One of the many challenges of parenting is getting your baby to sleep through the night.
This can be even more stressful for parents if they think about the small — but nevertheless frightening — risk of sleep-related deaths among infants.
A new study suggests that hospitals and pediatricians could do more to ease parents’ fears by helping them give their baby the safest and most sound sleep environment possible.
Unsafe sleeping environments
Previous research has relied on parents to report on how they put their baby to sleep.
Are they on their back or stomach?
Are there other objects in the crib?
Are they swaddled in blankets?
In the new study, published today in the medical journal Pediatrics, researchers made video recordings of 160 infants starting one hour before bedtime and continuing throughout the night.
More than two-thirds of the infants were observed three times — at 1, 3, and 6 months of age.
Even though parents were aware they were being recorded, most of them placed their babies in sleep environments that increased the risk of sleep-related infant death.
“Nearly all of them had some risk factors. For example, at one month [of age], 91 percent had loose or non-approved items on their sleep surface. At three months [of age], 87 percent had something on their sleep surface,” study author Dr. Ian M. Paul, M.Sc., a professor of pediatrics and public health sciences at Penn State College of Medicine, told Healthline.
The most common items were loose bedding, crib bumpers — which are banned in some cities — pillows, stuffed animals, and sleep positioners.
Although many babies started the night off in a safe sleeping space, it didn’t always last.
“If parents move their babies in the middle of the night, they usually move them to a less safe location,” said Paul.
Over the course of the entire night, 36 percent of 1-month-olds were placed in a position other than on their back. And 28 percent shared a sleep surface with a parent at some point during the night.
For 3-month-olds, 35 percent were placed on their side or stomach, and 22 percent shared a sleep surface with a parent at some point.
Guidelines for safe sleep
Doctors and professional medical organizations have long provided guidance to parents on the best way to put their baby to bed.
In 1994 the Back to Sleep campaign, now known as Safe to Sleep, was rolled out. Its goal was to educate parents about sudden infant death syndrome (SIDS), and teach them ways to reduce their baby’s risk.
SIDS is the leading cause of death among infants between 1 and 12 months of age. In 2010, more than 2,000 babies died of SIDS, according to the National Institutes of Health (NIH).
The exact cause of SIDS is not known. Research, though, has identified several risk factors for SIDS, including babies sleeping on their stomachs, on soft surfaces, under loose bedding, or in a bed with parents, other children, or pets.
Early on, parents were urged to place infants under 12 months of age to sleep on their side or back. This was later changed to placing babies only on their back — for every sleep. Later guidelines also targeted other risk factors for SIDS.
Although the guidelines have changed over the years as more research was done, the best ways to protect your baby are easy to remember.
“Boring is best. Please put your baby on their back to sleep, in their own sleep space, without anything around them. They will know that you love them for that,” Dr. Elizabeth Murray, a pediatrician at University of Rochester Medical Center’s Golisano Children’s Hospital, who was not associated with the study, told Healthline.
The American Academy of Pediatrics (AAP) guidelines also recommend against parents having their baby sleep in the same bed with them — known as co-sleeping.
“Whether it’s just a simple sheet from the adult bed or very soft bedding, if the baby rolls slightly, they can easily suffocate,” said Murray.
This includes avoiding devices designed to make bed-sharing “safe.” But the AAP does encourage parents to keep babies in the same room during sleep — just in their own sleep space.
The steps for lowering the risk of SIDS can also prevent infant deaths by suffocation or strangulation — what’s known as unsafe sleep deaths. These are fewer in number than SIDS deaths, but they are entirely preventable.
“SIDS deaths are deaths in which no explanation can be found after a thorough scene investigation and autopsy,” said Murray. “But unsafe sleep deaths are different from that. And I think a lot of misperception among the public exists.”
Modeling safe sleep
Much effort has been spent in educating parents and caregivers over the years about the importance of safe sleep.
For the most impact, though, hospitals need to be on board with the guidelines as well.
“It could be we don’t model good behaviors,” said Paul. “Most pediatricians will tell you that when they walk into a room in the hospital after the baby’s just been born, that there’s not always safe sleep environments modeled or discussed initially.”
The University of Rochester Medical Center is trying to change that. Between 2007 and 2013, the county where the hospital is located has had an average of 10 infants die each year due to unsafe sleeping conditions.
“We really wanted to make sure we got parents to understand that unsafe sleep situations and unsafe sleep-related deaths are 100 percent preventable,” said Murray.
A big part of the hospital’s efforts includes modeling safe sleep environments for infants from the start, for both newborns and infants that are admitted later to the hospital.
“We can talk to families a lot about [safe sleep],” said Murray, “but if you give them that additional step of modeling it and have them practice it, and have them watch a video and give them written material, it hits many different parts of your brain.”
All newborn families are given a sleepsack — a wearable blanket with holes for the baby’s arms and head. This keeps infants warm without the danger of it covering their face. All babies in the hospital are also put in a sleepsack while they sleep.
Good modeling can also inform other caregivers about the importance of safe sleep for infants — including grandparents, who may have done things differently in their day.
But practicing safe sleep repeatedly can help parents make the best choices even when they are up night after night trying to soothe a restless baby.
“If you can do the best that you can to get yourself in a routine of a safe sleep environment at all times, even if you are super exhausted, you are much more likely to do exactly what’s right for the baby,” said Murray.