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.

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)