How Safe is Your Baby's Sleep?

American Baby, in partnership with Safe Kids Worldwide, polled more than 4,500 new moms with babies 1 year old and younger to find out how they put their child to sleep. While nearly all told us they know the steps for reducing the risk of sleep-related infant death, too many disregard them. AB investigates.
Baby Care Basics: What is SIDS?
Baby Care Basics: What is SIDS?

When she was expecting, Heather Vanzandt never thought she'd be a mom who would break ranks with accepted safety advice. "I'd always read that the way for an infant to sleep is on his back in his crib," says the mom from Oil City, Pennsylvania. But every time she put her son down like that, he'd wake up wailing. "Nothing worked until I put him to sleep on his stomach and he slept. I was worried, but family members told me they'd done it, and that it was fine to do."

Vanzandt sounds a lot like many of the 4,547 moms of babies age 1 and younger that American Baby polled in partnership with Safe Kids Worldwide, an organization devoted to preventing childhood injuries. These moms recognize the rules -- 96 percent know a baby should sleep alone, on his back, in a crib. But they veer off course when caring for their own infant.

That's a risky move. The most recent data available (from 2010) reveals that 59 children younger than 1 died from car crashes; in that same year, 3,610 children under age 1 died of sudden unexpected infant death. SUID includes sudden infant death syndrome (SIDS), which is responsible for about half of SUID cases, as well as suffocation, strangulation in bed, and other deaths. Even if parents follow all the rules for safety, some incidences of SUID, including cases of SIDS, would occur -- not all can be explained, says Kate Carr, president and CEO of Safe Kids Worldwide. "But the number would be much lower." We're not interested in finger-wagging: "Moms who ignore sleep rules aren't bad parents!" Carr says. "Their baby is crying and they make a decision that seems okay at 3 a.m." Find out if you're making any of the missteps our survey uncovered, and learn how you can help your baby sleep safe and sound.

Sleep Mistake #1

We make the crib cozy.

An astounding 73 percent of moms in our survey say they have placed at least one item inside the crib with their baby. A blanket was most common (59 percent), followed by bumpers (35 percent), stuffed animals (23 percent), and pillows (8 percent). All are suffocation hazards for babies 1 and younger, and can increase the risk of SIDS up to five times, regardless of Baby's sleep position, reports the American Academy of Pediatrics (AAP). Still, many parents believe snuggly things are okay. "Everyone said my baby shouldn't sleep with her big stuffed bunny," says Anna Holmes, a mom in Manassas, Virginia. "But I felt that it was fine. So I let her."

To be fair, moms sometimes get a mixed message. "When women walk through a baby store or flip through a catalog or magazine, they see bumpers, blankets, and stuffed animals, and they think they need to buy them to be good parents," says Rachel Moon, M.D., director of academic development at Children's National Health System, in Washington, D.C., and chair of the AAP's task force on SIDS. American Baby fully supports the AAP's recommendation for a bare crib. Since 2010, we have pledged to show only safe sleep environments in the editorial pages of our magazine.

Safety upgrade Bare is best. The only thing you should have in the crib is a fitted sheet, Carr says. No pillows, no stuffed animals, no sleep positioners or sleep wedges (they pose the same suffocation hazards as pillows), and no crib bumpers, which have been linked to the suffocation and strangling of infants. This awareness for safe infant sleep is starting to catch on among policymakers. The city of Chicago banned the sale of all crib bumpers in 2011; the state of Maryland banned the sale of most of them last year.

Sleep Mistake #2

We're not putting Baby down on his back.

Twenty-eight percent of moms say they have put their baby to sleep on his stomach, a practice that leaves babies at increased risk for SIDS. And of those who take this risk, 47 percent do it before their baby turns 3 months old. "That's when the risk of SIDS is highest, in the first four months," says Jodi Mindell, Ph.D., associate director of the Sleep Center at the Children's Hospital of Philadelphia and author of Sleeping Through the Night.

Many of these parents are what we'd call "conscientious objectors," Carr says. "They think that what they're doing is somehow better or safer than what their pediatrician is telling them." Boston mom Elizabeth Nuzzo, for instance, put her son to sleep on his stomach after the first few nights home from the hospital. "I wasn't concerned that he was at risk," Nuzzo says. "He was unhappy on his back, and he was a big, strong baby who could shift and lift his head from side to side when on his belly."

Being healthy at birth doesn't prevent sleep-related infant death, Dr. Moon says. Parents who are desperate not to hear their baby cry, however, may find ways to rationalize stomach-sleeping. A common refrain of the moms who defied "back to sleep" wisdom was "He won't go down on his back." Dr. Moon notes: "It's true, babies do wake up more easily when they're on their back. But that may actually protect them from SIDS. Infants who sleep on their stomach don't arouse as well, which means they can get in trouble with their oxygen levels and never wake up."

Another common justification (for 10 percent of the rule-breakers) was worry that Baby would choke from reflux. No evidence supports this. In fact, stomach-sleeping is riskier than back-sleeping when it comes to choking concerns, Dr. Moon says.

Safety upgrade Make back-sleeping as non-negotiable as buckling your child into his infant car seat when you get behind the wheel. "The only way you're going to teach your baby to sleep on his back is to teach your baby to sleep on his back," Dr. Moon says. "It's the same thing as an infant who hates to be in his car seat. He just has to be in his car seat." Period. If your baby is able to flip himself onto his stomach while sleeping, it's okay to leave him that way. By the time he can do this, his risk for SIDS is much lower. But you should still continue to put him down to sleep on his back until he reaches age 1.

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