All newborns have one characteristic in common. They spend most of their time sleeping! On average newborn babies spend about 16 hours a day, or 66% of their time, sleeping during their first weeks of life. Newborns typically snooze in 3-4 hour stretches during which they experience different phases of sleep including drowsiness, REM (rapid eye movement), light sleep, deep sleep, and very deep sleep just like adults do.

Baby’s individual sleep patterns will vary, but as your baby grows he’ll sleep in longer stretches. By the time a baby reaches two months of age it’s common that he or she will sleep six to eight hours at night and will continue his daytime naps.

Put safety first
We all think about keeping our babies safe while they are awake, but have you thought about your baby’s sleep safety? Sleep safety for infants seems pretty straightforward, but you would be surprised at how complex it really is! Parents of newborns are faced with some challenging “snoozing” decisions.

You’ll want to decide how to position your baby for sleeping. What was your experience with your other children when they slept as babies? Does grandmother have strong opinions about what position your new baby should sleep in? Does your baby have a medical condition that requires a particular sleep position? If so, be sure to talk to your doctor about the safest sleep position for your baby. What’s the latest buzz from the medical experts for a healthy baby’s sleep position?

You will also need to decide where your baby will sleep. Will you use that beautiful brand-new crib in your baby’s newly decorated bedroom for your baby or for storing baby items? What about that heirloom crib passed on from family members? Do you plan on using a portable crib or bassinet in your own bedroom? Were you thinking of letting your baby sleep with you?

As you consider the how and where your baby will spend those 16 hours sleeping at night and during naps, keep the following sleep safety guidelines in mind.

“Back To Sleep”
Placing your baby on his or her back to sleep lowers the risk of Sudden Infant Death Syndrome (SIDS). SIDS or “crib death” is the leading cause of infant deaths between 1 and 12 months of age. A SIDS diagnosis is based on an autopsy, an investigation of the place where the baby died, and a review of the baby’s medical history. It is a diagnosis of exclusion, ruling out all other possible causes before determining SIDS as a cause of death. Positioning your baby on her back to sleep is the simplest, most cost-efficient way to lower your baby’s chances of SIDS.

Grandmother might need to be convinced about this change in baby’s sleep practices since she cared for you when you were a baby! Let grandma and other caregivers know that the American Academy of Pediatrics (AAP) has been recommending “Back To Sleep” for babies since 1992. As a result, our country’s SIDS rates have dropped dramatically, by 50% since 1994.

The country’s leading group of baby doctors also says that putting a baby on his side to sleep is not as safe as letting the baby sleep “wholly” or completely flat on his back. The side sleep position is not recommended. In the side sleep position, there is the likelihood that a baby will roll onto his stomach, the riskiest sleep position for SIDS.

You will definitely help your baby sleep safer by putting him on his back to sleep at night and for naps throughout his first year of life. This is especially important during the first six months of age when SIDS occurs most often.

When your baby is old enough to roll over on his own, you can let him sleep in the position that he prefers. It’s also a good idea to periodically check on your baby while he sleeps. When you peek in on your sleeping baby, make sure his head remains uncovered so he can breathe easier and so he won’t get too hot.

Use a sleep place designed for baby
Use a safety-approved crib that has no missing or broken slats (vertical side bars). The crib slats should be no further apart than the upright width of a soda can. If you have an heirloom crib, you may need to put it to the soda can test to make sure the slats are not spaced too widely, so that the baby’s body won’t slip through the slat spaces. Modern cribs have slats closer together to prevent this problem.

The crib mattress should be firm, not soft. Soft surfaces can be hazardous. Keep excess bedding out of the crib so that the sleep place is free of clutter. This also means making sure that pillows, soft blankets, and stuffed animals are not in the crib while your baby sleeps. Consider putting the toys and stuffed animals out of the way on a nearby shelf or in a basket on the floor.

Avoid bumper pads, memory foam mattress pads, fluffy sheep skins, and those wedges designed to keep babies sleeping on their backs. At a very young age, a baby won’t roll over from her back to her stomach, so the wedges aren’t necessary. Some babies begin to roll over on their own around four months of age.

Sofas, pillows, bean bag chairs, and cushions are not designed for babies. Resist the temptation to sleep with your baby, especially on the sofa. Babies can become trapped between cushions, and pillows pose a suffocation hazard.

Infant carriers, bouncy seats, and swings were not designed as sleeping places, so if your baby falls asleep in one of them gently remove him and put him flat on his back in his crib or in a portable crib or playpen. Sleeping in a sitting position can compress the baby’s chest, and if his head rolls forward his airway can become blocked. Making sure your baby sleeps lying flat on his back eliminates these concerns.

Help baby keep his cool
Keep your baby and the room temperature where he sleeps comfortable, not too hot. You’ll want to keep him from getting too hot because overheating is a risk factor for SIDS. Look for signs of overheating by observing that baby’s color is normal (not flushed), that his face does not feel hot to the touch, and that he is not sweaty. If your baby appears overheated, remove his blanket or take off a layer of clothing.

If your baby appears too warm, use a fan to circulate air in the room but be careful not to let the fan blow directly onto your baby. Lowering the room temperature can help keep your baby from overheating and promotes sleep comfort. As a general rule of thumb, a room temperature that is comfortable for an adult should be comfortable for a baby. A safe and comfortable room temperature range is 68-75ºF.

Be sure to keep your baby’s head and face uncovered! Using a light-weight receiving blanket tucked in along the sides and foot of the crib mattress can help keep your baby comfortably warm and prevent the blanket from coming loose and covering your baby’s head.

A sleep sack or wearable blanket that zips up the front and is stitched closed along the bottom is a safe alternative to a blanket. A sleep sack keeps baby cozy without the worry that baby’s face might become covered accidentally.

Breathe easier
Let your baby breathe air that has no traces of tobacco smoke. Cigarette smoke is made up of toxic gases and minute particles that have a harmful effect on your baby’s tiny lungs. Secondhand smoke doubles the chances of SIDS. Secondhand smoke also triggers allergies and respiratory illnesses such as asthma. A sleeping and living environment without cigarette smoke will not only help lower your baby’s chances of SIDS but also helps minimize the chances of your baby having an asthma attack or getting respiratory infections, earaches, and colds.

Do not allow anyone to smoke inside your home or car or near your precious baby! Ask people to smoke outside and to wash their hands before they hold your baby. Putting a “No Smoking” sign or sticker in your car or near your front door lets others know what to expect. It tells them that you care about the air both you and your baby breathe.

To bed-share or not?
Controversy swirls around the question of whether or not it is safe to let your baby sleep with you. Co-sleeping, co-bedding, or bed-sharing refers to the practice of sleeping with your baby.

Breastfeeding advocates support bed-sharing with the belief that the convenience of sleeping with a baby makes breastfeeding easier and encourages moms to breastfeed. But SIDS risk reduction advocates, including the American Academy of Pediatrics, warn against bed-sharing, citing that an adult bed poses dangers to a sleeping infant. In fact, many states, including North Carolina, have seen an increase in the number of infants dying suddenly and unexpectedly from SIDS and other causes in bed-sharing situations.

There has also been a rise in the number of accidental suffocation and strangulation deaths among bed-sharing infants as they slept with mom or dad. In 2004, in North Carolina alone, there were 22 accidental infant deaths from suffocation or strangulation associated with pillow use and bed-sharing. These deaths were not only tragic, they were likely preventable!

An alternative to bed-sharing is to “room-share,” a practice endorsed by the AAP and the national “Back To Sleep” campaign. With room-sharing you can let your baby sleep nearby, in a crib or bassinet in your room, instead of in the same bed with you. With their babies close by but in separate sleep places, parents can respond quickly when baby awakens for night-time feedings and diaper changes. Remember that successful breastfeeding does not depend on sleeping with your baby.

As you take your baby’s sleep safety into account, you’ll rest easier knowing that you’ve taken important steps to lower the risks associated with SIDS.

Prepare for child care
In addition to helping your baby sleep safely at home you can help ease your baby’s transition to napping in childcare by following the “Back To Sleep” guidelines. A handful of states have adopted infant safe sleep licensing requirements in childcare, and a growing number of childcare providers have adopted “Back To Sleep” as a professional standard.

For example, North Carolina childcare providers licensed to care for infants are required to place babies 12 months of age or younger on their backs to sleep. They are required to develop a written Safe Sleep Policy following state licensing requirements. They must also review their written Safe Sleep Policy with parents before a baby is enrolled in a licensed childcare center, and both parties must sign-off on it. Over 30,000 childcare providers throughout North Carolina have participated in the required Infant/Toddler Safe Sleep and SIDS Risk Reduction in Child Care (ITS-SIDS) training.

In other states, childcare providers are participating in an infant sleep safety training program developed by the AAP or the First Candle/SIDS Alliance. Like you, many childcare providers now know there are simple steps they can take that not only lower the chances of SIDS but put babies’ sleep safety at the top of everyone’s “To Do” lists.

Learn more
To learn more about sleep for newborns and older babies log on to:
http://kidshealth.org/parent/growth/sleep/sleepnewborn.html
http://kidshealth.org/parent/growth/sleep/sleep13m.html

You can read more about reducing the risks of SIDS at home and in childcare by visiting the North Carolina Healthy Start Foundation’s Web site at www.NCHealthyStart.org. Click on the links about the N.C. Back To Sleep Campaign and the childcare safe sleep training and licensing rules. Download handy and colorful pamphlets to share with others who care for your baby. Access national and international SIDS resources from this web site as well.

If you are a North Carolina resident, you can get free educational materials to share with other family members or babysitters that care for your baby by calling the NC Family Health Resource Line at 1-800-367-2229 or 1-800-FOR-BABY. You can talk with a health communications specialist in English and Spanish and request free educational materials.

The Consumer Products Safety Commission (CPSC) is a great source of information about crib, playpen, and bedding safety at www.cpsc.gov. The CPSC also keeps up-to-date recall information on sleep associated products and bedding.

Christine O’Meara, MA, MPH, is Campaign Coordinator for the N.C. Back To Sleep Campaign for SIDS Risk Reduction of the North Carolina Healthy Start Foundation (http://www.NCHealthyStart.org)

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