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Safety September: Sleep Safety

Updated: Sep 26, 2022

Infants are known to do three things: eat, sleep, and poop. Such a small person requires so much support and making sure there is a safe space for these activities can be a daunting task. With infants solely relying on their caregivers, it can be intimidating to make sure every decision is safe and best for the family. We are going to dive into safe sleep, and how to keep every baby as safe as possible.

There are a few general rules to keep in mind for infant sleep, especially under four months old.

· Put the infant to sleep on their back

· Have the baby sleep on a firm, flat surface

· No soft objects, toys, loose bedding, or crib bumpers in the

sleep space

A crib or bassinet should be empty with only a fitted sheet over the mattress. Soft baby containers are not approved for safe sleep and are only recommended for use for short periods of time while the adult and baby are awake. A swaddle can be used in the first few weeks of life, but then a sleep sack is safest to keep the baby comfortable. Sleep sacks are recommended because they allow the child to move without the risk of them pulling the loose fabric over their face. Also, make sure the baby isn’t getting too hot if they are wearing layers, as that is also unsafe.

Other factors that can increase safety during sleep are pacifiers, room sharing, breastfeeding (if possible), and tummy time while awake. All of these factors help in different ways such as strengthening muscles or increasing reaction times to the baby's needs.

Many families have their crib all set up for safe sleep with a tightly fitted sheet and nothing else in the crib. However, many families find themselves at some point during the night or early morning, during or after a feeding, bringing the infant to their bed. Bed sharing has risks, but there are things to know about bed sharing and staying as safe as possible, even if only for an hour some nights.

Bed sharing can increase feeding sessions or support families in breastfeeding longer, if that is their goal. It can also support the baby and caregiver to fall asleep and stay asleep. These are all factors that make bed sharing more common, even if it isn’t for the full night.

There are risks involved with bed-sharing, and it is at the discretion of the caregivers in the home. There are safety measures you can take if you choose to bed share. Here are the seven requirements to follow according to La Leche League International for safest bed sharing.

· Adults are nonsmokers

· Adults are sober and unimpaired

· The parent is breastfeeding and baby is:

o Healthy and full-term

o On their back

o Lightly dressed

· And both parent and baby are on a safe surface, such as a firm mattress.

For the first four months of life, safely bed sharing is done with the breastfeeding parent. This is due to an instinctual reaction in both parent and baby created by breastfeeding. The breastfeeding parent will “cuddle curl” around the baby. While side sleeping, the parents’ knees come up and their arm tucks under their head which creates an area safe for an infant. The infant will instinctually root toward the breast, keeping their face clear from the pillow or blanket the parent is using. The knee and arm of the parent will keep the adult from rolling onto the baby, and the arm under the pillow will keep the baby below the pillow and safe near the breast. La Leche International also states around four months any responsible adult can safely bed share with an infant.

If choosing to bed share with an infant, Kids Health recommends a certain environment be prepared before sleep. Ensure the mattress is firm and there are no gaps between the mattress and wall, headboard, or other objects where the infant could get stuck. Also check for gaps in the sleeping area between the frame and mattress or any other places, which makes couches and chairs unsafe for sleep. The sleeping surface should also be clear of dangling cords the infant could get tangled with: such as curtains, blinds, or charging cables. Swaddles are also not safe to use while bed sharing. According to La Leche International, an infant should have the ability to kick, bat away covers, change positions, and nurse. The covers used by the adult should also be light and kept away from the baby. Avoid blankets with tassels and quilts or heavy comforters.

Many families are aware bed sharing comes with risk, so they choose other methods to sleep that may seem safer at the time. It is not considered safe or recommended, according to Kids Health, for an infant to sleep alone or with a caregiver on the couch or to sleep between two caregivers. Night feedings can be very tiring, but it is not safe to sleep with an infant while sitting in a chair. It is recommended to find a way to wake up before feeding or finding a way to stay awake if choosing to do night feedings in a chair.

Keep in mind, the safest sleep for an infant is in the caregiver’s room in their own bed with only a tight fitted sheet over the mattress. Many families elect to bedshare but ensure those decisions are made with complete information on the risks and safety measures.

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