We’ve known for several years that a crowded bed and a decorated crib (pillows, quilts, stuffed animals, bumpers) can put babies at risk for sudden infant death syndrome (SIDS) and unintentional sleep-related suffocation. Boring, bare and basic beds are still best for babies. Tell every mother, father and grandparent to an infant you know. A Pediatrics study out today shows hazardous, soft bedding is still being used by as many as 50% of US parents despite years of public health messages urging the opposite. I see where these numbers come from– we parents love to dote on our babies. We instinctively provide warmth and coziness to our babies all day so images of abundant bedding at nighttime can look divine. Further, our families (mothers or mothers-in-law!), coworkers and neighbors may encourage soft bedding because of old habits; many feel warmer bedding is better. However when it comes to the crib, our instincts may deter us from providing the safest sleep. As friends, parents, relatives and co-workers we have to support new parents in creating a basic, boring, and bare crib. Our responsibility extends from our own home to the workplace and to our neighborhood — what we buy and hand-down for that baby showers matters! The study out today reminds us we have lots of work to do, especially as data finds some groups of parents may be at more risk for using the soft stuff…
Soft Bedding Increases Risk
Several studies around the world dating back to the 1990’s have found SIDS risk increases with soft, loose bedding. This includes blankets, pillows, stuffed animals, quilts and similar materials either covering/on top of or underneath the infant. Read more about risk modes for SIDS, and why I hate sleep positioners. What we know: data in the early 1990’s was so compelling that in 1996 the AAP began recommending that infants sleep in firm, stark bedding environments on their back. The great news is that parents took notice of the “back to sleep” campaign and there was a sharp decline in the use of bedding in the 1990’s. Between 200-2010 the progress slowed. More from the study about moms and babies at risk:
Pediatrics Study
- Phone interviews from 1993 to 2010 found that bedding use (blankets, pillows, quilts, similar materials under or covering infant) declined overall:
- 1993 -1995: 85.9%
- 2008 -2010: 54.7%
- More than half of parents are still using incorrect bedding (thick blankets [37%], blankets under baby [29%]). Soft bedding use was more prevalent in minorities, teenage mothers & lower education levels (although it should be noted young moms were underrepresented in the study while white, higher-educated and older mothers were overrepresented). Lowest use of soft bedding was in college-educated moms while the highest use was in teen moms. Although it must be noted that study authors stated, “1/2 of college-educated mothers put their infants to bed with some type of bedding.”
- Increase in unintentional sleep-related suffocation
- 7/100,000 live births in 2000
- 15.9/100,000 live births in 2010
- Decrease in rate of SIDS
- 66.3/100,000 live births in 2000
- 52.7/100,000 live births in 2010
- In 70% of deaths from SIDS or unintentional sleep-related suffocation infants were on a surface not intended for infant sleep (i.e. parents bed, floor with a rug).
Boring, Bare, Basic Bedding Best For Babies
- Control the temptation of “warmth & safety”and softness
- Avoid soft bedding, sleep positioners, bumpers (even the mesh ones!) stuffed animals, pillows and thick blankets both over & under the baby
- Back to sleep is still best
- Always put babies to sleep on their back. Since the 1990’s SIDS deaths have been cut in half with recommendation of back sleeping and sleeping without soft bedding
- Keep it cool
- Ideal temperature for sleeping infants is 65-68 degrees. No need to crank the thermostat at night, even during the cool winter.
- Learn from Finland — no need for fancy crib during early infancy
- Finland offers expectant families “baby box” or a “maternity packages” which include safe sleeping sacks (as opposed to blankets). It all comes in a box that is meant to be used as the baby’s first bassinet! Set new parents up for success.
Kimberly Bepler says
I am curious about the photo used to illustrate this article. Doesn’t the sleep position of this infant indicate that the infant is too warm? Arms up with arm pits exposed, and thighs turned outward are usually signs that infants are trying to discharge some heat. Seems like if we are going to learn how babies sleep in a cool room without bedding, we should see an image of a baby that is comfortable but not overheated. I know images are hard to find that show appropriate sleeping situations for babies–largely because the recommendations we all make don’t work very well. Infant sleep is a complex topic, but I think there is a reason there are so few images to use that illustrate what parents SHOULD do, vs. what they shouldn’t. Because for the most part, parents do what works regardless of what they are told and many times the recommendations don’t translate into enough sleep for parents to thrive. I wish we had some better recommendations for them that could be followed easily…and that actually resulted in safe sleep for everyone in the home.
Wendy Sue Swanson, MD, MBE says
Well, this is the position that my baby often slept in (cold or warm) during his infancy. However, this is a photo of him during a trip to visit my family in Central America so you likely infer some good insights from the photo — he was sleeping in a warm open-air room (without air conditioning) and likely was warm. That being said, I’ve not been taught that this position is a position of overheating/risk. Will look into this and consider getting a different image up when I learn more. Thanks for the tip.
E Canfield says
Thick blankets is hard to define; I make thin quilts, which are sort of in between. My 13 month old has only played on top of them thus far, and I intend to keep it that way for a while, but for future reference, at what stage/age do you usually okay blankets over sleep sacks?
Wendy Sue Swanson, MD, MBE says
After age 1 year (12 months) it’s fine to let toddlers use blankets and other soft bedding in their crib. Recommendations and data driving avoidance of soft bedding for safety do not extend past infancy.
Enjoy those quilts!
Amie says
My son is 10 months old. He out grew his sleep sacks. He is a big baby wears 12 month clothes and is a sturdy 26+ pounds. What do you recommend he sleep in? Can he sleep with a blanket?
Amber says
Thank you for the great post! It’s definitely difficult to keep well-intending grandparents from using blankets and less than firm beds. I like having articles with studies like the one you referenced to refer back to so I don’t sound like an overly paranoid new mom. 🙂
Anna says
These studies are great. But does the fact that 50% of people still use bedding and toys and such correlate for the decreased infant deaths or is it something else? Perhaps the back to sleep and safer bed sharing programs rather than just a bare bed? I’m currius if any studies have been done (like actual medical field studies) about how much chemicals in bed mattresses or pillows or carpets, or rugs (as you mentioned above as one cause of unintentional death) have impacted SIDS or unintentional infant death. I mean, if a baby is sleeping on something soft, it most likely also has flame retardants and other things in case of fire, let alone what they are made of. Inhaling these for long periods of time could be harmful and maybe those play a huge roll in deaths. I know companies say that the toxin levels are low and have been approved, but just taking a mattress out of the packaging and it smells horrible! I can barely breath near it. Yet, people put their infants in those all the time. And most people don’t have money for a $500 organic or natural mattress. I think if we are going to find more reasons why infant deaths happen, we need to look at chemicals and plastics/vinyls as well. Maybe they don’t play the only roll, but a great deal of it. Also, there needs to be more car seat propper use awareness programs like the “back to sleep”, but like “straps and rear for safety” for carseats.