About the Author
Rachel Y. Moon, MD, is the director of academic development for the Goldberg Center for Community Pediatric Health at Children's National Medical Center in Washington, DC. She serves on the Task Force on SIDS for the American Academy of Pediatrics. Fern R. Hauck, MD, MS, is a professor of family medicine and public health sciences at the University of Virginia. She founded and is the director of the International Family Medicine Clinic in the University of Virginia department of family medicine and serves on the Task Force on SIDS for the American Academy of Pediatrics.
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14 Ways to Protect Your Baby from SIDS
Safe Sleep Advice from the Experts
By Rachel Y. Moon, Fern R. Hauck
Parenting Press, Inc.Copyright © 2011 Parenting Press, Inc.
All rights reserved.
SAFE SLEEP GUIDELINE #1:
Get Regular Prenatal Care
Babies who are born prematurely or who weigh less than 5 lb 8 oz at birth are at increased risk of dying from SIDS. The best way to avoid this problem is to get regular prenatal care while you are pregnant. The doctor or midwife will check to see that your baby is growing properly and that you don't have any problems that could affect the baby. Take prenatal vitamins and iron as prescribed by your medical providers and follow all their recommendations. Be sure to ask questions if you don't understand why they ask you to do something.
Note: If your baby is born prematurely, sometimes the doctors and nurses in the intensive care nursery will need to place your baby on his stomach to help the baby's breathing. When your baby's lungs have developed enough that he is breathing easily, then it is time for the baby to sleep on his back. Try to have your baby start sleeping on his back before you take him home. That way, he'll be accustomed to it and be more comfortable (that means more restful sleep for both of you).
But what about ... apnea?
"My baby was born prematurely, and she has apnea. Are babies who have apnea more likely to die of SIDS?" Apnea is long pauses in breathing. It's common in premature babies until their brains and lungs fully develop. Then they outgrow it. Apnea and SIDS are not related at all. If your baby has apnea, this does not mean that he is more vulnerable to SIDS.
SAFE SLEEP GUIDELINE #2:
Get Your Baby's Sleeping Area Ready
The best time to think about your plans for your baby is before she is born. Your plans will include where she will sleep, whether you will breastfeed, who will care for her if and when you return to work, and who will be her health care provider. You want to be ready when she comes home.
You may have family and friends who want to help you get ready. Maybe they want to give you a baby shower. Some traditional gifts for babies are not safe. These include blankets and bumper pads. Both of these items can bunch up around a baby's face and prevent her from being able to breathe easily.
We are providing you with a "Doctor's Safe Sleep Baby Shower Wish List" to share with your family and friends who want to help you prepare for the new arrival. As you read through this book, you will understand why we recommend some items and not others.
Doctor's Safe Sleep Baby Shower Wish List Sleeping
Choose one or more of the following for safe sleep. Make sure the item you choose has been safety approved and has a tag attached to show for it.
* Play yard or portable crib
* Pacifiers (buy more than one style so you can see which kind your baby likes)
* Breast pump, if nursing
* Fitted crib sheets
* Sleep clothing (wearable blankets or sleepers)
* Front baby carrier
* Baby play mat for tummy time
Do not buy or use
* Baby pillows
* Bumper pads
SAFE SLEEP GUIDELINE #3
Get Regular Baby Check-ups and Vaccines
Regular check-ups are very important for your baby. The doctor or nurse will check to make sure your baby is growing and developing on schedule. They will weigh, measure, and examine him to make sure there are no problems. They will ask you questions about the baby: what is he eating, how is he sleeping, how much does he cry, do you have any concerns? Use this opportunity to get all your questions answered, even if you may think they are trivial. Keep a list of questions or concerns that occur to you over the course of the month and take it with you. It will reassure you to know that your baby is doing well!
But what about ... vaccines?
"Is SIDS caused by vaccines?"
No! Many studies have been done around the world, and none of them has shown that vaccines cause SIDS. Most babies who die from SIDS do so when they are between 2 and 4 months old. This is also when babies get their first vaccines. It is just a coincidence that these two events happen around the same time. Remember that babies get more vaccines now than they used to. If vaccines caused SIDS, we would expect to see the number of babies dying from SIDS to increase. However, the opposite is true. Fewer babies die from SIDS now.
SAFE SLEEP GUIDELINE #4
Provide a Smoke-Free Environment
Do not smoke while you are pregnant. After the baby is born, do not let your baby be around anyone who is smoking.
If you smoke while you are pregnant, chemicals in the cigarettes affect how your baby's lungs and brain develop. The more you smoke during pregnancy, the more your baby's brain and lungs are affected. Babies of mothers who smoke during pregnancy have more trouble waking up easily when they need to. This increases the baby's chance of dying from SIDS. Babies of smoking mothers are also more likely to be born prematurely and to weigh less at birth. Both of these factors increase your baby's risk of SIDS.
Smoking after your baby is born also increases the baby's chance of dying from SIDS. The more smoke around a baby, the more likely her lungs will be affected by the chemicals in the smoke. Do not allow anyone to smoke in the same room or car with your baby. The farther away from the baby the smoke is, the better off she will be!
But what about ... quitting smoking?
"I don't know anybody who was able to quit smoking. Why should I even try?"
It is hard to quit smoking, but many women do so, especially when they are pregnant. It is a great gift to yourself and your baby! Ask your doctor or midwife for help and information about local resources. Call the "Quitline" in your state to talk to a trained professional about how to quit smoking.
But what about ... other people smoking around me?
"What if someone who lives with me smokes while I'm pregnant? What does that do to my baby?"
Scientists know that there is some effect on the baby's brain and lungs when the mother breathes in smoking but there is still an effect. Encourage smokers around you to quit, too, or at least to smoke outside.
SAFE SLEEP GUIDELINE #5
Place Your Baby on His Back for Every Sleep Time
Research all over the world has shown that when babies sleep on their backs they are at much less risk from SIDS than if they sleep on their stomachs or sides. To put it another way, babies who sleep on their stomachs or sides (and roll over onto their stomachs) are much more likely to die of SIDS. Always put your baby on his back to sleep, even for short naps.
This strategy is working! Since the American Academy of Pediatrics recommended in 1992 that babies sleep on their backs, the number of babies dying from SIDS has dropped by half.
Some people who are unfamiliar with the research and whose own babies survived sleeping on their stomachs have questions or other beliefs. We will talk about these concerns here so that you know how to respond if anyone disagrees with your plan to have your baby sleep on his back.
Belief: The baby is more likely to choke when he's on his back.
Fact: All babies spit up food or vomit at some point. Every parent worries that the food or vomit will go down the trachea (windpipe) to the baby's lungs and cause him to choke. However, humans have a gag reflex that keeps us from choking. If you hear your baby gagging (as he should so that he won't choke), it means that he is protecting himself from choking. As an additional protection from choking, the flap at the top of the trachea automatically closes to protect the trachea when food goes down or up between the mouth and the stomach.
Our bodies are designed so it is harder to breathe food into the lungs when we are lying down on our backs than when we are lying on our stomachs.
You can see in the picture that when your baby is lying on his stomach, the esophagus (tube leading from mouth to stomach) is above, or on top of, the trachea (windpipe). When your baby spits up, the food is more likely to fall into the trachea purely because of gravity. However, if he is on his back, the food must go up against gravity to enter the trachea (windpipe). It's actually harder for your baby to choke when he is lying on his back.
Belief: Babies sleep longer on their stomachs; they prefer sleeping on their stomachs.
Fact: Babies who sleep on their stomachs do sleep longer and more deeply. This fact makes them more vulnerable to SIDS. They can't wake up easily when they need to protect themselves. Let's say, for instance, that your baby is lying face down on a quilt and his oxygen level is dangerously low. He may be so deeply asleep that he can't wake to save himself. Remember that being a light sleeper is a good thing when you are a baby!
Belief: When babies sleep on their backs, they "startle" more easily and wake themselves up.
Fact: "Startling" is a normal reflex (arms fling out to the sides) that protects babies. It is a sign that he can wake up if he needs to. If you find that it is happening so frequently that it wakes him too often, swaddling or wrapping him to keep his arms from moving suddenly and startling him may help. (More on swaddling below.)
Belief: The back of the baby's head will get flattened or he'll get a bald spot.
Fact: Both of these can happen if a baby spends most of his time on his back when he is awake. This includes time in a car seat, swing, and baby carrier. Constant pressure on the back of the baby's head is the problem.
Get your baby off his back as much as possible when he is awake. Hold him upright or use a front baby carrier. This will also help your baby learn to use his neck muscles and hold his head up. Tummy time will be a big help. Head flattening and bald spots are temporary and will disappear when the baby learns to sit up.
Sometimes one side of the head flattens. This usually means that there is something your baby likes to look at as he is falling asleep, a mobile or toy, the light in the hall, music from a certain direction. To prevent this problem, alternate the position of the baby in his crib, one time with his head facing the foot and the next time facing the head of the crib.
Belief: My family says I should let my baby sleep on his stomach because that's what they did with their babies, who all did fine.
Fact: Well-meaning older adults who had no information about SIDS can believe that putting babies to sleep on their backs is either a mistake or unnecessary. Here are some suggestions for your response:
"I know we all slept on our stomachs and we were lucky. Modern research has shown that sleeping on the stomach is much more likely to result in SIDS, and sleeping on the back is a protective measure against SIDS. I want to do the best job I can to protect my baby."
"I talked to the doctor about it. She agrees that this is the safest way for the baby to sleep. She also told me that babies are actually less likely to choke when they sleep on their backs. I want to do the best job I can to protect my baby."
SAFE SLEEP GUIDELINE #6
Teach Your Baby to Sleep on Her Back
Most babies who begin life sleeping on their backs are very comfortable in that position. However, some parents worry that their baby doesn't seem comfortable because she wakes frequently or startles herself awake. Remember that waking frequently or startling means that your baby is aware of her surroundings and will be better able to react quickly if she isn't getting enough oxygen. She is not uncomfortable.
To help your baby fall asleep more easily on her back, try any of the following:
* Motion is often soothing. Rock your baby or put her in a swing (fasten the safety strap!). Move her to the crib after she falls asleep and lay her on her back.
* White noise is soothing to babies. This is soft background noise such as a fan, a CD of nature noises or a human heartbeat, an air conditioner running, or a white noise machine.
* Pacifier for sucking. Pacifiers also help protect babies from SIDS (see #13).
* Swaddling can help. When a baby is securely wrapped she feels as safe as she did in the womb. Here is how to swaddle a baby:
Use a lightweight receiving blanket over diaper and T-shirt — you don't want to over heat your baby. If your baby is under 2 months, put her arms inside the blanket when you wrap her so that the startle reflex won't wake her. If older than 2 months, you may keep her arms outside the blanket so she can use her hands and fingers. Try both ways to see which works for your baby.
1. Spread out the blanket. Place your baby on the blanket with her head at one of the corners, at the top of the blanket.
2. Bring the left side corner of the blanket over the baby and tuck it snugly under her backside. As you go, put her left arm gently on her tummy under the blanket. The fold over the baby should be tight and tucked securely under her neck. Don't ever put the blanket over the baby's face!
3. Next fold the bottom corner of the blanket up to her tummy, over the baby's feet and legs.
4. Place your baby's right arm gently on her tummy and fold the remaining corner of blanket snugly over her body to her backside.
You want the blanket to stay snug around the baby, but not so tight she can't breathe or bend at the hips. You should be able to insert a finger easily between the baby and the blanket, and the baby should be able to bend at the hips.
Note: There are baby blankets on the market that are specially designed to swaddle, with two sashes to tie together or a Velcro closure instead of a pin to secure the swaddle. If you prefer not to spend extra money on these, you can learn to swaddle your baby using any of the several lightweight blankets you probably have on hand. Always place your swaddled baby on her back, never stomach or side. If she has begun to roll over or is 3 to 4 months old, stop swaddling your baby. If she rolls onto her stomach she might not be able to roll back to a safer position. If the swaddle becomes loose or undone, either fix it or take the blanket away from the baby.
But what about ... if my baby rolls over?
"Do I need to flip my baby back over if she rolls onto her stomach?"
Most babies begin to roll over when they are between 4 and 6 months old. If your baby can roll from stomach to back and from back to stomach very easily, you can leave her as is. If she rolls onto her stomach and you're not sure if she can roll back, then it's best to flip her onto her back. If your baby rolls during sleep, make sure there are no blankets, loose sheet, pillows, bumper pads, or stuffed toys in the bed that could cause suffocation or re-breathing of carbon dioxide.
SAFE SLEEP GUIDELINE #7
Give Your Baby Tummy Time Every Day
"Tummy time" is when your baby spends time on his stomach while he is awake and being watched by an adult. It is important for several reasons. While he is on his stomach he learns to:
* Use his head, neck, and arm muscles.
* Lift and turn his head when he hears a noise.
Being on the stomach also takes pressure off the back of the head and decreases head flattening and baldness.
Babies need tummy time every single day. This is the baby's workout time — it will make him stronger and healthier. Here's how to give a baby tummy time:
* Baby must be awake and supervised closely.
* Baby should have tummy time two or three times a day starting from when you come home from the hospital. Start with 5 minutes each time and increase the time every day as your baby gets stronger. Ideally, you want to work up to 20 to 30 minutes, two to three times each day. At first he may not like it because it might be difficult and uncomfortable for him to be on his stomach. Keep going with the plan; he needs this time to practice using his muscles, to help him develop.
* Tummy time can happen any time, but many parents find that after a nap or diaper change are the best times. Find out what works with your baby.
Ways to make tummy time more fun and challenging:
* Prop him up on his forearms.
* Place yourself or a toy just out of the baby's reach and encourage him to reach for you or the toy.
* Place toys in a circle around your baby. Reaching for different places in the circle will help him to develop the muscles needed for rolling over, scooting on his stomach, and crawling.
* Lie on your back and place your baby on your chest. He'll lift his head and use his arms to try to see your face.
* Invite older children to get on the floor and have fun making faces and talking to the baby and offering him toys.
Excerpted from 14 Ways to Protect Your Baby from SIDS by Rachel Y. Moon, Fern R. Hauck. Copyright © 2011 Parenting Press, Inc.. Excerpted by permission of Parenting Press, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Safe Sleep Guidelines,
ONE: Get Regular Prenatal Care,
TWO: Get Your Baby's Sleeping Area Ready,
THREE: Get Regular Baby Check-ups and Vaccines,
FOUR: Provide a Smoke-Free Environment,
FIVE: Place Your Baby on His Back at Every Sleep Time,
SIX: Teach Your Baby to Sleep on Her Back,
SEVEN: Give Your Baby Tummy Time Every Day,
EIGHT: Place Your Baby on a Firm Surface to Sleep,
NINE: Keep the Sleep Area and the Baby at a Comfortable Temperature,
TEN: Breastfeed Your Baby,
ELEVEN: Have Your Baby Sleep in a Crib in Your Room,
TWELVE: Protect Your Baby from Other Sleep Risks,
THIRTEEN: Offer Your Baby a Pacifier at Sleep Time,
FOURTEEN: Make Sure All Caregivers Follow the Safe Sleep Guidelines,
Understanding SIDS and Other Sleep-related Deaths,
Parent's Checklist for a Safe Baby Sleep Environment,