A generation ago, infant sleep looked very different than it does today. In the mid-1990s, recommendations on infant sleep safety began to change. Before these changes, infants were usually put to sleep on their tummies in cribs with bumper pads. They were covered with blankets and often had stuffed animals in their crib, keeping them company. Since then, directives have changed. So how do parents make sense of today’s confusing baby sleep information?
Placing Baby in the Back Position
Past information led parents and health-care professionals to believe a “prone position” would help protect a baby from choking if they spit up. Instead, researchers found the rate for Sudden Infant Death Syndrome (SIDS) plummeted by more than 50% after the American Academy of Pediatrics (AAP) began promoting their “Back to Sleep” campaign of putting infants to sleep on their backs.
The back position for sleep is advised for the first year of life. However, parents know that at a certain age many babies will start to roll onto their tummy in their sleep. Turning over usually happens around the time the age of highest risk for SIDS declines. According to the Safe to Sleep website, there’s no need to change a child’s position if they roll onto their tummy on their own.
SIDS and Sleep Rules
SIDS is every parent’s fear. According to statistics from Safe to Sleep, there were 1,360 cases of SIDS in 2017 (most recent statistics available). As more research on SIDS has occurred, more recommendations for sleep have been issued.
Parents are advised to give a pacifier when a baby is falling asleep as this sleep step is associated with a lower SIDS risk. Since breastfeeding is also associated with lower SIDS rates, new moms should wait until their baby is about a month old before introducing the pacifier. This allows time for breastfeeding to get well established.
Sharing a Room with Baby
The AAP recommends that babies sleep “in the parent’s room, close to the parent’s bed.” Some parents are confused by this recommendation because sharing a bed with a baby has been actively discouraged in recent years. The AAP states an infant should sleep “on a separate surface, designed for infants.” Sharing a room is advised for the first six months, ideally a year.
In spite of public campaigns advising against it more parents are bed-sharing with their babies, NPR reported the practice increased from 6% to 24% between 1993 and 2015. The reality is, most of the world’s parents share a sleeping space with their infants. The Natural Child Project quotes Dr. James McKenna as saying, “Most cultures that routinely practice co-sleeping, in any form, have very rare instances of SIDS.”
Dr. James J. McKenna, PhD, founder, and director of the University of Notre Dame’s Mother-Baby Behavioral Sleep Laboratory, and author of the upcoming book Safe Infant Sleep: Expert Answers to Your Cosleeping Questions, tells Parentology he believes co-sleeping is normal. His stance: “safe co-sleeping arrangements can actually help protect infants from SIDS or other sleep-related deaths, which are twice as likely to occur for infants sleeping in separate rooms from their parents.”
McKenna says the best infant sleep practices include, “…not smoking during pregnancy…breastfeed…and never let a baby sleep alone, outside of the vigilance of a committed caregiver, as proximity to a caregiver directly regulates a baby’s physiology (and behavior) through parental sensory exchanges (touch, sounds, movements, heat, smells), cutting its chances of dying by as much as one half.”
Advice from AAP and Safe to Sleep
The AAP particularly discourages bed-sharing with infants under four months of age, if a baby was born prematurely or was of low birth weight. Furthermore, co-sleeping on a sofa or armchair is particularly dangerous.
Other safe sleep recommendations include no pillows, blankets or stuffed animals in the crib and no bumper pads. Instead of covering a baby with a blanket, dressing them in a wearable blanket is advised. Swaddling is also not recommended.
According to the Safe to Sleep website, “Swaddling can increase the risk of SIDS and other sleep-related causes of infant death.” The use of wedges or positioners is not recommended, as is the use of heart or breathing monitors. Parents are also advised to not let their baby get too hot when sleeping.
Making Sense of Confusing Baby Sleep Information: Sources
James J. McKenna, PhD, founder, and director of the University of Notre Dame’s Mother-Baby Behavioral Sleep Laboratory and author of Safe Infant Sleep: Expert Answers to Your Cosleeping Questions
HealthyChildren.org: Sleep Position – Why Back is Best
Safe To Sleep: FAQ’s About SIDS and Safe Infant Sleep
Safe To Sleep: Ways to Reduce the Risk of SIDS and OTHER Sleep-Related Causes of Infant Death
Natural Child: Co-sleeping Around the World
NPR: Is Sleeping With Your Baby As Dangerous As Doctors Say?