery.
The base glows green when the levels are normal.
If something appears wrong, the color will change, and the monitor will alarm.
Some of the mommy NICU nurses I work with own this monitor and say it was well worth the peace of mind it gives them.
One of my coworkers said she could hardly sleep without getting up constantly to make sure her baby was breathing. With this device, she was finally able to sleep peacefully.
The monitor also comes with an app, so you can see you baby’s vital signs when the sock is on.
My coworker, who works night shift with me, checks the app at work and knows from miles away that her baby is breathing.
Imagine leaving your baby with a babysitter and being able to have this peace of mind.
I couldn’t imagine not having one.
The only caveat I would give to this device is that knowing your baby’s oxygen level and heart rate sometimes won’t be enough.
I believe it’s vitally important for parents to take infant CPR classes.
These classes can help you save your child during a choking, drowning, or suffocation event.
They will teach you exactly what to do if baby starts choking or stops breathing. Hospitals and local American Red Cross centers often offer this training.
I ALWAYS recommend parents of preemies, especially, take an infant CPR class.
The American Red Cross website provides information on infant CPR if you aren’t able to attend a class.
This website includes written, printable instructions as well as a video link if you’re a visual learner. I would suggest having a printout of these instructions available for yourself and babysitters. (This website also allows you to enter your location, so you can find classes near you).
Safe Sleep and Getting Baby on a Schedule
The safest place for baby to sleep is in his/her crib or bassinet (as long as it is safe sleep appropriate as discussed above).
But many parents end up in the situation where baby only wants to sleep in your arms. This will be sweet and wonderful at times, and you should absolutely soak it up (particularly during the day).
BUT if you let baby sleep like this too often, you could end up with a baby who can’t fall asleep in a crib. This will of course cause problems when you need to sleep at night and baby screams when you lay them down for bed.
If baby doesn’t sleep well at night, mom and dad don’t sleep well at night. This exhaustion can increase the risk of accidental co-sleeping and other unsafe sleep practices.
I wrote an entire post on newborn sleep tips that outlines everything NICU nurses do to get babies to sleep. I mentioned this at the beginning of the post as well but it fit here too well to not mention it again.
Baby sleeping well = parents sleeping well = decreased risk of accidental unsafe sleep = safe baby.
3,500 baby deaths per year is unacceptable. Don’t let your little one become a statistic. Remember, Alone-Back-Crib.
I hope you feel more confident in keeping your baby safe during sleep and have some practical tips to take away.
“Babies used to make me nervous, but these squirmy things are awesome once you’ve read the manual”,
(-David Z. Hirsch)
Carol-Ann, the NICU Nurse