While traditional sleep sacks are recommended for safe infant sleep, weighted sleep sacks are being taken off shelves due to concerns they could impair breathing and hinder a baby's ability to roll over.

The American Academy of Pediatrics (AAP) advises against placing weighted blankets, garments or other heavy sleep devices on or near a sleeping infant. Cook Children’s neonatologists, specializing in newborns, also have concerns about the safety of those items.

Neonatologists Chanda Simpson, M.D., and Bernadette White, M.D., say pressure on a baby’s chest puts stress on the lungs and heart. That’s because the added weight could impede the up-and-down movement of the diaphragm muscle working to inhale and exhale. Breathing interference can result in lower oxygen saturation in the bloodstream, elevated heart rate, and difficulty waking up to eat.

Dr. Simpson, Associate Medical Director of the Neonatal Intensive Care Unit at Cook Children’s, wants parents to be aware of possible short- and long-term risks for infants in weighted sleep sacks.

“Oxygen is important for the brain and development,” Dr. Simpson said. “Let’s extrapolate this down the line. What effects could this have on your baby?”

“I worry about anything that compresses the ribcage,” Dr. White said. “Babies’ bones and muscles are not fully developed, and I worry prolonged use could lead to chest wall deformities, the long-term complications of which could be significant.” 

According to reports in April 2024, Amazon, Target and Walmart have stopped selling weighted sleep sacks. But they’re still for sale by the manufacturers. Those companies promote the weighted sleep sacks as a gentle pressure stimulation that mimics human touch and helps babies sleep soundly. 

Dr. White points out that infants need to eat every two to three hours so they can grow and thrive. A weighted sleep sack could make it harder for a baby to wake up often enough for feedings, she said.

Dr. White has three children of her own, and she understands why parents want a good night’s sleep – for their baby and for themselves. But she cautions against buying a weighted sleep sack just because of positive website reviews. Customer satisfaction isn’t proof the product is safe, she said.   

The AAP’s advisory was included in a report of recommendations to reduce the risk of sleep-related infant deaths. Every year in the United States, about 3,500 babies die unexpectedly during sleep. In the first six months of 2024, six sleep-related deaths were recorded at Cook Children’s.

It isn’t safe for anyone to sleep in the same bed with babies at night or even for quick naps on the couch. A baby might fall, be strangled, or suffocate if loose sheets, a blanket or another person’s body accidentally covers the baby’s face and blocks the airway.

Cook Children’s wants parents to know the safest way for babies to sleep:

• Wearing a sleep sack (not weighted)
• On their back
• On a firm surface with a tight-fitted sheet
• In a crib, bassinet or pack ‘n play with no pillows, blankets, bumper pads or toys in the space
• Alone (not co-sleeping with an adult or siblings)

Further Concerns

The U.S. Consumer Product Safety Commission, Centers for Disease Control and National Institutes of Health (NIH) also speak out against weighted sleep garments. In addition to the risk of impaired breathing, the NIH cites possible risks that babies might overheat or get stuck on their stomach if they roll over in weighted sleepwear.

“There is not enough evidence that weighted blankets and swaddles are safe to use for babies,” according to the NIH. “Based on what we know about infant health, SIDS, and sleep-related infant deaths, weighted blankets and swaddles could cause harm.”

The topic needs further study, the NIH says, adding that the suggested benefits of babies’ weighted sleepwear are unproven. 

Instead of weighted sleep sacks, what are some safe ways to soothe an infant into slumber? Good options include a pacifier, singing a lullaby and patting their back.

Spreading the Word

The Safe Baby Sleep Council, led by Cook Children’s, last fiscal year distributed 3,540 sleep sacks to families. Council members also provide safe sleep education at area events such as Fort Worth’s Mayfest. The council has partnered with the City of Fort Worth for public service announcements on city buses and benches.

Jennifer Gadnai, MBA, BSN, RN serves as co-chairman. She shares the importance of appropriate sleep sacks when she meets caregivers in the community or in the Cook Children’s Emergency Department.

Gadnai also urges parents to watch for used unsafe items that might be handed down or resold. Products such as the recalled Rock ‘N Play sleepers and cribs with dropdown sides don’t meet updated safety standards.  

RELATED STORIES:

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)

The Safe Baby Sleep Council, led by Cook Children’s, takes a partnership approach to educating families and providing resources across much of North Texas.

In various locations from hospitals to health fairs to caregiver classes – even at Mayfest – the coalition’s 41 member organizations deliver the same reliable message. When parents of newborns request a birth certificate in Tarrant County, for instance, they receive a brochure about safe sleep, courtesy of the council. 

“Our hope is that families hear why safe sleep is important at their birthing hospital, and then when they receive their birth certificate, they are hearing the same message again,” said Samantha St. John, program coordinator for safe sleep at the Cook Children’s Center for Community Health (C4CH). “Consistency is key.”

Every year in the United States, about 3,500 babies die unexpectedly during sleep. Sometimes the cause can be determined, such as accidental suffocation or strangulation. But if the baby had no apparent medical problems, and their sleep space contained nothing potentially hazardous, the death is considered Sudden Infant Death Syndrome (SIDS). SIDS accounts for about one-third of all sleep deaths in infants younger than 1 year old.  

October is SIDS Awareness Month, a time to highlight the work of the Safe Baby Sleep Council in our region. St. John said council members are passionate about helping families create the safest sleep environment possible to reduce the chance of SIDS.

They want parents to know the safest way for babies to sleep is on their back, on a firm surface with a tight fitted sheet in a crib or bassinet or pack ‘n play, and with no pillows or blankets or toys. Co-sleeping with parents or siblings – in an adult bed, couch or recliner, for example -- isn’t safe for infants.

“There is a misconception that SIDS is a diagnosis, but you can't take your baby to the physician to be tested for SIDS. SIDS is simply the lack of a reason the infant should have passed away,” she said.

According to the National Institutes of Health, the risk for SIDS increases if three factors intersect: first, the infant has a condition that affects their heartrate or breathing; second, if they’re undergoing a spurt of rapid growth or development; third, if something external creates stress, such as exposure to secondhand smoke or being placed to sleep on their stomachs.

Spreading the Word

Safe Sleep is one of five injury prevention campaigns at C4CH along with gun safety, poison control, drowning prevention and car seats. The Initiative started in 2014 within Cook Children's Medical Center and then branched out to area hospitals. It grew over the years to include Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Tarrant County Public Health and other organizations that serve families. 

St. John coordinates the coalition partners and supplies the materials they hand out at their offices and community events. Sometimes bundled together, the main resources are:

• Sleep sacks
• Educational slim cards in English and Spanish
• “Sleep Baby Safe and Snug” children’s books, purchased through Charlie's Kids foundation and available in English and Spanish

Between October 2022 and mid-September 2023, the council distributed 3,540 sleep sacks and 28,404 books and brochures, funded by Cook Children’s.

“We're able to provide all the education and resources to our partners so they do not have to worry about budgeting for these materials or recreating resources that are already available,” St. John said.

The children’s book is popular because it is written in a rhythmic pattern that babies enjoy. An added bonus -- reading promotes bonding.

“Oftentimes we hear that parents share a bed because they want to bond with their baby. But bonding really happens much more when we're awake,” St. John said. “A great interaction with our babies is to read books.”

When caregivers learn the facts, they’re motivated to tell others. Jennifer Gadnai, MBA, BSN, RN serves as the council’s co-chair. She said the word is getting out through Safe Baby Sleep courses and other venues. And in a partnership with the City of Fort Worth, the safe sleep message gets additional exposure as a public service announcement on the banners of city buses and benches.

“This is getting the life-saving education to the people who need it the most,” Gadnai said.

Gadnai’s passion for safe sleep stems from her work in the Emergency Department (ED) at Cook Children’s. “Over my 17 years here I have seen too many sleep-related deaths in our ED,” she said. “It’s a horrible event and devastating for all involved.”

Out in the Community

Coalition members interact with families at community events, where information tables and pack ‘n play displays draw the attention of people passing by. Table attendants will ask: What’s unsafe in the pack ‘n play demonstration?

“Parents will point out the obvious like the blankets, but they'll often miss things like the wedge pillow or the hat on the doll's head or that there's a pacifier tethered to the doll's clothing,” St. John said. It’s an opportunity, then, to teach some the lesser-known points of safe sleep, like the importance of a tight fitted sheet. 

Another type of community outreach occurs in visits to area high schools. Daniel Guzman, M.D., Cook Children’s emergency medicine physician and medical director of C4CH, speaks to home economics classes about various injury prevention topics. In those conversations, students frequently tell Dr. Guzman that infant brothers and sisters sleep on their tummies or under a blanket. He wants teens to know they can and should make a difference at home.

“If they see their sibling on their tummy, turn them over and place them on their backs. It's as easy as that. That might save a life right there,” Dr. Guzman said. “Or remove any stuffed animals or blankets from the crib.”

Hearing the facts from a trusted source helps the safe sleep message resonate. “It's always about if you can change one life,” Dr. Guzman said. “If it's one person who responds, that change goes a long way. It saves lives.”  

Related stories:

• 30 Infant Deaths Lined to Unsafe Sleep Prompt Call for Awareness
• Safe Sleep Starts with Babies in Their Own Separate Sleep Area

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.

If you are the parent of a baby, you’ve probably been given the advice to sleep when the baby is sleeping. While well-meaning, it’s not always that easy.

As a mother of twins, now 14, I often rolled my eyes when someone would tell me this. It was hard enough getting one baby to sleep, much less two asleep at the same time long enough to catch any meaningful minutes of shut-eye for myself.

I’ll never forget one night in particular. On the way home from an outing the babies fell asleep in the car. My husband and I carried them into the house in their infant car seats and placed them by our bed. We were so tired and didn’t want to risk waking them in a transfer from their carriers to their cribs. Never wake a sleeping baby, right? Another well-meaning but not so practical or sound piece of advice.

So we left them strapped in their seats thinking they would wake on their own soon and we could move them then. In the meantime, we decided to get a little sleep, too. Hours later I woke up to find both babies still in their car seats and, uncharacteristically, still asleep.

I’ve since learned how dangerous it is to leave babies asleep and unattended in their car seats for long periods of time when not in a moving vehicle. Babies can and have died while sleeping in a sitting device like a car seat, bouncer or swing when used improperly as a sleeping location. A 2019 study that reviewed more than 11,700 sleep-related deaths over 10 years found that 3% of infant sleep deaths occurred in baby-sitting devices, most of them a car seat used improperly outside of the car.

So far in 2023, Cook Children’s Medical Center has recorded five baby sleep deaths, with one of them occurring while a baby was sleeping in a baby chair, according to Sharon Evans, Cook Children’s trauma injury prevention coordinator and car seat safety expert.

The danger lies in the positioning of the baby’s head and neck while asleep in a sitting device. The incline of the seat can cause a sleeping baby’s chin to fall and rest on its chest, closing their airway. Most newborns do not have the muscle strength to raise their heads on their own and, when in this position for too long, they can suffocate.

A seat’s degree of incline poses a risk, too. Baby sitting devices with an incline greater than 10 degrees is unsafe for baby sleep, according to the American Academy of Pediatrics. The incline makes it easier for a baby to turn over onto their belly in the seat. For those not strong enough to turn back, this can result in suffocation or injury.

A lot of babies are lulled to sleep while in their car seats in a moving vehicle, and that’s okay, Evans says. Who among us hasn’t driven extra miles during an outing so that your baby could finish their nap? When a car seat is properly installed in a car, it sits at the correct recline angle, which helps ensure the baby’s airway remains open. When placed on a flat surface like the floor or a table, the angle could pose a danger. Also in the car, you’re right there with your baby hearing their giggles and cries and are more likely to know if something is wrong. That’s not always the case when outside of the car where you can easily walk away, get distracted or, like me, go to sleep.

We were fortunate that nothing tragic resulted from that night of car seat sleeping, and were careful not to make the same mistake with our third baby. But, sometimes, exhaustion and desperation speak louder than reason and safety.

So what is a sleep-deprived parent to do?

Sireesha Mutyala, M.D., a pediatrician at Cook Children’s Pediatrics Plano Legacy, is a mom, too. As a working parent, she knows the exhaustion from sleepless nights followed by busy days as well as anyone. She also knows the dangers that certain factors bring to a baby’s sleep. Factors like cribs with blankets or stuffed animals, or unattended bouncy seats, and bed sharing, to name a few.

“With the alarming number of infant deaths from unsafe sleep that our medical center has already seen this year, I am so thankful that Cook Children’s is getting the word out to families about safe sleep,” Dr. Mutyala said. “It’s an issue near and dear to my heart.”

I asked Dr. Mutyala to demystify baby sleep. What’s normal and what isn’t? How can parents create a safe sleeping environment that encourages our little bundle — or bundles — of joy to sleep peacefully for as long as is appropriate for their age and development so that mom and dad can get some much-needed rest, too.

What is normal baby sleep in the first year? How long do babies usually sleep and how many times do they typically wake at night?

Usually, during the first three months, babies sleep about 14 to 17 hours per day, but in short spurts, like 30 minutes to two hours at a time all day and night. Newborns need to feed about eight to 12 times a day, so they have to eat almost every two to three hours even during the night. So there's very little continuous sleep happening in that stage.

Once they get to 4 to 7 months old, they're sleeping about 12 to 16 hours per day. Hopefully, five or six of those hours are at night, and they have three or four naps throughout the day. Those could be one to two-hour naps during the day and then a little bit longer stretch at night. At just a little under a year of age, they're still sleeping the same amount, 12 to 16 hours, but we're hoping about eight to 12 of those hours are at night, and they take about two to three naps during the day. Again, those are usually one to two-hour naps.

Typically nighttime sleep gets better as they get older. When a baby sleeps five to six hours in a row at night, we consider that sleeping through the night. Most babies will be able to do this between 3 and 6 months old.

Is it true that formula-fed babies sleep longer than breastfed babies?

That’s somewhat of a myth. Studies show that babies who are breastfed actually get more sleep throughout the night. They do wake up a little more frequently but their total sum of sleep is actually more, at least for the first few months or so. By the time babies are about 6 to 8 months old, the differences are gone and formula-fed babies and breastfed babies are sleeping much the same.

It’s important to know babies wake up for different reasons throughout the night, not just because they are hungry. They go through their sleep cycles multiple times throughout the night, so when they hit that light sleep cycle, that's when they wake up. For most that will be about four to six times a night. A lot of times they'll just go right back to sleep after a few minutes, which is why it's good not to rush in to them and automatically assume that they need to be fed every time. If you know they are safe, give them some time to fall back to sleep, especially if they're over 3 to 4 months of age. They will never learn to fall asleep on their own if we don't give them a chance to do it!

How should parents set the stage to encourage their baby to sleep?

Most importantly, make sure that it's a safe sleep environment. For every stage of infancy, babies need to sleep flat on a firm surface in a bassinet or crib and on their back. Close by is good, but definitely not in a bed with anyone else.

Most babies will sleep in a bassinet near the parents’ bed in the same room as them until they're about 3 months old. Then, they usually have to move from a bassinet to a crib. I wouldn’t wait too much past three months to move into a crib because it becomes really hard for a baby to change sleep environments after that age. A lot of families will keep the crib in the parents' room for maybe the first six to 12 months. The American Academy of Pediatrics recommends babies sleep in the parents’ room but on a separate surface for at least the first six months and up to one year, ideally.

Whatever you do, consistency is key. End the night where you started it. If your baby is in a crib, start the night in the crib. Keep the lights dim and the noise low from the beginning of the bedtime routine all the way through the night. That helps signal to them that it's nighttime.

Also, one of the things I really try to talk to families about is making sure that the baby's getting enough of their eating and drinking done during the day. Try to meet all those calorie needs during the day so that the baby understands that daytime is for eating and nighttime is for sleeping.

A lot of families do give babies a bath in the evening, give one last feeding, clean their gums or teeth and maybe read a bedtime story. Reading to them is important even at this early age as it helps with language development. Then, place the baby in the crib while they are sleepy, but still a little awake and have them fall asleep there.

Speaking of routine, how important is routine for a baby? Does it impact their sleep?

I find that routines really help babies understand what's happening around them and what to expect. You might not be able to do an actual schedule with exact times, but you can have an order and pattern to things. I liked having a pattern of eat, play, and then sleep for the baby. Even from the newborn period you can start establishing that pattern. Keeping a similar time for waking up in the morning and falling asleep at night actually helps them sleep better in general, too. It may be counterintuitive, but we don't want to make them overly tired by taking away naps in order to try to get them to sleep more during the night. Overtired babies can have a more difficult time falling asleep or staying asleep.

Look for their sleepy cues, too, like rubbing their eyes. Every baby may be different in what they do that signals they are tired, but look for those behavior patterns. When they start displaying those sleepy cues, that’s a good time to start getting them to sleep. If you wait too long, they’ll get past the point of tiredness and sleep will be harder.

There are a number of books written about different sleep training techniques. What do you recommend to parents about finding one that works for them?

Every baby is different, and so is every family. Sleep training can be very personal based on the parents’ comfort levels, their cultural practices and beliefs and a whole bunch of other factors. Families just need to be realistic in using a technique that they're going to actually be able to stick with and continue for a consistent amount of time.

Most of the common themes in these techniques is making sure the baby gets sleepy and then putting the baby down in their crib while they are drowsy but awake so they can learn to fall asleep on their own. This way, if they do wake up in the middle of the night, they look around and know that they are in the same place they fell asleep. They will be more comfortable going back to sleep again instead of being shocked that they're not in their parent’s arms or wherever they fell asleep initially.

I’d say the biggest difference in each of the techniques is what you’re supposed to do when the baby starts to cry during sleep time. Just remember it's not always hunger when they do wake up in the middle of the night, so don't rush in to them just because they're waking up. Give them a few minutes, and you might find they’ll put themselves back to sleep on their own.

The biggest thing that we find is parents say it doesn't work, but they're not sticking with it and being consistent. Give whatever method you are using a good solid two weeks of implementing it and continue with it as long as the baby is healthy.

I do not recommend any sleep training method before three months, as newborns need to eat every two to three hours for their growth and development.

What is sleep regression and how can parents get their baby back on track?

Sleep regression is when a baby who was previously sleeping well all of a sudden has trouble either falling asleep or staying asleep, and it can last a few weeks. A lot of times it can be triggered by things like growth spurts, teething, changes in routines like traveling or the baby starting a new daycare, or an illness. Reaching a new developmental milestone, like learning to roll or sit, can also cause a regression. We see it a lot around four months and then again at six months and nine months.

To get over the hump, you want to stay consistent with that bedtime routine, avoid letting them get overly tired and always give them a few minutes to try to go back to sleep themselves before you jump in there. Sometimes you do have to go back to your original sleep training method for a couple of weeks if you used one. It does tend to be much easier the second, third and fourth time around with that sleep training.

What is the most important thing you want parents to know about baby sleep?

Have your baby sleep in a safe sleep environment, flat on their back and alone in a bassinet or crib with a firm mattress every single time. This is healthy for the baby and really helps the family sleep soundly, too, knowing that the baby is safe.

When we are consistent with our baby's bedtime routines and have them fall asleep on their own, they tend to sleep so much longer and better. That continues on through early childhood and through those transitions with school bedtime routines. It really fosters good, long-term sleep habits. They grow better when they sleep well. They eat better when they sleep, and it translates to all sorts of healthy habits during the day, too.

Building healthy sleep habits is a marathon, not a sprint. We really need to remember that, even when we're exhausted, we've got to do what is going to be best in the long run and not just what is easiest to get us through the night. Healthy sleep habits are built over time and we just need to be very consistent with them. 

A recent study in the Journal of Pediatrics found that the teenage moms who participated are aware about sleep-safe habit recommendations, but ignore what they were told.

The most common reason given for co-sleeping was that “babies sleep better and were safest in bed with them.”

“We see this a lot with teenagers and risk taking behaviors,” said Jamye Coffman, M.D., a child abuse pediatrician and medical director for Cook Children’s Advocacy Resource and Evaluation (CARE) Team. “Their frontal lobes aren’t fully developed and they don’t think the bad outcome will happen to them. It is difficult for them to fully understand the potential consequences of their actions.”

Many investigations have tried to pinpoint the reasons why apparently healthy babies die during sleep, but one cause may be the increase in adults sleeping in the same bed with their.

In almost 200 years of research, no single cause of sudden unexpected infant death (SUID) has been found. It is now thought that there are a number of possible reasons why apparently healthy babies die unexpectedly. SUID is now broken into two categories:

• SIDS where a cause of death isn’t identified after a thorough investigation.
• Accidental suffocation and strangulation.

Of the two types of SUID, accidental suffocation and strangulation is the most common and most preventable cause of sudden unexpected infant death. In rare true SIDS deaths, about 25 percent of deaths are due to a heart rhythm defect, 5 percent are due to metabolic problems, and the rest are due to a combination of factors that likely includes an abnormality in the brain’s breathing center.

Here are the recommended ways to reduce the risk of SUID:

1. Babies should sleep flat on their back for every sleep time.
2. Babies should have their own sleep surface with a firm mattress and tight fitting sheet.
3. Room-share without bed-sharing.
4. Breastfeed exclusively for 6 months.
5. Offer a pacifier at every sleep time.
6. Keep blankets, pillows, bumpers, stuffed animals, mobiles, monitors and other humans or animals out of a baby’s sleep environment
7. Do not use infant positioners such as wedges or pillows. These items are a suffocation hazard and they make reflux worse.
8. Baby should sleep in a footed onesie or sleep sack.
9. Swaddling is not necessary and could be harmful. If you must swaddle, make sure you completely stop before your baby is 8 weeks old.