Lopez: ‘Back to sleep,’ by itself, is not enough (column)
April 16, 2017
Parents and caregivers of newborns receive a great deal of advice on keeping new babies healthy and safe, particularly during sleep. A primary theme is preventing sudden unexpected infant death, or SUID, the No. 1 cause of death for infants between 1 month and 1 year old. It can be overwhelming to sift through all that advice, so here's a concise summary of the most up-to-date research-based recommendations.
SUID refers to all causes of death during infancy that transpire suddenly and unexpectedly. Sudden infant death syndrome (SIDS), accidental injuries (including strangulation, asphyxiation and entrapment) and undetermined causes of death comprise most SUID deaths. Most occur during infant sleep.
Certain risk factors make SUID more likely, and regrettably, some cannot be controlled. These include premature birth, low birth weight, recent infection in the baby, young age of the mother and young age of the baby, who innately possesses an immature nervous system. The good news is that there are risk factors that can be controlled.
In past decades, the message to parents was, "Back to Sleep," encouraging them to place infants on their backs to sleep. That's great advice, but those educational efforts did not highlight other important strategies.
Research has shown that environmental factors are strongly associated with SUID and SIDS. So focusing on the sleep environment is just as important as the baby's position. To reduce the environmental risks associated with your baby's sleep, use the following practices, recommended by Dr. Ann Halbower, professor of pediatrics–pulmonary medicine, and director of pediatric sleep research at the University of Colorado School of Medicine.
Place infants on their backs to sleep in a crib made for babies. The mattress should be firm and fit the crib space with no gaps. Sleeping in car seats, chairs or Boppies can constrict or bend the baby's airway, potentially causing breathing difficulties.
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Avoid bed sharing, but keep the crib in your room. You can realize the benefits of co-sleeping (including encouraging breastfeeding — a protective factor) by placing the baby in a crib next to your bed at your mattress level. If the baby is in a separate room from his or her caregiver, the risk of death is 10 times higher.
Keep blankets and pillows out of the crib, even if the child is sleeping on his or her back. Blankets, pillows, crib bumpers and adult bedding are suffocation and strangulation hazards, increasing the risk of death five-fold. Instead of a blanket, use a wearable blanket such as a sleep sack or pajamas that allows arms to be free — not swaddled.
To avoid overheating, dress the baby appropriately for the environment. Don't cover the baby's head, as this inhibits heat venting. Hyperthermia (significantly above-normal body temperature) decreases sensitivity to carbon dioxide, decreases cough reflexes and can alter breath patterns.
Avoid smoke exposure, which causes changes in the areas of the brain responsible for breathing. Risk of death doubles from smoke exposure during pregnancy and after birth. Marijuana smoke is known to change babies' sleep-wake cycles. Tertiary smoke exposure (via clothing, surfaces, vehicle upholstery) is also harmful.
To learn more about infant safe sleep, and Dr. Halbower's work, visit InfantSafeSleep.co.
Sara Lopez, RN, BSN, works with Summit County Public Health.
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