Parents Gamble With Infant Sleep Guidelines

May 08, 2012

Do you let your baby sleep on her stomach? You're far from alone. Even though SIDS deaths have been cut in half since pediatricians began advising parents to put sleeping babies on their backs, 25 percent of U.S. babies still sleep on their stomachs or sides.

Rachel Saslow, former Post staff writer and new mother, looked into the issue and answered questions on Tue. May 8th.

Hi all, thanks for reading my article this morning on baby sleep recommendations. I’m excited to answer any questions you may have on the topic. Please note that I’m not a medical doctor—I have a bachelor’s degree in journalism—so please run any concerns you have about your baby by your pediatrician. That said, I did a ton of research and interviews for this piece and I’m happy to share what I learned. Perhaps just as relevant, I have a 9-month-old daughter so I’m in the same boat as many of you out there. Let’s have at it.

Since rolling over, my 8 month old rarely sleeps on his back, but I'm thinking that at this stage, the potential for SIDS is decreasing. Is that right? My other concern is what should be the temperature in the baby's room at night? We have an old house and it's been a struggle to maintain a cool temperature on the second floor. What should I be aiming for?

You're absolutely right: the rate of SIDS peaks between 1 and 4 months of age and is uncommon after 8 months of age. There's no need to run in and flip your baby onto his or her back. 

Regarding the temperature, the AAP just says to "keep the room at a temperature that is comfortable for an adult." Have you tried a fan? Besides keeping the room cool, babies also seem to like the white noise.

It's already pretty warm in D.C., so my baby has been sleeping in a onesie and one of those cotton Halo sleep sacks. She seems comfortable and is sleeping through the night. I stress about her temperature sometimes too, but it helps to remember that if she's ever uncomfortable, she isn't shy about letting me know. 

My daughter slept on her tummy and she was fine. She could not get any sleep on her back. But of course I also kept an eye on her all the time and did not have anything around her. I know some parents that don't keep an eye on their baby unless they cry and even then some want them to cry themselves to sleep no matter what. In that case, they should have them on their backs. I don't understand how some parents expect a baby to just be ok on their own so the parents can get some rest. Pediatricians fail to mention all the love baby needs to be happy rather then trying to tell you how to put your baby to bed.

I hear you re: the extreme emphasis doctors put on the sleep recommendations. My husband and I took a "Newborn Basics" class at the hospital when I was pregnant and it felt like a whole list of things you're not allowed to do. I remember thinking, "It sounds like they want us to put our baby to sleep in the middle of the kitchen floor." But SIDS is a terrifying thing, so we erred on the safe side and mostly followed the sleep recommendations (I cheated and gave her a light blanket sometimes). The doctors are just trying to keep the babies safe.

Hi Rachel, have you heard about Rachel Moon's latest study (from DC) showing moms who swaddle are about 1/2 as likely to put baby to sleep on the stomach as moms who dont swaddle. The key to safe sleep is laying babies on their backs...and using swaddling and white noise to boost baby's sleep so parens arent tempted to use an unsafe sleep location/position.

No, I haven't read that study yet, but it makes a lot of sense to me. The popularity of swaddling seems to be a direct response to the Back to Sleep campaign. On their backs, newborns tend to startle or hit themselves with their arms (which they can't really control yet, poor things!). Swaddling helps prevent this.

Once the infant can roll over, can you stop worrying about putting them to sleep on their backs?

The experts I interviewed said to put your baby on his back until he's 1 year old. That said, if he's strong enough to roll to his stomach, you can leave him in that position for the night. 

Do you think it's possible that pregnant women and new mothers (not to mention the super conscientious gals who follow "pre-pregnancy" health guidelines) get so many warnings about so many things--warnings without a clear indication of how rare or common problems actually are, warnings without an indication of how likely it is that a bad event could be due to something they did or did not do, and frankly some warnings that are as much about society's expectation of the mother role as about safety--that by the time they have a several month old child, they are experiencing warning fatigue?

Absolutely. I think these constant warnings are a hallmark of modern American parenting. My daughter has warnings on everything-- her crib, her bedding, her teething biscuits, her lotion, you name it. It kind of drives me nuts, but at the same time, we want to keep our babies safe. It's a tough balance. 

It's shocking to me that despite all the warnings, parents put their own comfort ahead of the safety of their baby. Apparently it hasn't been made clear enough that you cannot know which infant is vulnerable.

I think you'd be hard-pressed to find a parent putting his or her own comfort over the baby's safety. I'm not sure what you mean--putting the baby on its stomach so that the baby (and therefore the parents) get more sleep? Or bed-sharing, or...? Please clarify. 

Thank you for taking my question! My husband and I are expecting our first child in July (YaY!). 20 years ago, when my husband was in high school, his girlfriend got pregnant. At two weeks old the baby died of SIDS. I have no idea how they had her sleeping. My question is, how worried should I be about an increased likelihood of SIDS? Is there ANY genetic predisposition? Am I worrying needlessly?

I haven't heard of any genetic link to SIDS, but that sounds like a great question to ask a pediatrician. The bottom line is that as a new mother, you'll probably be a little worried about SIDS no matter what, and all you can really do is follow the sleep recommendations.

Congratulations on the baby! You have so much fun ahead.

I recently put a crib bumper in my baby's crib after he started rolling over and getting his legs and arms trapped between the slats. He would frequently get both legs stuck in the slats (rolling over while sleeping) and wake up shrieking and flailing because he couldn't roll back over. Our crib is new and meets safety specs, so it's not an issue of having a shoddy or inherently dangerous crib. I know crib bumpers are bad, safety-wise, but are they still bad for babies who are able to roll over?

Oof, that's a tough one. I'd ask your pediatrician for advice. One of my mom friends had exactly the same problem and she bought these new breathable mesh bumpers. Have you seen those? 

Do the rules change at all for naptime? Sometimes I let my baby sleep on her stomach when I'm watching close by.

Alas, the same rules apply for naptime. 

What do you think about babies sleeping on their side? Is this normal?

My baby just started sleeping on her side a couple of weeks ago (she rolls there after we put her down on her back). It's normal, but make sure to keep putting your baby down on his or her back until they're 1 year old. 

A paramedic friend ran a call where an infant had wedged her head into the bumper padding around the crib and suffocated. I'm sorry, but the bumpers serve no useful purpose. An infant hasn't got enough force to hit his/her head against the crib in any dangerous way. They are decorative and dangerous. The same for soft pillows. Most babies will never be harmed, but why risk your precious one?

That's a horrible story and a good argument against crib bumpers. 

Our darling daughter did not sleep through the night until she was over 2 years old. Really, I did not care where and how she slept. She first slept on my chest with me propped up in bed. Who cares about the naysayers of sleeping with your child! I got about 2 hours of sleep that way. Later, she was in our bed and I got 3 hours of sleep. She was sleeping on her side. Later when she began to crawl, still in our bed, she slept on top of us, on our pillows, feet on top of my head, propped up and laying like a drunken sailor on my husband. Heck we didn't care, I was finally getting 4 to 5 hours of sleep on a good night. I really could not get into the parenting bed argument because the dirty little secret is that parents will do anything to get some sleep. Truthfully, if she had kicked the dog out of his bed and I got 8 hours of sleep, she would have been sleeping on the dog bed. The sad thing is that the dog and the baby were the only ones getting a good night's rest.

Ah, the desperation of a sleep-deprived parent. That's one thing that's so crazy about this issue: parents are making these decisions about their babies' sleep at 3 a.m., in the dark, when they're just desperate for their own zzz's. I get why it's tough to follow the recommendations.

As my son is far from infant stage, I'm curious why some babies are put down on their stomachs? He's 7 now, and Back to Sleep was in full force already when he was born. He slept through the night at 3 months and always slept on his back-- always.

It sounds like you had an excellent little sleeper! Some babies don't sleep as soundly, or for as long. That's when parents start getting creative with the sleep recommendations. 

Great article, Rachel. There can't be too much information about such a sad and serious issue. I don't have a question but wanted to pass along something I wish someone had told me before I had my son: Sleeping on their backs is a very unnatural position for babies who have been all curled up and comfy in the womb for so long. So don't expect a newborn to take to sleeping on his back right away. It may take a few days or weeks. Every baby is different, of course, but we ended up practicing back-napping during the day to get our little guy used to it. Yes, that meant a few days and nights of him sleeping on his side or stomach, but he finally got it after a while and became a terrific back sleeper ... until he learned to roll over, that is!

This is more of an observation: I think the downside to so many recommendations and so much research is that parents begin to rely on it versus their own instincts and observations. These days, parents read endless books, blogs, etc., and once they get their baby home, they realize most of it doesn't apply to their situation or causes them so much confusion they lose confidence and become like helicopter parents (even w/ infants). Personally, I familiarize myself with the "official" guidelines and latest research, but I also trust myself and spend time getting to know my newborn's behaviors and capabilities (e.g., when she's able to lift and turn her head). That, plus a pediatrician who you trust, are a great path to successful, somewhat stressfree parenthood.

That sounds like a very sane, balanced approach. I like it. 

I read a study (actually a few) that talked about some newborn babies not having developed the reflex to start breathing again once they stopped for whatever reason (I'm not a doctor so my explanation isn't great). So they suggested having a fan (ceiling or otherwise) on while they are sleeping, because the constant moving air will stimulate them to continue breathing. Since we did not want to do the pacifiers at all for both of our kids, having ceiling fans on helped me to have a better peace of mind.

That's really interesting; I haven't heard that theory. I thought the fan was just to keep the room cool, since there's a link between SIDS and overheating. I know a lot of the SIDS research right now is about babies' automatic functions like breathing, heartbeat and body temperature. Scientists are looking into whether SIDS victims had pathway deficits in those regions of the brain.

There is a movement in the medical community (I'm a Pediatric Emergency doctor) to delineate the difference between SIDS and a mechanical suffocation. An infant who dies lying face down, didn't suffer from SIDS. That baby likely suffocated. I can't count the number of times that I've seen "near misses" where a child stopped breathing because he or she was sleeping in an unsafe environment (on top of an adult bed, surrounded by toys, with a parent on a couch, etc). And I've declared dead babies who weren't noticed in time. Once a baby can roll, they are thought to have the strength to lift their head if needed. My kids became stomach sleepers the second they learned to roll. But always start on the back. An adult may love a fluffy comforter, but babies don't! Put your baby on its back only in a crib and keep toys and blankets out.

Thanks for chiming in, doctor!

I find it disturbing how much bed press this gets. My babies slept with me (in a king-size bed) until they were nearly 2. There was a side bar, and I woke up the second they stirred. Our sleep cycles were synched, I rolled over and latched them on, and it was really secure and peaceful for them. There was never any crying at night, nor did I have to get up. The only reason I could see this is a problem is if the mother is a super-heavy sleeper, obese, or on drugs. So many studies support the benefits of this practice, yet it's generally looked at as horrific in this country.

Bed-sharing is a very controversial issue right now, with loud voices on both sides. I can definitely understand the appeal, but there's also a risk that comes with it. It depends what amount of risk you're comfortable with and what works for your family. 

The "experts" come up with something new and new parents jump to obey. I agree that the statistics on SIDS and back sleeping seem meaningful, but generations of babies slept on their tummies. Ditto the blanket/no blanket, cool room/warm room discussions. New parents should not let themselves be fussed into a panic.

Parents jump to obey because the stakes could not be higher: the health and safety of their babies. I agree that the sleep recommendations can seem extreme, even hysterical, and new parents definitely don't need more stress in their lives. But I don't think the recommendations should be written off.

And--if I may--send a message to new grandparents: please support your children's decision to put their babies on their backs, even if you think stomach-sleeping would be better! My mom kept rolling her eyes and making snide comments about "back to sleep" and it was not helpful nor empowering to me as a new parent.

A breathable bumper is fine to use but once your baby starts to pull up and stand in his/her crib: take it out! They can learn to step up on it and try and launch themselves out of the crib.

My daughter rolled over before we stopped swaddling her and we were so nervous about her inability to move her arms and legs to get herself back on her back we slept on the floor by her crib for several days before finally just unswaddling her (she had been breaking out regularly anyway). If your baby is strong enough to roll over, shouldn't we stop swaddling so that a baby can develop the strength to roll back over onto his/her back? Also, wouldn't a loose swaddle pose an additional SIDS risk?

It sounds like you made a good choice to stop swaddling your daughter.  I don't know if there are any real guidelines about when to stop--we stopped when my daughter started breaking out of it regularly (2 or 3 months old). Good question about the loose swaddle being an additional SIDS risk. I don't know the answer though! We always had those special swaddles with the velcro (I think they're made by Summer Infant). They're alarmingly like baby straightjackets!

Thank you, Rachel, for bringing up a great point! My mother was also judgmental about our decision to put the kids to sleep on their backs. I found with my kids that it never, ever, ever helps if we heap scorn and judgment on parents. It only alienates them and makes them avoid you. A (somewhat) related example: when attempting to Ferberize our firstborn, he would cry until he made himself throw up. Repeatedly. Almost all night. After several nights and countless loads of laundry, we abandoned Ferber. My sister has not let me forget that to this day, and blames any issue he has -- a bad grade at school or a fight with his sister -- on my son's failure to be Ferberized. I don't visit with that sister often.

That's horrible about the Ferberizing, both that he would throw up and that your sister continues to judge you for it! Sleep training is such a touchy issue.

I baby sat my great-niece for the first 14 months of her life, just a little while ago. It was a little nerve-wracking being in charge of such a helpless little gem. Putting her on her back to sleep was the only way for me, and getting all the loose stuff away from her so that nothing could get in the way of that tiny nose! Her head was a little flat for a bit, but when she had the strength to turn herself it adjusted to a normal curve. And during the day she could sleep on her tummy against my chest where I could feel her breathing just fine. Until those neck muscles are strong enough to move the head, I really don't think putting them on their stomachs is a good idea.

Thanks for being here, everyone! Good luck with your little kiddos. 

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Rachel Saslow
Rachel Saslow is a former Washington Post editorial aide. She lives in the District with her family and writes about parenting and health topics.
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