Safe Sleep Practices to Reduce Infant Death
Jennifer Hayman, MD
Although SIDS is rare, it is one of the most common causes of death in babies between 1 and 12 months of age.
Dr. Hayman and her associate Kelly Bowden travel the state teaching physicians and nurses how to teach their patients about safe sleep situations in the crib.
Their work was just awarded a collaborator award by Maine Children’s’ Trust.
Listen with confidence as Dr. Jennifer Hayman talks about this very serious and scary condition and what you can do to prevent SIDS.
Dr. Jennifer Hayman (Guest): Thank you very much for the opportunity to talk about this. There’s a lot of new things that parents may or may not be aware of and it’s good for them to talk with their doctors about it. Many people have known for years about the importance of placing babies on their backs to sleep and that is still very, very important. Newer information over the last couple of years has come out and babies should be sleeping in their own sleep environment separate from their parents or their caregivers. What we recommend is that babies sleep in a crib or a bassinet next to the parents’ bed. A baby should never be placed in bed with the parents asleep and should never be placed on a couch or a chair with the parents for sleep. The other important thing to remember is that if you are going to swaddle your infant, the infant should only be swaddled up until about the age of two months or until they can roll over. Otherwise, their arms can get trapped underneath them if they get on to their belly. Stopping swaddling at two months or taking the arms out of the swaddle is very important.
Melanie: Who is at risk, Dr. Hayman, for SIDS? Is there any way to tell whether certain children might be predisposed to this or not?
Dr. Hayman: Well, unfortunately, every baby is at risk for this because a lot of it has to do with the fact that their neurologic system is premature and doesn’t work like it does in older children. There are certain risk factors, however, that can put certain babies at extra risk of dying from SIDS. These include whether a baby was born prematurely, if they had exposure to environmental tobacco smoke either when the mom was pregnant with the baby or after they have been born. Babies who are sick in any other way are more likely to die from SIDS. Also, babies who have parents who are extremely tired or under the influence of drugs or alcohol are at a higher risk for dying in an unsafe sleep environment as well.
Melanie: Is there anything parents can do before their babies are born to reduce this risk?
Dr. Hayman: Absolutely. That’s a great question. The healthier the mom is during pregnancy, the healthier the baby will be and the less likely they are at risk for dying from SIDS. Moms should get full prenatal care, make sure they’re taking their vitamins and seeing their obstetrician regularly. Moms also should not be smoking during pregnancy. We know that that increases the risk of SIDS after the baby is born. If mom can stay healthy, baby will stay healthy.
Melanie: Is it ever safe to place our babies on their tummies?
Dr. Hayman: Absolutely. Babies definitely need to have tummy time so that they can learn to develop those neck and shoulder muscles and also to prevent the flattening of the back of the head that comes with a baby who spends too much time on their back or too much time in their car seat. When babies are awake and the parents are awake, the baby should be placed on their tummy to have tummy time and active play. The baby just needs to be monitored when they’re on their stomach.
Melanie: Dr. Hayman, set up a safe sleep environment for us. There’s bumpers and pillows and stuffed animals and people put all kinds of things in the baby’s cribs to make them look cozier for the baby, but they’re not really necessary, are they?
Dr. Hayman: That’s exactly right. The safest sleep environment for a baby is actually quite boring. It should be a mattress that is well fitted around the sides of the crib. One fitted sheet on the crib mattress, and that’s it – no bumper pads, no stuffed animals, no blankets, no pillows – nothing around the baby who is sleeping in the crib. In terms of blankets, the baby should be wrapped up in—if you’re going to use a blanket—one thin blanket only. However, I primarily recommend that babies sleep in sleep sacks, which are little sort of sewn-together blankets that you can put baby in to zip them up and there’s no risk of that material coming up and over the face like there is when you’re wrapping a baby in a blanket.
Melanie: What about pacifiers? Are they good, bad, or indifferent in this situation?
Dr. Hayman: There’s some data that pacifiers may prevent SIDS. Most of us who do this work don’t feel strongly about pacifiers because we also want to promote breastfeeding and there is some concern that, especially early use or early introduction of a pacifier may impede breastfeeding. I talk to parents who want to use pacifiers and recommend that if we’re going to do that that they give the baby the pacifier when the baby goes to sleep, but once the baby falls asleep and spits the pacifier out, they shouldn’t be in there all night long trying to replace that pacifier. It’s also really important to make sure that breastfeeding is well entrained before introducing the pacifier.
Melanie: Speak about breastfeeding as a way to help reduce this risk.
Dr. Hayman: Exactly. That’s one of the extra benefits of breastfeeding – there are so many – but particularly against SIDS is one of them. This has come out in the last couple of years as a really important way to protect babies from dying unexpectedly during sleep. We absolutely recommend breastfeeding for moms that it works out for and they have a good milk supply. It’s a great thing you can do. It protects your baby from infection and also protects them against SIDS.
Melanie: Dr. Hayman, we put our babies to sleep on their backs. You go in to check on your baby, they’ve rolled over on their tummy. How often do you start rolling them back on their back?
Dr. Hayman: That’s a great question. I’ve had a lot of people who I’ve talked to about this say, “I get into a fight with my child, my four or five-month old is rolling over and I go in in the middle of the night and flip them back over.” That’s not necessary. Once your baby is old enough that you place them to sleep on their back and he or she rolls over, at that point, they typically have the upper body strength that if they got stuck on their tummy, that they could lift up their head and turn it to the side. It’s always best to place them on their back, but if your baby is going to flip over as they get a little bit older, just leave them on their tummy. Most importantly, in terms of putting the baby to sleep, don’t use a wedge position or something like that to keep them in that back-only position because if the baby does manage to flip and around that, they can become entrapped in the positioning device.
Melanie: What about the clothing that we put them in? You talked about swaddling and stopping that at around two months; but there’s all kinds of little onesies and things. How do you know if your baby’s hot, too hot, or cold? What is about the perfect temperature for sleep for baby?
Dr. Hayman: That’s a great question. I live in Maine where it’s very cold, so people worry a lot about the baby being too cold when they sleep. We usually recommend to parents that the baby wear one more layer than what you would wear to sleep. If you’re going to use a sleep sack, we recommend putting the baby in a thin onesie below that sleep sack, but you don’t need to have a lot of heavy blankets. You definitely don’t want to put the baby to sleep in outer wear, like winter jackets or snowsuits, or put the baby to sleep in a hat because that will cause the baby to overheat, which can lead to death while sleeping.
Melanie: Dr. Hayman, I’d like to clear up a few myths, while we’re doing this, that SIDS and sudden infant death is not caused by. Is suffocating one of the reasons? What about immunizations and vomiting or choking?
Dr. Hayman: In terms of vomiting or choking, that is always a question that parents have because a lot of us has been taught that if a baby is on their tummy, when they vomit that they will be safer. That’s actually not the right way to think about it. Then if you just think about gravity and where the trachea or the windpipe is versus the food tube or the esophagus, the windpipe is in front of that, of the esophagus. When a baby is on their back, if they vomit and milk comes up into the esophagus, it’s not going to jump up and get into the trachea and cause them to have any breathing problem. It’s actually better for a baby to be on their back if they’re going to have any issues with vomiting when they sleep. As far as vaccines go, we know that a healthy baby is at much less risk of dying. We absolutely recommend that babies get their full set of vaccinations as soon as they’re able to by age. There is no data that vaccines cause SIDS or cause babies to die while sleeping, and in fact, we think that vaccines are protective against babies dying while asleep. Suffocation is a really big thing to think about, and what we’re seeing now is more and more babies dying in unsafe sleep situations that may be due to suffocation, either sleeping in an adult bed with a parent and becoming entrapped under that parent or being suffocated by a lot of blankets or pillows or other things in the sleep environment. We do know that suffocation is a growing reason why babies die unexpectedly.
Melanie: In just the last minute, Dr. Hayman, give us your very best advice for parents for safe sleep practices to reduce infant death.
Dr. Hayman: The best thing that you can do for your baby to reduce their risk of dying while sleeping is to place your baby alone in a crib or a bassinet while he or she sleeps, place your baby on their back and don’t have any extraneous items in that crib area, like bumper pads, stuffed animals, pillows, extra blankets, all of that should be away from the baby. Other things that you can do to protect your baby are to quit smoking if you are a smoker, have all of the baby’s vaccinations given to the baby, and also just to take care of yourself. If you yourself are ill or you’re particularly tired, ask for some help in monitoring that baby while the baby is sleeping so that you don’t get yourself into a situation where you may fall asleep with your child.
Melanie: That is really great information. Thank you so much. You are listening to MMC Radio. For more information, you can go to mainemedicalcenter.org. That’s mmc.org. This is Melanie Cole. Thanks so much for listening and have a great day.