Mixed messages: Where should babies sleep?

The Pediatric Insider

© 2017 Roy Benaroch, MD

A new study about the best place for babies to sleep – in their own rooms, or sharing a room with their parents – contradicts current AAP guidelines. But hopefully, in the long run, it will help more parents and babies get a better night’s sleep overall.

The most recent “safe sleep” guidelines were published in 2016. They stressed evidence-based recommendations for the safest way for babies to sleep: put down on their backs for every sleep, and on a firm, flat surface. Since bed sharing is has been shown to increase the risk of SIDS (especially in younger babies), it was also recommended that babies sleep on their own surface, designed for infants. And babies were supposed to sleep in their parents’ bedroom for at least the first six months of life, and ideally for 12 months.

It’s that last recommendation that I’ve never been completely happy about. The recommendation is based on three studies from the 1990s, all from Europe (where almost all babies slept in parents’ rooms, and, at the time, on their tummies.) In the aggregate, these studies showed fewer SIDS cases in babies sharing a room with their parents. But: there were very few SIDS cases to compare, and the one study that separated out babies by age at death showed that babies less than 4 months were safer in their own rooms (and less than 4 months is the peak time for SIDS.)  So the evidence, then, wasn’t very strong – but it was the best evidence at the time, and the AAP decided the “share room with parents” idea deserved to be a recommendation.

I also think the Academy was swayed by room sharing’s making nursing easier, which is true. Breastfeeding is associated with a decreased SIDS risk.

The “ideally until 12 months” part of the recommendation was especially problematic. SIDS rates are very low past 6 months, making conclusions about the effect of sleeping location for older infants tenuous at best. 12 months is also peak time for separation anxiety, and a terrible time to first put your child alone to bed. The AAP decided to extend the “ideal time” in parents’ room to 12 months to be extra cautious, but I’m not sure they considered the overall burden this could place on many parents and children in terms of overall quality of life.

Now, a new study throws a wrench into this “same room” recommendation. Researchers tracked the sleep habits of babies who slept in their parents’ rooms, versus their own rooms, and the results aren’t terribly surprising. Room sharing at 4 and 9 months is associated with less sleep for babies, and fewer long stretches of sleep. Babies seem less able to “consolidate” or organize their sleep into longer stretches if they’re sharing a room with parents. And: room sharing makes it more likely that babies will end up in known unsafe sleep positions – like sleeping directly in their parents’ beds. But wasn’t room sharing supposed to be safer?

It’s a mixed message, but it reflects that the evidence for this room sharing recommendation has never been very strong. With this new study, parents should feel more comfortable, and less guilty, if they choose to put babies in their own rooms to sleep.

The Fisher-Price Rock ‘n Play Sleeper is NOT for sleeping

The Pediatric Insider

© 2013 Roy Benaroch, MD

You might think a thing sold by a huge manufacturer of children’s toys and furniture as a “sleeper” would a safe, appropriate place for a baby to sleep. It is, after all, called a “sleeper.” But it is not a safe place for your baby to sleep.

The Fisher-Price Newborn Rock ‘n Play Sleeper is a sling-shaped baby holder sort of gizmo, fitted into a frame that allows it to rock back and forth. The baby is held kind of snuggled in a pouch, in a sitting-like position, tilted up maybe thirty degrees or so. The name implies that it’s for rocking (that seems right, though I don’t think they’re talking about this kind of rocking—give that man a towel) and for playing. The problem I’m worried about is that last word in the name, the “Sleeper”. This slingy soft thing is not a place to leave your baby to sleep.

Why? Because we know that to best prevent Sudden Infant Death Syndrome, and to best encourage normal physical and motor development, babies ought to be put down to sleep flat on their backs, on a firm, flat surface. The Rock ‘n Play Sleeper is not firm, and it’s not flat—so it is not a safe place to routinely sleep.

The AmericanAcademy of Pediatrics published detailed guidelines about safe sleeping environments for babies in October, 2011. The Rock ‘n Play Sleeper clearly doesn’t fulfill many of these evidence-based criteria. I contacted Fisher-Price in February, and spoke with a very nice person, the “Manager-Risk Management.” I’ve sent her a detailed e-mail with my concerns that she said she would forward to the Director of Safety Management. Since then, all I’ve heard from Fisher-Price is:

Thank you for your inquiry and comments. We did receive your email on February 7. 2013.  We have provided these comments to the appropriate people within Fisher-Price.

The Rock ‘n Play Sleeper complies with all applicable standards.  We encourage consumers who have questions or concerns about providing a safe sleeping environment for their babies to discuss these issues with their doctors or pediatricians.

We appreciate your taking the time to contact us.

OK, since they say they encourage consumers to discuss these issues with their pediatricians, let’s discuss it!

Below is what I had sent to Fisher-Price: the details of my concerns, based on the AAP’s recommendations in bold. The numbers refer to each recommendation in the AAP document.

1. To reduce the risk of SIDS, infants should be placed for sleep in a supine position (wholly on the back) for every sleep by every caregiver until 1 year of life.

The Newborn Rock ‘n Play Sleeper does not keep a baby wholly on the back, but rather in an inclined position. It is not a safe way for babies to sleep.

2. Use a firm sleep surface—A firm crib mattress, covered by a fitted sheet, is the recommended sleeping surface to reduce the risk of SIDS and suffocation.

The Newborn Rock ‘n Play Sleeper is not a firm crib mattress.

2e. Sitting devices, such as car safety seats, strollers, swings, infant carriers, and infant slings, are not recommended for routine sleep in the hospital or at home.

Though this sentence doesn’t specifically mention your product, the Newborn Rock ‘n Play Sleeper is shaped like the devices in this category, and is therefore not recommended for sleep.

2e. If an infant falls asleep in a sitting device, he or she should be removed from the product and moved to a crib or other appropriate flat surface as soon as is practical.

Again, babies should not be left to sleep in a device like your Rock ‘n Play Sleeper.

16. Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising.

From your website describing this product, at http://www.fisher-price.com/en_US/products/51903, I quote: “The seat is also inclined, which makes napping more comfortable for babies who need their heads elevated.” This implies that babies need their heads elevated, or that perhaps some of them need their heads elevated for comfort for napping. This is incorrect and contradicts the AAP, and is inconsistent with the safe sleeping guidelines.

In short, the Fisher-Price Newborn Rock ‘n Play Sleeper does not meet the standards established by the AAP for safe sleep. Parents, do not leave your babies sleeping in this gizmo. Their safety is too important.

Baby sleep positioners kill

The Pediatric Insider

© 2012 Roy Benaroch, MD

The AAP has been warning against these things for years, and finally the FDA and CPSC have weighed in: Infant sleep positioners don’t prevent SIDS, and don’t save lives. But they can kill your baby.

These things are wedge-shaped or U-shaped gizmos that are supposed to keep your baby in a certain position while sleeping, supposedly to prevent SIDS and other alleged problems. But the “back to sleep” anti-SIDS campaign, which has reduced deaths by over 50%, never suggested to have to keep your baby on his back. The message from the back to sleep campaign has always been to put your baby down on his or her back, then to go away. Once your baby can move or roll to a different position, that’s fine.

The SIDS prevention guidelines are pretty straightforward, but that hasn’t stopped companies from capitalizing on fear to sell devices that they claim will reduce SIDS. Special monitors, mattresses, pillows, bumpers, and infant positioners have all claimed to protect babies, yet the FDA (nor the AAP, nor anyone else who knows what they’re talking about) has ever endorsed or approved any such device.

Want to prevent Sudden Infant Death Syndrome? Here are some proven methods. These are from the AAP’s Details and references are all in the AAP’s 2011 policy statement on preventing SIDS and other sleep-related infant deaths, which includes more details and references for all of these recommendations.

• Breastfeed.
• Immunize – follow the established schedule, which reduces SIDS by about 50%.
• ALWAYS put your baby down to sleep on his or her back.
• Don’t use bumper pads or other padded fluffy things in the crib.
• Always use a firm, flat sleep surface. Babies should not routinely sleep in carriers, car seats, or bouncy seats.
• Place your baby on a separate sleeping surface, not your bed (Bed sharing is discouraged.) Babies can sleep in their parents room, but should not sleep in their parent’s bed.
• Wedges and sleep positioners should never be used.
• Don’t smoke during or after pregnancy.
• Offer a pacifier at sleep and naptimes.
• Avoid covering baby’s head.
• Avoid overheating.
• Practice supervised, awake tummy time to help motor development and avoid flattened heads.
• Ensure that pregnant women and babies receive good regular care.

The AAP’s recommendations not only address specific, known, modifiable risk factors for SIDS, but also help reduce the risk of death from suffocation and other causes. They are the best way to help keep your baby safe. Forget the hype and expense and unfounded promises from manufacturers—you can best keep your baby safe without buying anything.

Short questions on cramps, SIDS, lumps, spatulas, and suckers

The Pediatric Insider

© 2010 Roy Benaroch, MD

A quick-fire post! Time to clear out the inbox…

Michelle: “Is it possible for girls to have cramps before (about a year or so) they start their period?”

I don’t think that’s likely, at least not that far beforehand. Constipation, stress, poor diet (too much processed food, not enough fresh fruits/vegs/water), not enough exercise, and lactose intolerance would be far more likely.

L asked: “Why do some children develop knots in the leg after immunization injections?”

They’re called “sterile abscesses”, which isn’t a great name—they’re not really abscesses at all. The knots are caused by a local inflammatory reaction, and they’re more likely to occur if the needle was too short or if the child jerked away. The knots don’t really mean anything, and don’t interfere with the way the vaccine works. Expect them to gradually go away in a few months.

Sheri: “My 6 1/2 month old recently started sleeping on his stomach. I put him down on his back half swaddled with his arms out for every sleep. He cries, moves around and eventually rolls over on his stomach for the rest of the night. I know this increases his risk of SIDS but I can’t stop him from rolling over. Can I stop worrying?”

Yes. Stop worrying. The “back to sleep” campaign, which has reduced SIDS by about 50%, encourages parents to put babies on their backs to sleep—but never included any instructions to keep babies on their backs. Once your child can roll to him stomach, leave him there. You don’t have to stand aside his crib all night with a spatula, flipping him back over.

Melissa: “Hi- I was wondering what your opinion was on all of the antibacterial products that are available now and so widely used.”

No good studies have been able to confirm that antibacterial-coated products have been able to reduce infections. I doubt they could have any net effect on the germs that children are exposed to, with the single exception of alcohol-based hand sanitizers. Those have been shown to reduce infections among health care works and in day cares. You want to avoid infections? Try:

• Good handwashing
• Frequent use of alcohol-based hand sanitizers
• Vaccines against preventable illnesses like influenza
• Keeping your children away from sick children
• A good night’s sleep

Antibacterial surfaces, special vitamin supplements (including those “developed by a teacher” or sold by olympians), herbs, wands, sprays, magic air ionizers, and plenty of other gizmos and elixirs are big money-makers for some, and big money-wasters for others. Don’t be a sucker.