Baby's Safe Sleep
by Susan Miller

Deciding on where your new baby will sleep and what kind of bed he will sleep in is one of the important questions new parents need to address. Parents often hear a wide range of advice on this topic from family, friends and “experts.” First and foremost are the considerations around baby’s health and safety. If parents are feeling confused on this issue, it is no surprise since even the experts are not in total agreement. When the realities of nighttime waking and feeding emerge, however, many families find they change their approach simply as a matter of survival. Families choose baby’s sleep arrangement according to what works best for them, and what fits with their parenting philosophy and family culture.
 
In November 2004, the Canadian Paediatric Society (CPS) made a recommendation that “for the first year of life, the safest place for babies to sleep is in their own crib.” Parents must ensure that any crib or cradle that baby sleeps in meets the Canadian Safety Standards. The CPS also recommended that in the first six months, it is even safer if baby’s crib is in the parent’s room. Dr. James McKenna of the Mother-Baby Behavioral Sleep Lab at the University of Notre Dame in Illinois, strongly supports this recommendation, adding that when babies sleep in close proximity to their mothers, the risk of sudden infant death is reduced by half and babies arouse and feed more frequently, which are critical survival instincts that further protect a baby from a SIDS event. McKenna states that arguments against bed sharing ignore the fact that “bed sharing can be inherently protective. It is how the bed sharing is done that overrides the protectiveness.” The recommendation from the CPS that babies sleep in their own cribs reflects the concern that bed sharing, where identified risk factors are present, can lead to tragic infant deaths due to entrapment, strangulation or smothering by one of the parents during sleep.

Parents today are more likely to bed share with their babies than the parents of 40 years ago. This is largely due to the shift from formula feeding to breastfeeding, and a stronger emphasis on attachment and nurturing as a parenting approach. In a Today’s Parent survey, 83 per cent of the 1,500 parents surveyed reported that they had their babies sleeping in the parental bed “sometimes,” “often” or “always.” When asked about bed sharing with their baby, parents usually said that this was not what they had planned to do in the beginning, but found that it was the only way that baby slept between feeds and allowed the parents to get more rest. Often parents are reluctant to admit that they bed share for fear of strong criticism from family and others—especially health professionals. Even though the CPS advises against bed sharing with your baby, Montreal paediatrician Denis Luduc, one of the authors of the CPS statement says, “If you eliminate all the risk factors that have been identified, then bed sharing is in all likelihood safe. So be comfortable with what you’re doing.”

Consider the following safety factors when making a choice to bed share with your baby.

• Breastfeeding is correlated with a lower incidence of SIDS. Breastfed infants wake and feed more often than formula fed infants, making them less prone to the long deep sleeps that contribute to SIDS risk. Exclusive breastfeeding for the first six months, and continuing into the second year, provides your baby with immunities and protection against many diseases.

• Always place your baby on her back to sleep, whether she is in her own crib or in the same bed as the parent(s). Never let someone place your back-sleeping baby on the tummy to sleep, even once. Babies that have always slept on their back are at a 20 times greater risk of SIDS when they are placed on their tummy to sleep. Make this point very clear to babysitters and grandparents who might fear the baby could choke when placed on her back to sleep. Babies have the ability to guard their airway on their back and will turn their head to the side if they spit up.

• Sleep surfaces must be firm and clean. Do not put your baby to sleep, or sleep with your baby on a waterbed, beanbag, old sagging mattress, feather bed, couch, sofa or recliner chair, or any other soft surface or makeshift bed.

• Keep baby away from smoke of any kind. If mother smoked during pregnancy, or if baby is exposed to smoke after birth, the risk of SIDS is increased. If a baby has been exposed to smoke before or after birth, he should not sleep in the same bed as his parent(s). Exposure to smoke has been correlated with an increased incidence of SIDS when baby bed shares with his parent(s).

• Avoid putting too many clothes and blankets on your baby. Baby should be warm but not hot, and never sweaty behind the neck and ears.

• Keep the room temperature comfortably warm for you and your baby. If you need fresh air to sleep, have the window open just a little.

• Avoid swaddling your baby too tightly and leave her hands and arms free. This allows your baby to suck on her hands or fingers and to push anything off her face that is too close. Never cover your baby’s head or face with a blanket.

• Do not use quilts, duvets, sheepskins, comforters, bumper pads and stuffed toys in the baby’s bed. Never put your baby to sleep on or beside a pillow.

• Babies should never be put to sleep in the same bed as other children or pets, and a car seat or infant seat should not be used in place of a crib or bassinette for sleeping.

If you choose to bed share with your baby, here are some other safety factors to consider. Never sleep with your baby if:

• You have taken any medication or drugs that might make you sleepy and unable to respond to your baby. This includes such things as cold medications.

• You or your partner are very overtired or have consumed alcohol.

• You or your partner is extremely overweight.

• You or your partner has very long hair that could wrap around baby’s neck. Tie hair back securely for safety.

Check with your Public Health Nurse to discuss any further questions you may have regarding your baby’s safe sleep. When you know that you have done everything possible to ensure a safe sleep for your baby, you can sleep easier too.

Susan Miller, R.N. BScN, is a Perinatal Educator and Certified Breastfeeding Counsellor. She teaches, coordinates and develops prenatal, post-natal and early parenting programs in the Greater Victoria area.