When you bring a newborn baby home, there’s typically no shortage of opinions from well-meaning friends and family on how to properly care for that child. Some of the strongest opinions tend to center around sleep. Where should the baby sleep? How should you place the baby? What should the baby wear to bed? The list goes on and on, and chances are the valued generations of women in your life will all share different thoughts and opinions based on what they were taught back in the day.
But it’s important to understand the truth behind the latest research. The grim reality is that Cook Children’s Medical Center in Fort Worth has seen 30 infant deaths linked to unsafe sleep situations since January 2022. The U.S. Centers for Disease Control and Prevention (CDC) reports about 3,500 sleep-related deaths every year, including accidental suffocation or strangulation and sudden infant death syndrome (SIDS), as well as sleep-related deaths from unknown causes.
Once you let the heartbreak behind these numbers sink in, it’s only natural to wonder how to prevent your own child from becoming part of that statistic.
The current guidelines keep it simple for parents: For the first six months, babies should sleep next to your bed in a safety approved crib, play yard or bassinet with a firm, flat surface with a tightly fitted mattress and sheet.
We reached out to two local experts to help us navigate the most recent guidelines: Debbie Gearner Thompson, an advance practice registered nurse who works with newborns at Parkland Health in Dallas, and Lauren Guajardo, a certified pediatric sleep consultant with Heaven Sent Sleep, a Dallas-Fort Worth-based sleep support service that has used holistic, evidence-based techniques to help thousands of very tired parents.
The Latest Research
There’s a lot parents can do to create a safe sleeping situation for their baby. As a matter of fact, most unsafe sleep deaths simply involved a baby bedsharing with a parent or caregiver.
Thompson says that families bedshare for different reasons. Some simply don’t have a crib or bassinet, or sometimes it’s a long-standing cultural or generational preference to have a family bed.
“The parents want the babies close by them. I can totally understand that,” she says. “If the baby is fussy and cries, it’s easier to quiet the baby if the baby’s right next to you rather than if the baby’s in a bassinet or a crib even if it’s in your same room.
“What we try and explain to parents is it’s still not the safest way for your baby to sleep. Your mattress is not as firm as a newborn or an infant’s mattress. You have blankets, you have pillows, you have sheets. You have your own body that if the baby gets up next to it, put its face next to you, your breath, your pillow, whatever it cozies up to, [there’s a risk] it suffocates. So the risk to the baby is greater than the benefit.”
Thompson is right. Just last summer, the American Academy of Pediatrics (AAP) released its first update to safe infant sleep recommendations since 2016. Clear evidence shows that bedsharing significantly increases the risk of injury or death for the baby, so the AAP does not support bedsharing under any circumstances. Newborns simply don’t have the strength to move their head if their mouth, nose or airway becomes blocked and air can’t reach their lungs.
The risk of sleep-related infant deaths rises 67 times higher when a baby sleeps with someone on a couch or soft armchair or cushion and 10 times higher when sleeping with someone who has used sedating medications and sleep aids, alcohol, marijuana or other drugs. That list includes pharmaceuticals most moms wouldn’t have thought twice about. “Even a prescription pain medicine because you had a c-section—anything that is going to alter your awareness creates a risk that you could roll over on your baby without even realizing it,” Thompson says.
Create a Safe Sleep Environment
Where and how you put your baby to bed are among the most important aspects of safe sleep practices. Here’s an age-by-age guide to creating the safest environment for your baby’s slumber.
Safe Sleep for Newborn to Age 1
Babies are so precious that we often want to hold and cuddle them and enjoy those newborn scents and snuggles. But we also want them to be safe. Room-sharing works as a good alternative to bedsharing.
The current guidelines keep it simple for parents: For the first six months, babies should sleep next to your bed in a safety approved crib, play yard or bassinet with a firm, flat surface with a tightly fitted mattress and sheet. This option keeps the baby nearby for those middle-of-the night feedings and provides reassurance for parents that their baby is safe and sound.
Place the baby on their back without soft toys, pillows, blankets or even bumper pads in their sleep space. These items have the potential to block their airflow. That’s why the Safe Sleep for Babies Act, which went into effect in May of last year, bans the sale of unsafe crib bumpers and inclined sleepers.
Thompson explains why placing baby on their back on that firm, flat surface matters. “Think of a baby’s breathing tube as a small, bendable straw,” she says. “When the baby lays flat, that breathing tube is totally straight. When the baby is sitting up, on their stomach, or in a car seat or a swing, the straw bends. So the airway is not as open for breathing in positions other than laying flat on their back.”
As many parents can tell you, not all babies like to be placed on their backs alone in a bassinet. Guajardo acknowledges how hard it can be for exhausted parents of newborns to get their babies to sleep, and many people bedshare out of desperation or because they simply don’t know what else to do.
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“Babies are used to being in the womb for nine months. When they’re born, it’s like the fourth trimester. They’re not quite ready to fully stretch out and be on their own. They’re acclimating to the world,” Guajardo says, noting that a swaddle and white noise can help mimic the womb.
She shares this helpful method for placing babies on their backs: “As you’re laying them down, keep them close to your chest, and tilt them so their bottom lands on the bed first. Then you kind of fold them down, keeping their head tilted toward their chest,” she says. “Try not to let their head tip back, this can activate the startle reflex. If they start to wake or fuss, wrap your arms around them or use a heavy hand to help settle them.”
Keeping your baby in their own sleep space in your bedroom for at least the first 6 months could decrease the risk of SIDS by as much as 50 percent, according to the AAP. “There is some thought that with the parents’ breathing, the parents’ movement, the baby does not sleep as soundly. And so there’s something about limiting how hard and sound the baby sleeps with sudden unexplained infant death,” Thompson says, noting a pacifier also helps reduce the risk of SIDS for the same reason.
Breastfeeding to 6 months, continuing for a year or longer as desired by you and your baby, matters too. “Breastfed babies don’t sleep as deep or as long as the formula-fed baby,” Thompson says.
Younger babies can be swaddled for bedtime, but once your baby starts to attempt to roll (typically between 2 and 3 months old), swaddling can increase the risk of suffocation as the fabric can shift and tighten around the airway. “You really should go ahead and drop the swaddle cold turkey if the baby shows signs of rolling,” Guajardo says. If your baby loves being swaddled, transition with one arm out, then two.
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When babies move to their own room—after six months, the AAP recommends—they should still sleep on a firm, flat surface with just a fitted sheet. Instead of loose blankets for older infants, dress them in a sleep sack with a thermal overall grade rating of 0.5 in the warmer months and typically no more than a 1 in DFW even in the winter.
In the summer, light cotton footed pajamas are most comfortable for baby. In the winter, consider fleece long-sleeve fitted pajamas. You can always layer a onesie underneath for added warmth if need be. Once you leave the hospital, that cute little hat they put on baby should only be worn outdoors to avoid overheating.
“For babies that are still in a swaddle, keep the temperature around 68 to 72 degrees,” Guajardo says. “Generally, if it’s comfortable for us as adults, it’s considered to be comfortable for the baby as well.”
Steer clear of weighted swaddles, clothing or blankets and make sure the baby’s surroundings are smoke- and vape-free.
Plan ahead to ensure baby has a safe sleep space for traveling too. Short of a crib or bassinet, Thompson recommends a pack and play. “That’s the best sleep bed for the least amount of money. You can use it for a newborn, a 1- or 2-year-old, you can borrow it, loan it out to friends who come into town with their babies. It’s versatile,” she says.
Safe Sleep for Toddlers Ages 1+
As they get older, children may certainly have a favorite stuffed animal or blankie they want to sleep with. “After a year of age, that’s totally fine,” Thompson says. “That’s when they’re also cognitively aware that they get comfort from that animal or blanket.”
As far as introducing a toddler bed is concerned, Thompson says that’s a personal choice for the family because every child is a little bit different. If you’ve got a crib climber, you might want to consider a toddler bed sooner rather than later.
Just be sure and childproof the sleep space. “The same rules apply as for the rest of the house,” Thompson says. You know the drill: Use outlet covers, install cabinet and drawer locks, avoid cords on blinds and drapes, anchor furniture, lock windows, stash medications, secure entrances and exits. “Get down on the floor, at the child’s level, and look around. You will see things there that you never thought about when looking at the room from your eye-level,” Thompson advises.
“You can include your toddler in these decisions and say, ‘I need you to stay in your room whenever we’re sleeping because this is your safe place,” Guajardo advises, going on to say to make sure toddlers know why you may be installing doorknob safety covers, and that they can call for you at any time using their monitor. “Lots and lots of prep during the day,” she recommends. “Get them involved and empower them.”
Safe Sleep for Mom & Dad Too
In the end, Guajardo has some sage advice for all the weary parents out there. “Take care of yourself too,” she says. “A lot of new parents really lose that along the way. Come up with a sleeping plan prior to the baby’s birth in which both parents take turns getting four hours of protected sleep, where they’re not being disrupted. I do a lot of work with the babies, but I have a heart for the parents too.”
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This article was originally published in October 2023.
Top image: iStock
