When her first child was born in 2005, Crystie Byrdy, a mom in suburban Maryland, tried hard to follow sleep recommendations for infant safety from her doctor and from all the books and materials she had read. She always placed her baby to sleep on his back. And when she nursed him in her bed in the middle of the night, her husband, Ted, woke up to make sure his little namesake, Teddy, went back into his separate sleeper.
"He was so tiny and precious," Ted says. "I had a fear of rolling over onto him."
The parents, both architects, were well aware of the risks of Sudden Infant Death Syndrome (SIDS), the sudden death of an infant younger than 1 year old that remains unexplained after a thorough investigation. They also knew that advances in research -- linking SIDS to a baby's sleep environment -- had lowered the risk of SIDS. They got rid of their new decorative crib bumpers on the advice of their pediatrician.
In 1994, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) launched the national Safe to Sleep® campaign (formerly Back to Sleep) along with the American Academy of Pediatrics and other collaborators. In the past 20 years, the rate of SIDS has dropped by half across all racial and ethnic groups, and the rate of infants being placed on their back has increased by 40 percent. However, the rate of other sleep-related causes of infant death, such as accidental suffocation, has increased since 1999.
"Our research shows that where a baby sleeps matters," says Alan E. Guttmacher, M.D., director of the NICHD at the National Institutes of Health. "Every day, there are new parents and grandparents, and we need to tell them about the importance of a safe sleep environment for babies."
The Safe to Sleep campaign urges parents and caregivers to:
Aisha Dubose Campbell, of Bethesda, Maryland, learned about infant health from many sources -- her doctor's office, the pediatrician's office, and the Internet. "There's just so much information," she says.
When her first child was born in 2011, she took the recommendations to heart: Place infants to sleep on their back, on a firm sleep surface. Keep soft objects, toys, and loose bedding out of the baby's sleep area. "I followed every single rule," Campbell says. When she gave birth to her second child, a girl, on August 3, 2014, she was more relaxed but equally vigilant. And each of her doctors had his or her own preoccupation: "My ob-gyn constantly reminded me to put my baby on her back," Campbell recalls. "She was very worried about putting the baby on her belly to sleep." The pediatrician wanted to make sure there was nothing in the crib. The lactation specialist was realistic: She said, "You are going to fall asleep while nursing, but try not to."
Not sharing a bed with an infant is often the hardest recommendation to follow, says Marian Willinger, Ph.D., a researcher in NICHD's Pregnancy and Perinatology Branch, who oversees studies on SIDS and ways to promote safe infant sleep.
"We know that the risks are higher if a baby sleeps in bed with an adult or child," Dr. Willinger explains. "If parents wish to bring their baby into bed to comfort or to breastfeed, as soon as they or the baby gets sleepy, the baby should be placed in his or her own crib or bassinet in the parents' room."
In 2012, the research and medical community began to focus on the overall sleep environment to spotlight not only the importance of putting babies to sleep on their back but also where babies sleep. "Our research shows that babies who sleep on their back actually have the lowest risk of SIDS compared with babies who sleep on their stomach or their side," Dr. Willinger says. Babies who sleep on their back also have fewer respiratory and ear infections, she adds.
Carla Weise, a new mom, believes it's easier in a smaller living space to provide a safe sleep setting. She lives in a one-bedroom apartment in downtown Silver Spring, Maryland, with her baby boy, Quincy, born March 21, 2014. In the middle of the night, she sits up in bed, nurses her baby, and puts him back to sleep in his own crib, next to her bed. Still, she admits, she sometimes cradles and cuddles with her baby in bed in the wee hours of the morning: "Sometimes it's hard not to."
An important skill that new parents develop quickly, sometimes in the middle of the night, is communicating with grandparents, who are eager to help but often unaccustomed to the newer rules. Byrdy was grateful that her mother came to stay when baby Teddy was born. But there was a difficult moment when her mother put Teddy to sleep. Byrdy had been having trouble getting him to sleep on his own, yet when her mother put him in the crib, he was quiet.
"I thought, Man, how did she get him to sleep?" She peeked in to find Teddy swaddled on his side, which goes against Safe to Sleep's recommendations. "That led us into a conversation about how my mom had raised me and my brother sleeping on our tummy and our side, and how we turned out just fine." Still, her mother relented, and respected Byrdy's wish to keep Teddy on his back during sleep time. "But it was hard," Byrdy remembers. "She felt judged."
The Byrdys now have four boys, all younger than 10. With each baby it's been a little easier to get him to sleep, and it's also been easier to carry out the safe-infant sleep practices, she says. "We were so worried with our first. Friends joke that we had more kids so we could relax."
Dr. Artis leads the Safe to Sleep® Campaign at the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health, in Bethesda, Maryland.
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