*Back To Sleep:

Best Baby Practices

written By Marie Mitchell, PNP, FNP of Four Corners Health Care, Inc.

When Mary came to visit her new grandson, Timothy, she arrived carrying armfuls of blankets, pillows, stuffed animals and homemade bumper pads for the crib. Although she was appreciative of the gifts, Mary’s daughter, Cameron (the new mother), would not put anything in the baby’s bed, saying: “We just came back from Timothy’s first baby check-up, mom, and the rules have changed.”

NO PILLOWS, BLANKETS, TOYS OR BUMPER PADS

The American Academy of Pediatrics (AAP) recommends no loose items in a newborn’s crib. Instead, recommendations are for a tight-fitting mattress with sheet, dressing the baby so he is warm enough to not need a blanket and doesn’t get overheated, and keeping the temperature in the room comfortable and not too warm. The baby’s head should be left uncovered. The thoughts behind these recommendations are related to reducing risk of sudden infant death syndrome (SIDS). It is thought that babies who die from SIDS may have become overheated and/or smothered, which can be attributed to pillows, stuffed animals, and blankets in the bed. Infants can also get trapped between a loose-fitting mattress and the side of the crib, made worse with bumper pads.

WHAT IS SIDS?

Sudden infant death syndrome (SIDS) is the leading cause of death for babies from one month up to one year of age. No cause for the death can be determined (such as from infection or congenital abnormalities), even with autopsy. There are theories about the causes of SIDs—perhaps due to an unknown abnormality of the central nervous system causing an infant to not awaken enough to counteract heart or breathing problems. What we do know is that SIDS is highest between two and four months of life and most often associated with sleeping in the prone (stomach) position, especially on soft surfaces. Overheating, a mother who smokes, prematurity and low birth weight have also been implicated in SIDS.

A NEW THOUGHT ON PACIFIERS

Recommendations for use of pacifiers have also changed over the years. The AAP now recommends giving pacifiers to babies up to one year of age when putting the baby to sleep. With a pacifier in his mouth, the baby is likely to suck on it, which might make becoming alert easier and reduce the risk of SIDS. Pacifiers are not without controversy, however. Studies indicate that sucking on a pacifier might decrease the frequency of breastfeeding. As a result, the AAP recommends that a pacifier not be introduced to a breastfeeding baby until one month of age, when breastfeeding has been firmly established.

In general, there does not seem to be any long-term dental problems with pacifier use in the first year. However, pacifier use has been associated with ear infections. Ear infections occur less often in the first six months of life, which is the time when SIDS is most high. Pacifiers are also associated with stomach flu (gastroenteritis) and oral yeast infections. Keeping pacifiers clean might help reduce these diseases. Of course, pacifiers should not be dipped in any kind of sweetener, especially honey, which has been associated with botulism in babies under one year of age.

SUPINE TO SLEEP

Placing a baby on his back to sleep has shown to decrease the risk of SIDS. Back in 1990 a study in New Zealand (The New Zealand Cot Death Study) showed a decrease in the number of SIDs deaths in babies who were put to sleep on their backs rather than their stomachs. In 1992 the American Academy of Pediatrics recommended babies be put to bed on their backs or sides, and in 1994, a campaign to put babies to sleep on only their backs (“Back to Sleep”) was instituted. Studies show that as a result, the rate of SIDS decreased by more than 50 percent.

During the first six months of life, parents are encouraged to put the baby to sleep in the parents’ room for ease in feedings, so the baby can be monitored, and to promote bonding with parents and baby. However, the baby should be in his own bed or bassinet and not share a bed with the parents. Sleeping with the parents puts the baby at risk for suffocation, most likely in the first two months of life and increased if the mother smokes, is overtired or under the influence of alcohol, or if the bed is shared with multiple people.

FLATTENED HEADS

Flattening of the back of the head (referred to as positional plagiocephaly) has been associated with babies being put to bed on their backs. To reduce this risk, you can turn the baby’s head to the opposite side from the position it was the night before or switch where the baby is put in his crib (head at one end of the crib for a few days and then at the other end of the crib for the next few days). Parents are also encouraged to place babies on their stomachs (“tummy time”) when awake.  This position also provides an opportunity for babies to raise their heads and support themselves on their forearms, which is one of their first physical milestones.

THE NEW BASICS

Cameron was grateful for her mother’s help in caring for Timothy and support of the new baby care practices. Her mother was also intrigued to learn how sleep positioning had changed over the years. It brought back memories of Cameron’s baby days and mother and daughter enjoyed reminiscing while Timothy slept.

TAKE HOME MESSAGE

for infant sleeping:

back to sleep, prone to play

no pillows, blankets, bumper pads or other loose items in crib

crib/bassinette in parents’ room first few months

no co-sleeping

pacifiers to sleep, (start at one month for breastfed babies)

parents stop smoking

Related web sites:

http://www.healthychildren.org (type in infant sleeping)

http://www.cdc.gov (type in 2011infant sleeping)

http://www.aapd.org (search “pacifiers” and scroll to “Dental Care for your baby”)

Marie Mitchell is nationally certified as both a Pediatric and Family Nurse Practitioner and sees individuals and families at her practice, Four Corners Health Care. 556-8300.