Safe Sleep Practices for Infants

By James P Lee, MD, FAAP

When I was in my pediatric training back in the ’80s, unexplained infant death during sleep was called crib death.  The name was changed to SIDS – sudden infant death syndrome – and extensive research was and continues to be done to understand and prevent this tragic condition. Today, the old term is almost ironic because now the sad truth is most unexplained infant deaths occur as a result of unsafe sleep practices that could have been prevented if only the baby was sleeping in their crib!

Sudden infant death rates have decreased by 2/3 in the past two decades but nevertheless still occur. We now understand that the main cause of SIDS is suffocation and is much more likely to occur when the infant is sleeping in the same bed as the parent. Back sleep positioning and firm mattress support dramatically reduces SIDS risk and explains the AAP’s position on sleep practices for babies: room share but don’t bed share and the ABCs of safe sleep – Alone on the Back in a Crib.

Frequent feeding,exhaustion and philosophical beliefs of co-sleeping (attachment parenting) are part of the risk factors. These patterns can develop  innocently but can be habit forming as babies can easily become accustomed to the calming influences of rocking, being held and fed. These are all natural and instinctual parenting patterns but the practice of establishing safe sleep procedures is equally important as a parenting practice to be initiated in the newborn period and needs to be thought of in the same way as instituting other safety precautions (think car seats – you wouldn’t think of holding your baby in your lap on your car on the ride home from the hospital!)

The biology of sleep is fascinating and is in part natural and also part learned  behavior. In many ways, “establishing” safe infant sleep practices early in infancy is a parenting skill that requires understanding, patience and education. Safe sleep procedures  (the ABCs of infant sleep) need to be established as soon as babies go home. Safe parenting is the ultimate of good parenting and could be life saving.