If you are a new parent or are newly caring for an infant, you have probably received lots of advice about the "proper" way to raise your baby. Even as a pediatrician, my family and friends peppered me with often conflicting, sometimes confusing suggestions regarding all aspects of my own family's well-being. Yet, when it comes to the safety of my children and my patients, I trust the research-proven best practices, especially when it concerns one of the leading causes of infant mortality.
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Sudden Unexpected Infant Death (SUID) describes any sudden death, explained or unexplained, in infancy. It is a catchall term that includes SIDS (Sudden Infant Death Syndrome) as well as other explained causes of death including suffocation, asphyxiation, and entrapment during sleep. Across the country, there are approximately 3,500 SUID deaths each year.
In Miami-Dade County alone, we have had at least one asphyxiation death every year. For this reason, University of Miami Health System pediatricians have launched a “Back to Sleep” campaign to eliminate preventable sleep-related infant death by teaching their staff, patients, and the community about safe sleep practices.
Since 1994, the American Academy of Pediatrics (AAP) has recommended that infants be placed on their backs to sleep. Babies sleeping on their bellies are thought to re-breathe the same air from the pocket created by their noses and mouths in the sheets, leading to relatively decreased oxygen levels and increased carbon dioxide.
A common concern is that putting babies to sleep on their backs is dangerous; that they can choke on their saliva or spit-up. However, even if they were to spit-up, they can turn their heads sideways if needed, so long as there are no pillows or positioners preventing them from doing so. Since the “Back to Sleep” campaign began, there have been no reported vomit-related injuries or deaths, and the rates of SIDS have dropped by more than half.
It is normal for babies to wake up briefly throughout the night. This does not keep them from being well rested. Some babies, however, have a hard time waking themselves up, even when necessary, because of tobacco exposure during pregnancy or during infancy in the home. This exposure affects the brain’s ability to wake itself up.
Heavy bundling should also be avoided because babies who are warmer tend to sleep more deeply. A good rule of thumb is to dress your baby in no more than one extra layer than you would wear. As well, sucking on a pacifier during sleep keeps babies from sleeping too deeply, making it easier for them to wake up if there is a change in their oxygen levels. Offer a pacifier without a cord or clip once breastfeeding has been established, generally by two to four weeks of age. Breastfeeding is strongly recommended as it protects against SUIDS.
Babies should sleep on their own sleep surface with a tight, fitted sheet. Remove any bumpers, pillows, comforters, stuffed animals, positioners and wedges, as all these items pose a risk of suffocation. Couches, waterbeds and air mattresses pose added risks of potentially trapping the baby in a position where they are unable to breathe. Car seats, swings, and sitting devices are also not recommended for routine sleep. Do not rely on monitors or other devices that are marketed to prevent SIDS. Instead, place your baby to sleep on their back in a bassinet or crib in the same room where you sleep. The crib should be at least an adult’s arm length away from other furniture, shelves and windows to avoid injuries such as strangulation from window dressings. Crib standards have changed as recently as 2012 and older cribs may not be as safe. If the sides go down or you can fit a can of soda between the slats, don’t use it. Check the Consumer Product Safety Commission website to ensure that a crib has not been recalled for any reason.
Nothing in the world is more precious than your baby. Parents, caregivers, and pediatricians are all partners with the goal of keeping our little ones safe. Not every baby's risk of SUIDs is the same so please consult with your pediatrician for individualized recommendations for your family, and join UHealth in our effort to make our homes and child care centers safer places to sleep so we can all rest more comfortably!
For more information on providing a safe sleep environment for your baby, visit cdc.gov/sids, cribsforkids.org, healthychildren.org and safekids.org. For product safety and recall information, visit cpsc.gov.