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Safe to Sleep

By Dr. Scott Hamilton
November 7, 2019

The parents put their four month old on their bed, for just a few minutes, to tend to the toddler. She was in the middle of the mattress, with rolled up blankets around, to prevent her from scooting over and rolling off. Minutes later, they returned to find baby pale and limp. She had rolled on her side up against the blankets, face in, smothered by the thick bedding. The parents gave rescue breaths, called 911, and baby was recovering by the time they got to the Emergency Department. But what if it had been only a few more minutes before she was rescued?

October was Safe to Sleep SIDS Awareness month, a national campaign to remind parents about safe sleep positioning for newborns. In the last 50 years, we’ve discovered a lot of “crib deaths” happened because babies smothered, either because they had been placed face down on thick bedclothes, or rolled over by sleeping parents. In 1994 the American Academy of Pediatrics had their first “Back To Sleep” campaign, encouraging parents to put babies to sleep on their backs, on thin mattresses, in their own cribs. Crib deaths rates plummeted.


Since then we’ve found other factors also contribute to unsafe sleeping. When my kids were infants, we but them on their backs, but on sheepskin, with bumper pads in their cribs so they didn’t hit the hard bed rails. Our kids survived, but those things are also smothering risks. Pillows, plush toys, thick and loose sleeper suits, are all hazards. One risk for crib death that’s 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 three 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 slumbers by a careless, perhaps drunken nurse or mother.” You don’t have to be careless or drunken, to commit this grievous error. Babies are exhausting, up all hours with dirty diapers, feeding and consoling. Falling asleep with baby still in parents’ bed, instead of moving him to his own bassinette, is a real possibility.


Safe to Sleep SIDS Awareness month, October, coincides with Halloween. In this spirit, doctors and nurses at Montreal Children’s Hospital invented a training tool called the Crib of Horrors. They place a CPR baby mannequin in a crib with numerous safety hazards. Then they hold a contest wherein staff from different units (Emergency Department, ICU, clinics, etc) name as many violations as they can find. The Crib of Horrors includes several things we discussed last week: piles of blankets near baby’s head that he could smother in, and loose pajamas that could cover his face. There’s also more hospital specific hazards, like coils of oxygen tubing that could strangle a rolling baby.

This exercise illustrates mistakes parents sometimes make when putting infants to bed. Though it looks cozy, a crib with heavy blankets, stuffed animals, pillows, and bumper pads is unsafe. And like oxygen tubing, strings that hold pacifiers, or necklaces, are strangling risks. Babies should sleep 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 crib death, but no strings attached! When babies get colds, they become noisy breathers, rattling at night, occasionally gagging and vomiting mucus.


Parents worry that baby might choke to death on secretions. To watch babies more closely, they violate the cardinal rule about not bringing baby into bed with them. Unfortunately, “watching baby” becomes “sleeping with baby.” After all, infants are exhausting. Like we mentioned last week, the smothering hazard of “co-sleeping” with baby has been recognized for centuries. We recommend “co-rooming,” where baby sleeps in a crib next to parents’ bed. Thus baby is watched without being in the adult’s bed where mattresses, bedding and the adults themselves become suffocation risks.


One of my less happy duties is attending the Child Death Review panels at the regional Health Department, where we examine all Acadiana’s child deaths and discuss prevention strategies. It’s heartbreaking to see a crib death wherein the parents just wouldn’t put their baby to sleep in her own bassinette, continuing to keep her in their bed with them, until tragedy struck. Preventable deaths- don’t let them happen to