The display, put together by Cook Children’s Center for Community Health, will travel throughout the Cook Children’s Medical Center in Fort Worth.

 “SUID can happen in any sleep environment but is less likely to happen if the baby is in their own crib, bassinet, or portable crib,” explains Samantha St. John, program coordinator at Cook Children’s Center for Community Health.

 “By placing a baby in a safe sleep space, the risk of SUID is lowered significantly.”

 St. John explains that safe sleep refers to the safest environment for a baby under a year old to sleep.

 Safe Sleep: ABCs of Zzzs

“Babies should sleep in their own sleep space, such as a crib, bassinet, or portable crib, in the same room as the caregiver, but not the same bed,” explains St. John.

 Remember the ABCs of Zzzs:

• Alone: The sleep space should be clear of any soft items, such as blankets, stuffed animals, pillows, and bumper pads, leaving only a mattress with a tight-fitted sheet.
• Back: Babies should always be placed flat on their back for every nap and every night.
• Crib: A crib, bassinet, or portable play yard with a firm, flat mattress and a fitted sheet is the safest sleep surface. 

Reducing the Risk

 The American Academy of Pediatrics (AAP) recommends these tips to reduce the risk of SUID:

• Offer a pacifier with every sleep.
• Feeding human milk (whether breastfeeding or bottle-feeding).
• Avoid smoke and nicotine exposure.
• Avoid overheating.

 Understanding SUID

The crib and onesies are a stark reminder of the importance of safe sleep. According to the Centers for Disease Control and Prevention, there were 3,700 sudden unexpected infant deaths in the United States in 2022. Of those, 1,529 were deaths from Sudden Infant Death Syndrome (SIDS), 1,040 deaths from Accidental Suffocation and Strangulation in Bed, and 1,131 deaths from unknown causes.

 “SUID can occur any time before a baby turns 1 year old; however, the majority of instances occur between 0 and 4 months,” said St. John.

 There are three categories of SUID: Sudden Infant Death Syndrome (SIDS), Accidental Suffocation and Strangulation in Bed (ASSB), and Unknown/Undetermined reasons. 

 What is SIDS/ASSB or unknown?

• SIDS is a specific cause of death used when a baby dies for unknown reasons, even after an investigation. This means the infant was in a safe sleep environment, and there was no medical reason or external factor for why the infant died.
• ASSB is often used when the cause of death is related to an unsafe sleep environment, such as having soft items in the crib, becoming wedged between the mattress and a bedframe, or becoming entrapped under another person.
• Unknown/Undetermined is used when a death is unexplained even after an investigation; however, the Medical Examiner does not feel it meets the criteria to label it as a SIDS death.

Safe Sleep in Colder Months

 With fall and winter weather approaching, keeping infants warm is a priority for caregivers, and it is essential to do so safely.

 “Caregivers often use extra blankets and hats for warmth, but these soft items can easily become a suffocation or entanglement hazard,” said St. John.

 A safer alternative is a sleep sack, also called a wearable blanket. A sleep sack provides warmth and comfort without risk because it fits securely around the baby's upper body and is sized so the fabric cannot cover their face, while still allowing plenty of room at the bottom for comfort and movement.

 St. John adds that overheating is also a concern. She suggests a general rule to follow: dress the baby in no more than one layer of what an adult is wearing.  For example, if the caregiver is wearing pants and a long-sleeve shirt to bed, then they could dress the baby in a long-sleeve fleece onesie and add a cotton wearable blanket/sleep sack.

 Talk about Safe Sleep

When having conversations with family members about safe sleep, focus on the recommendations from the AAP on how to create safe sleep spaces and how to reduce the risk of SIDS, versus focusing on what they are doing wrong.  This allows everyone to move forward with the gained knowledge and make a more informed decision when creating a baby’s sleep space.

Cook Children’s Medical Center has seen 30 infant deaths linked to unsafe sleep situations since January 2022, more than the number of fatal gunshot wounds and drownings combined.

That’s why safety advocates at Cook Children’s are sharing the risks that pillows, loose garments, blankets and other objects can pose in an infant’s sleeping environment.

The majority of unsafe sleep deaths in 2022 and so far in 2023 involved co-sleeping with at least one parent or caregiver, who awoke to find the child unresponsive. Trauma records at Cook Children’s list a variety of other circumstances too, including babies placed on a pillow with a propped bottle, in the crib with a blanket or pillow, in a recliner or on the couch next to a sleeping adult, or wearing a loose T-shirt that covered their face. By the time these infants arrived at the medical center, they were in cardiac arrest or respiratory failure.

Sharon Evans, trauma injury prevention coordinator, said the number of unsafe sleep deaths in the past 15 months is at the highest peak since she started in her role at Cook Children’s in 2008. Demographic data shows the group with the highest unsafe sleep deaths were Black boys from 2 months to 6 months old.

Infant deaths linked to unsafe sleep from 2022-2023

Candle Johnson, APRN, CPNP-PC at Cook Children’s Renaissance Neighborhood Clinic in south Fort Worth often talks about Safe Sleep with her patient families. As a Black nurse and Certified Pediatric Nurse Practitioner, it’s important to her that all patient families, including Black families, receive education and know that she is passionate about keeping their baby safe.

“Unless it hits home, it doesn’t really resonate. We want them to understand this is a very preventable situation,” Johnson said. “Let’s be proactive today, so we don’t have to be reactive tomorrow. If a fatality happens, then how do we go forward when we could have prevented it from the beginning?”

Sometimes patient families share with Johnson that co-sleeping is a generational habit and give her pushback. While those conversations can be tough, Johnson knows it’s important to break through those misconceptions. She shares why it’s important that the baby sleeps separately on a flat surface, like a crib or bassinet.

“It seems to be so much easier to co-sleep when breastfeeding,” Johnson said. “I do advise against that because even though it may be easier, it’s not safe. No one can control their body function once they’re sleeping. When you’re in a deep sleep and your infant is next to you, you’re not able to say ‘I won’t roll over on them.’”

An infant can get wedged between the headboard and mattress, suffocate under blankets, or come under the adult’s body if they’re sleeping together, Johnson said.

She discussed barriers that could increase the risk of an infant being fatally injured from unsafe sleep situations. Those challenges might include a lack of education about safe sleep, distrust of medical advice, young maternal age, and inability to afford a separate crib or bassinet, Johnson said. In a crowded one-bedroom residence, she said, everyone in the household might sleep in one bed due to space constraints.

Data from Cook Children’s on unsafe sleep deaths in 2022-2023 show that the infants were in sleeping positions or circumstances that contributed to their deaths, not to be misidentified as SUID, sudden unexpected infant death. SUID describes the sudden and unexpected death of a baby in which the cause was not obvious; SUID cases are not all preventable. 

According to the U.S. Centers for Disease Control and Prevention (CDC), about 3,500 sleep-related infant deaths occur each year in the United States.

When it comes to sleep risks, the message is just as critical as the safety rules for other potential hazards such as swimming pools and riding in a vehicle. Parents know to buckle their children into lifejackets and car seats. Safe sleep also involves precautions:

• Always place your baby on their back to sleep. Side and stomach sleeping are not safe for infants who can't roll over.
• Use a firm, flat mattress or sleeping surface with tightly-fitted sheets. The surface shouldn’t be sloped.
• Share a room but not a bed with your baby. Babies should sleep in their own cribs or bassinet.
• Clear your baby’s sleep area of blankets, pillows, bumper pads and soft toys.
• Sleep sacks are recommended instead of swaddling, especially after your baby is able to roll over. 

Parents want to do their best, but they’re often exhausted by midnight feedings and other aspects of caring for an infant, Evans pointed out. They might decide impulsively to lie down beside their sleeping baby in an adult bed for just a few minutes, leading to a tragic outcome.

“Nobody intentionally does it,” she said. “I don’t think any of the parents who are co-sleeping feel like there’s any danger.”

Evans encourages parents and caregivers to consistently follow the evidence-based guidelines for safe sleep. Even if the baby’s fussy. Even if co-sleeping makes it easier to breastfeed. Even if you grew up co-sleeping as the family norm, put the baby in a crib or bassinet every night and for every nap.

Daniel Guzman, M.D. treats patients in the Cook Children’s Emergency Department (ED). It’s particularly heartbreaking to see infants needing emergency care for injuries that happened while they slept, he said. “You always hear ‘I never thought it was going to happen to me.’ The amount of pain that you see these families go through is just horrific. It hurts me every single time.”  

Dr. Guzman, who is a father of three, empathizes with moms and dads who are worn out by the demands of parenting an infant. He starts conversations whenever he hears parents in the ED report they sleep in the same bed as their baby. “I’m quick to say, ‘Let’s talk about this. What can we do to make you guys safer?’”

The Safe Baby Sleep Council, led by Cook Children’s helps provide sleep sacks and pack-and-plays to families. Reducing the number of unsafe sleep deaths will require greater public awareness plus resources, Dr. Guzman said.

“Cook Children’s is here to make that difference and provide not only the education and the information, but the tools that make us safer,” he said. “If we get one person to hear the message and have a shift in their mindset, we’ve already done our job. But we want to do more and we’re going to continue to do more.” 

Anu Partap, M.D., M.P.H., Physician Director of Health Equity at Cook Children's, said many dynamics factor into sleep-associated infant deaths, including financial hardship and housing arrangements. Input from community leaders is key, Dr. Partap said.

“We need to engage the communities who are losing their babies at higher rates and work with them to figure out what we can do to stop loss of life. Communities who are affected are our partners in protecting their children,” she said. “Learn from them and share with them what we know. We have to work together to solve this and we can.”

As a lactation consultant, I often hear regret from moms when they state that they “only nursed for ...” (insert perceived short time here.)

That always bothers me, because any distance that a mom makes in her breastfeeding journey, is a win to me.

New research also agrees, showing that moms who breastfed for just a couple of months, may have a significant reduction in the risk of SIDS.

In the United States, more than 80 percent of mother’s begin breastfeeding in some capacity at birth, but the number drops to about 22 percent for exclusive breastfeeding at 6 months.

Statistics like this may beg the question to some moms, is it worth doing at all, if you don’t plan to go the distance? And new research says, yes! Absolutely!

It does not have to be an all or nothing type of decision.

Realistically, I know that some mothers have no interest in breastfeeding from the start, while others find themselves at barriers that seem impossible to overcome, and decide that formula is a better option.

The truth still remains, the longer you breastfeed, the greater the benefits will be to you and your baby, but this new study shows that breastfeeding for at least two months cuts a baby's risk of Sudden Infant Death Syndrome almost in half!

SIDS is the leading cause of death in babies between 1 and 12 months, so this is not information to take lightly.

Interestingly, this study also showed that partial or combination feeding (breastfeeding and formula feeding) was also beneficial in lowering the risks, which was great news for the mommas that were not able to sustain their infant 100 percent from their breastmilk. However, exclusive breastfeeding, and longer durations did in fact decrease the risk of SIDS even lower.

At the end of the day, babies need to eat — and ultimately that’s our entire goal. Regardless if they are fed from the breast or the bottle, we believe we will get to the same outcome; beautiful, smart, thriving kiddos.

That said, breastmilk has many exciting benefits to mom and baby both. And if it is part of your plan, I am here to help you and baby reach whatever goals that you have set for yourself!

About the Author

Holly Erwin, LVN, IBCLC, is the virtual lactation consultation at Cook Children's. As a mom of three boys and has worked as a pediatric nurse for over 11 years within the Cook Children's Health Care System. When not working, she spends her time running to and from sports for her boys, being outside with her family and dreaming of traveling with her husband of 10 years. For now, she settles for their bi-annual date-night! Click here to learn more about the Virtual Lactation Consultant Program.

Through her own children and the thousands of moms that she has helped over the years, Holly found a special interest in infants and breastfeeding. In 2015, she became internationally board certified as a lactation consultant and now works as an IBCLC virtually through the Cook Children's telemedicine department.

According to the study published this month in the journal Pediatrics, just half of mothers surveyed said they always put their babies to sleep on their backs.

The findings are alarming for physicians who say back-sleeping is a key way to reduce the risk of sudden infant death syndrome (SIDS).

“We see it all the time, and it is tragic,” said Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children’s Medical Center. “SIDS is responsible for more infant deaths in the United States than anything else during the first year of life.”

While experts don’t know exactly why back-sleeping is best for preventing SIDS, it is believed that babies who sleep on their stomach get less oxygen and retain more carbon dioxide because they are “rebreathing” air. It is also possible that tummy-sleeping can lead to upper airway obstruction and choking.

“Infants should always sleep on their backs in a crib with a firm surface and a tight fitting sheet. No bumpers, pillows or soft bedding should be used,” mentioned Dr. Warmink.

Another big reason infants arrive in Cook Children’s Emergency Department is co-sleeping. While many parents find comfort in sharing a room with their baby, bed-sharing is never recommended.

“New parents are understandably exhausted, but even a quick nap with a newborn can turn deadly,” said Dr. Warmink. “It’s horrible to see a parent lose a child because they were accidently smothered in their sleep. Sharing a bedroom with an infant makes sense, but never on the same sleep surface.”

Dr. Warmink also insists infants should never sleep on a couch, sofa or cushioned chair, even when alone, and especially not with another person.

About Safe Sleep

Tarrant County has one of the highest infant mortality rates among Texas counties–exceeding the national average. The Center for Prevention of Child Maltreatment is guiding a safe infant sleep awareness campaign in collaboration with Baylor All Saints, JPS and Texas Health Harris Methodist. Learn more here.

Any parent of a 0-12 month old infant may be concerned about SIDS, but suffocation is the leading cause of injury related death in infants and it can be prevented.

Co-sleeping

The AAP recommends babies sleep in the same room as the parents, but not in the same bed (room-sharing without bed-sharing). Watch the video below to learn more about the dangers of co-sleeping with real stories from our experts:

Related Links:

• Ver el vídeo en español
• Safe sleep: Young moms, are you listening?
• Tummy time troubles?

For more information:

Child maltreatment includes all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child's health, development or dignity. The youngest children, age 0-3, are the most vulnerable.

We're working to make North Texas one of the safest places to raise a child. Click here for more information.

I get the question all the time at my office in Forest Park - "When can my baby safely have a blanket/pillow/lovey/stuffed animal in the crib with her?" I'll try to answer that here.

Don't we pediatricians seem silly sometimes? We're always lecturing you about what not to do. DO NOT put your baby on their stomach to sleep. DO NOT put anything in your child's crib. DO NOT sleep with your baby in your bed! DO NOT use those darn crib bumpers!

We seem mean, right? And strict. And out-of-touch with surviving the sleep deprivation involved in raising a small person.

I'm here to tell you that the reason we tell you these things is because we don't want your baby to die. Dramatic, I know. And I'm not trying to fear-monger. Hear me out.

A recent study by the American Academy of Pediatrics found that over half of American sleep environments for babies under 1 do not follow recent "safe sleep" recommendations. That's so scary to me.

Babies have died by suffocating under stuffed animals, blankets, and bumpers in bed. I know it seems silly, but it's happened. Open up your web search engine and do a quick search. I've personally done CPR on a 4-month-old infant who had gotten their little head trapped between a bumper and a crib rail. I will never forget the look on the mother's face of another child, a newborn who suffocated on a pillow in the crib. These memories haunt us, folks. These babies' deaths were preventable.

The reason these tragedies happen, and the reason we harp on "safe sleep environments" is because before age one, babies still have not developed the muscle strength and coordination to deal with crib items the way an older child or adult can. And their brains are still not old enough or developed enough to wake them up to change a dangerous situation, like their face being mashed into a soft mattress, or a blanket covering their head. They are not coordinated enough or strong enough to unwrap a tangled loose sheet, or unwedge their head from a loose bumper.

I don't think you should put anything in the crib with your baby, other than a wearable/zip-up blanket and a pacifier, until they are 12 months old.

After that, have at it. My 3 year old sleeps with no less than 15 animals/blankeys in his bed at night. My 18 month old has a small blanket and a lovey she adores and needs right now to soothe herself to sleep. The incidence of crib deaths drops drastically after age 1 - typically if a toddler dies suddenly in bed, it is due to a medical issue (though there are very rare exceptions out there).

Before age 1, put a wearable blanket on your baby. They're in all the baby stores and online, are washable, and they're affordable. They should have arm holes and a hole for the head, and should zip up. They come in linen, fleece, you name it. They keep kids warm enough in the winter.

Pacifiers are OK in the crib anytime. In fact, studies in recent years have shown a paci used at night drastically reduces the chance for SIDS death.

Loveys are a tough one. I consider a "lovey" to be one of those small pieces of cloth with a little soft animal head attached. I think they're safe to introduce around 12 months - when a child's core muscles are nice and strong and they're easily able to roll, prop up to sitting, and self-soothe. Some of them are bigger than others. I'd be worried if one was long enough to wrap fully around a child's head or neck.

You could do a little experiment to see if your baby is ready for a lovey. After they fall asleep, take the lovey and put in on their face, then observe. Do they breathe easily? Do they eventually swat it to the side? If the answer is yes, it's ok to keep it around!

I am a big believer in healthy baby sleep practices and children learning to self-soothe when they are ready. I hope this helps guide you in what can safely go in the crib!

Hugs,

Dr. Diane

Will it give you peace of mind? Will it prevent a bad outcome in your child?The answer is probably…no and no.Newborn technology innovation is driven largely by cashing in on the fears of parents. SIDS is the No. 1 fear of newborn parents. Of course, there will be those that try to capitalize on that fear.

The American Academy of Pediatrics (AAP) recommends against the use of these baby monitors in healthy infants, mainly because there’s no proof they work. A new article in the Journal of the American Medical Association (JAMA) has come out strongly against buying “smart” clothing with vital signs monitors. These monitors attach to your baby’s socks, onesies, buttons … and continually check vital signs like breathing, pulse rate and oxygen levels. If there are any abnormalities, you are notified on your smart phone. The problem is the amount of false alarms that freak out parents.

I know I would be freaked out if we were still in the baby stage. My wife and I no longer have babies at our house (Hallelulah!), and fortunately we got out of that stage before this stuff became popular. We went with the video baby monitor with sound and the ability to talk back. But, even if they were available, I wouldn’t have owned a respiratory monitor. Here’s why:

1. They won’t prevent SIDS. There has never been a study showing that a monitor, even a fancy hospital issued monitor prevents SIDS or any other negative health outcome. Particularly not in healthy babies.
2. It “medicalizes” sleep and safety. Ok, so I made that word up. But sleep is a normal process. Safety is something you do your best at but you can’t control for everything.
3. It would tempt me to do unsafe things with my baby thinking I had another layer of protection. Well, maybe not me because I’m the back-to-sleep-nothing-soft-even-crib-bumpers-and-stuffed-animals guy. But, someone might be tempted to.
4. I know what prevents SIDS. And it’s not a monitor. (See No. 3 above.)
5. I would be a nervous wreck. And not just me, but for my wife too. Every false alarm would literally lead to a whole night of missed sleep. I was crazy enough with the video monitor. Did you see that? Did she just move her leg a little?

So for me, it’s not time to be buying respiratory or other fancy monitors for your newborn. If you want to, whatevs. Go for it, but just know that it’s not completely benign.

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in 2017.

I hear this almost daily as a pediatric physical therapist. However, tummy time is more important than ever these days.

Our babies today tend to have more time on their backs than on their tummies. The Back to Sleep Campaign instructs parents to place children on their backs in their cribs to prevent SIDS (Sudden Infant Death Syndrome). We also have car seats that transport easily into shopping carts and strollers, bouncy seats, swings and rockers. Even when babies are nursing or taking a bottle, they are held in a parent’s arms, essentially on their back. All of this leads to decreased tummy time. But if we have all of these safety precautions and modern conveniences, then why make a baby cry on her tummy?

• Tummy time promotes neck and trunk strengthening for head control. It can be a baby’s first workout.
• Tummy time prevents babies from getting a flat spot on the back of their heads. These flat spots can lead to changes in head shape, facial appearance, and jaw alignment. In more significant cases, children may require the use of a special helmet to reshape their head. In tummy time, babies are taking pressure off the back of their heads and learning to move.
• Tummy time allows a baby to visually explore their surroundings.
• Babies learn to move, roll and reach side to side while on their tummies. These are all the first steps to bigger things like walking, running and climbing.
• In tummy time, babies push up on their hands and arms. They are building strength in their shoulders and hands. This time in weight bearing plays into handwriting, gripping and sensory development.

Tips for Tummy Time

Tummy time is not always easy, but there are definitely ways to help make it a success.

1. Start early. Even newborn babies can play on their tummies. It’s never too soon to let babies learn to explore on their tummies, getting that sensation of weight bearing on their stomachs, pushing with their hands and toes.

2. Build them up! If your baby is having a hard time lifting their head up, you can lay them on your chest while you are reclined on the couch. You can also place a rolled up blanket or towel under their chest to lift them a little and help make it easier for them. As they build their neck strength and head control, you can try laying them flat on their tummies again.

3. Get on the floor with them! Infants of all ages love faces. Especially the faces of those who care for them. A child will follow and respond to a caring face at a younger age than they will a toy. Getting on the floor with them and talking with them will often help them stay on their bellies longer without fussing.

4. Perform tummy time frequently. To start, a few minutes of tummy time after every diaper change is great. Each day, try to add 5 more minutes to their tummy time practice. With these short but frequent times, they will begin to build their strength and tolerance for tummy time.

5. Don’t give up! As tummy time becomes part of a baby’s routine, they will gain strength and learn to move and explore. Once it’s part of a baby’s routine, his strength will build quickly. He will be getting all of the wonderful benefits of moving, exploring, feeling and seeing the world from his tummy. And watch out! You might soon find that your baby actually loves being on his tummy!

About the author

Carrie Carney is a physical therapist at Cook Children's. Physical therapy focuses on large motor and functional skills to enhance development restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's offers Rehabilitation Services in Fort Worth, Hurst and Mansfield.