We're Still Not All Following Safe Baby Sleep Guidelines, Says a New Study

Elena Donovan Mauer

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Thanks to the “Back to Sleep” campaign launched in the ‘90s, almost all of us seem to know that the safest position for babies to sleep is on their backs, but there are other safe sleep practices that should become more commonplace, too, according to a new study.

The American Academy of Pediatrics (AAP) and the U.S. Department of Health and Human Services recommend parents take a few important steps to keep babies safe while sleeping. They include:

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  • Placing infants to sleep on their backs

  • Sharing a room with the infant, but not bed-sharing

  • Avoiding soft bedding

  • Using a separate, approved sleep surface — this is defined as only a crib, bassinet or pack and play that meets safety standards set by the CPSC

The study, released in today’s issue of Pediatrics, surveyed mothers and found that most (78%) were putting their babies to sleep on their back, but far fewer were following the other recommendations. Only 57% were both room-sharing and not bed-sharing. Only 42% percent were avoiding soft bedding where the baby was sleeping, and just 32% were using a separate, approved sleep surface.

Going against these recommendations puts babies at higher risk for suffocation, entrapment or strangulation. According to the AAP, there are about 3,500 infant deaths per year with sleep-related causes.

“We have substantial room for improvement for these sleep practices,” study author Ashley H. Hirai, PhD, senior scientist at the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services, tells SheKnows. “I think we need to do a better job, such as having better media campaigns in addressing the broader recommended practices, beyond ‘back to sleep.’’”

Over the years, the “Back to Sleep” campaign has been renamed the “Safe to Sleep” campaign and does include the other recommendations, but this study suggests there’s more that can be done on informing parents of all the steps they can take to keep their babies safe while sleeping.

In fact, the study showed that more than 90% of mothers said their healthcare providers recommended they put their babies on their back to sleep; 84% were told their baby should sleep in a crib, bassinet or pack and play; and 85% were told what items were safe to have in baby’s sleeping area. But far fewer received the other safety advice. Less than half received advice to place a baby’s crib in the same room as their parents. This suggests that doctors may need extra training and resources to make sure they’re fully informing parents.

“We want providers to be able to have these conversations with parents,” says Hirai. “And so that it’s not just about telling them what to do but understanding their actual experience and barriers to these safe sleep activations.”

For example, some parents may feel strongly about co-sleeping to bond with baby. A doctor who listens can provide a workable solution, such as keeping a bassinet close to the bedside.

Also, word on safe sleep practices needs to spread to everyone. In the study, sleep practices varied among different groups of women. For example, moms who were older, non-Hispanic white, more educated and married were more likely to report they usually used the “back to sleep” position, used a separate approved sleep surface and avoided soft bedding. Moms who were younger, Hispanic, had less education and who were unmarried were more likely to report that they usually room-shared without bed-sharing. (And c’mon — let’s involve dads in the conversation, too, as well as other caregivers.)

“The bottom line is to raise awareness about these better sleep recommendations,” says Hirai. “And so we just want to hit that home that the safest place for babies to sleep is on their back, on a separate [approved crib, bassinet or pack and play], without any soft bedding and that they should be in the same room as their caregivers.”

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