Safe to Sleep PDF Print E-mail
Written by Laura Maxson, LM   


Just say no is not an effective anti-drug message, just as abstinence only is not always helpful when it comes to pregnancy prevention. Both of these messages might work for some, but plenty of people will want more concrete information as a basis for personal choice. Not providing that information does not prevent other choices, it just prevents informed choices.

The same argument can be made for the Safe-to-Sleep message of “never put your baby on an adult bed.” Messages to reduce the risk for Sudden Infant Death Syndrome (SIDS) tend to be very directive, without much consideration of individual circumstances. The realization that 1 in 8 deaths occurred on couches or chairs made it clear that parents were choosing to sit up sleepily in the recliner or laying on the couch with baby instead of going to the potentially less risky but forbidden adult bed.

 Breastfed babies cut their SIDS risk by more than 60% with six months of exclusive breastfeeding. While sick or premature babies, smokers in the household, parental drug or alcohol use, or just living in a chaotic household can all increase the risk of SIDS. 

 These individual situations can result in parents considering different options. This year’s rollout of the newest Safe-to-Sleep guidelines includes a specific mention of the possibility of falling asleep while nursing the baby:

Before you start feeding your baby, think about how tired you are. If there’s even a slight chance you might fall asleep, avoid couches or armchairs and remove all soft items and bedding from an adult bed before you start the feeding to reduce the risk of SIDS, suffocation, or other sleep-related causes of death. 

This information is presented as a side note – an exception for the very special situation when the parent is sleepy when nursing a baby. This implies that it is not the norm most any night, especially in the early weeks and months when babies wake often in the night. 

Instead of a one-size-fits-all directive, care providers now have an opening to move beyond slogans and into discussions that reflect their patients’ nighttime realities. Along with a reminder to always put babies on their backs to sleep, a provider could also ask, “I wonder where you might nurse your baby if you were feeling really sleepy?” Many expectant parents have never considered falling asleep while nursing. Thinking about it in advance can help parents make plans. 

Thoroughly discussing the risks for SIDS (unexplained infant death) must also include discussing how to avoid explainable deaths that are accidental in nature. Any place a baby is going to be, especially for sleeping, needs to be free from danger.

Avoiding entrapment - Take, for instance, the small gap between an adult bed and the wall or bedside table. While a baby’s head couldn’t slip through such a small gap, feet first a baby might get trapped. Plug gaps securely with a rolled towel or other method that makes a firm, gap-free surface. 

Strangulation risk – Beware of cell phone charging cords near where baby is sleeping. Check also for window blind pull-cords and loose stings on adult sleepwear. 

The risk of suffocation is increased when anything is placed in the baby’s sleeping area. No crib bumpers, baby pillows or fluffy quilts. Cribs are big and newborns are small, but parents shouldn’t be tempted to use the extra space in the crib for storage. No stuffed animals or stacks of blankets in the crib. 

Keep it cool. Over-bundled babies can get too hot. Babies use their heads to regulate their temperature; baby hats can lead to overheating, as well as becoming a danger if dislodged.

Falls are always a concern with babies. Discussing ways to minimize this risk might include placing an adult mattress on the floor for nighttime nursing when the parent is sleepy. Cosleepers or bedside cots at the adult mattress level are often chosen by parents to give easier access for breastfeeding, while allowing baby to have a protected space.

Car seats, swings, nursing pillows and other baby holding devices aren’t designed for sleeping. Positioning devices and foam wedges are sometimes advertised as a safe sleep device, but can actually become a danger if a baby slumps down or rolls over near or in them.

The new guidelines should be applauded for allowing for a more open discussion with care providers; helping to ensure that any place a baby sleeps – co-sleepers, adult beds or cribs - should be treated the same, with no soft bedding, pillows or strings and careful consideration of individual circumstances. And remember, whatever they sleep in, keep them close! Babies are safest sleeping in their parent’s room for the first year. 

Laura Maxson, LM, CPM, the mother of three grown children, has been working with pregnant and breastfeeding women for over 30 years. Currently she is the executive director of Birth Network of Santa Cruz County and has a homebirth midwifery practice. Contact her at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .



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Last Updated on Wednesday, 31 January 2018 23:18
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