Holidays often mean more car trips as families drive to visit relatives. Sharon Evans, trauma injury prevention manager for Cook Children’s Health Care System, explains that during the holidays, there is an increase in motor vehicle collisions and related injuries.

Texas law requires children under the age of 8 and those under 4 feet 9 inches to be in a child safety seat. Failure to properly restrain a child can result in a ticket of up to $250.  Despite these laws, NHTSA data shows that 46% of car seats are installed incorrectly.

“There are more kids in the car than there are seatbelts and/or car seats, or the car is loaded with gifts and food,” said Evans. “So parents don’t make the child sit in their car seat, booster seat or wear their seat belt.”

Unfortunately, that leaves children unprotected in a crash and often results in severe injuries or death. 

“Don’t skip on safety over this holiday season,” said Evans, “make sure you and your children are buckled up correctly on every ride, no exceptions.”

A Child Passenger Safety Technician (CPST) can help ensure a child is safely and correctly secured in their car seat. Cook Children’s Health Care System has 66 CPSTs across North Texas.  

The Injury Prevention Collaborative offers free car seat checks with a CPST. Additionally, assistance is available to families who may need a car seat. To schedule an appointment, please call 682-885-2634 or click the link. You must have your child with you, unless you are an expectant parent.

Know the Four Stages of Car Seats

1. Rear-facing

Rear-facing car seats are the first stage of restraint for children ranging from newborns to preschoolers. This stage supports their head, neck, and back while riding in a vehicle until they meet the maximum weight OR height of their car seat. Experts highly recommend keeping your child in a rear-facing car seat for as long as possible, as it is the safest option available.

2. Forward-facing

Forward-facing is the second stage of car seats for preschoolers through school-age kids. Children should remain in a forward-facing car seat with a five-point harness until they meet the maximum weight OR height, then move into a booster seat.

3. Booster

Children must be at least four years old before transitioning into a booster seat. The booster seat stage is crucial for children who have outgrown a harnessed car seat, but do not yet fit safely behind a lap-shoulder belt. Still, booster seats are skipped over all too often. 

4. Seat Belt

A seat belt is the final stage of restraint. The safest time to transition to a seat belt is when your child is at least 4’ 9”, or 57 inches tall. Although the law states that children can transition to seatbelts at eight years old, Evans cautions that many children won’t reach 57 inches in height and should therefore remain in a booster seat until closer to 10 or 12 years old.

Firearm Safety

According to the 2024 Community Health Needs Assessment of households with guns in our eight-county service area, approximately 1 in 5 children live in a home with guns that are not always safely locked away.

Between 2022 and 2024, Cook Children's Health Care System in Fort Worth treated 179 individuals for firearm-related injuries. 10 were fatal and 169 were non-fatal. The majority of fatalities were from handguns and 136 were unintentional firearm injuries.  

The Aim For Safety program focuses on educating about firearm safety to decrease the number of youth injured or killed by a firearm.

The program shares these safety tips:

• Safe Storage
  • Store firearms unloaded and in locked locations, out of reach of children.
  • Use cable locks and gun boxes.
  • Secure ammunition separately.
• If You See a Gun
  • Stop.
  • Don't touch.
  • Run away.
  • Tell a grown-up.
• Safe Play
  • Ask the parents of your child's friends if they have guns in their homes and how they are being stored.
  • If you are asked about your guns, don't be offended.
  • Never aim BB guns or pellet guns at another person.

Poison Prevention

More than 800 children are treated at Cook Children's Health Care System every year due to accidental poisoning, and 65% of those poisonings are medication-related. According to the 2024 Community Health Needs Assessment, 1 in 2 children live in homes where medications are not always locked up and 4 in 7 children live in homes where cleaning products are not always stored in a locked area.

Tips for Poison Prevention

• Safe Medication Dosing
  • Follow the dosing directions listed on the medication by using the appropriate measuring items, such as a medicine cup or oral syringe.
  • Double dosing is NOT twice as effective, and in many instances can cause internal damage.
  • Adult medications may be too strong for children and should not be given in half doses. Only give medicine to your child that is intended for children.
  • Print the medication schedule to keep the right dosage for your family.
• Safe Storage
  • Many people leave medications on bathroom and kitchen counters as well as bedroom nightstands as a visual reminder to take them. Avoid unintentional injury and store medication up high, locked, and out of reach.
  • Hang purses and personal bags up high so children cannot reach prescriptions, vitamins, or other regularly used medications.
  • Remember, when visiting friends and family, it is ok to have an open discussion about safe storage.
• Safe Disposal
  • Visit a medication drop box at a local pharmacy. For more information on poison prevention, visit www.meddropbox.org.
  • The best disposal option is to find a drug take-back location, which may be found in retail, hospital, pharmacies, and/or law enforcement facilities.
  • Removing any unused or expired medication in the home can reduce the risk of access.

Safe Sleep

Each year in the United States, 3,500 babies die unexpectedly during sleep, according to the Centers for Disease Control and Prevention (CDC).  In Tarrant County, between 2018 and 2022, there were 124 deaths due to Sudden Unexpected Infant Death (SUID).

Sudden Unexpected Infant Death (SUID) can happen in any sleep environment, but it is less likely to happen if the baby is in their own crib, bassinet, or portable crib," explained Samantha St. John, safe sleep program coordinator at Cook Children's Center for Community Health.

Caregivers should remember the ABC's of Safe Sleep:

• 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. 

 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.

SUID can occur in infants younger than a year. It includes three causes of death: sudden infant death syndrome (SIDS), accidental suffocation and strangulation in bed (ASSB) and unknown/undetermined reasons. 

“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.

St. John shares how families can prepare and keep their little one safe as they build their baby registry. The U.S. Consumer Product Safety Commission (CPSC) requires that products include clear labeling with information such as age recommendations, safety warnings, usage instructions, and manufacturer details to help ensure safe use and inform caregivers of potential hazards.  St. John adds that while some items may be marketed to help ease parenthood, they may not be safe.

Safe Sleep:

Weighted sleep sacks: Weighted sleep sacks are often advertised as providing extra comfort to a baby by imitating a parent’s hand resting on the infant’s chest.  However, according to the CPSC, the additional weight on the baby’s chest may hinder movement and breathing, which could increase the risk of SUID.

Alternative: Parents should use unweighted wearable blankets or sleep sacks to keep the baby warm and allow the baby to take full, deep breaths. 

Bumper pads: Crib bumper pads are a common piece of décor for the crib. Due to the significant risk associated with crib bumper pads, the Safe Baby Sleep Act bans the manufacture and sale of this product in the United States. Between 1990 and 2016, bumper pads were responsible for at least 107 infant deaths, according to the CPSC.  Even alternative products that claim to be breathable still pose a risk of suffocation and strangulation.

Lounger: A baby lounger is a portable, cushioned space for a baby, often called an infant lounger, a lounge pillow, or newborn lounger.  Though these products are made for the baby to use while awake and supervised, we often see infants sleeping in these loungers while in their crib, bassinet, or on the couch.  According to the American Academy of Pediatrics (AAP), infants are at risk of suffocation if they roll into the cushioned side of the lounger and their nose and mouth become blocked. 

When in use: Caregivers need to supervise while the baby is awake.  The lounger should be placed on the ground to avoid the risk of falling.  Manufacturer instructions and guidelines should be followed.   

Pillows: It is a common misconception that babies need a pillow in their beds for comfort.  Adding this soft product to their sleep space can increase the risk of suffocation and SIDS. 

Alternative: Save the pillows for when the child is over the age of one and it is developmentally safe.  This includes wedge pillows, regular pillows, anti-roll pillows and head shaping pillows.

Stuffed animals: Toys should never be placed in a baby’s sleep space, as they can increase the risk of suffocation.  Stuffed animals make great décor for the nursery but are not safe for the baby to snuggle with while sleeping until they are over the age of one.

Toys with button batteries: Infants learn by exploring and putting items in their mouths. If swallowed, toys with small button batteries can get stuck in the throat and be a choking hazard or can travel through the digestive tract, causing serious or life-threatening injuries within three hours.  Parents need to inspect toys to ensure the battery case is securely closed, there are no loose or broken parts, and the case is sturdy enough to withstand continued use without the batteries falling out.

Blankets: Blankets are a popular registry item because they are cozy, cute, and useful during cuddle time and for tummy time on the floor.  However, blankets can cover the baby’s face and increase the risk of suffocation while sleeping. 

Alternative: To keep the baby safe and warm, use a wearable blanket or sleep sack.

Swings/rockers/bouncers: Baby swings, rockers, and bouncers are great products on a registry because they can help soothe the baby and allow the baby to enjoy independent time in a different position or location.  For sleep, these products are not a safe place for infants because the incline of the product makes it easier for the baby’s head to fall forward, which can block their airway and increase the risk of suffocation. 

When in use: Swings, rockers, and bouncers are great for supervised awake time, but not for naps or overnight sleep. 

Safety over comfort

In 2024, the CPSC report on Injuries and Deaths Associated with Nursery Products among Children Younger than Age 5, stated more than 60,000 children visited the emergency department in 2023 due to injury related to a nursery product such as an infant carrier, bouncer, swing, or other items. St. John emphasizes that when caregivers are determining which products to purchase, safety should be top of mind.

When looking at items for vehicle safety with a baby, she suggests:

Mirrors/Cameras: Caregivers need to be mindful that these products can become detached in an accident and cause injury to anyone in the vehicle. Any loose and unstored items in the vehicle can become a projectile in a car crash. Mirrors and cameras are often added to registries because parents want to be able to see their baby while they are rear-facing in their car seat. 

Car Seat Accessories: Items such as car seat covers, head support inserts, and toys are not often approved products by car seat manufacturers because they can affect the safety of the child in the car seat. Parents should check their car seat owner’s manual before registering for these additional accessories.

Counterfeit car seats: Fake car seats may not have a manufacturer date, model number, warning label, or instruction manuals.  Caregivers can schedule an appointment to have their car seat checked by visiting www.freecarseatcheck.org.

Vehicle Seat protectors: Vehicle seat protectors are advertised as being able to help protect the fabric of the vehicle seat.  However, many child safety seat manufacturers do not allow the use of these seat protectors.  When registering for this product, parents need to be sure the car seat manufacturer approves the use of vehicle seat protectors.

Federal safety officials have recalled the Fisher-Price Snuga Swings and revised their standard for nursing pillows, two moves intended to guard infants against unsafe sleep spaces.

The U.S. Consumer Product Safety Commission (CPSC) and Fisher-Price announced the Snuga Swings recall in October 2024. The swings aren’t designed for sleep. According to the CPSC, the deaths of five babies were reported from 2012-2022 when the swings were being used for sleep. Bedding such as blankets had been added to the swing in most of those fatalities.   

In September 2024, the CPSC issued a new safety standard for nursing pillows to prevent sleeping infants from suffocation, entrapment and falls. The commission knows of 154 infant deaths and 64 injuries from 2010-2022 associated with nursing pillows.

“Your child should be sleeping on a flat, non-inclined mattress,” said Sharon Evans, Cook Children’s Trauma Injury Prevention Coordinator. “Any more than a 10% incline poses a suffocation risk to your baby.  They can get in the chin-to-chest position and have a difficult time breathing. Swings, bouncers, or propping them up in a pillow is unsafe for sleep.”

The U.S. Centers for Disease Control and Prevention (CDC) reported about 3,700 infants younger than one died due to sudden unexpected infant deaths (SUID) in 2022. The report indicates that 28 percent of those deaths were due to accidental suffocation and strangulation in bed. 

Through early November, nine sleep-related deaths were recorded at Cook Children’s in 2024. In the past three years, Cook Children’s has seen several infant fatalities due to sleeping on a nursing pillow.

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 with no pillows, blankets, bumper pads, or toys. No other children or adults should share the sleep space.

Evans said caregivers should lay their babies down in a safe sleep environment – not the couch, swing, car seat, or an adult bed – when it’s time for sleep.

“There’s just as much risk to your baby when they are taking a nap as when they sleep overnight,” Evans said. “Every sleep time needs to follow safe sleep practices.”

The new CPSC safety standard for nursing pillows relates to labeling, firmness, seam strength, and restraints. It applies to pillows designed to position and support an infant while feeding. The rule is scheduled to take effect in April 2025.

“Nursing pillows are intended to be used for feeding when both the infant and the caregiver are awake, and the caregiver can ensure that the infant’s airways are not covered by the pillow,” according to the CPSC. Injuries occur when a sleeping infant rolls face down on the pillow or their neck falls forward or back, preventing their ability to breathe.

The new standard adds this statement to the label: “Move baby to an infant sleep product, like a crib or bassinet, if baby falls asleep or if you feel drowsy.” 

 RELATED STORIES:

Popular Weighted Sleep Sacks Pulled From Shelves After Suffocation Risk Identified

Winter Warning: Blankets Pose Risk to Safe Infant Sleep

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)

There were approximately 180 people who came to the event and dozens of volunteers from different organizations, including Fort Worth Police Department, Center for Community Health, Texas Christian University, North Texas Poison Center and LVT Rise. Organizations shared resources, information, fun activities and complimentary lunch. Community members learned about car seat passenger safety, gun safety, poison prevention, safe baby sleep, drowning prevention and much more from the Center for Community Health.

Community partners included:

• JPS Health Network
• Fort Worth Police Department
• Fort Worth Fire Department
• Fort Worth ISD – Parent Partnerships, Zero to Five
• Boys and Girls Club – Hemphill and Las Vegas Trail Branches
• Fort Worth Drowning Prevention Coalition
• Catholic Charities
• Cook Children’s (Injury prevention, oral health, healthy homes, ACEs, and trauma teams)

The Center for Community Health is dedicated to preventing injury and illness, and embracing wellness. Our teams focus on these key areas: Asthma, Healthy Lifestyles, Injury Prevention, Mental Health, Parenting & Family Support, Healthy Homes, ACEs (Adverse Childhood Experiences) and Oral Health. We served over 38,000 children and families in 2023. Our primary service areas consist of Collin, Denton, Grayson, Hood, Johnson, Parker, Tarrant and Wise counties. Learn more about our programs, how to find resources and how you can get involved here.

LVTRise is dedicated to helping residents of the Las Vegas Trail area improve their neighborhood and day-to-day lives. LVTRise is dedicated to collaborating with community partners, empowering community members through training and case management and impacting the Las Vegas Trail community addressing education, improved quality housing and reducing neighborhood crime.

Making sure your baby stays warm on a cold winter’s night is a natural instinct for any parent. While tucking them in with a soft, cushy blanket may seem like the obvious choice to keep them cozy, it can pose a risk of sudden unexplained infant death (SUID) for infants less than 1-year-old.

In nearly 30% of SUID cases, the cause is attributed to accidental suffocation or strangulation in bed, according to the Centers for Disease Control.

In 2023, Cook Children’s recorded 15 sudden infant unexplained deaths. All of them were caused by unsafe sleep conditions, which could mean a child was suffocated by a pillow, stuffed animal, another person in the bed, a too-soft sleeping surface or a loose blanket.

“In the colder months we often see parents adding lots of layers of clothing and extra blankets to keep a baby warm in bed,” said Samantha St. John, Community Health Program Coordinator at the Center for Community Health, led by Cook Children’s. “But our recommendations for safe sleep in the winter are the same as in the summer.”

In every season, babies should sleep alone, on their backs, and in a crib or pack n’ play with a firm surface and tight fitted sheet.

Alone means nothing in the bed but baby — no person, stuffed animal, pillow or blanket. All of these pose a risk of covering the baby’s nose and mouth. Because of their limited muscle strength and control, babies are not able to move the item off of their face or move their head away, leading to suffocation.

So what is a parent concerned about their baby’s comfort to do?

St. John recommends a wearable blanket, also known as a sleep sack. Babies fit inside the sack, which has armholes, zips up to their neck and billows out down toward their feet.

“It’s an extra layer that is just like having a blanket but, when fitted and zipped properly, there is no risk of the blanket moving up around their face and causing suffocation,” St. John said.

Wearable blankets that allow a baby’s arms to be swaddled inside the sack can be used up to 8 weeks or when the baby starts to roll on their own, whichever comes first. Babies use their arms to roll over and need them free once they show signs of reaching this developmental milestone. Sleep sacks should be fitted according to the manufacturer’s recommendations based on the baby’s height, weight and age.

A good rule of thumb for adding layers for warmth is to match what the parent is wearing, plus add one layer.

“There is a risk of overheating when too many layers are added and the baby becomes too warm,” St. John said. “Babies usually run a little bit warmer than what we do. So the recommendations for how many layers to put them in is no more than one additional layer than what the parent is wearing. We’re matching the parent’s layer and then adding one more.”

For example, if the caregiver is in flannel pants and a flannel long-sleeve shirt for bedtime, then it would be appropriate to put the baby in a fleece long-sleeve onesie and then put a cotton sleep sack over that long-sleeve onesie.

Anything that can come off during sleep, like a hat, poses a risk, too. Avoid using a twin sheet to cover a crib mattress. If the too-big and ill-fitting twin sheet comes loose during sleep, the baby can become tangled.

When you are bundling a baby up for a trip out of the house, be careful of puffy coats while they are riding in a car seat. Puffy coats make it difficult to tighten the harness as snug as it should be. In an accident, the loose harness can slide off the shoulders, creating a risk of ejection from the car seat.

St. John says to use a thin layer coat, like a zip-up sweatshirt jacket, instead.

“Another good option is to strap your older infant into their car seat and then put their jacket on backward,” St. John said. “So their arms will be through the armholes with the jacket laying on top of them. It gives them that warmth, but does not interfere with the harness so that it is still tight on their shoulders.”

By choosing the right layers and avoiding loose items in your baby’s crib, you’ll rest well knowing your little one is sleeping safe and sound in the long winter months ahead.

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)

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

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. 

--------------------------------

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)

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.

By buckling their children into car seats and lifejackets, parents are taking steps to protect against tragic accidents. Safe sleep practices fit into that same mindset.

Taking precautions in an infant’s sleep space -- just like the precautions involving car seats and lifejackets – helps reduce the risk of serious or fatal injury. That’s why Cook Children’s urges families to make it a priority to create a separate, safe sleep environment for babies 1 year and under. The safest place for babies to sleep is on their backs, on a flat and firm surface, in their own bassinet or crib without pillows, blankets or soft toys.

The message of Safe Sleep gained urgency at Cook Children’s and across the community after we shared that 30 infants died over a 15-month period from cardiac arrest, respiratory failure or other trauma due to sleep incidents that happened at home.

From January through April 2023, five sleep-related deaths were recorded at Cook Children’s, all to infants under 1 year old. These deaths happened on couches, adult beds, and during co-sleeping. 

It isn’t safe for anyone to sleep in the same bed with babies at night or even for quick naps on the couch or in a recliner, due to the risk of unintentional suffocation. Babies can fall, be strangled or wedged between furniture and walls. Loose sheets, a comforter or another person’s body can cover the baby’s face and block the airway.

Co-sleeping already creates unsafe risks for babies. The U.S. Department of Health and Human Services identifies several factors that increase the risk even further, including:

• Co-sleeping with one or more people
• Co-sleeping on a waterbed, old mattress or an especially soft surface
• Napping on a couch or armchair, either alone or next to someone else  
• Co-sleeping with adults whose fatigue or use of medication, drugs or alcohol makes waking up difficult 

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

What are some reasons that bed-sharing occurs?

Some parents share reasons such as convenient breastfeeding, generational or cultural habits, busy lifestyles, the expense of cribs, limited space to put a baby bed in a crowded home, and the belief that “it won’t happen to me.”

Bianka Soria-Olmos, D.O. of Cook Children’s Pediatrics Haslet says that when her patients report that they bedshare, she shapes the conversation from an injury prevention perspective. In her experience, most families that choose to co-sleep have tried but given up on putting their infants in a separate sleep place. 

“The majority of the time moms say the baby just won’t stay in the bassinet,” Dr. Soria-Olmos said.

Some parents opt for bed sharing because they believe it will promote strong emotional bonds. Dr. Soria-Olmos wants them to know that co-sleeping isn’t required for bonding. That’s because everything that parents do to care for their baby – feeding, bathing, diaper changes, singing, play and more – creates the parent-child bonds. 

Paulette See, M.D. at Cook Children’s Pediatrics Haslet understands how tempting it can be for parents to bring their baby to bed with them, especially when they’re exhausted. 

“I get where you’re coming from,” said Dr. See, who is a mother and grandmother. “As much as we want to love and cuddle our babies all the time, for them to sleep on their backs in their own space is the safest.” 

In Dr. See’s experience, postpartum anxiety can lead some mothers to incorrectly believe that their baby is safer sleeping in the parent’s bed. It eases their minds to realize they can still see and touch the baby if the bassinet or crib is within arm’s reach, she said.

Dr. See empathizes with patient families who say their baby sleeps longer and cries less in the parents’ bed. But “just because something fits our lifestyle better doesn’t make it right,” she pointed out.

Here’s a comparison Dr. See makes: Your baby might scream in their car seat, but you buckle them in anyway. The same logic applies to the crib, where your baby might cry at first when learning to sleep separately, but you stick with it from a safety standpoint.

Cook Children’s pediatricians and health care providers want to share the information you need to keep your child safe and healthy. Cook Children’s encourages all families to understand that they can check on, feed and comfort their baby without sleeping in the same bed. Share a room, not a bed. A safe sleep space for your baby can either be a bassinet, portable crib or play yard near their parent’s bed.

RELATED:

Pediatrician's Advice: Straight Talk About Sleepless Nights (checkupnewsroom.com)

So the Rock-N-Play’s Been Recalled. Now What? (checkupnewsroom.com)

Pediatricians Offer Virtual Newborn Classes for Parents (checkupnewsroom.com)

The Center for Community Health will be at these upcoming free safety and community events:

Additional information from organizers:

Run4Elise

The Run4Elise is a 5K and 1 Mile fun run that benefits the Swim4Elise Foundation and the Elise Cerami Memorial Scholarship. This family-friendly community event honors the life of Elise Cerami by promoting water safety through swimming scholarships and community outreach education. Go here for more information.

The Center for Community Health led by Cook Children's will share information and resources for Lifeguard Your Child. 

Pop Up Safety Center/Diaper Hub

The Center for Community Health will share information and resources for Lifeguard Your Child, Safe Baby Sleep, Aim for Safety and many other campaigns from the Center for Children's Health and Cook Children's. 

Super Safety Saturday- Burleson

Bring the entire family to Super Safety Saturday. The Burleson Fire Department is partnering with Texas Health Burleson for a family-friendly safety event that will include pool & sun safety education, home safety, bike safety and fire safety. There will also be free bounce houses, fire truck, ambulance and much more. Go here for more information.

The Center for Community Health led by Cook Children's will share information and resources for Safe Baby Sleep and Aim for Safety campaigns.

Argyle Child Safety Fair

It's almost that time again. The 3rd Annual Child Safety Fair is just around the corner on June 10th and it will be bigger and better (though still FREE) than before. There will be a water slide, a rock climbing wall, a water gun arena, a dunk tank, free snow cones, and so much more. And if you're an expectant mother or are looking to ensure that your car seat is installed correctly, we will have a car seat fitting event prior to the Child Safety Fair. Mark your calendar now! There will also be free drug lock boxes, free gun safes, free booster seats, and free bike helmets. Go here for more information. 

The Center for Community Health led by Cook Children's will share information and resources for Lifeguard Your Child, Safe Baby Sleep, Aim for Safety and many other campaigns from the Center for Children's Health and Cook Children's.

Defenderpalooza 2023

We’re excited to host our 2nd Annual Defenderpalooza event and making this event even bigger and better! Go here for more information.

The Center for Community Health led by Cook Children's will share information and resources for our Aim for Safety campaign.

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. 

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.”

Popular rocking sleepers have been in the news lately for all the wrong reasons. 

Last week, Kids2 recalled all of its rocking sleeping models after reports that say five children have died in its sleeper since they were introduced in March 2012. 

Approximately 700,000 products were sold at major retailers including Walmart and Target. The brand names of the sleepers included Disey Baby, Bright Starts and Ingenuity.

Earlier in the month, Fischer-Price chose to recall its Rock ‘n Play Sleeper after 32 infant deaths associated with the product. Fisher-Price chose to recall approximately 4.7 million of the units on April 12, following a report from the U.S. Consumer Product Safety Commission (CPSC).

Less than two weeks later, two class action lawsuits have been filed against Fischer-Price and its parent company Mattel.

While there were claims that the deaths were only associated with the unsafe use of the device, the CPSC stated the deaths occurred “after the infants rolled from their back to their stomach or side while unrestrained, or under other circumstances.”

“And our concern doesn't stop with only the Rock 'n Play or the Kids2 products,” said Justin Smith, M.D., medical advisor of Digital Health at Cook Children’s. “Other sleep aid devices such as hammocks, nests and wedges also can put babies at risk for both suffocation (where a baby turns into a soft surface and rebreathes their own breath) and positional asphyxiation (where a baby's airway is squeezed off by flexion at the neck).”

“It's clear that the safest position in which a baby should sleep is on their back, on their own in a boring, flat surface.”

So what do you do with a baby that never slept well anywhere else? We talked to Dr. Smith and Diane Arnaout, M.D., a Cook Children’s Pediatrician at Forest Park to get some ideas.

Dr. Smith: First of all, we want to say that we know the idea of making this transition away from a sleep device or the idea of having another baby without one (when your first baby only slept in one) is scary and overwhelming.

We hear you.

And, believe me, if we could recommend something magical that would help your baby sleep, we would tell you all about it. No one needs to sleep more than pediatricians, especially pediatricians who are parents.

Here are some tips that might help you survive with a baby who is a poor sleeper:

Give your baby their best chance to sleep by maximizing their environment.

Dr. Arnaout: Try to mimic the womb environment. What happened in the uterus? It was a dark, warm, noisy place. A baby is looking for that same type of environment outside of the womb.

Some adjustments that you can make that might help:

• Use a sleep sack that is snug but not tight (if you choose to swaddle make sure that you are stopping after two months)

• Turn on a sound machine to provide some white noise-this mimics the sounds of the blood vessels in mom's tummy.

• Allow your baby to use a pacifier once breastfeeding is established - not only does it help with sleep, it's also protective for SIDS.

• Help your baby go down to sleep drowsy but not asleep, this will help them make those transitions at night when they enter lighter sleep stages.

• Practice, practice, practice - use your sleep routine (or at least an abbreviated version) with every sleep, this helps your baby understand when it's time to go down.

Remember the bottom line is that babies should be sleeping alone in their own crib, staring on their back, with no blankets or pillows.

Dr. Arnaout: "I know this seems out of the blue and unrelated, but - It’s really important to make sure your baby is getting "full feeds". This doesn’t mean any particular number of ounces or minutes of nursing - this just means discouraging “snacking”. I tell parents daily that babies who snack all day are gonna snack all night. Babies who are encouraged to empty both breasts, or fill up on as many ounces as possible during a bottle feed, are able to go longer between feeds and are able to fast for longer periods at night."

We know that the transition out of the Rock N Play is going to be brutal. But you were going to have to make that transition at some point, this probably just accelerated the timeline (or kept you from having to make one at all). So, expect some rough nights and do your best to prepare.

Seek help when you need it. It's more than OK. It's necessary.

Dr. Smith: It's particularly hard to shoulder this burden of poor sleep when you feel like you're on an island. And I know there are parents out there who struggle to get help. But this is a situation where a tired baby, makes for a tired parent and a tired parent doesn't have the same patience to work with a fussy baby to help them through this transition.

I know that sometimes partners need to go to work the next day and feel like they can't work on shortened sleep. But, keep in mind, that staying home and parenting after no sleep is no walk in the park either. Find creative ways to share the burden. It's amazing what one good night of sleep will do to prepare you for a few difficult nights.

If both parents are working and your baby isn't sleeping well, seek out friends or family who might be willing to take a night or even just a few hours for you. Friends and family, when you hear that mom and dad are struggling to get sleep...don't ask what you can do to help, ask what night they want you to come over.

Dr. Arnaout: I think one of the hardest things for me to realize with my first baby was that we were gonna have good nights and bad nights, and one day…I’d sleep full nights again.

Dr. Smith: I think it’s important for parents to know that safe sleep is accessible for all babies. What doesn’t work one night may work the next, as the child grows and develops. And kids’ sleep is phasic - you’re gonna have weeks where they rock it, and nights when you’re totally questioning your life decisions.

Recognize your exhaustion as temporary! It will get better!

The more weight your baby puts on and the more self-calming mechanisms they develop as they grow will both help you climb out of the early infant months well-rested and feeling confident your child is safe while they sleep! And as always - if you need help - ask your pediatrician! We are honored to be a part of your “village” and have helped thousands of families during this trying time.

We know that this topic is one that inspires a lot of passion. No one wants to make a family feel guilty who has used the Rock n’ Play in the past or who are currently struggling with what to do. But, the reality is, that new information is almost always a good thing. And this information says that these devices are not safe. While we'd love to compromise, we can't advocate for using a device that causes infant death, especially when used as directed.

What about babies with reflux?

Dr. Arnaout: "One morning, I woke up to find that my first baby, who experienced pretty bad reflux, had barfed all over the place sometime in the night. It was everywhere - in his hair, his ears, and soaked into his sheet and sleep sack. I felt horribly guilty for not hearing it or being there to help - even though I was laying in bed right next to his bassinette. I was an exhausted mom, and looking back, I needed to forgive myself. I was worried that morning - what if he had choked? Aspirated? But then I remembered all the protective reflexes babies have to protect their lungs - namely, gagging and coughing - that gets it all out, and allows them to breathe again.

There is some thought that tucking a blanket or wedge under the mattress to elevate the baby might help, but lately, research has proven that elevation may not really help: "The supine sleep position does not increase the risk of choking and aspiration in infants, even those with gastroesophageal reflux, because infants have airway anatomy and mechanisms that protect against aspiration.”

What do you think about baby monitors?

Dr. Arnaout: I think monitors are both helpful and not helpful. The AAP says babies are most safe in the parents’ room in the first year, in their own sleep space (crib). But my kids were noisy little people - and I am a light sleeper who would jump up at every single noise. I’ve eventually used monitors with both of my kids when I moved them to their own room and depended on them to let me know when my baby wasn’t feeling well or was hungry. But I always turned the volume on low, and it only alerted me if the baby was yelling pretty loud. I did this because all babies make noises while they sleep: snort, sigh, cough. Refluxy kiddos are honky and loud sometimes when they sleep because the tummy acid juices and milk sometimes irritate the back of the nose as it goes up and down.

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

The new study, published online and in the April issue of Pediatrics, showed that cribs/mattresses “were the second most common source of injury and were associated with the majority of nursery product-related fatalities.”

The study states that it’s likely that sudden unexpected infant death accounted for many of the fatalities recorded.

“Sleep environment hazards play a key role in infant injury, especially sudden unexpected infant death, and health care practitioners should counsel caregivers to not place bumper pads or soft objects, such as blankets or pillows, in the crib because of the risk of strangulation, entrapment, and suffocation,” reads the article. “Caregivers should only use the firm, snugly fitting mattress designed for their crib and never use supplemental mattresses, which may increase the risk of entrapment and suffocation.”

Since 2011, the American Academy of Pediatrics has recommended against bumper pad use due to the risk of injury.

The study found that nursery product-related injuries were most commonly associated with:

• Baby carriers (19.5 percent)
• Cribs/mattresses (18.6 percent)
• Strollers/carriages (16.5 percent)
• Baby walkers/jumpers exercisers (16.2 percent)

Nearly 1.4 million nursery product-related injuries among children aged 3 and under were treated in emergency departments in the United States during the 21-year study.

During the time span, of the 0.2 percent of injuries that resulted in death:

• 80.2 percent were younger than 1 year old
• 86.9 percent were breathing related
• 73.4 percent were associated with cribs/mattresses

Related Articles:

• When Can My Baby Sleep With A Blanket and Pillow?
• SIDS, Suffocation and Co-Sleeping Dangers
• Safe sleep: Young moms, are you listening?
• What is the Fort Worth Safe Infant Sleep Initiative?
• 8 ways swaddling your baby increases risk of injury or death

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.

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.