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Safest sleep for babies

Sudden infant death syndrome has been cut in half since a 1994 safety campaign urged parents to put babies to sleep on their backs. But there’s still danger.

Sudden infant death syndrome has been cut in half since a 1994 safety campaign urged parents to put babies to sleep on their backs. But there's still danger. SIDS is still the top cause of death in young babies – and rates are holding steady. In addition, suffocation deaths in babies less than a year old have risen 54 percent in recent years, according to a new CDC report on injuries in kids.

Big causes of both are risky sleeping arrangements. A new study that looked at 568 SIDS deaths in California between 1991 and 2008 found that deaths in infants put to sleep on their side rose from 7 to 17 percent. And deaths in which babies were sharing a bed with an adult increased from 19 to 38 percent. Meanwhile, suffocation deaths have risen four-fold in the past 20 years – due to soft bedding in a baby's crib or bassinet, an adult rolling over or up against an infant while sleeping, or a baby becoming trapped such as between the mattress and a wall or between the bars of a crib.

What can parents and caregivers do to protect babies when they go to sleep? I asked Adam P. Richards, M.D., director of Pediatric Emergency Services at Kennedy University Hospital in Washington Township, N.J.  Here's his advice:

Q: Have you seen this tragedy in the emergency room?

A: Yes. I have attempted to resuscitate at least two infants whom I suspect died of accidental suffocation, although the younger of the two may have been SIDS. One was a newborn found unresponsive in bed with his mother.  The other was an older infant, around 6 months of age who was found unresponsive while at home in bed with a family member. Neither child could be resuscitated.

Q: What should parents of a newborn or infant know about making a crib or bassinet safe?

A: Soft mattresses, thick blankets, crib-bumpers, soft toys, and positioning wedges are all unsafe. However, swaddling your baby in thin cotton blankets and dressing infant in appropriately warm clothing are safe.  It is true that you don't want the infant to be uncomfortably cold, but remember that over-heating is thought to be a contributing factor to SIDS.  And remember, your baby is perfectly comfortable on a firm mattress.

Q: Bed-sharing with a baby is popular these days, especially for nursing mothers. I admit I did it myself for a while. But is it ever really safe?

A: There is also nothing wrong with nursing an infant while in bed with mom. And breast-feeding is actually protective against SIDS.  However, when mom is ready for sleep, the infant should be placed back in the bassinet or crib. Although our prehistoric ancestors may have practiced bed-sharing, one must acknowledge the difference in the "beds."  Sleeping next to your infant on a matt or on the floor is not equivalent to sleeping in a typical bed found in the U.S. today. The combination of softer bedding and large disparity between parent/infant size could account for the increased risk. Whatever the case may be, for parents whose bed-sharing caused or contributed to the death of their otherwise healthy infant, the tragedy is profound and eternal.

Q: What about putting a baby to sleep somewhere other than her own crib— in an adult or kid's bed, on a sofa with pillows and blankets. If you're not at home, what's a good option?

A: Sleeping on a sofa or bed surrounded by pillows increases risk of sudden infant death. A portacrib that meets safety standards is probably best. I don't recommend putting babies to sleep in their car seat – sleeping in this position can cause the neck to flex and the head to fall forward. This can obstruct a baby's airway, especially in a premature infant.

Q: And putting a baby down to sleep on his or her back is still the best position?

A: Yes. Sleep in the supine position (on the back) has almost certainly had the most profound effect on reducing SIDS. There is a myth among some parents that sleeping on one's back increases risk of choking.  This is, in fact, only a myth. One notable recent clarification in sleep recommendations for babies is that "side-sleeping" is no longer an acceptable alternative to supine position. Side-sleeping is statistically similar to prone position (putting a baby to sleep on her tummy) in terms of increasing the risk of sudden infant death.

You'll find more information about safe sleep here.

And tell us what you think. How do you put your baby to sleep?