Tag Archives: crib

Safe Sleep Environment for Infants 2011 (Pedcast)

This podcast is part of the Essential Series for parents with newborns and infants.  Knowing the dos and don’ts when it comes to safe sleep environment for infants is something that parents must master.   Sleep associated deaths may, to a large degree, may be preventable.  Listen to what experts feel is the safest environment for babies to sleep.


-I created this podast in order to bring parents useful information they can use to help their children from the crib to the country club, from the bassinette to the board room.
-This episode is part of my essential knowledge edition of DocSmo
-Today we are going to talk about the new recommendations, appropriate for most babies, from the Academy of Pediatrics regarding Safe Sleep Practices for infants.
-A task force, working for the AAP, consisting of academic pediatricians. Reviewing available data and making recommendations based on available evidence and some opinion, albeit informed opinion.
-So get ready and sharpen up your pencils if you are a new parents bringing a newborn home from the hospital. I have some detailed recommendations for you hot off the AAP press. Important since deaths during sleep are the most common cause of death in infants during the first year of life!!! Pay close attention and learn what the experts at the AAP think constitutes the safest sleep environment for infants.
-Let me remind my listeners that, I am not your child’s doctor and for specific advice regarding your child, consult the wonderful person you call your child’s doctor.

First some definitions so we are all on the same page;

Our discussion today revolves around deaths that occur in infants during sleep time in the first year of life after they have transitioned from the birth process. These fall into a few categories;
-APNEA is the medical term for lack of breathing that is centrally mediated, that is, your brain forgetting to breath…common in premature infants before they have mature centers in their brain’s to control breathing, especially during sleep. Remember, no need for breathing in the womb so many immature premies just forget to breath…especially if they are asleep.
-SIDS Sudden infant Death Syndrome- Any sleep associated infant death that cannot be explained after a thorough medical investigation that includes an autopsy, toxin screens, metabolic tests…no trauma, no sickness, no suffocation etc. Presumably, the terminal event in a SIDS death is an apneic spell.

-SUID Sudden Unexpected Infant Death- Any sleep associated sudden death of an infant whether explained or unexplained which includes SIDS deaths as well as suffocation, asphyxia, entrapment, infection, ingestions, metabolic diseases, cardiac deaths, and trauma whether accidental or non accidental.

-New distinctions about sleep related deaths depend not only on traditional medical information like autopsy and lab tests but also on scene investigation. In recent years, a new tool that can explain many of these sleep associated deaths.

The goal of the new emphasis on safe sleep environments is to eliminate all sleep associated deaths in infants, whether they be SIDS type or SUID type. Here is the consensus of the AAP experts of the do’s and don’ts when it comes to a safe place for your infant to when they are unattended–Hot off the press.

-Except in rare cases, Back to sleep for EVERY sleep in the first year. Not side, not elevated, not in or on a device such as a wedge.
– Your babies “sleep surface” should be firm and conform to Consumer Product Safety standards for ALL sleeping, day and night.
-Your babies mattress should have no gaps around the edges (suffocation risk) and should only be covered by a fitted sheet…no loose bedding, no toys, no bumpers
-Dress your baby in light, comfortable clothing such as a one-piece sleeper in a room that is between 68-72 with no more than one layer more than that which would make an adult comfortable. No clothing that can get near the babies face.
-Breastfeed your infant
-Consider using a pacifier after breastfeeding is established.
-Put your infant’s crib or sleep surface in the room with the parents for the first 4-6 months?
-Its OK to put your baby down on their tummies for supervised Tummy Time everyday as soon as you get home to prevent flat spot on head however, this time must be supervised and follow the same rules I just outlined except the child is on their tummy rather than back.

Don’ts of sleep;
-NEVER Use pillows, soft bedding, sheep skins, quilts, pajamas with hoods, or blankets that can get near a babies face. If a blanket absolutely has to be used, tuck it firmly under the mattress so it cannot get loose.
-Crib should be free of loose toys or mobiles that can be reached. And nothing should be tied to the baby like jewelry or pacifier tether.
-No co sleeping. Feeding at night…must go back into crib. Infants should not sleep with siblings, parents, strangers, or anyone.
-Do not rely on monitors… cardio respiratory or any other type.
– Do not use a crib that has any broken or mended parts
-NEVER let a baby sleep on an adult who is drowsy or asleep
-NEVER let a infant sleep in a device that covers their face.
– Do not leave your baby to sleep in a car seat or carrier
– NEVER smoke before or after your baby is born
-Never use drugs or alcohol while caring for your baby

Easier said than done. I recently got a note from a Mom with a now 3 month old late preterm infant and you could hear the angst in her note. Let me read a portion of it for you. ” …it can be very frustrating as a parent (trying to preserve one’s own sanity) when doctors make these rulings that are not so easy to execute in the trenches!- Like –Never doze with your baby!! No toys in the bed!! Car seat MUST face back (This mom is particularly distressed when I’m alone with a young baby in the car!) Or—Sleeping in unapproved device may result in DEATH! Never leave baby unattended!!(How do I go to the bathroom, she asks??) She goes onto to say, It’s enough to make anyone lose their marbles. I know doctors just want the best for us, but take pity on us poor sleep deprived parents!”
– Here is hoping that you don’t lose your marbles. We need all the healthy, energetic healthy parents we can get to raise this next generation.

– If you want to read the full Academy of Pediatrics recommendations about safe sleeping environments, check out the references in the Smo Notes.
-Thanks for joining us today.
-Take the plunge and subscribe for your free pediatric education by getting the RSS feed from DocSmo.com or signing up on iTunes, Facebook or twitter.
-Remember this is a blog so your comments are welcome and may possibly be posted for others to ponder and comment on.
-This is your podcast host, Dr Paul Smolen, broadcasting from studio 1E in Charlotte, NC… hoping it is not a great leap for you to provide a safe place for your infant to sleep!

-Until next time

Smo Notes:

1.  Charlotte Observer- safeSleepPoster.pdf (application/pdf Object)-http://www.charlotteobserver.com/images/graphics/post/safeSleepPoster.pdf

2.  http://pediatrics.aappublications.org/content/early/2011/10/12/peds.2011-2284.full.pdf+html

3. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;116/5/1245#SEC15

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Lunchroom Lowdown- Safe Sleep Guidelines for Infants 2011 (Article)


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!

Sleepless Nights…Beyond the Crib (Pedcast)

Sleep problems are common with preschoolers as well as elementary age children. Here is a simple but effective strategy to deal with the majority of children who have separation difficulties at night. Sweet dreams!

Subscribe on iTunes!Transcript:

Sleep problems in older children

It is very common for children who are out of the crib to have sleep problems; it probably stems from our tribal roots. Children don’t like to be separated from their parents, especially at night. Their very survival depended on staying with the tribe! One of our most primal fears is fear of abandonment. Add to that a vivid imagination that develops at around 2 years of age and you have a recipe for serious trouble with regards to sleep. Sleep problems are an everyday problem presented to most pediatricians; I have a lot of experience with this problem. Today, I plan to discuss my dos and don’ts for helping children with nighttime fears. I will give you a practical strategy to smooth nighttimes with preschool and young children. If you already have sleep problems, today’s pedcast is definitely for you. Pay close attention. If not, maybe we can avoid many sleepless nights.

Let me remind my listeners that by listening to this podcast, you are agreeing to my terms of use posted at my website, www.docsmo.com. This podcast is intended to provide information that is general and not specific advice for an individual child.

If your child is begging you to stay with them until they fall asleep, the skill they are lacking is laying down and falling asleep without you. “Daddy, I need to potty, Mommy, I need some water, Daddy, just one more story. Mommy, I’m scared.” What your child is really saying is, “Sleep with me or can I sleep with you, because I don’t want to separate from you, Mommy.” In other words, the tribe might move on! Here is a strategy to help your child become more independent at night and overcome the challenge of separating from his/her parents for sleep. I am going to show you how to get Janie or Johnny to calmly go to bed without raising your voice, locking doors, or disrupting the entire neighborhood.

So, let’s get started.

Step one…Ritualize bedtime: cut out magazine pictures of a child eating, reading, bathing, and then getting into bed. Post these on the refrigerator door (one of the central communication devices for parents) and refer to them every night to decide what is the next step in the bedtime routine. Make sure you use it to direct your child’s bedtime.

Step 2…Make “The Deal.” Here is the agreement you will have with your child: if they are quiet and stay in their bed playing, reading, or whatever, you will come and check on them frequently. By doing so, everyone gets what they want out of this deal.  The child does not get left to themselves because you are visiting frequently, and you get a child in their bed where they will eventually fall asleep without you. MAGIC!

Step three…Put the plan into motion and BE CONSISTENT and PATIENT. Don’t forget to praise success and ignore failure.

In your child’s mind, you are not gone, but in reality, they are falling asleep without you and getting comfortable with that…just like riding a bike or learning to swim…you are right there to assist, but they are learning to do this independently. If books are the entertainment in their bed, they become literate to boot!

I recommend that you DON’T, even once in a while, do the following:

-Lay down with your child

-Sit in the room

-Let them get drowsy or fall asleep somewhere other than their bed and then take them to bed

-Use a TV or videogame  as a surrogate parent

-Put them in your bed

If your child is sick or there is an unusual circumstance such as frightening weather, break the rules. All bets are off. Help them get to sleep, but get back to your routine as soon as things are normal.

Question:   OH, OH, DocSmo, what do I do if my Janie wakes up in the middle of the night and comes running??

I’m glad you asked.

Simply do the exactly same thing.

If your child is sneaky and creeps out of their room to sleep on your floor or get into your bed at night, I recommend that you put a bell on their door so you can hear them if they are out of their bed.  Some parents put the bell on the child instead.

Question: But Doc Smo, how long will this process take?

Probably about 2 weeks to become smooth, 2 months to become the new reality.

Question: Doc Smo, what do I do when we go to grandma’s and sleep… Sharp audience today, good questions. I recommend  the same ritual.

Question: How  about when we all sleep in a hotel? That’s tough. Not many choices when you are all in the same room. Just retrain when you get home.

Question: Doc Smo. What if I did everything you said and this training doesn’t work after two weeks?

Under those circumstances, you need to consider the possibility that your child may have delayed emotional development, trouble with anxiety, ADD, or a myriad of other reasons they don’t sleep well. Consult your child’s pediatrician; they know you and your child best.

Let’s review the steps to help children with sleep separation:

-Ritualize bedtime and be consistent.  I recommend the refrigerator picture method.

-Reassure your child that you are there to help them with a task that they find difficult with the “frequent checking” method.

-Keep the ritual simple, and you are NOT going to do the following:

—Lay down with them.

—Sit in the room.

—Let them fall asleep somewhere else and take them to bed.

—Use a TV or videogame as a surrogate for you.

—Or put them in bed with you.

You can break the rules for unusual circumstances, but the more consistency the better.

Thanks for joining me today. I hope you found that talk useful if you have little ones who resist sleep. Your comments are welcome on the blog. Start a conversation. This is your host, Dr. Paul Smolen, broadcasting in full digital splendor from studio 1E in Charlotte, NC hoping your children get a good nights sleep without as much as a  peep.


Until next time.

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*By listening to this pedcast, you are agreeing to Doc Smo’s terms and conditions.

All Rights Reserved.