Ask Dr. Mom: Safe Sleep Practices

Updated recommendations and safe sleep techniques to help your baby rest properly.
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Reducing the number of sleep-related infant deaths (approximately 3,500 annually in the U.S.) is the impetus behind new guidelines issued by The American Academy of Pediatrics. Here, Amy T. Nathan, M.D., neonatologist and mother of two, provides updates on recommendations regarding everything from swaddling methods and sleep positions to baby gear that facilitates safe snoozing.

Is swaddling recommended?
Swaddling is a way to soothe babies and encourage them to sleep more soundly, and it remains an effective technique for those things. However, new evidence shows that continuing to swaddle babies after they are about four months of age and start to turn over can actually increase the risk of Sudden Infant Death Syndrome (SIDS).

There are really two issues with swaddling: the risk of SIDS and hip development. Regarding hip development, it’s really the tight swaddling that’s dangerous because for the hip socket to develop normally, hips have to be able to move on a regular basis and to be in a gently flexed position. Sometimes with a tight swaddle, we’re keeping the hips really still. Since a baby spends much of their early months asleep, their hips are held in one position for hours at a time. At Cincinnati Children’s Hospital Medical Center, we are not making a specific recommendation to families about swaddling; but if they choose to swaddle, we want to educate them on the safest way to do that. A lot of new wearable blankets and wraps on the market facilitate swaddling of the upper chest in a snug way but let the hips be free. Sleep sacks are nice products that give parents the option of keeping the baby wrapped without using loose blankets [that can ride up around the baby’s face].

Should parents use baby monitors that track movement or breathing?
We do not recommend the use of these monitors. They’ve never been shown to reduce cases of SIDS and there are a lot of false alarms, which means less sleep for parents who then get overtired and are less able to respond appropriately when there really is an emergency. Instead of monitors like that, we recommend that a baby sleep in the same room as the parents. This has been shown to cut the rate of SIDS in half. I’ll be clear, I don’t mean in the bed, but in the room, “rooming in” in their own crib but the parents are then able to visually see the baby.

What sleep position is best?
Flat on the back is the safest position for an infant. It’s more likely they’re going to roll onto their tummy and their face if they’ve started on the side, even with the wedges that they sell. A baby on its back has a full 180-degree arc to move its head [to get away from something that might be obstructing the airway or suffocating him or her], but if a baby is on his or her belly, aside from lifting their head they can’t really move their head. Even on the side, they can really only move about 90 degrees.

I often hear parents say, “my baby just doesn’t sleep as soundly or as deeply on their back” or “they don’t like sleeping on their back.” I try to point out that there are many things our children do not like to do…but they really do get used to it pretty quickly, and infants are very moldable. And the really, really deep sleep that babies do when they’re on their tummies may actually contribute to SIDS. We all want our babies to sleep through the night, but it’s every parent’s nightmare to put your baby down and have them never wake up.

Are Baby Boxes safe?
Cradle Cincinnati has posted a nice summary about our stance on these boxes. The jury is still out on the safety and efficacy of baby boxes. We recommend a crib over the use of a baby box at the current time.

Dr. Amy Nathan has been an attending neonatologist at Cincinnati Children’s for the past 12 years, and currently oversees the clinical operations as Medical Director for the Perinatal Institute. She is passionate about improving outcomes for sick and premature infants.

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