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How Safe is Your Baby's Sleep?

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.

 
Sleep Mistake #3

We share a bed with Baby.

Bedsharing, defined as sleeping on the same surface with Baby, is common, Dr. Mindell says. Sixty-five percent of the moms we polled have slept in bed with their infant, and of those, 38 percent do so regularly. The majority of these bedsharing moms worry about their baby's risk of accidental suffocation, but they do it anyway. Why? To help their child sleep, to make nursing easier, to bond with Baby, and because Baby won't sleep anywhere else, they say.

"It was the only way I could get my son Joshua to go down," says Nicole Bogert, of Waterbury, Connecticut. "He would be miserable in his Pack 'n Play, and the instant I put him in bed with us it was like magic -- he went right to sleep."

But bedsharing is perilous. Studies show that about half of all suffocation deaths among infants happen in an adult bed. Compared with sleeping in a crib, the overall death rate is more than 40 times higher for babies who sleep with a parent. "There are multiple dangers in an adult bed that can suffocate Baby, from a less-firm mattress and big pillows to fluffy comforters and extra blankets," Carr says. "Parents also mistakenly believe they're light sleepers and would wake up if they rolled over on their baby, but that's not the case in so many tragic instances."

Safety upgrade For a newborn, attach a co-sleeper to the side of your bed. It's a smart option for a mom who wants to keep her infant close. To transition your little one to a crib, do so in small steps, suggests Dr. Mindell. For instance, put your baby in her crib and sleep in her room with her until she adjusts. If there's nowhere in there for you to sleep, place her in a portable crib in your room. Then, when she's used to that, move her to a crib in her own room. Not only will be she be safe, she'll snooze more deeply. "In one study I conducted, we found that babies who sleep with Mom and Dad wake up twice as often than when they sleep alone," Dr. Mindell says. "They don't learn to soothe themselves, and that's what keeps them up."

 
Sleep Mistake #4

We take naps on the couch with Baby.

A staggering 53 percent of moms in our poll report they share the couch with their infant, a number that astonished our experts. It's by far the most dangerous choice because couches can be softer and more plush than an adult bed, and Mom or Dad could accidentally roll over and suffocate Baby, Dr. Moon says. Ironically, some parents think couch-sharing is relatively safe because if they put Baby between their body and the back of the couch, she can't fall off like she could in a bed. In reality, the child can become trapped between the parent's body and the couch, and that can be much more dangerous, Dr. Moon says.

Joann Ramaker, from Austin, Minnesota, is among the moms who thought she was making a responsible choice. "When my son came home from the hospital, I wound up sleeping with him on my chest on the couch every night," she says. "I was scared of sharing a bed with him because he was so tiny." Her son had been born premature and spent his first weeks in the hospital. "I thought that if we were on the couch together, I wouldn't move or roll over on him, and he wouldn't fall off." But after several weeks of that, Ramaker began sharing her bed with him. "I knew it was a bad habit, but since he would not breastfeed, for me it felt like our bonding time, and I loved it."

Safety upgrade Bond with your baby before bed, and then put her in her crib, Carr says. When you're wiped out or if it's nighttime, avoid nursing or feeding your baby on the couch. You're more apt to doze off there than in a less comfy spot, Dr. Mindell says. If your sweetie falls asleep and you're tempted to snuggle her while you browse your Netflix queue, think twice. Finally, never place a sleeping baby on a couch. About 18 percent of moms say their baby has slept on a couch alone, but even if you're awake, it's never safe. It takes only a minute for suffocation to occur. Practicing safe sleep habits for your baby can be grueling during the first year. You're exhausted, up and down all night, and listening to your baby wail on her back in her bare crib. In these moments, sticking to what you know is right may feel insurmountable. But this stage won't last forever. Your baby will drift off. Soon enough, she'll outgrow these risks (and you'll graduate to big-kid concerns). In the meantime, you'll rest better knowing that you've done the safe thing.

As we pored through the comments in our study, one thread stood out: Many moms who wouldn't dream of putting their baby on his stomach at nighttime do so at naptime. "Parents think that since they're up and about, they're watching their baby," says Dr. Mindell. "But the reality is, you're in the kitchen, you're on the computer, and if your baby is having a hard time breathing, it's silence." Dr. Moon points out that research also shows that a baby who is used to sleeping on his back but is periodically put on his belly to snooze is 18 times more likely to die from SIDS. Experts aren't sure why, but one theory is that babies who nod off on their back most of the time develop motor skills differently and can't lift their head as easily when they're on their stomach, which puts them at risk for asphyxiation.

SIDS Happened to Us

At 3 weeks old, Charlie Hanke typically slept on his back in his crib, but one night he was particularly fussy. "I thought I'd hold him on the couch until he calmed down," says his father, Sam Hanke, M.D., a pediatric cardiologist at Cincinnati Children's Hospital. Dr. Hanke rested Charlie on his chest. "I fell asleep, and when I woke up, Charlie didn't," he says. He and his wife, Maura, an elementary school teacher, started Charlie's Kids Foundation in 2010. Their goal is to get the nonprofit's new bedtime board book, Sleep Baby Safe and Snug, which includes a sleep-safety checklist, into the hands of all new parents as they leave the hospital with their newborn. "What happened is something I still struggle with everyday," Dr. Hanke says. "We want to educate parents because too many babies are dying this way." Buy the book ($8; Amazon.com) and all proceeds go to the foundation; learn more at CharliesKids.org.

Will Cribs Become Safer for Babies in 2014?"

New federal standards for cribs were implemented in 2011 by the U.S. Consumer Product Safety Commission (CPSC). As part of that, traditional drop-side cribs manufactured before June 2011 can no longer be sold because the moveable side could detach and entrap, suffocate, or strangle a baby. The agency is now applying scrutiny to crib bumpers, researching whether they, too, are a hazard. The CPSC states that "bare is best" when it comes to a baby's crib. But a federal safety rule requires an investigation and that takes time, explains CPSC spokesperson Nychelle Fleming. "It can be a challenge to distinguish whether a case of SUID is due to a bumper or other bedding, such as a blanket or pillow, or from stomach-sleeping, or is unexplained," she says. In the meantime, public opinion is shifting against crib bumpers. Chicago banned the sale of all crib bumpers in 2011, and Maryland banned the sale of most of them last year. Another significant milestone is that companies are voluntarily phasing out crib bumpers or making them less prominent in their product lines. As of press time, Aden + adais, Babyletto, and Kushies don't offer crib bumpers on their websites. The Land of Nod stopped developing crib bumpers in 2013. Giggle.com's Better Basics Bedding, Skip Hop's Complete Sheet Bumper-Free Crib Bedding, and Wendy Bellissimo's 5-Piece Crib Bedding don't include bumpers. American Baby is on board! We stopped showing crib bumpers in our editorial pages in 2010, and we make every effort to keep them off our sister websites Parents.com and ShopParents.com. If you happen to spot an unsafe sleep environment or product on our sites, we want to remove it. If you know a company that's focusing on safe infant sleep, we want to hear about it! Email us at cribsafety@americanbaby.com. Together, let's make 2014 the year that babies sleep more safely.

Originally published in the March 2014 issue of American Baby magazine.

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