Another co-sleeping death; Another warning for parents

In light of news today of another infant death in St. Louis linked to bed-sharing, I wanted to bring back some tips I’ve shared in the past  about preventing Sudden Infant Death Syndrome (SIDS.)

SIDS, also known as “cot death” or “blue baby” is a devastating situation where a previously healthy infant dies in his or her sleep.  I know first hand how terrible SIDS can be; thirteen years ago I a lost a nephew to SIDS.  The good news is that SIDS is largely preventable!  The “ABC’s” of SIDS help us remember how to keep our babies safe while sleeping:

A: Babies should sleep ALONE.

B: Babies should sleep on their BACK.

C: Babies should sleep in a CRIB.

Rose CribI find that many parents have more questions about safe sleeping. What do I do when my baby learns to roll over?  How long should he sleep on his back?  What about bumpers and sleep positioners?  And so much more… I will answer these and other questions below.  Please feel free to continue this discussion with your own questions and comments.

“I like to sleep with my baby, especially when she needs to feed during the night. Is this safe?”

Sleeping with your baby in the same bed, or “bed-sharing” puts your baby at significant risk for suffocation. It is especially dangerous to sleep with your baby on a couch, a waterbed, or a bed with a comforter. Sadly, many babies die when they get wedged between a parent and a couch cushion or get their faces buried in bedding. As a breastfeeding mother myself, I know how hard it is not to co-sleep while breastfeeding. Breastfeeding itself reduces SIDS risk and has many other benefits to mother and baby, so please don’t let a fear of co-sleeping discourage you from breastfeeding! Bedside bassinets and other cribs can make life easier when your baby wakes frequently in the night for feeding. Be sure that your baby’s bed is SIDS safe, though. Many beds such as “Moses baskets” and beds with soft bedding and blankets are not safe. Several companies now make “co-sleepers,” three-sided cribs that abut the edge of a parent’s bed. Most co-sleepers meet safe sleeping recommendations. They are especially helpful for breastfeeding mothers.

“How long should my baby sleep on his back?”

The American Academy of Pediatrics recommends that babies sleep on their backs until they are one year of age.  As a mother, I know this is hard to accomplish!  Put your baby to sleep on his back from the time he is born and let him learn to be a back sleeper.  Do not let him sleep on his belly even if he is on your chest.  Do not let him sleep on his side.

“My baby rolls over when I put her to sleep on her back.  What should I do?”

Once a baby is able to roll from front-to-back and back-to-front, it is okay to let them sleep in whichever position they assume.  During the period when an infant is learning to roll over, it is especially important to be sure there are no blankets, bumpers, pillows or other suffocation risks in the crib.  It is also essential to put babies to sleep on their back, not their side.  Babies put to sleep on their sides learn to roll over onto their belly quickly, but often they are “stuck” and cannot roll onto their back.

“What if my baby spits up while he is sleeping on his back? Will he choke?”

No, neurologically healthy babies cannot choke on their own spit-up, even if they are sleeping on their backs. They may cough a bit but this is normal.

“I have a crib set with a bumper, blanket, stuffed animal and other matching pieces. Is it safe?”

No! Nothing goes in a crib except the baby and a tight fitting crib sheet! The “crib sets” marketed by many retail stores include many unsafe items. Never use a blanket in your baby’s bed except to swaddle the baby as described below. Bumpers are not recommended because many experts feel they are a suffocation hazard. Never put pillows, blankets, stuffed animals, or other objects in your baby’s bed.

“Can I swaddle my baby like they did in the nursery at the hospital?”

Yes, you may swaddle your baby tightly until he knows how to get out of his swaddling blanket, which usually occurs within the first month. “Wearable blankets” and swaddling blankets with Velcro closures are now highly recommended to keep your baby warm and safely swaddled. They can also help your baby sleep for longer periods of time at night, which means you get more sleep, too!   Be careful that your baby is not too warm.

“Can I use a sleep positioner or wedge?”

Sleep positioners and wedges are now considered suffocation hazards. Only a few years ago these were marketed as SIDS prevention devices, yet now they are known to be dangerous. If your baby spits up a lot or has been diagnosed with gastroesophageal reflux, you may consider raising the head of the crib mattress. Remember, nothing goes in the crib except the baby and a tight fitting crib sheet.

Additional resources regarding SIDS are available from SIDS Resources, a St. Louis-based not-for-profit network providing Missouri and surrounding counties with free bereavement services for Infant Loss and educational information relating to Sudden Infant Death Syndrome.

Kathleen Berchelmann, M.D. About Kathleen Berchelmann, M.D.

Kathleen M. Berchelmann, M.D., is a pediatrician at St. Louis Children's Hospital and Washington University School of Medicine, director of the St. Louis Children's Hospital Social Media Team, and co-founder of the ChildrensMD hospital physician blog. Her work has been featured in print and online publications including the St. Louis Post-Dispatch, the Chicago Tribune, and TIME magazine. She is a frequent contributor to Fox2 News STL Moms. Kathleen and her husband are raising five children.

Follow Dr. Kathleen Berchelmann on Facebook: ChildrensMomDocs Twitter: @MomDocKathleen and connect with her on .

Comments

  1. Dr. Berchelmann,
    I am unsure of your claims about just how unsafe co-sleeping/bed sharing is. What studies are you citing or do you base your rejection of bed sharing on? My research into this subject seems to indicate that safe cosleeping practices do not in of themselves increase the risk of infant death. In most, if not all cases, there was another contributing factor (usually unsafe sleep practice or another know risk factor for SIDS) present. Bed sharing was a standard practice until recently, in terms of human history, and I really don’t believe that putting a baby in a crib has been the mainstay in decreasing infant mortality. In fact, we have done so many things to increase the risk of the baby with the decrease in breastfeeding rates, and increases in smoking, obesity, and poor maternal-infant bonding. In is unfortunate that you base your conclusions of bed sharing based upon incidences that occur under unsafe practices, rather than seeing that the majority of co-sleepers do not have these issues. I highly recommend you visit this website. There is so much more to this debate and for parents to understand than simply “You should never co-sleep.”

    Most respectfully,

    Brian Burke M.D.

  2. Dr. Berchelmann,
    I am unsure of your claims about just how unsafe co-sleeping/bed sharing is. What studies are you citing or do you base your rejection of bed sharing on? My research into this subject seems to indicate that safe cosleeping practices do not in of themselves increase the risk of infant death. In most, if not all cases, there was another contributing factor (usually unsafe sleep practice or another know risk factor for SIDS) present. Bed sharing was a standard practice until recently, in terms of human history, and I really don’t believe that putting a baby in a crib has been the mainstay in decreasing infant mortality. In fact, we have done so many things to increase the risk of the baby with the decrease in breastfeeding rates, and increases in smoking, obesity, and poor maternal-infant bonding. In is unfortunate that you base your conclusions of bed sharing based upon incidences that occur under unsafe practices, rather than seeing that the majority of co-sleepers do not have these issues. I highly recommend you visit this website. http://cosleeping.nd.edu/ There is so much more to this debate and for parents to understand than simply “You should never co-sleep.”

    Most respectfully,

    Brian Burke M.D.

  3. I’m afraid you’ve given one piece of wrong advice in this otherwise excellent article.

    RE: what to do once your baby flips himself over, from the 2011 AAP position statement on SIDS, recommendation 1.d.: “Once an infant can roll from supine to prone and from prone to supine, the infant can be allowed to remain in the sleep position that he or she assumes.”

    The “Back to Sleep” campaign has always been about PUTTING your baby down to sleep on the back. It has never suggested that parents need to KEEP their children on their backs. Flipping a child back over and over once he learns to roll is not a part of any official recommendation.

  4. Dear Dr. Burke,

    Thank you for your comment, which highlights the crux of this very controversial issue of bed sharing. I am well aware of Dr. McKenna’s research. Dr. Sears, also, is a popular advocate of bed sharing. I applaud their efforts to improve maternal-infant bonding and breastfeeding. But I feel that the death statistics speak for themselves. In 2011, 57 Missouri infants died while sharing a bed with a parent according to the state’s Child Fatality Review program. And the risk of sudden death during sleep increases by 15 times when a parent sleeps in the same bed as an infant. It is true that substance abuse increases risk of bed-sharing death, as does sleeping with your infant on a couch. Parents should be specifically counseled about these risks. But many deaths were not associated with substance abuse or couch sleeping. I am sure you are already aware of the AAP’s statement on SIDS, which is actually hyperlinked in Dr. Benaroch’s comment above.

    I also appreciate your argument that humans have bed-shared with infants for most of antiquity. The difference today, however, is that modern American bedding is must softer and more prone to causing suffocation than the kind of bedding that has been used for most of antiquity. We also do not have statistics on how many infants died while bed-sharing through history.

    To promote breastfeeding and maternal-infant bonding, I personally recommend the three-sided “co-sleeper” cribs, a photo of which is included in my article above. This photo is of my own 4th child, and she is sleeping about 8 inches away from me, and out of the way of my soft adult bedding. It is easy to breastfeed even every 1-2 hours as needed, then simply place her back in her “co-sleeper” crib where I know she is safe and I can sleep soundly. And my feet never have to touch the floor. Of note, the American Academy of Pediatrics feels there is insufficient research to recommend for or against “co-sleepers.” I, however, do recommend them as a sort of compromise between bed-sharing and crib sleeping. I feel c0-sleepers really are the best solution to optimize breastfeeding and maternal-infant bonding while minimizing risks of suffocation/SIDS.

    Thank you, Dr. Burke, for your commitment and hard work towards infants and their families, and for taking the time to comment on my post.

    Warm Regards,

    Kathleen M. Berchelmann, MD

  5. Dear Dr. Benaroch,

    You are correct! I have corrected the post above to reflect the most recent 2011 AAP position statement on SIDS.

    This post is a slightly modified re-post of a 2010 article, which we put up a bit hastily so as to take advantage of today’s local news media coverage of bed-sharing death. We always try to take advantage of these tragic situations to promote safe sleep!

    Thank you so much for taking the time to read my article and make corrections– you are really keeping me on my toes!

    Warmly,

    Kathleen Berchelmann, MD

  6. Dear Dr. Berchelmann,
    I’m a little confused. In your article you state that crib bumpers should never be used because they are a suffocation risk. Then in the comments you mention that the photo in the article is of your 4th child sleeping in a cosleeper. There are bumpers 0n the bed in the photo. With all due respect, it seems inconsistent. If they are a hazard and you caution parents to never use them, why did you use them with your own child?
    Respectfully,
    Angela

  7. Dear Angela,

    You are very observant, and correct! Infant bumper data was contraversial and inconclusive at the time of my 4th child’s birth. I have gotten rid of the bumpers, now, as I await the birth of my 5th child. Thank you for pointing this out!

    Warmly,
    Kathleen Berchelmann, MD

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  2. [...] make be harmful.  Children (not infants) need to learn patience and self-control, gently.  Adult bed-sharing with infants is a known risk factor for infant suffocation.  Sleep-training for infants, which is discouraged by most attachment parenting proponents, does [...]

  3. [...] make be harmful.  Children (not infants) need to learn patience and self-control, gently.  Adult bed-sharing with infants is a known risk factor for infant suffocation.  Sleep-training for infants, which is discouraged by most attachment parenting proponents, does [...]

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