B'more for Healthy Babies

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 your baby’s risk. Most of these deaths are preventable.

What you can do:

Put your baby to sleep safely EVERY TIME he or she goes 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. Share your room with your baby, but not your bed.

Back

Babies are more likely to die of SIDS if they are placed to sleep on their stomach or side. The safest position for a baby to sleep is on his or her back. Experts know that babies are not more likely to choke while lying on their back. In fact, when a baby is on its stomach, anything spit up can block the air pipe and cause choking or breathing problems.

Crib

Your 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. Your baby can wear a sleeper if it is cold.

Keeping your home or center smoke-free can also reduce your baby's risk.

Don't let anyone smoke around your baby. That includes you!

You can also use a pacifier to calm your baby and help him or her go to sleep. Research suggests that pacifiers help reduce risk too.

More Information for Parents on Safe Sleep:

What kind of crib should I get for my baby?

Your 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 Play™ or the portable crib 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 a 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 your baby – no quilts, blankets, comforters, pillows, bumper pads, stuffed animals, or soft toys.

Car seats and infant carriers should not be used as your baby's bed. Your baby could get knocked over or roll over. It's just not worth taking a risk.

For more information on crib safety go to: http://www.cpsc.gov/info/cribs/index.html

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 PDF
Download B'more for Healthy Babies Sleep Safe rack card in Spanish PDF
Download the AAP Safe Sleep brochure for Parents in English PDF
Download the AAP Safe Sleep brochure for Parents in Spanish PDF

Why should my baby sleep alone? I feel safer with my baby near me.

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. You can place your baby’s crib next to the bed in your room or put a mattress where you can sleep next to the crib in your 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. Some parents admit that they sleep with their babies out of convenience. However, the most important thing is your baby’s safety. This means that the baby should always sleep alone in a crib, Pack ‘n Play, or bassinette - every night and every nap. No exceptions.

My baby looks so uncomfortable on his back. He can’t sleep 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 your baby lies down to sleep, he should be on his back- not his side or stomach. No exceptions.

Put your newborn baby on his or her back to sleep from day one. Your baby will soon get used to sleeping like that—he or she will think it is natural.

If your 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 your baby will think it is natural. You can give him a pacifier to help calm him.

Won’t my baby choke if he sleeps on his back?

Many parents believe that babies are more likely to choke if they sleep on their back. But this is not the case. That position is safer because when your 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- not back down the throat.

However, when your 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 my baby rolls over by himself?

Once your baby has reached an age where he or she is able to roll over from back to stomach, there is no need to watch or reposition him. You can let the baby sleep in any position he or she wants. Do not use a pillow or rolled up blanket to keep your baby on his back. These items may also increase the risk of your baby suffocating.

Doesn’t my baby need to spend time on his tummy?

Yes, your baby should spend part of his playtime while awake on his tummy. You or another caregiver should watch your baby closely during this tummy time.

For more information:

Download a Tummy Time brochure from the AAP in English PDF

Download a Tummy Time brochure from the AAP in Spanish PDF

Why do I need to get a special crib for my baby to sleep?

Your baby shouldn’t sleep on a couch, waterbed, or airbed or with pillows, cushions or stuffed animals. These increase your 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 crib should I get for my baby?

Your 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 Play™ or the portable crib 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 a 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.

Car seats and infant carriers should not be used as your baby’s bed. Your baby could get knocked over or roll over. It’s just not worth taking a risk.

Won’t my baby get cold without a blanket or sheet?

Dress your baby in a sleeper for warmth, but do not use blankets or allow your 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 your baby.

Click here to download the Crib Checklist from the AAP PDF

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 smoke while you are pregnant or anywhere near your baby. It’s best not to smoke at all if you have a small baby—chemicals from cigarettes can get on your skin, hair and clothes and rub off on your baby.

Make sure your baby’s daycare center or caregiver’s 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.

My mother and auntie are telling me that they placed their babies on their stomachs while sleeping and that I slept on my stomach, so my baby should sleep on his stomach. Should I listen to them?

No. 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 your baby's safety first.

How am I going to breastfeed if my baby doesn’t sleep with me?

Remember—share a room, not a bed. Put your baby’s crib next to your bed so that you can easily pick him or her up for feedings during the night then return him or her to bed for sleeping.

How am I going to bond with my baby if she doesn’t sleep with me?

Holding your infant for feedings and bonding is encouraged. It is only when your infant is sleeping that he or she needs to be alone, on their back and in a crib. You may find you sleep better too!

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 at
http://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