An ER Doctor Answers All Your Questions About Keeping Your Baby Safe

Welcome to Ask the Expert, a series in which real medical experts answer questions from real Babylist parents. In this installment, board-certified emergency physician Dr. Seran Kim is answering questions you have about keeping your baby safe, covering topics from feeding to sleeping to pooping and allergies and a whole lot more.

Keeping your baby safe is your number one priority as a parent, and there’s a lot to remember when it comes to little ones. So it’s understandable that you have questions. Like, do I really need a baby monitor? And when can I give my baby a lovey to sleep with? We’re here to answer all your questions, and hopefully give you a little more clarity and peace of mind.

Do I Need a Baby Monitor?

There are many different types of monitors, including audio or audio/video, with or without night vision, motion sensors and oxygen sensors. But the bottom line is that nothing beats the real thing. Despite all of the advanced technology, home monitors are never a good substitute for direct supervision. In fact, there is no evidence that home monitors actually prevent Sudden Infant Death Syndrome (SIDS). Therefore, the American Academy of Pediatrics (AAP) does not recommend relying on these monitors, which can give a false sense of security and complacency.

To decrease the incidence of SIDS, practice safe sleep habits, which have been proven to be more effective than any monitor. These include:

• Placing your baby to sleep on their back. Placing your baby on the side or stomach may compromise breathing.
• Avoid placing your baby on a soft surface, such as a couch, fluffy comforter, or soft mattress.
• Avoid placing any pillows, blankets, stuffed toys, or crib bumpers in the baby’s sleep area.
• Do not co-sleep with your baby. While the risk of SIDS is lowered if a baby sleeps in the same room as his or her parents, the risk increases if the baby sleeps in the same bed with parents, siblings or pets.
• Dress your baby in thin layers, and avoid over-bundling. Overheating can increase a baby’s risk of SIDS.

When Can Baby Sleep with a Stuffed Animal?

Remove all pillows, blankets, stuffed animals and toys from the crib, including crib bumpers, until baby is at least 12 months old. All of these items pose a potential risk for suffocation, strangulation and entrapment.

The AAP warns against the use of any of these items in the crib, as they can increase the risk of SIDS during the first year of life. Contrary to popular belief, crib bumpers do not prevent injury of any kind. Crib bumpers were originally designed to prevent infants from getting their heads caught between the crib slats, and decrease the risk of injury as babies roll around. However, cribs are now highly regulated by the Consumer Product Safety Commision (CPSC), and therefore the slats are much closer together, preventing babies’ heads from getting stuck.

Pillows are also popular registry items, but babies should always lay flat on their backs, on a firm surface.

Remember, inclined sleepers and bedsharing are also not recommended—ever. And if you are concerned that your baby will get cold, use a swaddle or sleep sack, rather than a loose blanket, which could suffocate and strangle a newborn.

How Can I Tell if a Crib Mattress is Firm Enough?

Always place your baby on a firm, flat sleep surface, which means that it should not indent when you place your baby on it. Be sure the crib mattress is designed for your specific crib, and that it fits tightly. Always check that your mattress (and crib) meet the safety standards of the Consumer Product Safety Commission (CPSC), which is constantly evaluating and updating its safety recommendations. Be sure to double-check for recalls of baby items through the CPSC website, because even if products were approved for your older child, they may have been recalled since. Hand-me-downs are amazing (and encouraged), but verify that these are still safe. And even if certain items are banned, they may still turn up at garage sales or second-hand stores. You can also sign up to receive free safety alerts and resources directly from the CPSC, and stay up-to-date.

For Babies with Reflux, Can You Tilt the Crib?

The AAP generally does not recommend elevating the crib, or any device (including sleep positioners or nests) or gadget marketed for treating reflux. Studies show that placing your baby in a semi-inclined position does not make reflux any better. In fact, there is some evidence that a semi-inclined position can actually make a baby’s reflux worse. Not only is it ineffective in reducing reflux, but elevating the head of your baby during sleep can also increase the risk of your baby rolling to the foot of the bed or into a position that might cause serious (and fatal) breathing problems.

So with sleep positioners and gadgets out, what can a desperate parent of a reflux baby do? You need to wait. Reflux will naturally end for most babies, when they outgrow the symptoms. By four months of age, most babies will be able to spit up on their own, and by six months, they are able to sit up on their own. If you have any concerns about your baby’s reflux, be sure to discuss these with your pediatrician.

Can Babies Sleep in Car Seats?

Despite going against every ounce of parental intuition to move a sleeping baby, if your baby falls asleep in a car seat, it is recommended that you move them to a firm sleep surface on their back, as soon as possible.

Every year, several hundred infants fall victim to sleep-related deaths in sitting devices, mostly car seats, for routine sleep. Although sitting devices are designed for activities such as transportation, parents may inappropriately rely on them as an alternative to a crib or bassinet. When the devices are not used as directed, infants can fall from an elevated surface on which the device was placed, or flip onto a soft surface and suffocate. They also can be injured or killed with improper buckling of car seat straps. Therefore, the AAP recommends that babies be placed for sleep in a supine position for every sleep, by every caregiver, until the child reaches one year of age.

How Do I Keep Baby’s Head up in the Car Seat?

“Head slump” is used to describe the position of the head when the chin moves towards the chest in a moment of forward flexion of the cervical (upper) spine. This position most commonly occurs when children fall asleep, restrained in a car seat. For older babies and children with head control, this is nothing to worry about. For newborns, however, it gets a little more complicated.

Newborns have airways the size of drinking straws, which are subsequently easier to block or collapse. They also do not have a mature neurological drive to signal that the airway is being compromised, nor the neck muscles to lift their proportionally large heads against gravity. So to prevent head slump in newborns, be sure to adhere to the following steps:

• Make sure the car seat is in the maximum rear-facing recline angle, as defined by the car seat manufacturer.
• Be sure that the harness is snug and that the chest clip is appropriately placed. If in doubt, set up an appointment with your local Child Passenger Safety (CPS) technician.
• Do NOT use any after-market devices, such as head straps or slings. These devices can cause a secondary “rebound” motion that the rear-facing child experiences in the late phases of a frontal crash, causing significant spinal injury. Even without a crash, these slings can slide out of place and pose a strangulation or smothering risk for your baby.

For a child with special needs or considerations, discuss car seat safety with your doctor. And for babies with head control, head slump is no longer your concern!

Are Car Seat Protectors Safe?

As tempting as they are, car seat protectors are generally not recommended for use under infant car seats. This is because a thick seat protector or mat between a child restraint and the vehicle seat introduces space between the two. If the seat protector shifts over time, that can loosen the car seat’s installation and compromise your car seat’s safety and effectiveness.

That being said, refer to your car seat’s instruction manual. Some manufacturers may allow a thin towel, blanket, or their specific brand of seat protector underneath the seat. Or the manual may specify that nothing should be used under the car seat at all. If your car seat manufacturer produces car seat protectors, they will generally advocate their own product. However, be aware that even if they assert that they comply with Federal Motor Vehicle Safety Standards, that does not necessarily mean they have been crash-tested with their car seats. There are no standards, regulations or benchmarks for testing these accessory products.

Can Caby Sleep in a Swing?

The simple answer is no. Infant swings can be a valuable asset when parents need help soothing a fussy baby or a safe respite for their infant—and they should always be supervised on these devices. But the AAP advises parents against using infant swings for sleeping babies. These recommendations were placed after many injuries (and even deaths) were reported with infants in swings, for the reasons outlined above (head slumping in car seats).

In general, the following tips can help keep babies safe when in infant swings:

• Newborns/infants under age four months should be seated in the most reclined swing position to avoid head slump and suffocation.
• The swing should not tip over or fold up easily.
• If the seat can be adjusted to more than a 50-degree angle, it should have shoulder straps to keep the infant from falling out.
• Toys on mobiles attached to the swings should not be pulled off easily.
• The baby should not be heavier than weight limits specified on the swing label or instructions.
• The swing’s cradle surface should stay fairly flat while in motion and while stopped so the infant will not tip or fall out.
• If the baby falls asleep in a swing, the AAP advises moving the child to a firm sleep surface as soon as possible.

Should I Avoid Eating Common Allergen Foods Near Baby?

Well, you should always be cautious of eating anything near your baby that might be a choking hazard. Peanuts and nuts are hard foods, and babies are unable to chew them safely. They can get stuck in breathing tubes and lungs, so avoid eating these next to your baby for only that reason.

However, in regards to allergens, there is a growing body of evidence that actually shows that introducing foods earlier can prevent allergies. Previous recommendations regarding timing of food introduction included delaying foods such as cow’s milk protein until one year of age, eggs until two years of age, and peanuts or seafood until 3 years of age. It was thought that early intestinal exposure to allergenic foods would cause sensitization and subsequent development of allergy.

Based on newer data, the American Academy of Pediatrics subsequently made changes to its previous recommendations by stating that although solid foods should not be introduced before 4-6 months of age, there was no convincing evidence that delaying their introduction beyond this period was protective against allergy. In fact, early introduction of foods such as peanuts, fish and eggs (at an appropriate age) might actually be beneficial in preventing food allergy, and that delaying food introduction might contribute to allergic disease.

What’s the Best Way to Toddler-Proof the House?

Congratulations, your toddler is up and running! This is a big milestone, but be sure to prep your entire home well in advance, and prevent household-related injuries. Infants and children under five years old account for over 40% of pediatric Emergency Department visits. Most of these common injuries occur in and around the home, so do not forget to check all of these precautions off your list:

• Cover all unused electrical outlets with plugs, to prevent electrical shock.
• Keep all cords out of reach, including electrical cords (which can cause oral electrical burns if baby chews on the wire), as well as cords for blinds (which can be a strangling risk).
• Secure TVs, bookshelves and furniture, which are significant topple risks.
• Use protective padding on corners of coffee tables or any furniture with sharp edges.
• Cover your fireplace with an appropriate gate, to prevent flame injuries.
• Use safety gates on the top and bottom of stairs.
• Use safety latches on lower cabinets and doors.
• Lock medicine cabinets or boxes.
• Lock cleaning supplies. Don’t forget to keep bleach and laundry pods (which may look like candy) out of reach as well!
• Keep house plants out of reach. Some plants (which thankfully do not taste good) may be extremely poisonous if ingested in larger quantities.
• Use window guards or move furniture away from windows (which could provide climbing access to toddlers). Windows should be able to open no more than four inches.
• Lock away any guns separately from ammunition, or better yet, remove any guns/firearms from the house.
• Check for chipping paint, especially in older homes, which can be a lead poisoning risk.
• Use stove knob covers. Be sure to also turn pot handles backwards when in use, and use rear burners.
• Cover radiators and heating vents to prevent burn injuries.
• Apply door pinch guards to all doors, to prevent finger crush injuries.
• Use toilet locks, as even one inch of water can pose a drowning risk.
• Lock your liquor cabinet.
• Lock away batteries, especially button batteries, which can lead to serious injury or death, if placed in the nose/ears, or ingested.
• Avoid games with marbles or small balls or beads, or any small part smaller than 1¾ inches, which can pose as common choking hazards.

Remember, prevention is the best safeguard. Thoroughly baby-proofing your home helps prevent accidental injuries and help avoid visits to the ED.

What if My Baby Falls and Bumps Their Head?

Trust your instincts. If you are worried, I am worried. For any traumatic injury in a baby, consult your doctor immediately, or go to the nearest emergency department. These should be evaluated by a medical professional. Red flags for serious head injury include:

• Loss of consciousness, even for a second
• Weakness or limpness
• Inability to wake
• Seizure
• Incessant crying or difficulty to console
• Refusal to eat or nurse
• Vomiting

Remember, if you think that your child is having a medical emergency, call 911 immediately!

Why Does My Baby Get So Sweaty?

It is completely normal for babies to sweat, as their temperature regulation systems are still maturing. Sweating is the body’s natural response to becoming too hot. Babies who get too hot may be overheating, which causes them to sweat (they can’t tell you that they are hot or peel off layers themselves). They may sweat all over the body or only in certain areas, such as the back. Other common causes of sweating include crying or mounting (or breaking) a fever.

But in rare cases, sweating can indicate a medical issue. These include sleep apnea, congenital heart disease, idiopathic hyperhidrosis and other endocrine or glucose disorders. In a few studies, it has been shown that sleep apnea (when a baby stops breathing for 20 seconds or more during sleep) occurs more frequently when babies are hot. Sleep apnea does not cause overheating, but overheating may cause sleep apnea.

Babies who have congenital heart disease sweat nearly all the time because their bodies are compensating for the cardiac defect, and working harder to pump blood through the body. These babies also have a hard time feeding, which is often associated with fast, shallow breathing.

Idiopathic hyperhidrosis is excessive sweating without a clear cause. Most babies with this condition have the same number and size of sweat glands as those who do not sweat excessively. However, the sweat glands are more active, possibly due to the increased activity of part of the nervous system, and is most common in the hands, armpits, and feet.

Sweating can also be the earliest indicator of an endocrine problem, such as a thyroid disorder or diabetes. It is important to discuss any sweating symptoms with your doctor, if you have any concerns.

What’s a Safe Room Temperature for Babies?

The ambient temperature of your house is very important to infants, who have immature thermoregulation systems, especially in the first few months of their lives. They also have a high body surface area to weight ratio, which means they can lose body heat quickly.

Some studies have found that a room temperature between 68 and 72 degrees Fahrenheit may be comfortable for babies, while others range between 61 and 68 degrees Fahrenheit. However, the AAP refrains from providing a specific temperature range for the baby’s bedroom, as the optimal room temperature for a sleeping baby might depend on the typical climate in your region. Therefore, dress your baby in clothing that is appropriate for your local ambient temperatures. For example, if you live in a warmer climate region, your baby might be able to handle a slightly warmer room temperature.

Keeping a comfortable home and bedroom temperature helps your baby thermoregulate, especially at night. This also promotes better sleep (which means your whole family will sleep better, too)! A bedroom that is too hot or too cold can affect sleep quality and lead to more nighttime awakenings. And it is very important to note that dressing your baby in too many layers, using thick blankets, or having the sleeping environment too hot are all associated with overheating—and an increased risk of SIDS.

To check your baby’s temperature, touch your baby’s chest or abdomen, as these areas can give you a more accurate reading. Sweating and feeling hot to the touch can be signs of overheating. If your baby’s skin feels cool to the touch or they shiver, they may have hypothermia. If the room temperature is at a comfortable temperature but your baby appears too hot or too cold, contact your pediatrician.

Can Babies Have Cough Medicine?

No! It is important to know that the FDA does not recommend any over-the-counter medicines for cough or cold symptoms, including cough syrup and expectorants, containing dextromethorphan, guaifenesin (such as Robitussin, NyQuil, Triaminic, Theraflu) in children less than two years old. These include: expectorants (for loosening mucus so that it can be coughed up) and antitussives (for quieting coughs).

The label may also include “nasal decongestants,” “cough suppressants” and “antihistamines,” all of which should also be avoided in children less than two years of age. Manufacturers are now voluntarily relabeling packaging to warn for use in children under four years of age. Ingestion of these medications can lead to convulsions, rapid heart rates, decreased levels of consciousness and even death. Safer alternatives for cold symptoms include a cool mist humidifier and/or nasal suctioning with saline.

How Do You Clean Baby’s Ears?

Despite the variety of products directed towards baby ear cleaning, none of these (including cotton swabs) are safe or endorsed by the AAP. Earwax (cerumen) buildup in infants is rare. Cerumen acts as a waterproof lining of the ear canal, protecting it and the eardrum from germs that can cause infection. It also traps dirt, dust, and other particles, keeping these from injuring or irritating the eardrum. Most of the time, there is no need to remove cerumen, as it comes out by itself. Simply wipe the outside of the ear with a warm, damp washcloth. Regular bathing is usually enough to keep cerumen in check.

Never stick anything inside the ear, which could damage the ear canal or delicate ear drum. Cotton swabs can actually push cerumen further inside, and make matters worse. If the cerumen seems to be causing pain, or hearing loss, seek advice from your pediatrician, who may remove the cerumen impaction or provide drops.

When Can You Fly with a Baby?

In general, it is advised to avoid unnecessary airline travel for newborns, as their immune systems are immature and they are at increased risk of catching an infectious disease. It is recommended to wait at least one month for full-term infants, though most doctors recommend anywhere between three and six months. It’s also prudent to check the airline’s policies on newborn travel. They might have a minimum age requirement, ranging from two days old to two weeks old. In some cases, newborns won’t be granted permission to fly without medical approval.

In light of the COVID-19 pandemic, babies under one year are at increased risk of severe illness with COVID-19. If you are planning to travel, be sure to take steps to keep your baby (and yourself) safe, by ensuring all eligible family members, including children, are vaccinated to reduce the risk of getting and spreading COVID-19. Also, wear a well-fitted, high-filtration face mask (such as N95) in the airport and on the airplane, frequently wash your hands or use hand sanitizer and avoid contact with obviously ill travelers. If your newborn is sick, do not fly unless agreed upon by your pediatrician.

COVID-19 aside, there are many other serious airborne illnesses that can be transmitted to newborns, including influenza, measles, tuberculosis and other bacterial/viral illnesses. Even though extensive filtration and ventilation measures are in place on modern aircraft to filter the air, your baby can still be exposed to germs. That’s not typically a problem for healthy adults, whose mature immune systems can more easily fight these off. But an infant’s immune system is no match for some of the viruses and bacteria that may be present on airplanes and in airports. If you do fly, make sure to wash your hands regularly, and avoid sitting near sick passengers.

Other factors to consider when flying with a newborn are their developing ears and lungs. Ordinary cabin pressurization can cause intense pain in infants’ ears. This may be helped (somewhat) by having the baby suck or drink during ascent and descent. And since airplanes have lower air pressure, some babies may have trouble breathing, especially if they were born premature or have heart, lung or respiratory issues. Be sure to discuss any concerns with your pediatrician before deciding to fly.

Don’t forget the car seat. Most infant car seats are certified for air travel. Although airlines may allow infants to ride on a caregiver’s lap during flight, the AAP and the Federal Aviation Administration (FAA) recommend that infants ride in properly secured safety seats, installed with the airplane’s seatbelt.

Lastly, do NOT be tempted to give your baby an over-the-counter medication, such as diphenhydramine (e.g. Benadryl), to encourage sleep during the flight. In fact, children under two years of age should never be given any kind of cough and cold product that contains a decongestant or antihistamine because serious and possibly life-threatening side effects could occur.