Safety in Sleep

by T. Berry Brazelton, M.D., author of Sleep: The Brazelton Way

At times, babies can be active during the night. They scrabble around in the bed, as though searching for a corner in which to contain themselves. A preemie researcher, Evelyn Thoman, felt that premature babies wanted to find a corner of the crib in order to wedge their heads into it—perhaps to reproduce the feeling of containment and safety of the womb that they had left too soon. As a result, a number of safety precautions are necessary to protect a baby during sleep. The following are basic measures to prevent smothering and choking. However, all parents should learn emergency measures and keep emergency numbers by each phone. Parents should also consider obtaining training in infant CPR from their local hospital or Red Cross.

In a crib:

• It is critical that a baby's crib be stripped of any extra bedclothing that could bunch up. Infants can suffocate when their faces become wedged against or buried in a soft mattress, pillow, infant cushion, or other soft bedding. Never use a pillow in a crib.
• The mattress in a crib should be flat and firm.
• A sleeper or pajamas that fit over a baby's legs and arms can keep him warm and contained without having to use sheets or blankets that might strangle or suffocate him. Be sure pajamas and bedclothes are made out of non-toxic flame-resistant material—cotton sleepers burn in a fire.
• A soft mattress is not safe for an infant. He can sink down or burrow his head and face into it, trapping his own exhaled carbon dioxide. When this happens, the oxygen content of the air around him diminishes. He becomes dopey and won't struggle to get enough air. If an infant is co-sleeping, a parent also needs to be sure that the mattress is firm and won't sag around the baby's face and head. Don't lie too close to his face.
• Crib slats must be no wider than 2 3/8 inches apart. More widely spaced slats allow a baby to fit his head between them, and possibly suffocate. Be sure to look for the Juvenile Products Manufacturers Association certification label on both crib and mattress and on any portable crib or playpen.
• Headboards and footboards of a crib should be solid and fit snugly against the mattress so that the baby's head cannot be trapped. Cornerposts and knobs should not stick out more than 1/16 inch, to prevent strings or bedding from catching and creating a risk. Make sure drop-side latches work properly and cannot be released by a baby inside the crib. When the baby is in the crib, always keep the side rail locked in the up position.
• Be sure the crib has not been painted with lead paint or paint that flakes off. Babies will eat flakes of lead paint, which can cause lead poisoning.
• Be sure there's nothing for him to pick up and swallow in his crib. Strings or wires that hang over a crib should be kept out of a child's reach. Never use a string longer than 7 inches. Take away crib gyms and mobiles as soon as your child can push up on his hands and knees.
• Cribs should never be near radiators, windows, curtains, or other hazards.
• Sleep monitors that allow you to hear a baby cry out if he is in trouble may be comforting if you aren't nearby. But they can be overalerting. Every time the small baby moves in his bed, or comes up to light sleep, you will be alerted. As the child gets older and the risk of SIDS falls, it may help to seek the judgment of the child's doctor to decide when the sleep monitor is no longer needed.
• Crib bumpers should be firmly tied to the sides of the crib top and bottom, and at both ends and in the middle. Get rid of them once your child can pull to a stand if they are large enough to serve as a step for him to use in his attempts to climb over the railings!
• When a toddler can climb out of his crib, it is time to move him to his bed.

In an adult bed:

• If you have decided to sleep with your baby in your bed, check for potential dangers: entrapment in headboards, footboards, and bed frames (you may do best to place the mattress on the floor on a firm, padded rug in the center of the room), and suffocation or strangulation in soft bedding (these must be kept away from the infant, and off the floor around the mattress, in the event that the baby falls). If in a frame bed, help protect from falls by placing the bed on a thick, padded rug.
• Consider a co-sleeper "side-car" crib to provide protection from many of these possible dangers.
• Do not sleep with your baby if you are a heavy sleeper, or if you have taken medications, alcohol, or drugs that cause heavy sleep. These may increase the risk of rolling over onto a sleeping infant.
• Do not allow children under 6 to sleep on the top bunk of a bunk bed. Ensure that spaces between the guardrail and bed frame and all spaces in the headboards and footboards are less than 3.5 inches.

In a car:

• When your baby is sleeping in a car seat (rear-facing until 1 year and at least 20 pounds), be sure he isn't able to plop his head forward abruptly, which could possibly damage his neck muscles or his spinal cord. If your infant's head flops forward, the seat may not be reclined enough. The American Academy of Pediatrics recommends "tilting the seat back until it is reclined as close as possible to a 45-degree angle (according to manufacturer's instructions). Your seat may have a built-in recline adjuster for this purpose. If not, wedge firm padding, such as a rolled towel, under the front of the base of the seat."
• Never leave a child, especially a sleeping baby, unattended in a car.

For more information see the Web sites for the American Academy of Pediatrics (www.aap.org) and the United States Consumer Product Safety Commission (www.cpsc.org).

Excerpted from Sleep: The Brazelton Way © 2003 by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Perseus.

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