Sudden unexpected infant death (SUID) is the leading cause of death among infants one month to one year of age, with more than 3,500 infants dying unexpectedly each year. Sudden Infant Death Syndrome (SIDS) is a major contributor.
It's very important that parents follow the main recommendation for reducing the risk of SUIDs, which is to lay babies flat on their backs in their own sleep area, says Dr. Gaurav Kumar, a board-certified pediatrician at LifeBridge Health Pediatrics' Baltimore North location in Lutherville.
"Historically, many parents have found that when they put their babies to sleep on their tummies, they might sleep a little bit longer. But because we now know that there's a huge risk associated with that, we have to keep the risks in mind, therefore it's not recommended," Kumar says.
Although the supine position recommendation has been in place for more than 25 years and has helped to bring down the SIDS death rate, it bears repeating as it is not always followed by everyone, says Kumar, who stresses that the technique should be followed for both nighttime sleep and naps. Babies shouldn't be placed on their side as they can roll over and end up sleeping on their tummy, he says.
The American Academy of Pediatrics recommends that infants sleep in the parent's room at least for the first six months of life, and ideally for the first year. But the child must have his or her own sleep area in the room-;a safety-approved bassinet with a firm, flat sleep surface right next to the parent's bed-;to "exclude the possibility of suffocation, which can happen when a child sleeps on an adult bed or a sofa," Kumar says. Parents should always be aware of how tired they are when caring for their baby so as not to fall asleep while on unsafe surfaces with their child, he adds.
"When parents are sleep deprived, as they often are, they might sleep very deeply and they may not always be fully aware of their surroundings. So they shouldn't have the baby anywhere close to them, except in a bassinet or crib, while they're sleeping, because if the baby is close to them, that baby could potentially be in a position that prevents it from breathing," Kumar says. "The baby could get pressed against bed clothing, or pressed against a very soft adult mattress."
Baby mattresses, Kumar says, generally are much firmer than adult mattresses and provide better support for the back of the baby's head. "They also have the added benefit that in the event a child's face becomes pressed against the mattress, the mattress doesn't conform to their nose and mouth and has some space so air can come in from the side," Kumar said.
The mattress should be covered with a fitted sheet and parents should keep the bassinet free of other objects including soft toys, stuffed animals, loose bedding, bumper guards and wedges. "When a baby is put in a bassinet, the bassinet should not have anything else in it. And that includes such things as stuffed animals," Kumar says. "These are things that are often used to set up the room in anticipation of the baby's arrival. Once the baby arrives and is to be placed in their bassinet or crib, these objects are potentially harmful because the baby might get pressed against them and possibly suffocate."
Kumar pairs his sleep recommendations with encouragement for tummy time when the infant is awake and alert and being supervised. "We very much want to encourage parents to put babies on their tummies when they're awake. We actually have a phrase that says 'Tummy to play, and back to sleep,'" he says.
Tummy time can help prevent flat spots on the back of the baby's head; make the baby's neck, shoulder and chest muscles stronger; and improve the baby's motor skills. As for sleep time, Kumar says parents should be mindful of the supine sleep position at all times, even during precious moments of bonding.
"It's good for bonding for the baby to have skin-to-skin contact with the parent. A lot of times when parents do that, they'll have the baby lying on their tummy on the parent's chest. I think that's a very good thing to do when the baby's awake," Kumar says. "But when the baby starts to fall asleep in that position, the parent should pick up the baby and put him or her back down in the bassinet or crib on his or her back."
Kumar adds: "Their face should always be up, and that's the best way to think of it. If their face is up, they'll be able to breathe more easily and without the risk of obstruction."
Some additional safe sleep recommendations parents may find helpful:
- Try breastfeeding. Breastfeeding is associated with a reduced risk of SIDs.
- Consider offering a pacifier at bedtime. Some medical studies have found that pacifier use can help reduce the risk of SIDs. The pacifier shouldn't be attached to anything (especially items that carry a risk for suffocation, like string, clothing and stuffed objects). If the pacifier falls out of the baby's mouth during sleep, you don't need to reinsert it.
- Keep the baby warm, but not too warm. It is recommended that infants be kept in a 'sleeper' or a wearable blanket such as a 'sleep sack,' which are designed to keep infants warm without the need for loose blankets in the sleep area. It is also recommended that the room be kept at a temperature that an adult finds comfortable and not warmer.
- Avoid exposure to cigarette smoke. This is important because smoking during pregnancy and exposure to secondhand smoke afterward can raise the risk for SIDS.
LifeBridge Health Pediatrics North accepts walk-ins every morning from 8 to 9 a.m. and offers same-day appointments for sick visits as well as for physicals. To schedule an appointment, call 410-308-7865. You can also schedule an appointment with a LifeBridge Health physician by completing our online appointment request form or calling 410-601-WELL.