Safe Baby Sleep: Keep Decorating 'Extras,' Blankets Out of Infant Cribs

By Jean Yaeger

Fluffy pillows, soft blankets and stuffed toys look cozy and cute in a crib. But they can be hazardous for a sleeping infant.

Safety experts say the only bedding to use is a tight fitted sheet around the mattress. Extra objects such as loose sheets, quilts, bumper pads and lovies pose the risk of accidentally suffocating or strangling a baby. Pillows, covers, teddy bears and decorative things don’t belong inside the infant’s sleep space.

Older used items tucked away in your closet might be subject to safety recalls. Certain inclined sleepers and other products have been taken off the market -- including the Fisher-Price Rock ‘n Play and Boppy Newborn Loungers -- due to infant fatalities reported with their use. The Consumer Product Safety Commission (CPSC) in June 2023 repeated its warning about the Boppy loungers after two more infants died since the original 2021 recall.  

Parents can take protective steps when it comes to safety during naps and bedtime. That’s why we at Cook Children’s want to emphasize the message that babies under 1 year of age sleep safest when they’re:

• On their back
• In a separate space like a crib or bassinet or play yard (not sharing a bed with parents or siblings). If co-sleeping occurs, someone might roll over on the baby.
• Atop a sleep surface that’s firm (not squishy or scooped like a hammock). Don’t use couches, waterbeds, memory foam mattresses, air mattresses or sheepskin.  An infant could get wedged between the soft surface and a wall or bedframe. 
• Atop a sleep surface that’s flat (not tilted up). An inclined surface could cause the baby’s body to slide down and their head to slump forward, blocking the airway.
• Zipped into a sleep sack. Sleep sacks provide the warmth of a blanket without the risk of covering the baby’s face.   

Over a 15-month stretch beginning in January 2022, 30 infants at Cook Children’s Medical Center in Fort Worth died from cardiac arrest, respiratory failure or other trauma due to sleep incidents that happened at their homes. Factors in many of those 30 deaths involved sleeping on an adult bed, a couch or a pallet made from blankets.

Nationwide, more than 3,500 sleep-related infant deaths occur each year in the U.S., according to the Centers for Disease Control and Prevention.

“When babies are really young they’ll get their nose down into the bed or the pillow or the blanket or the stuffed animal, and they don’t have the strength to turn their head side to side,” said Stephanie Eidson, RN. “The carbon dioxide builds up, and then they suffocate.”

Helping New Parents

Eidson prioritizes the topic of safe sleep in her role as clinical education specialist at Texas Health Resources (THR). Eidson educates nurses in the THR system who work with postpartum mothers, newborns and infants in the NICU. Lessons about safe sleep are built into the curriculum Eidson uses for new employees and for continuing education. Opportunities for instruction also come up every day in the nurses’ encounters with patient families. 

“We nurses have to role model safe sleep,” she said. “When we see a parent or a grandparent put something in the bed that’s not safe, we very gently take it out. Then we educate the parents ‘This is why I’m taking this out.’ We have to over and over again be saying the same thing from shift to shift.”

Nurses at THR talk about safe sleep practices with every family on the postpartum floor. Eidson says the standard conversation hits these key points: If you’re feeling tired, put the baby in the crib, on their back, with no blankets or pillows. Booklets given to families of newborns when they’re discharged feature a section on safe sleep information.

Eidson serves on the Safe Baby Sleep Council, which encompasses Tarrant County and a few surrounding locations. Her passion for safe sleep stems from a long career in nursing. But it’s also personal; her relative’s infant, napping on an adult bed, died after becoming trapped between the bed and a wall. It can happen to anyone, she said.  

What gives Eidson hope? Young moms who embrace the recommendations of medical experts. Consistent messaging is encouraging too. Out shopping recently, Eidson spotted a statement about safe sleep posted on the retailer’s display of cribs for sale.

“Being a NICU nurse for 40-plus years now, I want what’s best for our babies and our families. The data’s out there, the research and best practices are out there. It’s part of my job and my mission to educate whoever will listen.”

More About Safe Sleep Spaces

State regulations for child care centers in Texas prohibit anything except for a mattress cover and fitted sheet in an infant’s crib or play yard.

Don’t use car seats, strollers, swings or carrying devices as sleeping spaces. If your baby falls asleep in a car seat or stroller, move them from the seat and into a crib or bassinet one you're home. If the baby falls asleep in a swing, move them to a crib or bassinet.

Make sure the sleep space your baby uses conforms to CPSC safety standards:

• Cribs -- No missing, loose, broken or improperly installed slats, screws, brackets or other hardware. Slats should be spaced no more than 2 3/8 inches apart (about the width of a soda can).  
• Mesh-sided cribs or play yards – No tears, holes or loose threads in the mesh. Side panels should be securely attached to the top rail and the floor plate.

The federal Safe Sleep for Babies Act, signed in 2022, outlaws the manufacture and sale of crib bumper pads and infant sleepers that have an incline of more than 10 degrees. Drop-side cribs have been banned by federal rules since 2011. Don’t sell or give away any item subject to a safety recall.