What you need to know:
All young babies are at risk for dying while they are sleeping but there are things you can do to reduce the risk of the babies under your care. Most of these sleep-related deaths are preventable.What you can do:
you can put the babies your care for to sleep safely EVERY TIME they go to bed at night or for a nap. There are three things to remember:
Alone
Most sleep-related deaths occur when babies sleep with an adult or another child, or in an adult bed or on a sofa. Each baby should have his or her own crib. Pack 'n Play™ playpens and portable cribs, like those given out by the Health Department are safe to use as cribs.Back
Crib
A baby's sleeping place should be clean and clear. No blankets, pillows, fluffy toys or stuffed animals. Just put a tight-fitting sheet on a firm mattress. The baby can wear a sleeper if it is cold.Keeping your home or center smoke-free can also reduce risk.
Don't let anyone smoke around the babies you care for. That includes you!You can also use a pacifier to calm a baby and help him or her go to sleep. Research suggests that pacifiers help reduce risk too.
We recommend that you develop your own policy around safe sleep. You can:
- Train all staff members on the importance of safe sleep and make sure they know about your policy
- Have staff members sign an agreement that they will always follow safe sleep guidelines with every infant
- Require parents who do not want their baby to sleep on his or her back to have a signed note from a health care provider.
More Information for Caregivers on Safe Sleep
Am I a caregiver?
If you are a grandmother, grandfather, aunt, sibling, other relative, daycare provider or daycare center worker, babysitter or anyone else who puts a baby to sleep at night or for a nap, then you are a caregiver. It doesn't matter if you are paid or not, or licensed or not.All caregivers need to know how to put a baby to sleep safely.
Is unsafe sleep a problem in Baltimore?
Yes! In Baltimore, far too many babies between the ages of 1 month and 1 year die because they were not put to sleep properly. Between 2002 and 2009, 156 infants in Baltimore City died unexpectedly while sleeping.
- At least 140 (91%) were in unsafe sleeping environments
- At least 117 (75%) were sleeping with at least one other person (bed sharing)
- At least 117 (75%) were in sleeping on s surface with soft bedding
- At least 93 (60%) were both bed sharing and placed in soft bedding
- Other major risk factors include stomach or side sleeping and exposure to cigarette smoke
- Most at risk? Infants who are born pre-term and/or low birth weight, are male, are born to a young mother, a mother who did not receive prenatal care, or a mother who smoked while pregnant.
Are these deaths due to SIDS?
SIDS is the diagnosis given for the sudden death of a baby under one year of age that remains unexplained after a complete investigation, including an autopsy, examination of the death scene and review of the symptoms or illnesses the baby had prior to dying and any medical and family history. SIDS deaths fall under a broader classification of infant deaths call SUID (Sudden Unexpected Infant Death). As many as 80-90 percent of SIDS/SUID deaths may be the result of unsafe sleep practices.The exact cause of SIDS/SUID is unknown but we do know there are several risk factors that put some babies at higher risk.These include:
- Prematurity
- Low birth weight
- Exposure to cigarette smoke in the womb and after birth
- Being male
- Having young parents and
- Having a mother who did not receive prenatal care
Many of these deaths are due to sudden unexpected infant death (SUID) — a broader category that includes infant deaths due to SIDS as well as accidental suffocation, homicide, or unknown causes. Being in an unsafe sleeping environment is the most common risk factor for SUID deaths in Baltimore City. Many of these deaths are preventable.
Download B'more for Healthy Babies Sleep Safe rack card in English 
Download B'more for Healthy Babies Sleep Safe rack card in Spanish
Download the AAP Safe Sleep brochure for Child Care Providers in English
Download the AAP Safe Sleep brochure for Child Care Providers in Spanish
Why should the babies sleep alone?
Most babies in Baltimore who died last year due to unsafe sleeping conditions last year were sleeping with an adult or other children. Remember, it doesn't take much for a baby to suffocate.Share a room, not a bed.
Research has shown that room sharing is associated with a reduced risk of SIDS. If you are taking care of a baby overnight you can place the baby's crib next to the bed in your room or put a mattress next to the crib in the baby's room.
On the other hand, bed sharing is associated with an increased risk of SIDS. Bed sharing is placing your infant in the same bed with you while you sleep.
The babies look so uncomfortable on their backs. They just don't sleep well that way.
In most of the sleep related deaths reported in 2009 for Baltimore City, the babies were found sleeping on their stomachs. Two of them had been placed to sleep on their side. Doctors have known for years that babies sleep safest on their backs. Since the Back to Sleep campaign started almost 20 years ago, deaths due to SIDS have been cut in half. Every time you put a baby down to sleep, he should be on his back- not his side or stomach. No exceptions.
Put a newborn baby on his or her back to sleep from day one. The baby will soon get used to sleeping like that—he or she will think it is natural.
If a baby is used to sleeping on his stomach it may take a few days for him to get used to it, but rest assured—he will. Soon the baby will think it is natural. You can give him a pacifier to help calm him, if the parents agree.
Won't a baby choke if he sleeps on his back?
Many people believe that babies are more likely to choke if they sleep on their back. But this is not the case. When a baby is placed on his or her back, the windpipe (trachea) is above the food tube (esophagus). Anything that is spit up from the stomach has to go against gravity to be inhaled into the windpipe. A healthy baby generally will turn his or her head so that spit up goes out of the mouth and not back down the throat.
However, when a baby is on his or her stomach, anything spit up can block the windpipe and cause choking or breathing problems.
Infants are actually less likely to choke when placed on their backs compared to their stomachs. Since the American Academy of Pediatrics changed the recommended sleeping position to the back, there has not been an increase in the number of deaths due to choking.
What if a baby rolls over by himself?
Once a baby has reached an age where he or she is able to roll over from back to stomach, you there is no need to continuously watch or reposition him or her. Because the baby can turn over without your help, there is less risk they will suffocate. Do not use a pillow or rolled up blanket to keep a baby on his back. These items may also increase the risk of your baby suffocating.Don't babies need to spend time on their tummies?
Yes, all babies should spend part of their playtime while awake on their tummies. You or another caregiver should watch each baby closely during this tummy time.For more information:
Download a Tummy Time brochure from the AAP in EnglishDownload a Tummy Time brochure from the AAP in Spanish
Do parents need to get a special crib for their baby?
A baby shouldn't sleep on a couch, waterbed, or airbed or with pillows, cushions or stuffed animals. These increase the baby's risk of suffocation because the baby's head could become buried in or under these soft materials. A baby can fall off a couch or adult bed and get hurt or even die. The baby could also become trapped in between cushions and pillows or get stuck between the bed and the wall. These tragic situations actually occur all too frequently in Baltimore City.What kind of cribs should I buy for my center?
A baby's crib does not need to be fancy or expensive, but it must be safe. There are many types of stationary and portable cribs (such as a Pack 'n PlayTM or the portable cribs given out by the Baltimore City Health Department) that are safe—you just have to make sure that it meets current safety guidelines. When purchasing a crib, look for Juvenile Product Manufacturers Association (JPMA) certification.If you borrow or get a used crib, check to make sure that the slats are no more than 2-3/8 inches apart. Widely spaced slats can trap an infant's head.
The mattress should be firm and fit snugly in the crib. The crib sheet should fit tightly all the way around and under the mattress. Nothing else should be in the crib with the baby – no quilts, blankets, comforters, pillows, bumper pads, stuffed animals, or soft toys.
Car seats and infant carriers should not be used as a baby's bed. The baby could get knocked over or roll over. It's just not worth taking a risk.
Won't the baby get cold without a blanket or sheet?
Dress the baby in a sleeper for warmth, but do not use blankets or allow the baby to get too warm. Overheating can be a risk for SIDS. If the room temperature is comfortable for you, then it is also comfortable for a baby.Click here to download the Crib Checklist from the AAP
What does smoking have to do with SIDS?
Several medical studies found babies exposed to cigarette smoke in the womb and after birth are at increased risk of SIDS. Research in Baltimore City found that babies who were exposed to smoke in the womb were five times more likely to die from SIDS than babies not exposed to cigarette smoke. Babies in homes with cigarette smoke also had an increased risk of dying from SIDS.Don't allow smoke anywhere near a baby. It's best not to smoke at all if you are in contact with a baby—chemicals from cigarettes can get on your skin, hair and clothes and rub off on the baby.
Make sure your daycare center or home is smoke-free as well.
If you smoke and want to quit, call 410-545-1530 for a free listing of smoking cessation resources and classes.
I have placed infants, including my own, on their stomachs to sleep for several years. Why should I stop now?
As the years have passed and more studies have been done, we have learned that infants are less likely to die from SIDS if they are placed on their back for sleep.Everyone I know sleeps with their baby—it's part of my culture.
Babies are more likely to suffocate when they sleep with an adult in an adult bed. It is important to remember to put the baby's safety first.When can I stop placing a baby to sleep on her back?
You should always place the baby on her back, but once the baby is able to roll over on her own don't worry about trying to keep her on her back.Where do I go to get more information on safe sleep?
Safe Sleep Resources in Baltimore City
For help in getting a crib, or in accessing health services, contact Baltimore Health Care Access at 410-649-0526
For help with stopping smoking, call 410-545-1530 for a free listing of smoking cessation resources and classes.
Other Resources
Visit the American Academy of Pediatrics' Back to Sleep Website, located athttp://www.healthychildcare.org/SIDS.html
Read the American Academy of Pediatrics' most recent policy statement on safe sleep:
American Academy of Pediatrics' Policy Statement on Safe Sleep
Visit the Centers for Disease Control's Webpage for more information on SIDS found at
http://www.cdc.gov/SIDS/index.htm
Visit the First Candle Website for more information on SIDS and Sudden Unexpected Infant Deaths (SUID) at
http://www.firstcandle.org/
Visit The Association of SIDS and Infant Mortality Programs Website at
http://www.asip1.org/
Visit the National Sudden and Unexpected Infant/Child Death & Pregnancy Loss Resource Center at
http://www.sidscenter.org/
Receive more information on the Back to Sleep Campaign by the National Institute of Child Health and Human Development including campaign materials at
http://www.nichd.nih.gov/sids/sids.cfm
Visit the Baltimore City Health Department's Website at
http://www.baltimorehealth.org
