Safe sleep for baby is flat — not inclined
© 2019 Roy Benaroch, MD
In June, 2019, Fisher-Price recalled almost 5 million of their “Rock ‘n Play Sleepers”, after publicity surrounding dozens of deaths. Pediatricians and other advocates had been saying these things were unsafe for years – at least one blogger even tried to warn the company directly, six years before the recall — but a lack of oversight and formal safety testing kept them on the market for far too long.
It was clear that the device prevented parents from being able to put their babies to sleep in a safe way, following the guidelines of the AAP. Babies, for safest sleep, should always be put down flat on their backs on a firm, flat surface.
Now, a new study (summarized here, details here under “Tab B”) has added even more weight to the evidence. It turns out that even a small inclined angle, raising the head even slightly, dramatically changes the way a baby can breathe, potentially causing death. The bottom line: these researchers showed that an incline of greater than 10 degrees makes sleeping less safe. So what’s ten degrees? Less than you’d think.
I’ll use an ordinary cookbook and my fingers to demonstrate. Here’s a firm, flat surface, at zero degrees – completely flat, which is the recommended way for babies to be put down to sleep:
If I put one finger under the edge, the book is at 5 degrees. This is just a tiny little angle, and the new study shows this slight incline is probably still safe:
But just two fingers reaches 12 degrees, above the unsafe threshold:
Three fingers gets you to 17 degrees:
And if I stick my whole hand under one edge, the book is at 30 degrees – the angle the recalled Rock n Play sleeper was designed for:
From the photos you can see that anything beyond the slightest angle is unsafe. And these “inclined sleepers”, like the recalled Rock n Play, went way beyond that. They were unsafe for other reasons, too – their sleep surfaces were not firm, and they surrounded the baby with soft cushy material. No wonder babies died.
Please, put your babies down to sleep on a firm, flat, not-inclined surface. If you’ve still got an “inclined sleeper”, return it or destroy it (don’t give it away or donate it!) Be safe!
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The Pediatric Insider 
November 22, 2019 at 1:18 am
Hi Dr. Roy, both of my twins had horrible GERD. At two months of age, my son had an ALTE (caused by the GERD). Several pediatricians recommended inclined sleep for my son – such as an incline pillow underneath his mattress, raising one side of his crib slightly, and even placing a small sack of rice to bolster him at an incline. I’m concerned that all of this advice was bad. What would your recommendation be? We want to expand our family, and I want to know what to do if we have another baby with GERD. Even the hospital had an inclined crib when my son was there after his ALTE, and after both kids were born, the other hospital put their basinets at an incline…
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