By Karen Speropulos, PT, MPT, PCS
One of the most peaceful sights in all of life is to see a sleeping infant, eyes closed, breathing quietly. But, leaving a child to sleep can be scary for families sometimes, so it’s important to know the facts. We now know that there truly is a right way to lay infants down to sleep. Niswonger Children’s Hospital was just recognized by the National Safe Sleep Hospital Certification Program as a “Gold Safe Sleep Champion.” Our local children’s hospital prioritizes safe sleep and education regarding safe sleep for families. Everyone should understand, including grandparents, aunts, babysitters and all caregivers.
Approximately 3,500 infants die each year without any obvious cause; the leading cause of these deaths is SIDS, which accounts for approximately half of all unexplained infant deaths (Center for Disease Control and Prevention). While statistics can seem distant from our daily lives, once you have talked with one family who has lost an infant to SIDS, the number (and the preventative measures) are very real.
SIDS is defined as a “sudden, unexplained death of a baby younger than 1 year of age that does not have a known cause even after a complete investigation.” SIDS remains the leading cause of death among babies between 1 month and 1 year of age (most of these deaths occur between 1 and 4 months). Prior to 1992, there was not a clear message from the medical community regarding infant sleep. But in 1992, the “Back to Sleep” campaign began, and the American Academy of Pediatrics started educating others regarding safe sleep. Since this campaign, the cases of SIDS have decreased 50%. In 1994, 4,073 infants died from SIDS and only 27% slept on their backs while in 2009, 2,226 infants died from SIDS and 74% of those infants slept on their backs. This statistic alone should be convincing enough; it’s simply how we lay our children down.
Further guidelines from the American
Academy of Pediatrics include:
1. Always place a baby on his or her back.
2. Use a firm, safety-approved crib mattress with a tight-fitted sheet. Safe surfaces can include bassinets and pack-n-plays. Do not allow infants to sleep in a car seat, swing, or similar device.
3. Share the room, but not the bed. Keep an infant in the same room where you sleep.
4. Keep soft objects, toys, and loose bedding out of the crib. No bumper pads; as sweet as bumper pads look in a baby crib, they are a safety hazard.
5. Regular healthcare during pregnancy and avoiding smoking, alcohol and drugs decrease risk of a SIDS event.
6. Do not smoke around an infant.
7. Breastfeeding decreases the risk of SIDS.
8. Consider a pacifier during the infant’s transition to sleep.
9. Do not allow an infant to overheat
(too much clothing or heat too high). If an infant seems cold, the best way to warm him or her is through skin-to-skin contact.
Do not add extra blankets to bedding.
10. Do not use products claiming to reduce SIDS risk.
11. Infants should receive recommended vaccinations.
Choking: Many people are concerned about an infant choking while on their back. This is actually an “old wives tale” when one considers an infant’s anatomy. When a baby is in the back sleep position, the airway lies on top of the esophagus (the tube that carries food and liquid from the mouth to stomach). If the infant regurgitates, that fluid has a much greater chance of avoiding the airway while the infant is on his or her back versus when the infant is lying on his or her stomach.
Products: There are NO known products backed by the FDA, Consumer Product Safety Commission, or the American Academy of Pediatrics that can prevent a SIDS incident. If a company claims their product prevents SIDS, it is not a research-based statement and the previous organizations do not endorse any product. Surprisingly, this includes monitors or mattresses with monitors. There is not a monitor on the market that can guarantee the prevention of a SIDS event.
Keeping a baby on their back is important for safe sleeping, but there are many other reasons to make sure that infant has awake, alert tummy time. Tummy time is important for head shape and the prevention of a flat head. Babies learn head and trunk control while on their tummy. Because an infant must lift his or her head to see the world while on their tummy, there is an increased motivation to move. Tummy time also helps stimulate the sensory systems as infants feel and move differently while in this position.
At Niswonger Children’s Hospital, when infants leave the NICU, we often recommend families initially start with a goal of twenty minutes of tummy time per day. This is awake, supervised tummy time. It can be divided throughout the day such as five minutes in the morning, five minutes around noon, and ten minutes in the evening to equal twenty minutes total for the day. As the infant does this daily, early in life, parents can work toward allowing the infant to spend increasing amounts of active tummy time.
Tummy time can also be a sweet, fun time interacting with infants. If an infant is awake just after eating, this can be the perfect time for tummy time allowing the infant to pass any extra “toots” and “burps.” Five suggestions of how to do tummy time are as follows (Adapted from “Essential Tummy Time Moves” by Pathways.org):
1. TUMMY TO TUMMY. An adult can lie flat on their back on a the floor or couch placing the infant on the adult’s chest or tummy so the infant and adult are face to face. Be sure to hold infant securely and sometimes holding a little extra security on the infant’s bottom gives just enough stability so the infant can more easily lift his or her head.
2. ACROSS THE LAP. Holding an infant on his or her tummy across your lap. Provide a hand on your baby’s bottom to help steady and soothe.
3. CARRYING ACROSS THE ARM. Place your hand under the infant’s torso and tummy with your arm between the infant’s legs. Snuggle the infant close to your body.
4. USE A TOWEL ROLL. With the infant on his or her tummy, place a rolled up hand towel under the infant’s chest and arms to give an extra help to the infant for lifting the head. Place toys, or your face, eye level to motivate the infant to lift his or her head.
5. JUST ONE MINUTE. Everytime you change an infant’s diaper, roll the infant onto their tummy for just one minute as you clean up. If the infant
doesn’t like it, it’s only for one minute and, over time, the infant will build strength and develop tummy time skills.
Having an infant is such a precious time in the life of a family. These tips are intended to provide facts to increase the safety and development of babies so that families can truly enjoy the miracle of having such a blessing in their lives.
Resources and research information available upon request. Please email me, or talk with your pediatrician, with questions/concerns regarding safe sleep and active, awake tummy time. firstname.lastname@example.org
Karen Speropulos, PT, MPT, PCS is a pediatric physical therapist at Niswonger Children’s Hospital.
What exactly does safe sleep look like? The easiest way to remember is:
“A”—Alone: Babies should always sleep alone and not in a bed with anyone else, where a baby could be smothered.
“B”—Back: An infant should always be placed on his or her back.
“C”—Crib: Always place the infant in a Crib with a firm mattress and close-fit sheet.