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4 Common Myths About Safe Sleeping Positions For Infants

Every year more than 2,300 healthy infants die in the United States from Sudden Infant Death Syndrome (SIDS). This number is half of what it used to be before the 1994 “Back to Sleep” campaign started teaching parents to use supine (on the back) sleep positioning for all infants. However, even one SIDS death has devastating conseqences for families and communities, and ongoing research and education efforts are working to decrease this number. We are still learning what exactly causes SIDS. As shown below, the risk of SIDS peaks around 3 months of age and declines after that. After age 6 months the risk is much lower, but it can still occur. In 2011 the American Academy of Pediatrics released an updated policy with even more specific recommendations about safe sleeping environments for babies. Even now, three years after these new guidelines, I still frequently see families who are misinformed about the safest way for their baby to sleep. Here are some common myths about infant sleeping that seem to confuse many families: Myth #1 – Side-sleeping is a safe position for babies – Many parents reason that as long as their baby is not sleeping on her stomach, he or she is in a safe sleep position.  However recent studies have shown that SIDS risk is similar with side and stomach positioning, and some evidence suggests the risk may be even higher in side positioning! Side positioning is unstable and babies are very likely to roll to their stomach. Many parents may use pillows, rolled cloths, or other objects to prevent their baby from rolling onto her stomach, but these objects can increase risk of entanglement or suffocation. Myth #2 – My baby may choke on her spit up if she’s sleeping on her back – Babies often spit-up during the first few months of life, and parents are concerned they may choke when lying on their back. However numerous studies in different countries found no difference in the rate of aspiration or choking before and after the change to the recommended “Back to Sleep” position. Myth #3 – Sleeping on his or her back in a car seat or swing is ok – The trouble with sleeping in these devices is that the babies often slouch into a position that worsens reflux or may block their airway. Also, there is the risk of overturning or falling from the seat. Myth #4 – Many cultures practice bed-sharing, therefore it must be safe – There are some cultures for which bed-sharing is the norm and SIDS rates are low, but these cultures tend to have different sleeping practices from the United States (with firm mats on the floor, a separate mat for the infant, and no soft bedding). Studies here have shown that bed-sharing more than doubles SIDS risk. The risk is even higher in certain circumstances: when one or both parents are smokers, when the infant is younger than 3 mos, when the parent has consumed alcohol, when soft bedding such as pillows or blankets are used, or when an excessively soft surface is used (such as a waterbed, a sofa, or an armchair). There are many “co-sleeper” products marketed to improve safety of bed-sharing, but none of these have been proven to prevent SIDS. The AAP policy statement includes many other recommendations, including avoiding bumper pads, wedges, and other devices. You can read all of their recommendations here. A pediatrician friend who is also a mom once jokingly summarized the new AAP SIDS prevention policy statement as this: “Any condition which may be condusive to the infant actually sleeping is dangerous and should be avoided.” As a mother myself I fully appreciate the difficulty in following some of these guidelines, especially when you are exhausted and your baby just won’t stay asleep!  However SIDS remains the most common cause of death in infants after the newborn period, and I am sure all parents will sleep easier knowing that they are doing everything they can to decrease their child’s risk.
Dr. Angela Mazur, Texas Children's Pediatrics Braeswood physician