What Is a Safe Sleeping Environment for a Baby?

Accidental suffocation and SIDS deaths have declined in recent years, but experts still want to do more to put an end to these unnecessary deaths. (Photo: Evgeny Atamanenko/Shutterstock)

Pediatricians have been telling parents for years to put babies to sleep on their backs and keep soft bedding such as blankets, bumpers, stuffed animals or pillows out of cribs as they pose a suffocation risk. But despite decades of warnings and recommendations to reduce the risk of sudden infant death syndrome (SIDS), many parents aren't getting the message.

In 2015, about 3,500 infants died from sleep-related deaths. So maybe The American Academy of Pediatrics (AAP) thought that their updated "safe sleep" guidelines would be the nudge that finally got the organization's advice to sink in.

The group's report restated advice that's worth repeating from their 2011 guidelines: Always put baby to sleep on his back on a firm sleep surface, keeping soft objects and loose bedding out of the crib. Avoid using wedges or sleep positioners, as the AAP groups these devices in with risky soft bedding. Feel free to use a pacifier. And breastfeeding is recommended as it reduces the risk of SIDS by 50 percent. These tips are worth heeding considering the findings of an August 2017 study released by the AAP. Researchers found that while over 70 percent of mothers occasionally placed babies on their backs to sleep, only 43.7 percent of mothers intended to do this and then actually carried through with that intention.

Aside from sleeping positions, where a baby sleeps, the use of soft bedding and keeping a baby warm at night can also play a part in your baby getting the rest it needs.

Co-sleeping problems

The AAP says baby should sleep in the parents' room in a separate bed, like a bassinet, for at least the first six months. However, a June 2017 study led by a pediatrician at Penn State College of Medicine and published in the journal Pediatrics broke with that advice. Researchers analyzed surveys from 230 mothers and found that infants slept for longer periods at a time if they slept in their own room. At 9 months old, babies in their own rooms slept 40 minutes longer at night and 20 minutes longer overall, compared with babies sleeping in their parents' room. Researchers followed up with the families after 2.5 years and found that toddlers who slept alone by 9 months old slept 45 minutes longer at night, though total sleep time (including naps) was about the same.

“I think the back-to-sleep message has gotten out loud and clear,” said Rachel Y. Moon, M.D., FAAP, lead author of the statements and chair of the task force. “When you ask parents, almost every parent knows — whether they are doing it or not is a different thing. We have been less successful at getting people to not sleep with their babies, and much less successful in getting the soft bedding away from babies.”

Which is why the new guidelines specifically address an important fact of life for new moms and dads: Sometimes, tired parents may fall asleep while feeding baby. Basically, co-sleeping happens, even though parents may not intend to do it, and even though it may be dangerous.

“For the soft bedding, everybody thinks if it’s soft, then it can’t hurt the baby. But soft bedding is actually really a problem because it’s so soft they sink into it. People will often use pillows to ‘cushion’ the babies, and babies sink into them. ...That’s very dangerous," said Moon. She adds that the same is true with bed-sharing: “Some parents think if baby is right next to them, they can tell if there is a problem and protect the baby.”

As dangerous as it can be to co-sleep, falling asleep with the baby on the couch is even worse, the AAP says. "No matter what, babies should never sleep on a couch, especially with another person” because infants can get wedged between the person and the cushion, said Dr. Michael H. Goldstein, M.D., FAAP, a neonatologist and task force member.

There's also a higher risk of SIDs for co-sleeping when the parent has been drinking alcohol or smoking because they could roll over on top of their baby. A baby is 18 times more likely to die from SIDS when sleeping with a parent who's been drinking, reports NPR.

Too soft for sleep

Baby asleep on its back without bedding
This baby has it exactly right: asleep on the back, in his own bed, wearing warm clothes, but not using blankets, bedding or stuffed animals. (Photo: FamVeld/Shutterstock)

A 2016 study from the AAP found an alarming number of babies still sleep in unsafe ways, increasing the risk of SIDS, and it may be more revealing than previous similar ones because researchers used video cameras to watch more than 160 babies while they slept for one night at three points during infancy: 1 month old, 3 months old and 6 months old. Previously, researchers simply asked parents how they put their infants to sleep, but in this study researchers could watch for themselves.

Researchers found more than 90 percent of one-month-old babies had loose items on their sleep surface. Nearly 20 percent of three-month-old babies were put to sleep on their sides or stomach. And at six months old, more than 30 percent were put to sleep on their sides or bellies, and more than 90 percent had loose items in their cribs.

"Most parents, even when aware of being recorded, placed the infants in environments with established risk factors for sleep-related infant deaths, including positioning the children on their sides or stomachs; soft sleep surface; loose bedding; or bed-sharing. Among the 167 infants enrolled in the study, those who were moved in the middle of the night were even more likely to be placed in a sleep environment that posed hazards," the AAP said in a press release.

A 2014 study showed that more than half of American babies are still in danger from the threats posed by soft bedding. Researchers from the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention analyzed data from nearly 20,000 parents. In 1993, almost seven out of eight parents used blankets or other soft bedding in their baby's cribs. Although those numbers dropped sharply over the years, by 2010, more than half were still in the habit. The study, which was published in the journal Pediatrics, found the practice was most common among young mothers, Blacks and Hispanics.

How to keep baby warm

This baby is wearing a sleep sack to stay warm. The arm-less one-piece garment will keep baby toasty without the suffocation risk of blankets.
This baby is wearing a sleep sack to stay warm. The sleeveless one-piece garment will keep baby toasty without the suffocation risk of blankets. (Photo: loflo69/Shutterstock)

In the cold winter months, or even in the summer in an air-conditioned home, keep the blanket on the shelf. Instead, use a thicker one-piece sleep outfit (approved for use as infant sleepwear). Pajamas with feet will keep baby warm from head to toe. If you're still worried she won't be warm enough, add a onesie underneath or a sleep sack on top for an extra layer.

If you're concerned about cold hands, try baby mittens, which not only keep hands warm, they'll prevent baby from scratching herself with her fingernails, the National Sleep Foundation says. And you can prevent heat from escaping from the top of baby's head by using the soft-knit hat the hospital likely gave you when she was born.

Lastly, keep the room at a cozy temperature. Like adults, babies may sleep better in cooler temperatures. It depends on your preference, but between 68 to 75 degrees is recommended.