How much greater is the risk for sleep related death if an infant sleeps on the stomach or the side?
Babies sleeping on their stomachs have a 230%-1,300% greater risk of sleep related death. In addition, if a baby is placed on the side to sleep but ends up prone, there is an 8.7 times greater risk of sleep related death.
Why is it important for babies to sleep on their backs all the time, including when they are being cared for by child care providers or baby sitters?
A baby that usually sleeps on the back is at an elevated risk for SIDS the first time and every time he or she is put on the stomach for sleep.
What are some reasons sleep position is a risk factor for sleep related death?
Here are three important reasons to share with families:
- Prone sleeping (sleeping on the stomach) increases the risk of rebreathing the same air that is under the baby’s face.
- Sleeping on the stomach increases the risk of the baby getting overheated.
- In young babies, 2 to 3 months, sleeping on the stomach changes how the nervous system controls the cardiovascular system.
Why is using the mattress that comes with the sleep surface important?
Other mattresses may leave space on the sides where babies can get stuck and unable to breathe or may be too soft.
Why are soft surfaces and other soft items where the baby sleeps a problem?
Pillow top mattresses, foam mattresses and other soft surfaces are a problem because the baby’s face can get pushed into them and breathing can be blocked. These items in the baby’s sleep area can increase the risk of sleep related death fivefold.
What is safe-approved sleep surface?
Safety approved cribs are those that have been manufactured and sold since the requirements went into effect on June 28, 2011. They have been designed to have the spaces between the bars too small for a baby’s head to get through and get stuck. Standards for other safety approved spaces such as bassinets ,portable play areas and side cars (attachment to an adult bed that provides a separate, but close safe space) have also been developed by the U.S. Consumer Product Safety Commission, the agency that tracks accidents and deaths with products and helps keep babies safe from products that can be harmful or cause accidents.
In the Going Deeper section for Module 3 you will find links to the information from the U.S. Consumer Product Safety Commission.
Bumper pads were supposed to keep babies from getting hurt, why are they now considered a problem?
Bumper pads are a problem because the babies can get their faces stuck into soft ones and not be able to breathe or get wedged between firm ones and the crib side and not be able to breathe. Also there have been reports of babies getting caught in and strangled by the ties that hold on the pads. With the new safer cribs, babies do not get their heads stuck between the slats which was an original reason for bumper pads.
Why aren't couches, chairs and sofas a safer alternative to sleeping with a baby in an adult bed?
Sleeping with a baby on any of these is more of a risk than the adult bed. Couches, chairs, and sofas create danger because the babies can get their faces stuck in soft pillows or get wedged in corners or between the seat and the arms and not be able to breath.
How can babies not properly positioned in a sling have their breathing compromised?
If fabric from the product covers the baby’s face or the baby’s face is pressed into the adults body, this can block breathing and the baby will not get enough oxygen. In addition, if the baby is curled up with chin on chest, this can also block breathing.
Why are car seats, baby carriers and other sitting devices unsafe places for infants to sleep?
Car seats, swings, baby carriers and other sitting devices are not safe places for babies to sleep. They can get into positions that increase reflux, cause flattening of the head and most importantly, especially for babies less than four months of age, get into a position that blocks the airway and causes them to not get enough oxygen. Also these types of equipment can tip over and cause a fall and there have been reports of infants who were strangled by the straps in car seats.
How can features of an adult bed can put babies at risk?
Babies can get their faces stuck in soft pillows, pillow top mattresses, soft water bed surfaces and cause suffocation. Babies can get wedged in the space between the bed and the wall and suffocate. Blankets on the bed can cover the baby’s face and cause suffocation. Babies can fall from adult beds. Portable bed railings intended to keep a child from falling off a bed should not be used for infants.
Breastfeeding is associated with a reduced risk of sleep related death. Why might formula feeding increase risk?
Formula feeding puts the baby at greater risk of SIDS. This may be related to the decreased number of infections and diarrhea related to breastfeeding and because babies who are breastfed do not sleep as deeply and could more easily arouse themselves if they are not getting enough oxygen. Thus the advice that parents receive to add formula to the baby’s diet to get the baby to sleep longer is counterproductive—sleeping more deeply and longer may increase risk of death.
What are the benefits to infants of breastfeeding?
Breastfeeding protects babies from many disease risks including ear infections, upper and lower respiratory infections, asthma, and leukemia. For all of these, the benefits are noted to be related to how long the baby is breastfed, and to exclusive breastfeeding. Thus, achieving exclusive breastfeeding for six months and continuing alongside developmentally appropriate complementary foods for at least 1 years is very important for the baby’s health.
Children who are breastfed for at least six months are less likely to become obese. Childhood obesity is a risk for adult obesity and a range of diseases including diabetes and heart disease.
Infants exclusively breastfed for at least 3 months have 30% lower incidence of type 1 diabetes and 40% reported lower incidence of type 2 diabetes. This information is very important for racial and ethnic groups with high incidence of type 2 diabetes. The protection may be related to reduced risk for obesity.
What are some long-term health benefits of breastfeeding for mothers?
This is a reduced risk of reproductive cancers, including breast cancer. Lactation is the final stage of the reproductive cycle. There is a decreased risk of type 2 diabetes and the risk decreases with length of breastfeeding. (If the mother had gestational diabetes, there is not the protective effect.) There is a decrease in risk of heart disease, hypertension, or high cholesterol in women who have breastfed a total of 12 to 23 months.
How important is having the baby sleep in my room in reducing the risk of SIDS?
There is evidence that sleeping in the parents’ room but on a separate sleep surface reduces the risk of SIDS by as much as 50%.
Why might room sharing reduce the risk of sleep related death?
Placing the crib close to the parents’ bed allows parents to see the infant, monitor the infant and can make feeding and comforting easier. Room sharing infants have more small awakenings and this may keep them from sleeping very deeply in a way that increases the risk of sleep related death. Finally, room sharing supports continued breastfeeding and its protective effects and positive health benefits.
What are ways that others in an adult bed can increase risk for sleep related death?
AAP acknowledges that parents frequently fall asleep while feeding an infant and it is less hazardous to fall asleep in the adult bed than on a chair or sofa.
It is important that families anticipate the possibility of and plan for reducing the risk of bed sharing for some period of time, even if it is only for few hours by removing items that create a danger to the baby before-hand. To address hazards in the adult bed, parents who take infants into their bed to feed should make sure there are no pillows, blankets or other items that could block the infant’s breathing or cause overheating in the bed. Bed sharing is much more common than is planned. The infant should be placed back in its own sleep space as soon as the parent wakens.
AAP acknowledges that parents frequently fall asleep while feeding an infant and it is less hazardous to fall asleep in the adult bed than on a chair or sofa. It is important that families anticipate the possibility of and plan for reducing the risk of bed sharing for some period of time, even if it is only for few hours by removing items that create a danger to the baby before-hand. To address hazards in the adult bed, parents who take infants into their bed to feed should make sure there are no pillows, blankets or other items that could block the infant’s breathing or cause overheating in the bed. Bed sharing is much more common than is planned. The infant should be placed back in its own sleep space as soon as the parent wakens.
There is a risk that an adult will roll over on the infant or sleep so close that the infant’s breasting is blocked and the baby will suffocate. An adult who smokes (or if the mother smoked during pregnancy) because of increased exposure to the smoke and the chemicals in it. Smoke exposure has a negative effect on the baby’s ability to rouse itself if it is not getting enough oxygen. It also puts the baby at risk for respiratory infections and other health problems in general. E-cigarettes also known as “vaping” involve the same chemicals. Someone who is impaired or has trouble rousing due to medications or substances such as alcohol or illicit drugs because they may not notice an infant’s distress if they roll over on the infant. Adults who are impaired in this way should not bed share with the baby.
People other than the parents, including other children, because they may not be attuned to the dangers of rolling over on the infant. Also more people in the bed may increase the risk of crowding leading to accidently laying on the infant or the infant’s face getting blocked. Also remember the information in this module about sleep surface—blankets, pillows and other soft items in the adult bed represent a risk for the baby.
What are ways that smoke exposure before the baby is born increase the risk for sleep related death?
Smoke exposure before the baby is born is related to: being born too early and having low birth weight—both factors are risk factors for SIDS.
How is smoke exposure after the baby is born related to sleep-related deaths?
The chemicals given off from smokers (even if they are not smoking directly near the baby) impact the funtioning of the baby’s nervous system and can have negative effect on the baby’s ability to wake up if she is not getting enough oxygen. Also these chemicals increase the baby’s risk for respiratory and other infections that are associated with higher risk of sleep related death and are of course, not good for the overall health of the infant and other children in the household.
How does caregiver drug or alcohol use increase the risk of sleep related death in bed sharing sitautions?
Using alcohol or drugs impairs a parent’s judgment in general, however, there appears to be a particular risk when bed sharing—the parent is not as easily roused by and attuned to cues of distress from the baby. This concern applies to prescription or over the counter medications that are sedating—cause drowsiness or sleepiness—not just illegal drugs.
What does overheating actually mean?
The “why” for this recommendation is somewhat difficult to explain. This recommendation requires clarification, since the term “overheating” is difficult to define. There is evidence that there is a greater risk of sleep related deaths related to the amount of clothing the baby is wearing or the room temperature. There is no specific room temperature that can be recommended and there is not sufficient evidence to recommend using fans to cool the room. It is also unclear how much of the risk from overheating is due to blankets or clothing such as hats that can cover the baby’s face and lead to suffocation. Thus it is suggested that the amount of clothing the baby needs to be comfortable is similar to what the adult needs in the same situation and that hats not be used for sleep. In addition, blankets may be a risk due to overheating as well as suffocation and sharing a sleep surface with others (particularly with blankets) may overheat the baby.
For families who live in hot climates or come from countries where it is hot, this recommendation may be particularly confusing. It is important to share the idea that blankets and other clothing designed to keep babies warm in the U.S. are made to hold in body heat and the baby cannot kick off blankets or take off clothing as an adult might do when overheated. In addition, young babies’ bodies are not yet efficient in regulating body temperature and this can affect how their heart and other body systems function. Without this context, concerns about overheating may not make sense to families who come from hot climates.
Also in some cultures hot and cold have a specific meaning related to health and health events. It is important to understand what heat means to families you are serving.
