Helping Babies Sleep Safely

Three thousand infants die every year from Sudden Infant Death Syndrome, commonly known by the acronym SIDS, sometimes called “crib death.” In SIDS, the death of an infant less than one year old remains unexplained, even after the most thorough investigation. This tragedy can occur anytime, anywhere; 20 percent of SIDS cases occur in child-care settings.

Researchers recommend one simple precaution that greatly decreases the risk of SIDS: for sleeping, parents should position healthy infants on their backs. (Parents of babies with birth defects, with heart, lung, or breathing problems, or who often spit up after feeding, should consult their physician.)

Why this “supine” position? Considerable research has shown that babies who sleep on their stomachs have a higher incidence of SIDS. As many as thirty percent of SIDS cases may result from the baby’s “rebreathing” of exhaled carbon dioxide. With the baby on its stomach, this exhalation may become trapped. With the baby on its back, this exhalation is better dispersed into the environment.

The “Back to Sleep” initiative launched in 1994 by the American Academy of Pediatrics (AAP) has already had significant impact, lowering the percentage of parents who incorrectly position their infants on their stomachs from 75 percent to 20 percent. Worldwide, the incidence of SIDS has been reduced markedly, although it is still the leading cause of infant death.

With their baby sleeping on its back, parents should guarantee a certain amount of “tummy time” when the baby is awake, for developmental purposes. Also, the position of the head should be altered. For example, the baby’s head could be positioned to one side for one week, then turned to the opposite side for the following week. The baby should be surrounded—at all times—by a smoke-free zone.

The U.S. Consumer Product Safety Commission, the AAP, and every other organization studying the SIDS problems make the following recommendations to further assure that the baby does not inhale previously exhaled carbon dioxide.

• Place the baby on his or her back on a firm, tight-fitting mattress in a crib that meets current safety standards.
• Remove all pillows, quilts, comforters, sheepskins, stuffed toys, and other soft products from the crib. (In 1992, certain “bean bag” cushions were banned by the U.S. Consumer Product Safety Commission.)
• Consider using a sleeper as an alternative to blankets, with no other covering.
• If you use a blanket, place the baby with its feet at the foot of the crib. Tuck a thin blanket around the crib mattress only as far as the baby’s chest.
• Make sure the baby’s head remains uncovered during sleep.
• Do not place the baby on a waterbed, sofa, soft mattress, pillow or any other soft surface to sleep.
• Do not place the baby in an adult bed.

A report by AAP’s Task Force on Infant Positioning and SIDS does not recommend any device that claims to “maintain sleep position or reduce the risk of rebreathing,” because “none have been tested sufficiently to show efficacy or safety.” Likewise, there is no evidence that electronic respiratory and cardiac monitors decrease the risk of SIDS.

Nevertheless, there are numerous such items on the market today, all claiming to provide a firm bedding surface and good ventilation. Several companies market foam wedges to prop babies into a side-sleeping position. The AAP task force suggests that if the baby is placed on its side, the arm beneath the body should be brought forward to lessen the likelihood that the infant will roll onto the prone position.