Before leaving your infant with a friend, grandparent, other relative or babysitter, it’s important to make sure the caregiver practices the basics of safe sleep. It might feel like an awkward or unnecessary topic to bring up with your mother or mother-in-law or favorite auntie who provides free babysitting. But not all caregivers are aware of the safe sleep practices backed by medical evidence, as they have been updated over the years.

At nighttime and every nap – whether at home or away, with parents or sitters -- the safest way for infants to sleep is: 

• on their backs
• alone (no co-sleeping)
• in a crib or bassinet with a firm and flat mattress
• without pillows, sheets, blankets, toys or other objects

More than 3,500 sleep-related infant deaths occur annually in the U.S., according to the Centers for Disease Control and Prevention. In 2022, 25 infants at Cook Children’s Medical Center in Fort Worth died from cardiac arrest, respiratory failure or other trauma due to unsafe sleep incidents that happened at their homes. A majority of those deaths involved co-sleeping with at least one parent or caregiver who awoke to find the child unresponsive.

So far in 2023, Cook Children’s has seen nine deaths due to unsafe sleep conditions, including co-sleeping with adults. Suffocation can occur if someone rolls onto the baby or if bedding covers the baby’s face.

Juan Cocjin, M.D., of Cook Children’s Neighborhood Clinic – Renaissance, said grandparents shouldn’t assume that it’s OK for babies to bed-share, even if that’s the norm the grandparents are used to or have done in the past.

It’s a sensitive topic because sleep customs get passed down in families from one generation to the next, Dr. Cocjin says.

Some of his patients are being raised by grandparents or even great-grandparents. He occasionally hears a caregiver say their baby shares a bed with others in the family. While these conversations can be tough, it’s important to break through misconceptions that co-sleeping is safe.

“I share with them the hazards of co-sleeping,” Dr. Cocjin said.

Creating a safe sleep environment for your baby takes consistent practice until it becomes automatic. Dr. Cocjin urges grandparents to seek out reputable sources of information and have an open mind about what the experts say. As he puts it: You can’t stick with unsafe habits hoping “maybe it’ll be OK.’’

Communication

Cook Children’s social worker Lorie Palacios, LMSW spreads the word in English and Spanish as a Safe Baby Sleep Council member, a coalition of partners including the Cook Children’s Center for Community Health. She shares safe sleep education at injury prevention at community events.

Palacios emphasizes the importance of sharing your safe sleep plan with everyone who cares for your baby. If mom and dad don’t live together, for instance, they should communicate about their baby’s sleeping arrangements in both residences. Ask if your baby’s caregivers have a crib or bassinet.  

“We want to make sure that conversation is happening,” she said. Transparency and communication are key.

Palacios pointed out that licensed day care facilities in Texas are required to follow protocols for safe sleep. That’s not the case when a friend or family member volunteers to watch your infant. And if a parent feels indebted to the babysitter, she said, they might worry that they’ll be seen as critical or questioning the sitter’s abilities if they speak up about safe sleep.

“If you’re dependent on a family member, especially a grandparent, that’s a very difficult conversation to have with someone you love and trust,” Palacios said.

When Palacios’ children were little, their grandmother kept them while Palacios worked. One day she found her 3-month-old daughter sleeping on the grandmother’s bed with a pillow and blanket.

“I had a playpen. I had a bassinet,” Palacios said. “All these things were available, but those were not the things that my mom used when she was raising her babies. To her, the bassinet felt awkward.”

Prior to that day, Palacios said she and her mom had only touched on the topic of safe sleep.

“The toughest thing is this idea that you’re questioning your elders,” she said. “I wasn’t really pushy because I wanted to maintain my respect.”

After that day, Palacios clearly and specifically told her mom her expectations for the baby’s sleep environment going forward. The words weren’t easy to say; but her mom respected Palacios’ wishes.

When you rely on a network of relatives or neighbors to help care for your baby, she said, you need to stand your ground on matters of safety. A caregiver might mean well but be misguided.

“It definitely takes a little more courage to find your voice when you’re part of a big village,” Palacios said. 

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More about safe sleep from Cook Children’s Checkup Newsroom:

• Safe Sleep Starts With Babies in Their Own Separate Sleep Area (checkupnewsroom.com)
• Safe Baby Sleep: Keep Decorating 'Extras,' Blankets Out of Infant Cribs (checkupnewsroom.com)
• Pediatrician's Advice: Straight Talk About Sleepless Nights (checkupnewsroom.com)

Being a new parent is hard.

Being a new parent today is even harder.

With the limitation of visitors, changes to doctor’s offices, and lack of ability to get out of the house (among many other challenges), being a parent in COVID-times is causing new parents to feel even more isolated and ill-equipped.

But, when can you have visitors over to meet your newborn?

Like most things COVID-related, it’s not a simple question.

It’s also a decision that, given all the same information, two families might make very different choices.

Even in “normal” times, I believe that babies under 2 months should have a pretty tight circle drawn around them, which can relax more with each round of shots at 4 and 6 months. COVID has just heightened my desire to protect them even more.

It appears that infants less than 1 year are at a higher risk of severe illness than other kids.. Because of the upfront, face-to-face nature of caring for them, they may be at higher risk for exposure from a caregiver. When considering this decision, it’s essential to keep in mind the reverse (and perhaps more significant) risk to the person entering the house. Many grandparents and other family members might fall into higher-risk categories based on age or medical conditions.

But that doesn’t mean you have to go it alone.

Here are three factors to consider:

1. The purpose of the visit.
2. The behavior of the visitor.
3. The activity at the visit.

The purpose of the visit.

The first time this comes up is at the time of delivery. If you have an older child at home, they need to be taken care, of and you should have the opportunity to have someone to support you at delivery. This one is easy. Ask the grandparent or other caregiver to take caution with social distancing, masking and other precautions around 36 weeks so that they can be as safe as possible entering the home.

After the initial delivery phase, some parents may need ongoing support from a close family member. When a parent has to go back to work or doesn't have a lot of experience with babies, they may need ongoing support. The safest way to do this is to ensure that the person entering your home has been following guidelines for at least 2 weeks before the visit. If possible, they should plan to come and stay as much as possible rather than coming and going frequently. Staying put limits their number of contacts and lowers the risk for everyone.

Purely social visits are probably the riskiest. Having any number of visitors drop in to say hi significantly increases the baby's risk because of the number of possible contacts and the lack of control over their behavior and exposures. Some parents might feel comfortable with a very close friend or family member. Still, we all must recognize the risk of doing so.

The behavior of the visitor.

There are many different approaches and mindsets concerning coronavirus. While I wish everyone took a cautious approach, that’s not the case. And while you may have family members who argue they have the right to make their own decisions regarding social distancing, mask-wearing and the like not everyone has the right to make their own decisions AND get to spend time with your baby.

If you have a close friend or family member you trust is taking an extremely cautious approach, you may feel more comfortable inviting them come over to meet your baby. Remember that you get to make your own decisions about what makes you comfortable. If you decide to take a more conservative route than your family appreciates, feel free to blame your pediatrician (especially if it's me). I promise we’re cool with that.

The activity at the visit

Once you’ve decided you’re going to see family, there are still questions about what will happen at the visit. Of course, at a baseline, we’re going to do all the usual things we would ask anyone to do when visiting a newborn.

1. No one comes over who has possible symptoms, such as a cough, runny nose, (obviously) fever, etc.
2. No one holds the baby without washing hands first.
3. No one kisses the baby period.

Extra precautions you might consider in the context of COVID would be (in decreasing order of safety): drive-by only visits, patio/outside visit, no-holding/across the room visit or a masked visitor visit.

Be gracious with yourself and others

Remember again that every parent and family will make different decisions and have different comfort levels. Be kind to yourself and your fears. Consider the impact of not having visitors vs. having visitors and what that means for your level of stress because it might affect each parent differently. If you are the potential visitor, be kind, and understand if the new parents in your life ask you to stay away

We're all in this together for the long haul, and they are dealing with enough stress as it is.