In the 1990s, a national “Back to Sleep” campaign cut down on the number of sleep-related deaths in babies.
Recommendations from the American Academy of Pediatrics provided simple tips to parents to help prevent deaths due to sudden infant death syndrome, accidental suffocation and other unknown causes.
But the decline of deaths has slowed, according to a new Vital Signs report from the U.S. Centers for Disease Control and Prevention, in part because parents are not following those recommendations.
“These strategies will help reduce the risk and protect our babies from harm,” said CDC Director Dr. Brenda Fitzgerald in a news release.
Annually, about 3,500 U.S. babies die in their sleep, the CDC said. In truth, some deaths have no explanation, said Dr. Stephanie Thomas, family physician at St. Vincent Healthcare’s Heights Family Practice in Billings.
“Sometimes no matter what you do, the unimaginable happens,” Thomas said. “But there are steps we can do to at least reduce the risks.”
As its name implies, the “Back to Sleep” campaign encourages parents to place babies on their backs when they sleep. But the advice doesn’t stop there, said Abbey Volf, a nurse practitioner in the Pediatric Pulmonary Office at Billings Clinic.
“What we’re not very good at explaining is the other part of ‘Back to Sleep,’ ” Volf said. “It’s on their back on a flat sheet, without a blanket, without a bumper, without stuffed animals or anything else.”
A barren crib may not appeal to parents-to-be who see magazines featuring photos of baby nurseries filled with color-coordinated accessories like “cute bumpers and little stuffed animals” that seem so welcoming, said Volf, herself the mother of three little girls.
“We feel it’s almost rude and cold and not kind-hearted to stick your baby in a crib without anything,” she said. But having items in a baby's crib puts the child at a much higher risk of dying, she said.
Babies' heads can get caught in blankets, in the bumper or even in a stuffed animal and they can suffocate or be strangled. In a cold-winter state like Montana, it seems even more difficult to take the blanket out of the crib.
Thomas, a physician who also is the mother of a baby boy, suggests the alternative of dressing babies in layers. Put them in a sleeper and then into a wearable blanket that’s more fitted in the chest and arms but a little bit looser in the legs so they have freedom of movement.
“But we don’t want babies to overheat,” she said, which can make it more difficult for them to arouse.
Instead, dress them for the season, in thinner or thicker sleep sacks depending upon the time of year.
Infants who find it soothing to be wrapped tightly can be placed in a swaddling sleep sack that also encloses their arms.
“But once babies can roll, put them in a sleeper with their arms free so they can push themselves back over,” Thomas said.
Another recommendation, Volf said, is to have the baby sleep in the parents’ room, but in a separate bed from the parents. Originally a guideline for the infant's first six months, it has been upgraded to one year.
There’s something with neurotransmitters that makes certain babies less likely to arouse, Volf said. That changes when a baby reaches age 1 and the brain matures.
Sharing a room, she said, the parents can hear if the baby is in discomfort. And their movements may help rouse the baby.
“We can’t predict which babies will die from SIDS,” Volf said. “The only thing we know is if the baby arouses more, they’re less likely to die from it.”
She warns parents from sleeping in bed with their babies or together on a couch. A bed has a soft mattress, pillows and blankets, along with parents who in their exhaustion could roll over on their sleeping infant.
“We know your highest risk of SIDS is if you bed-share,” Volf said.
Equally dangerous is falling asleep on the couch with your baby because “cushions are so dangerous,” she said.
Breast-feeding is shown to have a protective benefit in babies, Volf said. In theory, breast-fed babies arouse more frequently because they need feeding more often.
Pacifiers also keep babies from sleeping quite as deeply, she said.
For babies who frequently spit up, Thomas recommends parents keeping them in an upright position after feeding them. A wedge can also be placed underneath the mattress, to raise the baby’s head.
Babies born to mothers who smoke have a higher risk of SIDS, Thomas said, and the risk continues after birth if the infants are exposed to second-hand smoke.
Volf adds that parents who do smoke should not smoke in the car because the smoke can both enter the baby’s lungs, cling to the baby’s car seat and get into the vehicle’s ventilation system.
“If you have to smoke at home, smoke outside and have a smoking jacket that you can take off and leave outside before you hold the baby,” she said.
Thomas suggests parents give their babies supervised "tummy time" while they’re awake, to strengthen their head and neck muscles. That allows them to swing their heads freely and also helps offset the pressure on their heads, to prevent them from developing flat heads.
Once babies develop the ability to roll over, they are able to protect their airways and some may develop a preference for sleeping on their stomachs. That's OK, Thomas said, as long as they’re in a safe environment without anything that can cover their faces.
“We don’t recommend going in and turning them over on their back multiple times,” she said. “Put them down on their back but if they roll over, let them be.”