Cozy Does Not Equal Safe

She thought she was doing the right thing.  She was leaving baby for two minutes to get her toddler dressed.  She put the 4 month-old in the middle of the bed and rolled up blankets around the edges in case baby scooted over, so baby wouldn’t fall off.

Minutes later she came back, finding baby against one of the blanket rolls face- in, pale and limp.  She screamed for her husband to call 911, snatched up baby, and began rescue breaths.  When the paramedics arrived, the infant was breathing. When they got to me in the Emergency Department, baby was still groggy but awake, and we all heaved a sigh of relief.  And shuttered to think, what if mom had been another few minutes…..

October is SIDS Awareness Month.  SIDS is Sudden Infant Death Syndrome, sometimes called crib death, wherein babies are put down to sleep and found dead.  In the last 50 years it was surmised that many of these deaths were from smothering, babies often being found face down in thick bedclothes.  Two decades ago the American Academy of Pediatrics began it’s Back-To-Sleep campaign, encouraging parents to put their babies to sleep on their backs.  The SIDS death rate plummeted.

Since then we’ve found other factors in crib deaths.  When my kids were infants, my pediatric-nurse wife and I put them to bed on their backs, but on sheepskin, with bumper pads in their cribs.  We also placed stuffed animals with them.  My kids survived, but those things are now on the danger list too. Sheepskins, bumper pads, quilts, plush toys, and pillows are all smothering risks.

One risk for SIDS that has been known for centuries is co-sleeping, or sleeping in the same bed or couch with baby.  Even medieval societies recognized this smothering risk. Germany had a law in the year 1291 forbidding women from taking children under 3 years-old into bed.  In 1862, the English Women’s Journal warned, “Nor must we forget a frequent and lamentable cause of death that in which the infant is “overlaid” in its slumbers by a careless, perhaps drunken nurse or mother.” 

SIDS Awareness Month in October coincides with another fall tradition, Halloween.  In this spirit, doctors at Montreal Children’s Hospital invented a training tool they called the Crib Of Horrors.  They placed a CPR baby mannequin in a crib with numerous safety hazards, and held a contest wherein staff from different units (Emergency Department, ICU, clinics, etc) would name as many violations as they could find.  The winner was the team that found the most hazards.

They included several things we discussed above: piles of blankets near baby’s head that he could smother in, loose pajamas that could cover baby’s face, and other articles in the crib that could suffocate.  There were also more hospital-specific violations, like coils of oxygen tubing that could strangle a rolling baby.

The Crib Of Horrors illustrates mistakes that parents often make when putting infants to bed.  Though it looks cozy, a crib with heavy blankets or quilts, stuffed animals, pillows, and bumper pads is unsafe.  And like the oxygen tubing, strings that hold pacifiers, or necklaces, are strangling risks.

Babies should sleep in on their backs, face-up, in a thin, one-piece sleeper, on a thin mattress with a fitted sheet. Pacifiers have recently been shown to be protective against SIDS, so they’re okay.  But no strings attached.

When babies get colds, they become noisy breathers, rattling and snorting at night, occasionally gagging and vomiting mucus.  Parents become worried that baby may choke to death on secretions (which actually is NOT a SIDS risk).  To watch baby more closely, they violate the cardinal rule about not bringing baby into bed with them.  Unfortunately, “watching baby” often becomes “sleeping with baby.”

Like we mentioned above, the smothering hazards of “co-sleeping” with infants has been recognized for centuries.  We recommend “co-rooming”, where baby sleeps in a crib next to parent’s bed.  Thus baby is watched without being in the adult’s bed where pillows, blankets, thick mattresses, and the adults themselves become smothering risks.

Cozy does not equal safe when it comes to sleeping babies.  Keep infants on their backs, even if they have colds- babies are designed to handle congestion and reflexively keep their airways clear lying face-up.  Be sure your infant’s bed doesn’t become a Crib Of Horrors. 

Rockabye Baby. Safely.

We see a lot of little babies in the Emergency Department when they get their first colds. They cough and are congested, have noisy breathing, gag and hack on mucus, and sleep miserably.  When I talk to the parents about what to do, I ask, “So where does baby sleep?”  I usually get a sheepish look and a guilty smile and mom admits, “with me.”

Then I take the opportunity to talk about sleep safety and Sudden Infant Death Syndrome (SIDS).  I talk about how baby should sleep on his back and be in his own crib or bassinet, how sleeping in bed with others is a smothering risk.  The parent often says that when baby is sick, they bring him in bed with them so they can watch that he is okay. Yes, I go on, that seems to make sense, but is the exact wrong thing to do with a sick baby.

October is SIDS Awareness Month.  The CDC, the American Academy of Pediatrics, and many other experts are getting the word out- keep baby safe!  SIDS happens when babies suffocate while sleeping.  They smother when they are face down in thick bed clothes or regular mattresses.  They smother when in parents’ bed by getting their faces stuck up against heavily sleeping adults, or when they slip between the mattress and a wall. Napping with babies on couches is dangerous too- there is even less room for the adult and a clear space for babies’ faces, and the cushions are even softer and easier to smother in.  Babies can also smother in their own cribs if there is too much soft stuff with them- thick blankets, sheep skins, stuffed animals, pillows, or bumper pads.

When babies gets their faces into something too soft to breathe through, they suffocate. And babies under 6 months old cannot rescue themselves.  They do not have enough arm control to push away from a smothering situation.  They can’t do a push-up when face down on a thick mattress, blanket, or pillow.  They can’t roll over purposefully yet. Their brains and nervous systems aren’t mature enough for such maneuvers.

What about our mom from above who brings her congested baby into her bed to watch him? If she is watching baby, doesn’t that protect him from smothering?  Unfortunately not. Too often “watching baby” becomes “sleeping with baby.” You’ve seen the old comedy routine in movies or on TV, where the character must stay awake to watch something, only to be overcome by sleep, and then be caught snoozing.  Well, this happens in real life when mom and baby are warm and snug in bed together.

This is one of those cases where what seems better is shown by science to actually be worse.  Statistics show that sharing the bed with babies is much more dangerous, particularly when they are sick.  So how do you watch baby without sharing the bed? Pull that bassinet up next to your bed!  That way baby is safe in his own crib, and you can watch him from your bed.

Here are the rules then, to prevent SIDS.  As above, baby sleeps in her own bassinet or crib. Baby sleeps on her back, face up.  Baby sleeps on a firm mattress that is specifically designed for babies.  Baby should sleep dressed in a onesie, so no pajamas shirts can ride up over her face.  If you must put a blanket in bed with baby, make it a thin one that is tucked in at the bottom of the bed, again to minimize the chance of it riding up over baby’s face.  And definitely no pillows, stuffed animals, or bumper pads. These things make baby’s bed cute, but they also are suffocation risks.

Some moms try to compromise on baby position by putting their babies on positioners or “boppy” pillows.  Unfortunately, the safety of these has not been established.  So play it safe with baby, keep baby in his own bed with minimal padding.  Put baby to sleep on his back.  You and baby may be more restless on a given night, but in the long run you both will sleep much more soundly.  And safely.





Spread The Word: Babies Sleep On Their Backs!

There has been an unusual number of crib deaths in Acadiana recently.  Crib death, or SIDS (for Sudden Infant Death Syndrome) is a rare but devastating event where baby is found in bed dead for no apparent reason.  We in the Emergency Department hate these cases because there is nothing we can do when the baby comes in- our resuscitation efforts are far too late to help.  All we can do is help to get the word out to prevent these tragedies from happening.

What happens in a SIDS case?  How does baby die?  To put it simply, the baby smothers to death.  They suffocate when they are face down in thick bed clothes, like pillows or soft mattresses.  They get caught with heavy blankets over their faces.  They get stuck under a heavily-sleeping adult.  Newborn babies and young infants do not have enough coordination and strength to rescue themselves from these situations.  They can’t do a push-up or roll over to recover from face-down smothering.  They can’t use their arms well enough to push blankets or pillows off their faces.  And they certainly can’t push an adult off themselves.

In the past two decades, the American Academy of Pediatrics has been trying to get the word out so that parents can prevent these tragedies.  The campaign was first called “Back To Sleep,” meaning that babies should sleep on their backs, not on their tummies.  That way their faces stays clear of pillows and soft mattresses.  There should not be pillows, thick blankets, or stuffed animals in the baby’s bed- these are all smothering hazards.  Baby should not share a bed with adults, other children, dogs, or cats.  The old tale of cats stealing babies’ breath has some truth.  However, the cat does not “steal” the baby’s breath through some supernatural means.  They merely smother the babies when they snuggle up next to them for warmth and accidentally cover the babies’ faces.

Many parents already know these rules, but break them when baby gets sick.  When baby spits up or has a cold, they bring baby into bed with them at night to “watch” them more closely.  Unfortunately, this “watching baby” becomes “sleeping with baby,” as the exhausted new parent finds it impossible to stay awake.  Then the parents and their soft beds becomes a suffocating risk.

Parents also worry that colds and spitting up will clog babies’ airways.  It seems to make sense that when babies lie on their backs, they might choke to death on vomit or mucus.  So besides putting babies in bed with them, they are also tempted to put baby to sleep on their stomachs.  Again, this seems to make sense, as a baby who lies prone can let the secretions and vomit just run out their mouths.

However, like many things in science, what seems to make sense turns out to be more dangerous.  Babies sleeping on their tummies doubles their risk of crib death, colds or vomiting or not.  Babies actually seem designed to handle vomit and secretions when they lie on their back.  Sure, they cough and gag and make choking sounds.  But these are the sounds of the reflex to clear their airways.  They cough out the secretions and gag but then swallow, and clear their airways themselves.

So help us get the word out, since not every parent has heard or heeded the message: Babies should sleep on their backs.  They should sleep alone.  They should sleep on a firm surface with only thin blankets.  No pillows, stuffed animals, or crib bumpers.  And if you want baby closer to you at night, pull his or her bed up next to yours, but keep baby in that safe bed.  I am counting on you to do the right thing, and so is baby!



Go Back To Sleep, Baby

When we bring a new baby home, we want to do everything to make our new family member comfortable.  We got a sheepskin as a shower gift- put it under baby!  Cover her with an extra blanket- don’t want her to get chilly.  Put some stuffed animals in the bed with her- it makes her so much cuter.  Uh oh she is crying- there, she is sleeping quieter now when I roll her on her stomach.  Still crying-I’ll bring her into bed with me. I’ve got to feed her in a half hour anyway.

Sounds great, right?  Unfortunately, everything I just mentioned doubles baby’s risk for crib death, or Sudden Infant Death Syndrome. SIDS is a rare but devastating event, where baby is found in bed dead for no apparent reason.  In the past two decades it has been discovered that crib death happens when babies smother.  Their faces get stuck in thick and soft bedding, or stuck under a heavily sleeping adult, and new babies don’t have the ability to roll over or do a push-up to save themselves.  In fact, babies really can’t save themselves until they can sit up on their own, which usually doesn’t happen until after 6 months of age.

The American Academy of Pediatrics rolled out their “Back To Sleep” campaign 20 years ago.  The idea was to let every new family know that babies should sleep on their back.  Since then, the rate of crib death has fallen by 50%.  Besides having babies sleep on their backs, cribs should have no sheepskins, thick blankets, bumper pads, quilts, stuffed animals or toys, or pillows.

Babies should sleep only in cribs.  Babies in beds get accidentally smothered by sleeping adults, or shoved to a corner where they get stuck between the bed and a wall.  Also, babies should not sleep on couches with adults.  My last crib death case happened when a father took a nap with his new baby on a couch, and when he woke up baby was dead, suffocated face down between him and the cushions.

Finally, a lot parents are worried that if baby is on his back, he may choke on saliva or spit-up.  Not to worry!  Babies have been designed to handle spit up or mucus by coughing, gagging, and swallowing, to protect and clear the airway.  No baby with a normal brain and reflexes has died from choking on mucus or spit up.

So put that baby Back To Sleep, on his back.  Feel free to use a pacifier- new evidence suggests that pacifiers are protective against SIDS, and help babies sleep quieter on their backs.  Resist the temptation to fill the crib with soft stuff you think will make baby more comfortable- that only makes it more dangerous.  Then after feeding baby at night, put him Back in his crib, where he belongs.