Nearly every parent has been seized by fear that his infant could stop breathing while asleep. Though not everything is under parental control, there are ways to reduce a baby’s risk, says Yale Medicine's Eve Colson, MD, a pediatrician and professor of pediatrics at Yale School of Medicine. Known worldwide for her work in decreasing infant mortality, Dr. Colson has dedicated her career to newborn care, research and education. Here are her evidence-based tips for keeping your sleeping baby safe.
Each year in the United States, about 4,000 babies die from Sudden Unexpected Infant Death (SUID). About half of those are attributed to Sudden Infant Death Syndrome, or SIDS, a disorder that causes babies to stop breathing. Many of the other sudden deaths are the result of suffocation and strangulation. SIDS peaks at 3 to 4 months, but the risk continues until age 1.
Put babies on their backs
Since 1992, experts have told parents to put infants to sleep on their backs. “Since we started recommending ‘back to sleep,’” Dr. Colson says, “the rate of SIDS has dropped about 50 percent.” The reason sleeping on the back reduces the risk of a child dying of SIDS is not completely known, but might have to do with how sleeping on the stomach could affect the way the baby breathes and the body temperature.
Babies should have their own spaces
The mattress should be firm, and the crib or bassinet should be certified by the U.S. Consumer Product Safety Commission. “New or recently used cribs should be fine, but older cribs, such as those inherited from relatives, might have slats that are too far apart, or other features that go against current standards,” Dr. Colson says. "We recommend checking standards before using a crib."
Cut the clutter
The crib or bassinet should be free of stuffed animals and toys, heavy blankets and pillows, and “bumpers” or cushions lining the sides. A very thin blanket (as a cover or swaddle) or sleeping bag-style pajama is acceptable. Dr. Colson says not to swaddle infants after 3 months, or sooner if you think your infant is going to roll, as they can become trapped in the swaddling blanket once they have more mobility.
Breastfeeding is good
Dr. Colson encourages mothers to breastfeed for overall health benefits, and says that there is also some evidence that breastfeeding specifically decreases the risk of SIDS.
Many mothers take their babies into their beds to breastfeed and then return them to their cribs or bassinets. While there’s nothing wrong with this routine in theory, very tired mothers can fall asleep while the baby is nursing. Having a partner monitor the situation and/or simply being aware of how tired you are before deciding to nurse in bed is helpful.
“All of the items we tell parents not to put in cribs, such as pillows and blankets, are in your bed,” Dr. Colson says. In addition, there is a risk of rolling over on a baby and suffocating him or her–a completely tragic situation that does occur.”
Use a pacifier
“Though we don’t know why,” Dr. Colson says, “using pacifiers during sleep does decrease the risk of SIDS.” Mothers who are worried that introducing a pacifier might interfere with the baby’s ability to breastfeed can introduce a pacifier at one month, once breastfeeding is established.
Don't fall asleep on a chair
Many babies love to nap on a parent or caretaker’s chest. “Holding your baby on your chest is great,” Dr. Colson says. “But if the lights are off and/or you’re really exhausted, you could fall asleep and endanger the baby.” A sofa or chair can be particularly unsafe because of the risk of a baby getting caught in between cushions. Knowing your own level of tiredness or having someone keep an eye on the situation are, again, the most helpful safeguards in this situation. It's important to make sure the baby can get plenty of air while resting on your chest.
Don't bother with breathing monitors
Some parents might be intrigued by ads for monitors that go off when a baby stops breathing. “There is no good evidence that a monitor is going to help you,” Dr. Colson says. “If you think it will make you feel better, you can certainly try it. But it could go off in ‘false alarms’ and may drive you crazy.”
Of course, don't smoke
Smoking increases the risks of SIDS. If you must, do it outside. Finally, wash your hands before handling the baby–a good practice in general, and especially helpful to remove any potentially dangerous components of cigarettes that could linger on your hands. We also recommend changing clothing or wearing a jacket they can take off over clothing that is exposed to cigarette smoke. This can reduce the lingering smell and contact with chemicals in cigarettes.