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Suitable Sleeping Sites: Safe at Night & Naptime

By: Laura A. Jana, MD, FAAP & Jennifer Shu, MD, FAAP

Before you lay your baby down to sleep at night or for a nap, consider these safety tips and practical considerations.

Sleeping solo or filling the family bed

Probably since the beginning of time, babies and parents around the world have slept together in what has come to be commonly referred to as "the family bed." But in recent years, particularly in industrialized nations such as the United States, the trend has been to have children sleep separately starting from birth. Given that this trend is in keeping with what we now know to be safest for babies, we suggest you let common sense and a strong commitment to safety prevail.

  • The family bed. Whether because of space limitations, cultural norms, or a strong belief that bed-sharing is an integral part of parenting, parents have slept with their babies for thousands of years. In many parts of the world and in a good 60% of US households, many babies still sleep in bed with their parents, at least on occasion, despite increasing concerns about the associated risks. Followers of attachment parenting seem to feel quite strongly that parents and babies benefit most from bonding whenever possible, including during sleep. Proponents also feel that bed-sharing makes breastfeeding easier. We encourage you to read on for some important things to consider before you opt for the family bed.

  • Sleeping solo. By sleeping solo, we don't mean to imply in a different room, just not in the same bed. In the United States, there has been a definite shift toward placing babies down for sleep independently, whether in a crib, cradle, or bassinet. Our country's movement toward independent sleep may well be, in part, attributable to recent and well-founded concerns that bed-sharing in the first year increases the risk of sleep-related infant deaths. Other practical reasons why parents opt for solo sleeping: they find it to be safer, sounder (for their baby and themselves), and less intrusive on their "adult" time.

Bed-sharing safety concerns

Many new parents are tempted to take their newborn into bed with them—often out of fatigue and convenience, as well as for cultural and philosophical reasons. Whether bed-sharing is safe, however, has been the subject of much debate. Recent studies suggest that bed-sharing may significantly increase the risk of infant suffocation, so you'll find that many experts (including those responsible for writing AAP policy) now strongly advise against it and instead suggest the very practical and safer alternative of sharing the same room but not the same bed during your baby's first year. If you choose to sleep with your baby in your bed, even if only infrequently, here are some extremely important safety considerations.

  • Make your bed like a crib. The heavy blankets, comforters, pillows, and other accessories typically found on adult beds can suffocate or smother a baby and therefore have no place being in the same location where newborns sleep. (While we're on the subject of simple yet potentially lifesaving measures, we also strongly recommend removing any and all such items that may have already found their way into your baby's crib.)

  • Bed-sharing babies are at risk from falls or the possibility of being trapped between the mattress and the wall, headboard, or other furniture.

  • Bed-sharing and the use of tobacco, alcohol, or drugs don't mix. These substances, including over-the-counter or prescription medications, all have the distinct potential to cause excessive drowsiness or impaired judgment, making those who choose to indulge at risk of being less aware of a baby in the bed.

Crib safety considerations

Whether you decide to set up a crib for your baby as soon as your pregnancy test turns positive or months after your newborn's much-anticipated arrival, there are a few general safety principles that you'll want to follow to ensure your baby's safety. Some may not seem particularly relevant during your baby's first few months, but given that cribs tend to be big-ticket items and the one you invest in is going to be put to the test for years to come as your baby learns to roll, sit, stand and climb in it, it's well worth considering present and future safety concerns.

  • Crib slats. The slats should be no more than 2-3/8 inches apart. All new cribs must meet this standard, but older cribs may not. Avoid using any crib that does not meet this 2011 standard.

  • Posts & cutouts. Steer clear of bedposts taller than 1/16th of an inch (we realize that's almost nothing, but that's the point) and/or cutouts in the headboard or any other parts of the crib, where a baby's or toddler's body parts could get stuck.

  • Bumpers and pillows. Yes, they're soft and cute. But soft and cute should not be your deciding factor. For safety's sake, keep crib bumpers and pillows out of your baby's crib.

  • Crib toys. They may seem harmless, entertaining, cute and cuddly, but keep all stuffed animals (and most toys) out of your newborn's crib because they can pose a small but nevertheless real safety risk. The exceptions are the types of toys that strap securely to the side of the crib. Some babies like mirrors or toys with parts they can play with (such as spinners, rattles, and music), but your newborn probably won't be terribly interested in them for at least a few weeks.

  • Mobiles. Mobiles are special hanging toys designed to entertain your baby and can be attached to the crib, ceiling or wall. Some are even adorned with lights or play music. They are fun but definitely optional. If you do choose to use mobiles, make sure they do not hang low enough to entangle your baby, especially once they begin to roll. In fact, once your baby is able to sit up, it will definitely be time for their mobile to come down.

  • Crib placement. Unless you don't mind a bit of redecorating and rearranging when your baby starts to get around, we suggest you place your crib well away from any windows and no less than an arm's reach away from any nearby dressers or tabletops. Knowing that it won't be long before anything and everything within reach will be fair game, we also recommend limiting your over-the-crib wall decorations to painted walls and wallpaper. Picture frames and mirrors over cribs may be cute, but they are also injuries waiting to happen. Be forewarned that while they may be safe, even paper borders placed within reach of the crib don't often stand up well to prying fingers.

  • Firm-fitting mattress/fitted sheet. While they seem to be mostly standardized, cribs and mattresses can and do come in more than one size. So be sure to double-check measurements and read labels to make sure you end up with a mattress that fits snugly into your chosen crib. Any extra space between the mattress and crib frame has the potential to trap a baby's arm, leg or head. Also make sure your fitted sheets are tight enough that they don't slip off easily, thus posing a serious safety hazard.

  • Tooth-resistant rails. Some railings are covered by a special plastic to prevent teething babies from gnawing on the paint or wood.

  • Adjustable mattress height. Many cribs have adjustable heights so you can lower the mattress as your baby gets taller, making it more difficult for them to climb out. You will likely want to keep it at the highest level while your newborn is relatively immobile and you are coming and going frequently because it will allow you to save a good deal of strain on your back. Remember that by the time your baby is able to sit or stand up, you'll want to lower the level of the crib mattress accordingly.

Bare is best when it comes to cribs

If you come to find that the excitement you feel about having a new baby is wrapped up in the buying of a fancy baby bedding set complete with bumper and quilted blanket, we suggest you work on changing your mindset rather than your nursery décor. Simply remember that the AAP recommends that nothing but a snugly fitted sheet be placed with your baby in the crib during the first year.

Why drop-side cribs are a thing of the past

In years past, crib railings were almost always adjustable—meaning you could raise and lower one or both side railings. While this feature had long been appealing to parents as a convenience, it became a safety concern. Numerous injuries from crib side-rails resulted in the largest crib recall in history (2.1 million cribs!) in 2009. As a result, the Consumer Product Safety Commission (CPSC), which sets voluntary industry safety standards, required that going forward, all full-sized cribs be manufactured with 4 immovable sides. The take-home message for all parents: Always check out the latest safety information on the CPSC website before dropping your guard.

More information

About Dr. Jana

Laura A. Jana, MD, FAAP, is a pediatrician and mother of 3 with a faculty appointment at the Penn State University Edna Bennett Pierce Prevention Research Center. She is the author of more than 30 parenting and children's books and serves as an early childhood expert/contributor for organizations including the Maternal and Child Health Bureau, Primrose Schools, and US News & World Report. She lives in Omaha, NE.

About Dr. Shu

Jennifer Shu, MD, FAAP serves as the medical editor of HealthyChildren.org and provides oversight and direction for the site in conjunction with the staff editor. Dr. Shu is a practicing pediatrician at Children's Medical Group in Atlanta, Georgia, and she is also a mom. She earned her medical degree at the Medical College of Virginia in Richmond and specialized in pediatrics at the University of California, San Francisco. Her experience includes working in private practice, as well as working in an academic medical center. She served as director of the normal newborn nursery at Dartmouth-Hitchcock Medical Center in New Hampshire. Dr. Shu is also co-author of Food Fights and Heading Home with Your Newborn published by the American Academy of Pediatrics (AAP).

Last Updated
6/22/2022
Source
Adapted from Heading Home With Your Newborn, Fourth Edition (Copyright 2020 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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