Safe Sleep for Babies: Good, Better, Best

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Pediatricians make all sorts of recommendations that a lot of us parents end up ignoring. Why? Because real life doesn’t match guidelines. For example, take safe sleep for babies. Nearly every pediatrician knows and shares the ABC’s of safe sleep with parents:

Alone (in their safe sleep space)
On baby’s Back
In a Crib, bassinet, portable crib or play yard that meets the safety standards of the Consumer Product Safety Commission (CPSC).

But, pediatricians usually forget to tell the babies that this is what is to be expected. As such, most babies would prefer to sleep snuggled up with mommy or daddy – as close to in utero as possible – thankyouverymuch. And we can’t really blame them – if you spent months in a snug, warm, soft, darkly lit space, being out in the open feels, well, less than ideal.

So, what’s an exhausted parent to do?

I'm a child injury prevention expert with specialties in infant safe sleep. Below, I’ve shared some common situations where parents have to make safety trade-offs. For each situation I’m offering good, better, and best options.

Situation #1:

Going to visit family

We all know the drill. You’re going to visit grandmommy and, understandably, there’s no crib at your final destination. What’s a safety-conscious parent to do

Good:
A dresser drawer or laundry basket. This one should be all too familiar to grandma, it’s a generations-old trick. Grab a sizeable drawer or firm-sided laundry basket, line it with a single towel, folded over. Ta-da! You’ve got yourself a sleep space that you didn’t have to haul from home. In a pinch, it’s a better option than sleeping in bed with baby.

Better:
A pack ‘n’ play. These can be the devil to move from place-to-place, but they do offer a pretty safe place for baby to sleep when you’re away from home. They’re easy to toss in the back of your car (with all the other gear) if your destination is within driving distance, but they become less convenient when airplanes are involved. Just be sure to follow the manufacturer’s instructions – if set-up incorrectly they carry a risk of collapse.

Best:
Travel Crib. Travel cribs meet safety standards and they are light and compact enough to take on a plane. Their only downside is that they can get pricey - especially compared to a laundry basket.

Situation #2:

My baby only sleeps when I hold her

And who can blame her? Wouldn’t we all prefer to be held, rocked, and gently patted while we sleep? But, especially in those early weeks, babies who only sleep when held can be a recipe for total parental exhaustion. Plus, we know that when babies sleep on their sleeping parents, there’s a higher risk for something bad, like suffocation or injury. SO how can you both get some rest?

Good:
A structured carrier. Wear baby in a carrier and then sleep on your back in bed or on the sofa – no blankets for parent or baby here. The carrier helps make sure that baby can’t slip off your chest and get hurt from falling, or risk being smothered by pillows or blankets. I’m a little nervous to offer this idea because it still comes with risk – baby could overheat in the carrier, you might accidentally roll over, etc… This is definitely not the ideal solution, but if you’re desperate it can help eliminate a few of the risks of sleeping with baby while still getting everyone some rest. This is a better option for naptime than it is for overnight.

Better:
Practice safer bed-sharing. Intentional bed-sharing may be a way to help your baby feel close to you, but start to learn how to sleep when she’s not *on* you. See situation #3 for safer ways to bed-share.

Best:
Transition to a safe sleep space. I know. This is probably not the answer you were hoping for. But, the safest thing to do is to help baby learn to sleep in a bassinet, pack ‘n’ play, or crib. Start slowly and focus on naptime first. Put them down drowsy but still awake for a nap in their new bed. Give them 3 minutes to settle in. After 3 minutes, if they're crying, pick them up and try again at the next nap time. The next day, try 5 minutes. Eventually, they’ll adjust to their new sleep space.

Situation #3:

Most pediatricians discourage bringing baby into bed. Sleep-deprived parents everywhere say “that’s easier said than done, Doc.” While there’s no way to make bed-sharing perfectly safe, there are ways to make it much safer while still keeping baby close by. I’m not doing a “good, better, best” for this one. Instead, here’s a checklist to make sure your bed is as safe as possible for you and baby.

Plan ahead.
Look at your sleeping situation in the (harsh) light of day and figure out what will make it safest for baby. Try to avoid deciding to bed-share for the first time in the middle of the night when none of us have our wits about us.
Keep your bedding to the bare minimum.
Use a pillow for yourself and a blanket you will wrap around your body (keeping it away from baby). Nothing else needed.
Only bed-share one parent at a time.
If baby’s in bed, send one parent to the guest room or couch for the night. (Think of it as a vacation?)
Sleep on a firm mattress.
Nothing squishy like a couch, armchair, or waterbed (do people even have those anymore?).
Choose bed over a couch or chair.
Studies show bed-sharing is riskiest if you sleep on the sofa or in a recliner. If you think you might fall asleep while feeding your baby – feed baby in bed.
Make bed-sharing for parents only.
Bed-sharing with adults other than a parent has a higher risk of suffocation. (Why? Parents tend to be more aware of baby and sleep less deeply when baby is nearby.)
Avoid alcohol before bed-sharing.
Quit smoking if you do smoke.
Being exposed to smoke raises baby’s risk of SIDS.
Don’t take medicines or drugs that make you sleepy before you bed share.
Avoid in-bed sleepers that look cozy or promise longer sleep.
Cozy almost always equals unsafe. Longer sleep is a myth. The goal of safer bedsharing is to keep your baby’s space open and protected. Away from anything that might cover her face.

Your baby is less than 4 months old
Your baby was born premature or low birth weight
You smoked during pregnancy
You are excessively tired (Well who isn’t? You just had a baby.)

Situation #4:

Acid-reflux

Some babies have acid reflux bad enough to require medicine. Nearly all babies have acid reflux to some degree because the sphincters (insert Wayne’s World joke) at the ends of their esophagi (aka throat tube) aren’t very strong yet.

Often, well-meaning parents and pediatricians recommend elevating baby’s head. Surprisingly, the research shows that lifting baby’s head may actually *increase* symptoms of reflux. Not to mention that raising baby’s head for sleep is a pretty risky maneuver on the safety front. A raised head can shift baby’s chin onto their chest and make it hard for them to breathe. So, when your kiddo has reflux, what can you do to help them sleep?

Happily, this is an easy one. No need for a good, better, best. Just keep following the ABCs of safe sleep listed at the top of this article. Their sphincters (heh.) will get stronger over time and the reflux will ease.

For those hard cases of reflux, simply holding your baby upright for 10 minutes or so after a feed will also help. Try not to get into the habit of propping baby up with something like a pillow or putting them in their car seat. Baby can slip down and get into that potential chin-to-chest suffocation position.

Situation #5:

Baby loves sleeping in a less-than-safe space

The truth is that most products that help babies sleep more deeply aren’t safe. It’s a sad reality of parenting. Places like bouncy seats, boppies, car seats, recalled Rock ‘n’ Plays, soft-sided in-bed sleepers, and daddy’s chest are ok for playtime, but not-so-safe for sleep time.

Why? Well, boppies, car seats, bouncy seats and the like all put babies in that “chin-to-chest” position. Their tiny airways can get closed off when in this position and they may not wake up in time to adjust. Soft-sided sleepers and daddy’s chest also increase the risk of suffocation by putting baby’s face too close to a soft, suffocate-able surface. What’s a parent to do when your wee one loves to sleep somewhere that you know isn’t safe?

Good:
Wear your baby for nap time. Littles love sleeping right next to your heart. Wearing your baby during their nap time will help keep them out of chin-to-chest position and still probably results in them sleeping well. Be sure to carefully follow the instructions that come with your wrap or carrier to make sure baby is in a safe position. If you’re unsure, ask a member of your local babywearing group for feedback. Bonus: You’ll have two hands free and can do stuff around the house/actually eat a meal.

Better:
Delay, but don’t give up on a safe sleep space. Super fresh infants may love a snuggly bed, but as they get a little older, they’ll become more amenable to a flatter, firmer bed. If you’re using something like a bouncy seat or squishy sleeper for overnight sleep, consider making the switch to a bassinet or crib when your sweetie is 2-3 weeks old. Most babies will adapt without much fuss.

Best:
Suck it up and make the switch. SIDS and suffocation are scary. No one here wants to scare parents, however, the best thing you can do is get your kiddo into a safe sleep space as soon as possible. Will they immediately love it? Probably not. Frankly, they’d really like to be back in utero, so anything short of that is likely to piss them off for a little while. But, happily, babies are incredibly adaptable. Before long your little one will be sleeping just as well in the new, safer bed. Caveat: If your kid was a crappy sleeper in the less-than-safe space, they probably aren’t going to suddenly start sleeping magnificently in their new bed.

Situation #6:

You are an exhausted new parent

This one applies to pretty much every parent. (And if it doesn’t apply to you, no one wants to hear it, mmkay?) Having a fresh, new baby is hard. They need you all.the.time. Then you read some well-meaning blog post about self-care that tells you it’s important for you to get sleep, take a shower, or have “me time,” too. So, how can your sweet pea sleep safely while you also, you know, live your life?

Good:
Put baby down wherever you are. You could put her to sleep in her car seat or swing, but that increases the risk of suffocation. Instead, put your baby flat on her back on the floor. To make yourself feel better (baby doesn’t care), you can even put a thin blanket underneath her. Resist the urge to put pillows around her. I promise your baby is perfectly comfortable without pillows. If you have pets, put them outside or shut them in another room. Make sure other adults and children in your home are aware of where baby is sleeping.

Better:
Keep a safe sleep space set up where you spend the most time. Where do you hang out? Living room? Kitchen? Wherever that is, set up a safe sleep station where you can put baby down nearby. A safe sleep station might be a pack ‘n’ play or mini crib. This is less ideal because you can’t easily move your safe sleep station around the house, but at least you’ll have a place for baby in the room where you spend the most time.

Best:
Use a portable sleep space such as a bassinet. This does not mean one of those devices that takes three hands to break down and move. No, get something that is light enough that you can carry it with one hand. This will give you the ABCs of safe sleep within arms reach, no matter where you are or what you’re doing.

To sum up safe sleep for babies

It’s not always perfect and its time we stopped shaming parents and gave them the damn tools they need to make more informed decisions. Real life doesn’t come with an instruction manual. So, do the best you can when it comes to safe sleep and if nothing else remember- face up, face clear, baby near. Cheers.

Our next reco: The Cry-Just-A-Little Sleep Training Method