Safe Sleep for Babies: Everything You Need to Know
Babylist's Real-Life Guide to Safe Sleep for Your Baby
April 30, 2021

Babylist's Real-Life Guide to Safe Sleep for Your Baby

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Babylist's Real-Life Guide to Safe Sleep for Your Baby

Many first-time parents have a rough idea of what’s safe and what’s not around baby sleep. Spend even a few minutes with Google or looking over paperwork from your pediatrician’s office and the basics on safe sleep start to become pretty clear: babies should sleep alone, on their backs, and in a crib or a bassinet with a firm sleep surface.

But then…real life happens. Your baby arrives, and suddenly things become very real very quickly. All those sleep rules you thought you knew? Now it’s time to put them to the test in your life as a new parent.

My baby loves the swing, but can they sleep there?

What do I do if my baby falls asleep in their car seat? Can they stay put, or should I move them ASAP?

My Instagram feed is filled with cute babies asleep in infant loungers—is that safe?

There are important rules around safe sleep, and then there are the real-life situations you’re going to find yourself in as a new parent.

We turned to two experts, Dr. Nkeiruka Orajiaka, pediatrician in Emergency Medicine at Children’s Hospital in Columbus, Ohio and Dr. Kelly Fradin, a pediatrician who also shares parenting and pediatric health tips on social media, to help you interpret the guidelines around safe sleep for your baby and answer all the burning sleep questions you’re likely to have as an anxious new parent.

The Basics of Safe Sleep for Babies

The American Academy of Pediatrics (AAP) is the first place you should start when learning about safe sleep for your baby. Safe Sleep: Recommendations provides a detailed guide for babies up to one year of age and should be your go-to source for all things involving sleep safety. (How to Keep Your Sleeping Baby Safe is another helpful AAP resource to consult.)

The first thing to learn about safe sleep is to always follow the ABCs: babies should sleep Alone, on their Backs, in a Crib or bassinet with a firm sleep surface and covered in a fitted sheet with no other bedding.

Other AAP recommendations for safe sleep:

  • Room share for the first six months, ideally up to the first year. Room sharing is not bed sharing. Infants should sleep close to the parents’ bed but on a separate surface like a crib, portable crib, playard or bassinet. Note that there’s no published data around bedside or in-bed sleepers so there’s no official recommendation from the AAP provided for those products.
  • Never bring your baby into bed with you for sleep and never let your little one sleep on a couch or chair.
  • Keep soft objects and loose bedding away from your baby’s sleep space. This includes things like stuffed animals, toys, teethers etc. and loose bedding like pillows, quilts, bumpers and blankets.
  • Swaddling is okay, but be sure the swaddle isn’t too tight or too loose and stop as soon as your little one shows signs of rolling over.
  • Consider offering a pacifier at nap time and bedtime once breastfeeding has been established.
  • Avoid alcohol and illicit drug use during pregnancy and after birth.

Sudden Infant Death Syndrome: What You Need to Know

Many safe sleep practices are put into place in order to prevent something called Sudden Infant Death Syndrome (SIDS). While SIDS is extremely scary, it’s important to remember that it’s very rare and there are many things you can do as a new parent to help prevent it by creating a safer sleeping environment for your baby.

What is SIDS? What causes SIDS?

SIDS stand for Sudden Infant Death Syndrome. It’s the unexplained, sudden death of an infant younger than one year of age. According to the AAP, approximately 3,500 infants die each year from sleep-related infant deaths.

“The actual cause of SIDS is unknown,” explains Dr. Orajiaka. While many researchers believe SIDS may be associated with defects in the part of an infant’s brain that controls breathing and arousal from sleep, no definitive answers have been reached yet.

What are the risk factors of SIDS?

According to Dr. Orajiaka, there are many predisposing risk factors for SIDS. These are usually considered in two parts: maternal (parent) and infant/environmental factors.

Maternal risk factors for SIDS include:

  • Young mother
  • Maternal smoking during pregnancy
  • Drug and alcohol use
  • Late or no prenatal care
  • Infant and environmental factors include:

  • Prematurity
  • Low birth weight
  • History of sibling dying of SIDS
  • Sleeping positions including sleeping on belly, sleeping with bedding accessories or loose blankets, and bed sharing

How can you prevent SIDS?

Research shows that creating a safe sleeping area for your baby by following all safe sleep guidelines can help reduce the risk of SIDS, according to the Centers for Disease Control (CDC).

In addition to following the ABCs of safe sleep, other recommendations for reducing the risk of SIDS include:

  • Breastfeeding your baby.
  • Visiting your baby’s healthcare provider for regular checkups.
  • Keeping your baby appropriately dressed for the environment and avoid overheating.

Safe Sleep in Real Life

Understanding the guidelines around safe sleep for your baby is very empowering. Baby sleep is one of the most anxiety-inducing parts of new parenthood for many families, and knowing the rules around what’s safe and what’s not can help you feel more confident as you navigate those early months with your newborn.

But what does safe baby sleep look like in real life? We asked Dr. Orajiaka and Dr. Fradin about some of the sleep situations you’ll find yourself in just trying to get through the day as a new parent. Here’s what they had to say.

Is it safe for my baby to sleep in their car seat?

Car seats are really important for safety,” explains Dr. Orajiaka. “But if an infant falls asleep in a car seat, they should be removed and placed in a crib or a bassinet (or other safe sleep space) as soon as possible. The AAP recommends against the use of car seats for sleep outside of a car.”

Dr. Fradin adds, “If the vehicle is moving, it’s important they stay fully buckled. The AAP does advise that babies have a break from the car seat every 90 minutes.”

Can my baby nap in their car seat?

We’ve all been there: your baby falls asleep in their car seat while you’re driving and is still asleep when you arrive at your destination. What do you do?

“The best practice is to remove them and transfer them to a safe sleep environment,” says Dr. Fradin.

“However, many parents, myself included, will want the child to finish their nap for a brief period. If you choose to do this to reduce risk be sure the baby is not overheating by removing hats, blankets and ventilating the car. Also, keep the straps snug and place the car seat on the floor under your direct supervision.”

Can my baby sleep in their car seat if it’s attached to a stroller?

“If babies are in an approved stroller with the car seat properly restrained, I think of it the same as being in a vehicle,” explains Dr. Fradin. “Keep them cool and supervised.”

“Of note, if you bring your baby in a car seat into a store, place the car seat in the large part of the cart. In a restaurant, I would rather the child’s car seat be in a stroller than on top of a table or high chair where he or she could fall,” she says.

Can my baby sleep in an infant lounger?

Infant loungers like the DockATot and Snuggle Me are safe spots for your baby to chill and relax, especially when you need to get other things done—but only if they’re awake. “DockATots and other ‘pods’ are NOT safe for sleep,” says Dr. Orajiaka.

Dr. Fradin agrees. “DockATots and infant loungers are not intended for sleep and pose a safety hazard,” she notes.

Can my baby sleep in a swing?

“I think a lot of swings are designed to be similar to car seats in terms of the baby being restrained and at a healthy incline,” Dr. Fradin explains. “However, these are not intended for sleep and these containers will inhibit the movement that promotes a rounded head shape so I would not recommend them.”

Can my baby sleep in a Moses basket?

Dr. Orajiaka isn’t in support of babies sleeping in Moses baskets and recommends a bassinet instead.

“Moses baskets are not properly regulated by CPSC (the Consumer Product Safety Commission, an independent federal regulatory agency that works to reduce the risks of injuries and deaths from consumer products),” she explains. “Even though some may be considered as bassinets, some others are unstable, have small parts or are structurally insufficient to hold an infant safely. There have also been a few recalls in the past. Choose a recommended bassinet instead.”

If you do choose to put your baby in a Moses basket, Dr. Fradin recommends making sure the base is flat and firm.

Can my baby sleep in a wrap or other type of baby carrier?

Our experts had slightly different takes on this scenario.

Wraps and carriers can be used when helping a baby fall asleep, but as with every sleep, baby should be placed alone, on their backs and in their crib for sleep,” says Dr. Orajiaka.

Dr. Fradin is supportive of carrier naps but with a few safety considerations in mind.

Baby carriers are great ways for baby to nap on the go, just be sure that the infant is high on your chest, at “kissing height” without fabric covering their face. There is a helpful mnemonic device called TICKS to keep in mind: the carrier should be Tight, the child’s face In view, Chin off the chest, Kissing height and Supported back. Especially in the summer be aware of overheating,” she explains.

What is room sharing and why is it recommended?

“Room sharing means keeping the baby’s sleep area (crib, bassinet, playard) in the same area where you sleep. This is recommended for at least the first six to 12 months because it is safer than bed sharing. It also makes it easier for feeding, comforting and watching your baby,” explains Dr. Orajiaka.

Is co-sleeping safe?

Dr. Orajiaka gives a firm no here. “No, there are no safe ways to co-sleep. As a pediatrician and based on AAP policies, I do not recommend this,” she says.

But what if you’re finding yourself falling asleep in your bed while feeding or comforting your baby? There are a few ways to decrease your risks.

“The safest way for an infant to sleep is alone, on the back and in a crib,” says Dr. Fradin. “However there are ways to decrease the risks of co-sleeping by placing a mattress on the floor, making sure the adults in the bed are sober and not on medications that may decrease awareness, tie up long hair, and not using covers or blankets. I recommend parents considering co-sleeping discuss the choice with their doctor and do their research.”

Are crib bumpers safe?

No.

“Bumpers introduce risk without any benefit,” says Dr. Fradin.

How should I dress my baby for sleep?

“I recommend one more layer than an adult who is comfortable in the environment. It can be very helpful to have feet and hands covered in infants,” explains Dr. Fradin.

Can my baby sleep in a hat?

There’s a risk of suffocation if your baby’s hat slips down onto their face while asleep, says Dr. Orajiaka, so she doesn’t recommend putting your baby to sleep in their crib while wearing one.

But if you’re out and about and trying to keep baby warm, hats can be worn safely. “I think they are okay for car seats and strollers, especially in cold weather,” says Dr. Fradin.

Should I flip my baby over to their back if they rolled onto their stomach by themselves?

“We can save a lot of parent sanity by sharing the message that it’s not necessary to flip the baby over if they flip themselves over!” says Dr. Fradin. (Cue the applause.)

You’ll definitely want to stop swaddling, though. “Place your baby in a sleep sack with their arms out so they can help themselves flip back around if they want to,” recommends Dr. Orajiaka.

And speaking of swaddling…

Is swaddling safe? When do I need to stop?

Swaddling using appropriate technique (leaving room for the hips to move) is safe and a healthy way to promote sleep. When your baby begins to roll, it’s time to stop swaddling,” says Dr. Fradin. This happens at a different age for every baby, so be sure to be on the lookout.

Can I put my baby to sleep with a pacifier?

“Yes, pacifiers are actually considered a protective factor for SIDS,” explains Dr. Orajiaka. “For breastfeeding parents, wait till breastfeeding is established before doing this. Also choose pacifiers without ropes or clips attached to them.”

Is the Snoo bassinet safe and how long can my baby sleep in it?

“The Snoo is a wonderful product, but once baby begins rolling, even if before six months, I would advocate for moving to a crib,” recommends Dr. Fradin. “The Snoo has a built-in swaddle and safety mechanisms to prevent rolling over while swaddled, but I think it’s a natural time to make the transition.”

Are baby movement and breathing monitors like the Owlet safe?

Both pediatricians agree that there’s nothing unsafe about these types of monitors; however, they note that since they’re not FDA-approved or regulated, they aren’t always very reliable.

“I do not have any safety concerns with the baby movement and breathing monitors, but I do not recommend them. I know many parents feel they decrease anxiety, but false alarms can increase anxiety and impair sleep quality. These devices also are not replacements for safe sleep choices, as if the battery dies or the Wifi doesn’t connect they may not function correctly,” says Dr. Fradin.

“They create a false sense of security for families who may depend on them a lot to prevent SIDS,” adds Dr. Orajiaka. “Some babies, such as premature babies and those with apnea, may benefit from them but it is better discussed with a pediatrician on a case-by-case basis.”

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