I convened a “lunchroom lowdown” the other day on the topic of new AAP Safe Sleep Guidelines, and my partners eagerly offered their opinions and impressions when it comes to safe sleep for infants. My partners–Drs. Plonk, Riley, Downing, and Moorman–are outstanding doctors, and I can’t thank them enough for sharing their expertise with me. Let me try to summarize our conversation about “Safe Sleep for Infants.”
A lot of the discussion revolved around the practicality of running a household with three or four children following the new recommendations. I think all the doctors felt that the guidelines are good goals but are not always practical. Dr. Riley doubts that parents can always be present when their infant is asleep. Also, can the surface they sleep on always be on a “sleep safe surface” as outlined in the guidelines? Probably not. Dr. Plonk wonders what happens when an infant falls asleep in a swing or car seat: should they always be awakened and moved to a safe place? Again, unlikely. Dr. Downing thinks that it is very unlikely that after a child feeds in their parents’ bed that the child will always be put back onto a safe surface by an exhausted, half-asleep mother. Since only one person is supposed to be in the bed with the infant, does that mean Dad gets exiled with every feeding? Dr. Downing doesn’t think that will happen, and neither do I.
Drs. Plonk and Riley felt that not only are some of the guidelines impractical, but some are ambiguous. The “no monitor recommendation” seems to imply not to use audio or video monitors; why? If not, do parents need to watch their children sleep 24/7 in person? What about that “no over-bundling recommendation” (not to use more than one layer more than would make an adult comfortable)? How many layers are in a swaddle? Is swaddling with a large blanket now forbidden?
Dr. Downing felt that the new guidelines are excellent recommendations, but wondered if they will change very many parents’ behavior. We all know how difficult it is to change someone’s behavior. There was uniform agreement that despite the new guidelines’ impracticality and potential ambiguity, overall the AAP’s new guidelines for safe sleep are a big step forward for children.
As we were discussing this topic, the thought crossed my mind that hospitals should be the number one place where these guidelines are followed, but that is often not the case. Hospitals should be setting the best example for parents and physicians. If anyone should know what actually happens in a hospital, it is the group at the Lunchroom Lowdown; combined, we have over 100 years worth of hospital nursery experience. We know what goes on in hospital nurseries. Many of the guidelines are not being followed on a routine basis to this day. For instance, twins are often put in one bassinet together (“Babies should sleep on a safe surface by themselves”). Babies are routinely swaddled with multiple wraps (“No more than one layer above others in the room”) and placed on their sides (“Back only”). Additionally, the bassinets have solid sides which could get up against a baby’s nose and cause obstruction (“No surfaces near a baby’s face that can cause suffocation”). It is not unusual for lovies to be placed in the crib from the day a child is born (“No toys”). What about those cute little hats that almost every newborn wears: could it get down over a child’s face? You bet. Finally, the move toward infant bonding, skin to skin, and rooming-in encourages very exhausted moms and dads to hold their newborns when everyone may be very sleepy (“No sleeping on unsafe surfaces”). Hospitals, let’s get with the program!
The death of a otherwise healthy infant is a terrible thing, and the new guidelines are a big step toward making such an event a thing of the past. When you really dig down into the recommendations, you begin to see how difficult they are to follow at all times. Let’s hope that both parents and hospitals can do a better job in the future of providing the safest sleep possible for our newest citizens we call our children!