Too Many Babies Still Sleep Unsafely—Let’s Change That

by Dr. Harvey Karp

Photograph by Twenty20

By now, we all know babies should only sleep on their backs because it reduces the risk for sudden infant death syndrome (SIDS). That’s no-brainer, easy-to-follow advice, right?

Unfortunately, it is not. A new study shows that only 43.7 percent of parents always place their babies on the back to sleep.

As a pediatrician, the statistic is disheartening. However, I don’t believe the problem is ignorance or lack of caring. Rather, I’ve observed parents take risks when they are desperateabsolutely desperate for sleep. Yes, doctors like me need to keep reminding new moms and dads about sleep safety, but we also need to offer explicit advice for helping them to improve infant sleep. To that end, here are my new and improved top 10 SIDS prevention steps (with sleep advice woven in):

1. Put your baby to sleep on their back. Always.

Let there be no confusion: The back is the only safe position for infant sleep. Stomach sleeping multiplies the SIDS risk up to 12 times. The problem for parents, though, is that many babies don’t sleep great on their backs, with their arms free or in a quiet room, and that fact is causing many to lay their infant to sleep on the stomach or to take risks like bed sharing or sofa sleeping. The great news is that the tools for improving sleep are readily available. I’ll walk you through it all in step 10.

2. Keep your baby’s bed free of toys, pillows, loose bedding, etc.

This also means no blankets under your baby and no crib bumpers unless they’re made of breathable mesh. When swaddling—which I absolutely recommend for boosting sleep—be sure to wrap your infant snugly or choose a swaddle sack that can’t unravel. The idea is to put nothing extra in your baby’s bed that could pose suffocation or strangulation risk.

3. Sleep your baby alone, in their own bassinet or crib.

I can’t stress this enough: You cannot bed share safely with babies under 9 months of age. Some 70 percent of infant sleep deaths occur in an unsafe place—mostly in adult beds. It’s always risky because of a problem I call “drunk parenting.” Exhaustion makes you the equivalent of drunk: forgetful, accident-prone and sleeping very deeply. That’s why exhaustion causes as many car accidents as drunk driving! You would never bed-share if drunk, so please, please don’t take a baby into bed when you’re “drunk” tired.

4. Have your baby sleep in your room for at least 6 months.

American Academy of Pediatrics data shows that room sharing decreases the risk of SIDS by as much as 50 percent. Bonus: It’s also more convenient for feeding and diaper changes!

By talking about sleep efficacy in addition to SIDS prevention, we now have the means to avoid many—if not most—of these deaths.

5. Never let a baby sleep on a couch, recliner, sofa, armchair, beanbag chair or waterbed.

It’s rare that babies are laid down to sleep on these soft surfaces (don’t do it!), but often, parents accidentally fall asleep on these surface when up at night trying to calm their crying baby. When parents learn to boost sleep, we reduce this very serious risk factor.

6. Transfer your baby out of a car seat or baby swing, if they fall asleep there.

Many parents aren’t aware of this one. In 2016, the AAP declared devices that position infants on an incline are unsafe for sleeping because they may allow a baby’s head to roll forward and cause suffocation and death. This advice pertains to car seats and most swings.

7. Breastfeed if you can.

Nursing cuts the SIDS risk by 50 percent! And, by the way, one of the top reasons moms abandon breastfeeding are exhaustion and persistent crying. So, when we help you sleep, we’ll help you succeed in nursing, too!

8. Give your baby a pacifier for naps and nights.

There’s evidence that pacifiers consistently reduce the SIDS risk. Don’t worry if the paci pops out—it will. No need to put it back in. Just make a binky part of your nap and nighttime routines.

9. Keep your house smoke-free and avoid room temps that are too hot or cold.

Don’t smoke (or allow friends or family to light up) and avoid wood stoves, incense, scented candles and fireplaces unless the room is very well vented. A room temperature of 68°F–72°F (20°–22.2°C) is ideal for baby sleep. Avoid overdressing to prevent overheating.

10. Use sleep-boosting methods.

Now to the fun stuff, sleep advice to benefit baby and you! There are three simple ways to improve slumber for back-sleeping babies: sound, swaddling and rocking. These methods have one thing in common. They all mimic the soothing sensations that lull babies to sleep in the womb!

Rumbly white noise is inexpensive and so effective. It instantly makes babies drowsy and helps them stay asleep longer by droning out sudden household noises and other sleep stealers. Responsive sleepers—beds with technology that detect cries and respond to soothe the baby—combine swaddling, white noise and motion.

Swaddling is a wonderful sleep aid. Without it, back-sleeping babies flail their arms and accidentally startle themselves awake again and again throughout the night. Traditional swaddling, however, comes with a safety caveat. The AAP now recommends that parents stop wrapping at two months of age. However, read on—there’s a solution!

Motion or swinging both fantastically boosts sleep. But parents must be careful, as mentioned in no. 6, not to let their infant keep sleeping in any device on an incline.

For nearly 20 years, despite widespread public education, there has been no reduction in infant sleep death. Year after year, 3,500 infants die in their sleep. We need to change the conversation.

By talking about sleep efficacy in addition to SIDS prevention, we now have the means to avoid many—if not most—of these deaths. This has been the missing link in our approach: We’ve been doing nothing to help parents resist the temptation to bed share. I urge you to share this information with all the new parents you know. Together, we can make a difference by spreading the word.

Dr. Harvey Karp is a nationally renowned pediatrician, child development specialist and author of the best-selling book, "The Happiest Baby/Happiest Toddler on the Block" parenting guides. For over 20 years, Dr. Karp has been a tireless advocate and a national leader in the promotion of children's rights to a healthy and safe environment. His work in protecting children has directly led to state and national laws protecting children. He is also the founder and CEO of Happiest Baby, a smart-tech and parenting solutions company, which launched the SNOO smart sleeper in 2016. Since its launch, the SNOO has been widely applauded by parents and critics alike, winning countless awards and accolades including the first ever National Sleep Foundation SleepTech award for the most innovative product in 2017. It is the only sleeper that prevents rolling and provides safe swaddling for 6 months, a breakthrough advance in infant safety.

Explore More: sleep, advice