Infant recliners kill babies

The Pediatric Insider

© 2014 Roy Benaroch, MD

Last time I objected to an infant recliner, I got all sorts of colorful comments*. I was even accused of having a “personal vendetta” against one of them, because I said that they’re not appropriate or safe to use as routine sleepers for babies. Of course, most of the time, having your baby sleep semi-upright in a cushy sling will probably work out fine. Most of the time. Until it doesn’t.

The “Nap Nanny”, sold between 2009 and 2012, was one of those baby recliner-things. It was sold as a way to help babies sleep. Predictably, what happened happened: babies died. Six of them became entrapped or otherwise suffocated in the “Nap Nappy,” or in another version called the “Nap Nanny Chill.” It was recalled last year, but they’re still out there and in use. Another baby just died in it.

We know the safest way for babies to be put down to sleep is flat on their backs, on a firm surface. Not semi-upright, or in a sling-shaped thing. Once babies can roll over on their own, they should be allowed to do so, without straps or other devices to hold them in place. I don’t know how all of the babies died in the Nap Nanny, but the most recent case I linked to seems to have involved entanglement in the straps.

Using a recliner or car seat or similar device as a routine sleep positioner is a mistake. It will probably work fine, most of the time—very much like driving with your child in your lap instead of a car seat. Or not getting vaccines on time. Those decisions, most of the time, will work out fine. Until they don’t.

*Most of the comments objecting to my last article on sleep positioning were from families with babies had specific medical diagnoses, and were told to use a reclined position for sleeping by their docs. I’m not addressing babies with special situations or diagnoses here—I’m talking about ordinary, healthy babies.

 

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12 Comments on “Infant recliners kill babies”

  1. Sarah Says:

    What are your thoughts on the Fisher Price Rock ‘n Play? I’ve heard many parents use this in place of a regular bassinet and they loved it. They also said it helps baby with reflux. Are these safe? Getting ready for second baby and was considering using this. I know a lot of parents also swore by putting baby in a swing during the night (turned off). I’m not sure if these are considered recliners or not but would appreciate your feedback.

    http://www.fisher-price.com/en_US/brands/babygear/products/51903

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  2. Jb Says:

    Dr. Roy has an entire post on the Rock n Play. In fact, it’s the post he is referring to in this post, and it’s the link in the very first sentence above. Here it is again. https://pediatricinsider.wordpress.com/2013/04/29/the-fisher-price-rock-n-play-sleeper-is-not-for-sleeping/

    His thoughts? Don’t use it. Read the post at the link.

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  3. Jb Says:

    And I think the swing idea is also a bad idea. Baby should be flat on his or her back on a firm surface, as Dr. Roy mentions above.

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  4. MJ Says:

    The rock n play is much different from the Nap Nanny, though. It has firm sides and ventilation, and you can’t put it in a crib or on a table, and the sides are much higher to avoid entrapment. When you see it in person you can tell it’s basically a bassinet with a bit of an incline. And also there are no reported safety issues despite its wide usage – unlike the Nap Nanny, which has an incredibly shocking fatality rate for a product.

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  5. MJ Says:

    Also, the CSPC seems to have a process underway to design voluntary standards for inclined infant sleepers. Not sure how the results will apply to the Rock n Play.

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  6. Dr. Roy Says:

    There has been a Rock -n- Play recall, but it had nothing to do with the recline. It was about a potential for mold growth.

    MJ states that the the Rock -n- Play is different from the Nap Nappy, and it is different in many ways. However, it still fails to meet the AAP recommendations for safe sleep: it is not a firm surface, and does not allow baby to be put flat on the back in a supine position. We do not know if the Rock -n- Play reclined/soft sling position is unsafe, but we do know that reclined sleeping in other contexts increases the risk of SIDS, plagiocephaly, and developmental delay. Fisher-Price is marketing this as a sleep thing, and time will tell if it turns out to be unsafe. I do not recommend performing this experiment on your own baby.

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  7. Dr. Roy Says:

    MJ is referring, I think, to this CSPC rulemaking effort: https://www.cpsc.gov/en/Regulations-Laws–Standards/Federal-Register-Notices/2013/Safety-Standard-for-Bassinets-and-Cradles/.

    Note in this section of the proposed rule verbiage limiting rest angle to 7 degrees: “For this reason, a 7-degree rest angle is a reasonable and achievable requirement for bassinets that will address suffocation hazards associated with an angled sleep surface.” 7 degrees is far less than the Rock-n-Play, which to my eyeballing seems to old Junior at about 30 degrees. I cannot honestly tell from the document if this is going to be a “rule” or a “guideline”, or when or if it will ever be enforced.

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  8. Dr. Roy Says:

    Sarah, swings are absolutely not for sleeping, and especially not for routinely sleeping all night. Nor are car seats, or rockers, or bouncy seats. The safest sleep position is on a firm, flat, horizontal surface.

    http://aapnews.aappublications.org/content/34/1/25.5.full

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  9. Kerry Says:

    Do you advise against allowing babies to fall asleep in the car? I drove many long journeys to and from my husband’s military base when my son was newborn and he usually slept all the way there. If he didn’t nap the whole time he would scream the whole time. (You can imagine which I preferred.) Once when we arrived at our destination I found him with his head slumped forward and it gave me a fright. If it’s considered dangerous to leave a baby to sleep in a car seat all night it stands to reason it’s better not to let them sleep in them any time(?) not sure how you would get around that without pulling over every five minutes to check on them or having someone sit in the back with them.

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  10. MJ Says:

    Dr. Roy, that’s actually a separate rulemaking for bassinets that may rock from side to side. I think the 7 degree angle they’re talking about there is side-to-side, so the baby doesn’t roll into the side. Not an incline.

    The other proceeding I was mentioning is specifically about inclined sleep devices like the rock n play. I think that CPSC is participating in an ASTM standard-setting proceeding, which would be voluntary, not governmental/mandatory: http://www.astm.org/DATABASE.CART/WORKITEMS/WK45274.htm.

    In any event, I appreciate your fundamentalism on this point. I put my infant in a rock n play and never felt great about it, but felt like he needed it to sleep. It would be great if peds could give better advice about how to cope with infant sleep on their backs. It seems clear that infants sleep worse on their backs, alone, and so the unintended consequence is that parents resort to these devices. Honestly, tummy sleep has got to be a safer alternative than the Nap Nanny.

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  11. Volyund Says:

    Dr. Roy, what are your thoughts on inclined sleeping for an infant with a severe congestion?
    My 4 months old daughter had cold, and developed severe congestion. We used Nose Frida on her to suck out as much snot as we could, but she would still wake up crying every hour at night not being able to breathe through her nose. The next day we called our Pediatrician, and she recommended letting her sleep in a car seat. Lo and behold, she was able to sleep for 3-4 hour stretches for the next two nights, until she got well enough to put her back in the flat crib.

    And about R’n’P, I’ve read your post, and while I agree that recommendations are clear, they just didn’t work for us. My daughter developed reflux at 1 month, severe enough to interfere with her eating (it’s pretty scary when your 4 week old suddenly refuses eating after 2min, and screams arching her back any time when laid horizontally). When we went to the doctor, she got a prescription of ranitidine, and recommendation that we put her to sleep at 30 degree incline, preferably R’n’P (as wedges in a crib present dangers too, at least R’n’P has 3 point harness). So there she slept until she outgrew her reflux at 4 months.

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  12. KT Says:

    I know I am late to this, but I wanted to support the prior commenter who said,

    “In any event, I appreciate your fundamentalism on this point. I put my infant in a rock n play and never felt great about it, but felt like he needed it to sleep. It would be great if peds could give better advice about how to cope with infant sleep on their backs. It seems clear that infants sleep worse on their backs, alone, and so the unintended consequence is that parents resort to these devices. Honestly, tummy sleep has got to be a safer alternative than the Nap Nanny.”

    My oldest daughter had a terrible Moro reflex up until she could bust out of any and all swaddling products (and get them up over her face) and after we dropped the swaddle. As a newborn she adored tummy time and her grandparents routinely commented how much she would have loved tummy sleep. It seemed like for every sleep problem of hers that came up – and there were tons to the point where she was waking up multiple times in a single sleep cycle – tummy sleep would have been an answer, but because we followed the AAP recommendations to the letter, we did not do it.

    The result? She had to be sleep trained in a process that involved far too many of her tears and far too much overtiredness. I ended up vomitting and ill from sleep deprivation. It was awful.

    Normal, healthy babies have serious sleep problems. Pediatricians talk about the difficulties of sleep deprivation in babies too. Where’s the balance? Where’s the compassion for families struggling to take care of their babies while maintaining enough rest for the entire family? Babies don’t read the AAP guildelines in-utero.

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