The 5 Safe Sleep Rules You Are Probably Breaking (and How to Stop)
October is SIDS awareness month, a subject close to my heart. It’s close to my mamma heart for obvious reasons – what mom isn’t afraid of something sudden and tragic happening to their babies? I’ve also known 2 families who have lost their babies to SIDS, which really makes this hit close to home. But it’s also close to my sleep consultant heart, because I come into contact with so many parents who are using unsafe sleep practices. According to my informal Instagram poll, more than 90% of my audience has broken one or more safe sleep practices at some point. Sometimes it is from misinformation or lack of awareness, but more often, it’s from sheer desperation.
I know, because I’ve been there. My own first daughter refused to sleep anywhere but in our arms or in a swing for the first 3 months. This caused us so much anxiety- we would try to stay awake watching her at all hours of the night, but would always end up falling asleep at some point.
So, please know that this list isn’t to condemn you or judge you for decisions you’ve made in the past. It’s just my hope that with some extra education AND support for actually implementing these rules in tough situations, that our babies will all be a little safer.
Because the numbers are clear – about 3,500+ infants die from sleep related causes every year, including SIDS. A young baby is far more likely to die from SIDS or SUID while sleeping in a grown-up’s bed (check out the evidence and the difference between SIDS/SUID here). As awful and heart-wrenching as those statistics are, if there is any good news in it, it’s that through prevention and education, many potential future deaths can be avoided.
This article is not a comprehensive list of safe sleep practices, but is a list of the safe sleep practices I most commonly see broken and the reasons this often happens, so that I can help you figure out what to do instead. Because it’s one thing to KNOW the safe-sleep rule, but it’s an entirely different thing to actually follow it when it turns out following it means endless nights of no sleep.
Read to the end for an awesome summary infographic of safe sleep practices which Jenny Silverstone of MomLovesBest.com was kind enough to share. (For a comprehensive list of ALL safe sleep recommendations, go here.)
Baby should always sleep on a flat surface:
This is one of the most fundamental recommendations for safe sleep, but unfortunately, one that I see disregarded the most often. With the invention and promotion of so many baby products that enable upright sleeping positions, such as the rock’n play, or automatic baby bouncers like the Mamaroo, or just a basic baby swing, it is not uncommon for some of my newborn clients to come to me not doing any of their sleep on a flat surface. Even though these products specifically say they are not for sleep, and that babies should always be supervised, this is often disregarded.
Why breaking it is so dangerous:
A baby sleeping in an upright position is at risk of having his head tilt forward so much that it cuts off his airway and blocks his breathing. There is also the less dangerous but very real risk of baby developing flathead (positional plagiocephaly.)
Why we break it anyways:
Baby won’t sleep anywhere else. They seem to want to be upright, or at least tilted up, and cuddled up more, like in the swing or rock’n play. Or, baby falls asleep in the car seat or stroller and is not transferred.
Another common reason is that your baby has reflux. This is such a tough one, because they seem truly uncomfortable laying flat on their backs. They also often need to be kept awake after feeds, which can contribute to overtiredness, making sleep even harder.
What to do instead?
Make sure you swaddle your baby securely and safely, so that they have the comfort of the womb and their startle reflex is in check. Follow wake-times to make sure overtiredness isn’t contributing to their inability to sleep flat. (See my Top 5 Newborn Survival Tips here.) Also, when transferring a sleeping baby from your arms to the crib, have his feet touch the mattress first, not his shoulders or head (which can make babies feel like they’re falling and trigger the startle reflex.)
If you’re finding safe-sleep impossible with your newborn because of genuine reflux, talk about the options for medication with your pediatrician. Continue holding baby upright after feeds, but then place him down on his back. There is no evidence that sleeping in a slanted, upright position actually helps their reflux anyways.
2. Baby should always sleep on a firm surface.
Along with sleeping on a flat surface, it should also be firm and approved for baby sleep. So, this means never place your baby to sleep on a couch, waterbed, memory foam mattress, pillow of any kind, etc.
Why breaking it is so dangerous:
Soft surfaces mean that the weight of the baby’s head can make an indentation into the surface that they could bury their face into, potentially leading to suffocation or creating a little air-pocket in which they can re-breathe their own carbon-monoxide.
Why we break it anyways:
This one is sometimes not followed accidentally – like if mom falls asleep on the couch or memory foam mattress while nursing the baby. Other times, parents think their child will be more comfortable on a softer surface, not realizing this is unsafe.
What to do instead?
Always check to make sure the surface your baby is sleeping on is approved for BABY sleep. If the product has the word “crib”, “bassinet” or “play yard” in it, it has been approved for sleep by the AAP. Make sure to stay awake while feeding the baby and, if you fall asleep with the baby on an unsafe surface, as soon as you realize it, transfer the baby to a safe sleep space.
3. Baby should always be placed to sleep on their back for sleep
When the American Academy of Pediatrics started recommending back for sleep, instead of tummy or side position, SIDS deaths decreased by 40% in a 2 year span! That is a pretty incredible result. Yet again, parents desperate for sleep who discover their newborn really prefers tummy sleep (and many do), it becomes very hard to stick with this recommendation.
Why breaking it is so dangerous: Research isn’t very clear about exactly why tummy sleep is such a SIDS risk. It could be because a tummy sleeper is more likely to breathe into the mattress, creating a little pocket of air where they are re-breathing their own carbon-monoxide- one of the leading theories on the cause of SIDS. Regardless of the exact reason why, research is VERY clear that placing your baby to sleep on their backs greatly reduces their SIDS risk.
Why we break it anyways: Some babies sleep much better on their tummies, and parents are desperate for sleep. Also, some parents worry about a baby with reflux choking on their own spit up.
What to do about it: Insist on still placing your baby to sleep on their backs, and work on encouraging self-settling at an early age to give them a chance to learn to be comfortable sleeping longer on their backs (until they can roll themselves over). Again, swaddling and following wake-times is extremely important to make sure they are catching their ideal “sleep wave” and not going to sleep overtired. Also, make sure their sleep environment is optimal – dark, loud white noise, and cool. Some babies who prefer tummy sleep might also benefit from a swaddle or sleep sack like the Nested Bean, which puts a gentle amount of pressure on their chests, similar to what they feel with their chest against the mattress.
In regards to choking on their spit up, thankfully no research has shown this to be a risk because babies have preventative mechanisms to prevent choking – so you don’t need to worry about it! Babies may cough a little, but they don’t actually choke (choking = blocked airway), so you can rest assured they are safe on their backs.
4. Babies should room-share but not bed-share.
In another informal Instagram poll, more than 50% of moms admitted to bed-sharing with their baby, whether safely or not. Though bed-sharing can be done in a safe way, there are so many specific guidelines to follow to make it safe that most parents are not doing it safely. But, the temptation is real because, for a baby who only wants to sleep attached to your boob, a mom is happy to be a human pacifier as long as she can be horizontal, and hopefully get a little bit of shut-eye that way.
The scary reality is that the risk of SIDS skyrockets for babies who are sleeping in adult beds unsafely. This is due to many factors, including that there are usually too many big blankets and pillows around, the bed is up high and up against a wall, and parents are extremely exhausted because of having a newborn. The risk goes up even higher if there is any smoking, alcohol, or exhaustion (hello new parents!) involved for either parent, or if a parent is obese. People who recommend bedsharing usually make the assumption that this will help you and baby get MORE sleep, but the reality is that bedsharing often leads to extreme exhaustion, which is one of the HUGE safety risks of bedsharing!
Why breaking it is so dangerous: Bed-sharing increases accidental death by SIDS by up to 40%, mostly because of the risk of rolling on top of your baby, baby getting wedged between the mattress and a wall, baby having too many pillows and blankets near his face, or baby overheating.
Why we break it anyways: Some babies will only sleep attached all night to a boob, or if you replace the pacifier all night. Other reasons include cultural norms, wanting extra bonding at night, and that it’s easier to breastfeed.
What to do about it: Unless you’re going to follow every single guideline for safe bed-sharing, please just draw the line and do not pull your baby into bed with you when you know you’ll fall asleep, especially when you’re so sleep deprived! Again, work towards encouraging healthy sleep habits from the beginning. Keep your baby in a safe bassinet right next to you, if that helps give you peace of mind. Use very loud white noise to help keep baby calm.
5. Do not put anything in the crib or bassinet with the baby
Tiny little babies in their big cribs, or even just their empty bassinets can seem so…lonely. It can be tempting to add some cute stuffed animals, a warm blanket, or comfy pillow to help them feel more cozy. But, this truly goes against the basic safe sleep recommendations from the AAP. Their cribs or bassinets should be basically empty besides the baby and what baby is wearing (sleep sack or swaddle and pjs.) This includes any baby positioners, wedges, or large “loungers” like the Dock-a-tot and the SnuggleMe. Resist the temptation to put the cute stuffed bear from Grandma in there (except for a quick photo op J).
Why breaking it is so dangerous: Having things like bumpers, pillows, or stuffed animals in the crib increases the risk of baby overheating or accidentally creating that air-pocket where they re-breathe their own carbon-monoxide. Thin blankets and the ties of bumpers are also a strangulation risk.
Why we break it anyways: Crib bumpers are still sold and seem cute and cozy, or parents might feel bumpers are necessary for a baby who bangs their head on the crib slats or gets limbs stuck between the slats. Sometimes parents want to provide more warmth or comfort by adding blankets and pillows. Parents often overestimate how warm a baby needs to be.
What to do instead: RESIST THE URGE! Focus on dressing baby properly for warmth, and know that babies don’t actually need pillows for sleep- they are so squishy already! Focus on healthy sleep habits, preventing overtiredness, and creating comfort with cozy PJs and swaddles and loud, continuous white noise.
But what about:
Baby sleep positioners
Nope, not even to keep baby on his back. These are made of soft materials that are basically little pillows, therefore, not safe. If baby is rolling himself to his belly or side, it’s ok to let him sleep that way.
A blanket for warmth
Nope, just use a warmer swaddle and warmer pjs, as needed. One extra layer of clothing more than what you’re wearing is fine. Feel their ears to see if they truly are cold, and if so, add a onsie under their pjs, or get a thicker swaddle. A baby that is too warm is also at an increased risk for SIDS, so remove layers if they are sweating or their chest feels hot to the touch.
Ok, you may all hate me for this, because I know a lot of moms swear by the Dock-a-tot for improving their newborn’s sleep, but someone’s gotta say it - Dock-a-tots are NOT safe for unsupervised sleep! I know this is hard to hear for moms who had one of those babies who started magically sleeping through the night after introducing one of these. I even told moms, before becoming better educated, that Dock-a-tots are ok for sleep. I thought the worst part was that they may become a sleep crutch to be weaned off of later. But I was wrong! As I dug deeper into the Dock-a-tot’s claims about it being a safe-sleep option, it’s mostly based on it being a flat, firm surface (good!) and it being made out of a “breathable” material, which sounds good, but in reality, “breathability” is not a term monitored by the AAP or verifiable in any way. Even “breathable” materials can create that air-pocket where they are re-breathing their own carbon-monoxide.
Again, the only things approved for sleep by the AAP is anything labeled “crib”, “bassinet”, or “playyard”. “Co-sleeper”, “napper”, “lounger”, etc. are definitely NOT approved for sleep.
If following the suggestions in this article doesn’t work, you need a deeper tool box of safe baby sleep solutions that help improve newborn sleep safely and gently. Check out my newborn mini package here, and my deluxe package here.) Babies can sleep great in a safe environment - it can take some worth, but it’s totally worth it!