Dr. Allen Cherer focuses on how promoting safe sleep for infants is beneficial to your child's needs.

1. Promoting
Safe Sleep
for Infants
Dr. Allen Cherer

2. Very few life events result in the anguish that
comes with the death of an infant, especially
one that is sudden and unexpected. Each year
in the United States, approximately 3500
sudden, unexpected infant deaths (SUIDs)
occur generally between the ages of 1 month
and 1 year at a time when most infants sleep
between 12 ‐18 hours/day.

3. They consist of three main types with Sudden
Infant Death Syndrome (SIDS) being the
predominant one, and deaths due to
unknown causes and those due to accidental
suffocation and strangulation in bed (ASSB)
comprising the remainder.

4. The combined SUID death rate declined
markedly following the 1992 American
Academy of Pediatrics infant sleep
recommendations and the initiation of the
Back to Sleep campaign in 1994 with a
primary focus on supine positioning during all
infant sleep.

5. The combined SUID death rate decreased
again slightly in 2009, and since that time has
remained fairly constant. On the other hand,
the ASSB, traditionally the least common of
the three main causes of SUID, mortality rate
remained unchanged until the late 1990s and
has started a slow increase with its highest
point in 2014.

6. Due in part to the success of the Back to
Sleep campaign and to the increasing
incidence of other sleep‐related causes of
SUID, the American Academy of Pediatrics
broadened its focus since 2005 to include
other factors resulting in an unsafe sleep
environment and contributing to sleep‐
related infant deaths.

7. It is important to remember that the
recommendations from the Safe to Sleep
campaign are wholly derived from case‐
control studies and are based for the most
part on epidemiologic studies including infants
up to 1 year of age. The recommendations
should therefore be applied to infants up to 1
year of age, except for those individuals in
whom medical conditions warrant
modification.

8. When it comes to safe sleep environment,
remember the phrases “Back to Sleep”, “Bare
is Best”, and “Room‐sharing without Bed‐
sharing”. The basic underlying point to
promote a safe sleep environment starts with
every caretaker positioning every healthy
infant on his or her back for every sleep.

9. Protective airway mechanisms prevent
choking and aspiration. Only those infants
with significant upper airway disorders
warrant modification. Side sleeping is not
recommended, and elevation while supine can
be complicated by respiratory compromise if
the infant’s position changes.

10. Preterm infants requiring prolonged
hospitalization should also be maintained in
the supine position during sleep when they
are medically stable and long before they are
ready for discharge to home.

11. Although the general recommendation pertains to
infants up to one year of age, once an infant is
capable of rolling from supine to prone and vice
versa, the infant can remain in the sleep position that
he or she assumes. Since infants spend almost all of
their time in a crib, bassinet, or play yard, these
environments are especially important. Many infant
deaths are associated with broken cribs with loose or
missing parts.

12. Cribs should be no older than ten years and
conform to the safety standards of the Consumer
Product Safety Commission. Before use, the
product should be checked for previous recall.
Cribs require narrow slats and stable sides. Since
2011, federal safety standards prohibit the sale of
drop side rail cribs. Specific mattresses designed
for the crib should be firm and covered with a fitted
sheet.

13. There should be no gaps larger than two finger
breadths between the mattress and the crib. Soft
materials or objects, such as pillows, comforters, or
sheepskins even when covered with a sheet ,
should not be placed under a sleeping infant.
Research shows that babies who sleep on soft
surfaces which allow the baby’s head to sink into
the surface are at higher risk for SIDS and
suffocation.

14. If an infant falls asleep in a sitting device,
such as a car safety seat, stroller, swing, or
infant carrier, he or she should be removed
from the product and moved to a crib or
other appropriate firm flat surface as soon as
practical.

15. When infant slings or cloth carriers are used, the
infant’s head should be up and above the fabric, the
face visible, and the nose and mouth not obstructed.
The crib surface should be free of stuffed animals,
pillows, toys, bumper pads, or blankets to reduce the
risk of suffocation or entrapment. The crib, bassinet,
or play yard should be positioned away from wall
hangings, and the area should be free of blind and
curtain cords which can result in strangulation.

16. Room‐sharing without bed‐sharing is recommended
and is most likely to prevent accidental suffocation
especially from overlaying, strangulation, and
entrapment that might occur when an infant is
sleeping in an adult bed. Soft mattresses, pillows,
quilts, and loose bed linens provide a high risk
environment for infants. Certainly, infants can be
brought into the bed for feeding or comforting but
should be returned to their own crib or bassinet
when the parent is ready to return to sleep.

17. Epidemiologic studies have demonstrated
increased risks for SIDS and suffocation when bed‐
sharing involves infants less than three months of
age, other children or multiple persons, and
caretakers who are excessively tired, current
smokers, or are using medications or substances
that impair alertness or ability to arouse. It is best
to provide separate sleep areas and avoid co‐
bedding for twins and higher multiples in the
hospital and at home.

18. Certain sudden, unexpected infant deaths are not
preventable. Continuing research particularly
related to SIDS will provide new insights into the
mechanisms resulting in this tragedy. Nevertheless,
vigilance in attending to those modifiable
environmental risk factors is highly desirable.