PJ’s Corner: New Safe Sleep Guidelines for Infants

Dr. Pooja Parmar, a pediatrician at Warren Clinic Owasso who provides comprehensive healthcare for infants, children and teens, answers some important questions about infant sleep safety and the new American Academy of Pediatrics guidelines for safe sleep.  She is welcoming new pediatric patients and referrals, and Warren Clinic accepts most insurance plans.

Q: The AAP, which is the American Academy of Pediatrics, has changed its safe sleep guidelines for the first time in eight years. What necessitated these changes?

A: Every year, unfortunately, there are about 3,500 sleep-related infant deaths. After a monumental decline in 1990s, there has been little decline since the 2000s. So, in 20 years, we haven’t really seen a decline. And that’s the reason. It’s time to get information out there for families, so that they can be informed about safe sleep and what kind of changes need to be made to ensure safety for their babies.

Q: Walk us through some of the main changes that the AAP is recommending.

A: The crux of the safe sleep guidelines is still the same, which is talking about how babies should be sleeping in their own bed, in either a crib or a bassinet or a play yard with a flat, firm, non-inclined sleeping surface. Those things haven’t changed.

What has changed are the specifics of what is not a safe sleep surface for babies, including inclined surfaces or bed sleepers or loungers. The AAP also says that sleeping in strollers, car seats, swings and slings is not considered safe. It’s OK if the babies fall asleep there, but as soon as you can do so, move them to a safe sleeping surface.

Q: Parents often want to buy the latest, cutest sleep-related items for their babies. Can you give examples of some of these items that are sold but may be unsafe? We assume these items are safe because they’re for sale? Is there a place to check for safe and unsafe items?

A: The new AAP guidelines also throw some light on that. Just because products are marketed as being safe does not mean that they are regulated by the Consumer Product Safety Commission. If it’s not regulated, it means it isn’t tested enough to ensure safety, so it doesn’t meet the safety standards of the other products that we are calling safe.

There are other products out there, which over recent years have become very popular, such as a pulse-oximeters or heart monitors. Parents use them at home, thinking that they are safe, but there is no evidence to support that these products ensure safe sleep or prevent SIDS.

Q: Is there a place to check for safe items?

A: The AAP guidelines again reinforce that the only safe surfaces for babies to sleep in are a crib, bassinet or a play yard with a flat, firm, non-inclined mattress and a very tightly fitted sheet. There should be no stuffed toys, loose blankets or loose sheets in the sleeping area.

The guidelines also talk about room-sharing. Until baby is 6 months old, parents can have the crib, bassinet or play yard in their own room. That way they are room-sharing with the baby, but not sleeping in the same bed.

Q: So, having an infant in bed with you is not safe. Is that correct?

A: Yes. If the babies are not sleeping in a crib, in a bassinet or in a play yard by themselves, it’s not safe. That’s what the guidelines reinforce.

Q: You mentioned Sudden Infant Death Syndrome, or SIDS. It’s the sleep-related death risk that we’ve all heard about. But what are some of the other sleep-related risks? And tell us what SIDS is. Is there a cause for SIDS?

A: SIDS is Sudden Infant Death Syndrome. It’s actually a sub-category of Sudden Unexpected Infant Death. Sudden Unexpected  Infant Death is a term that is used to describe deaths that occur suddenly and unexpectedly during infancy, meaning for babies under 1 year of age. These sleep-related deaths can be because of an identifiable cause or because of an unknown cause. SIDS is the term used for babies that have died suddenly because of an unknown cause after an investigation has been done.

Some of the other sleep-related causes for death include strangulation and suffocation. Babies can sometimes roll over on the bed and get trapped between the bed and the wall. Babies who are sleeping on a couch may roll over and get trapped between the couch and couch cushion. They may fall from an unsafe or soft sleeping surface. There’s also positional asphyxiation, where the position that the baby’s sleeping in can block the airway. That can happen with some of the other unsafe sleeping environments such as strollers, car seats or inclined surfaces. Those are some of the other identifiable causes.

Q: What are some of the reasons that parents and caregivers give for not using safe sleep guidelines?

A: I think there’s a survivor bias, where we often hear, “I slept with my four or five kids, and they turned out OK. They are just fine.” There are also older generations, grandparents as caregivers, who sometimes take offense if they are asked to care for a baby or a newborn that is different from the way they cared for their child. And there are cultural norms with different ethnic backgrounds and with generational gaps. Cultural norms can go from generation to generation, even if those don’t meet the current safety standard. I think a lot of that comes into play here.

I do want to emphasize to grandparents, parents and new parents out there, that just because things have changed, it does not mean that you did anything wrong. With scientific and medical evidence and research, we are learning more. We know better now. And since we know better, we ought to do better.

Q: Is there anything else you would want parents or caregivers to know about putting their infant to bed and safe sleep?

A: If there’s any doubt, if there’s any question about whether what you are doing is unsafe or not, just talk to your pediatrician or family doctor. On a personal note, I have a 2-year-old at home, so he was a newborn not too long ago. I would like to share with all the parents out there that, as a mom, I know that we are worriers, we worry about so many things: Are they eating OK, are they growing OK, are they going to make friends when they get older, are they going to be kind individuals when they grow up? A lot of those worries keep us awake at night. But the one thing that helps us all sleep better is knowing that our babies are safe. Ensuring that they are sleeping in a safe sleep environment is just one way to do it.

To find Saint Francis Health System’s Safe Sleep Guide and additional resources visit: saintfrancis.com/postpartum-and-newborn-care