Q: What does a safe sleep environment look like for a newborn?

Dr. Kinloch: Safe sleep should be simple and honestly a little boring. A newborn should sleep:

• Alone
• On their back
• In a crib or bassinet
• On a firm mattress with a fitted sheet

That means no pillows, blankets, stuffed animals or other loose items in the sleep space.

Q: What about blankets?

Dr. Kinloch: Newborns should not sleep with blankets. Loose bedding can create suffocation and strangulation risks, which is why pediatricians recommend keeping the sleep environment completely clear.

Q: When is it time to stop swaddling?

Dr. Kinloch: As soon as babies start showing signs that they may roll over. If they're beginning to roll during tummy time, it's time to stop swaddling. Once they're actively rolling and pulling up, caregivers should also move them from a bassinet to a crib if there is a risk of falling.

Q: Why is bedsharing discouraged?

Dr. Kinloch: Bedsharing increases the risk of Sudden Infant Death Syndrome (SIDS) and other sleep-related deaths. Several factors can increase risk, including:

• Caregiver fatigue
• Alcohol use
• Certain medications
• Prematurity
• Tobacco exposure
• Sleeping on couches or recliners

In fact, sleeping with an infant on a couch or recliner is among the highest-risk situations.

Q: If babies love sleeping on caregivers, what should families do?

Dr. Kinloch: It's perfectly normal for newborns to want to be held. Caregivers should respond when infants cry, especially during the early weeks and months. Holding, comforting and responding to babies is not creating bad habits. As children grow, families can begin gently encouraging self-soothing while continuing to respond to their needs appropriately.

Q: What should caregivers know about newborn sleep patterns?

Dr. Kinloch: Babies are active sleepers. They grunt, wiggle, move and make noises throughout the night. Not every sound means they need intervention. Sometimes pausing briefly before immediately picking a baby up allows them to settle themselves back into sleep.

Q: How does safe sleep change as children become toddlers?

Dr. Kinloch: The focus shifts. With infants, we're protecting them in the sleep environment.

With toddlers, we're protecting them from themselves. That means:

• Lowering crib mattresses
• Securing furniture to walls
• Covering outlets
• Removing cords and hazards
• Transitioning to toddler beds when climbing begins

Q: When should families talk to their pediatrician about sleep concerns?

Dr. Kinloch: Anytime sleep is affecting a family's quality of life. Other warning signs include:

• Breathing problems while sleeping
• Color changes
• Persistent unusual movements
• Loud snoring
• Pauses in breathing
• Excessive daytime fatigue
• Chronic mouth breathing

If something feels off, it's always appropriate to check with your pediatrician.

Q: What about sleep aids?

Dr. Kinloch: Families should always talk with their pediatrician before starting sleep products or supplements. Not every product has strong evidence behind it, but providers can help families weigh risks and benefits.

Q: What's the best way to build healthy sleep habits?

Dr. Kinloch: Consistency. Whether it's bath, book and bed, dimming lights at the same time every evening or creating a calming bedtime routine, consistency helps children learn what to expect.

It may not work overnight, but routines become powerful over time.

Final Thoughts

Dr. Kinloch: Safe sleep is about more than where a baby sleeps. It's also about making sure caregivers have support when they're exhausted. Ask for help. Give yourself grace. Create safe sleep environments. That's one of the most important families can do.

It’s not that my own pediatrician didn’t ask how my then 15-month-old daughter was sleeping. She did. I answered truthfully when I said that she slept well. She fell asleep promptly after her bath each night, or occasionally she’d fall asleep after our evening meal which was often late in the evening. It was our Parents as Teachers educator who sat on our living room floor with us and calculated that our toddler was not getting the recommended 12-14 hours of sleep recommended for her, even when we included her afternoon nap. 

I knew about sleep deprivation. I was in the middle of my pediatric residency training before there was an 80-hour per week work limit.

Lack of sleep makes it difficult to:

• Concentrate. 
• Retain what you have recently learned.
• Deal with stress.

Sleep deprivation may increase an appetite for less-than-healthy high fat and high carbohydrate foods as well. Sleep is not just for the weak. It is important to our health and survival. Our nervous, immune and hormone systems are maintained when we are deeply asleep. We had to change bed time to a reasonable hour.

Fortunately, we had many good sleep habits already established. We just needed to start our bed time routine earlier in the evening. That time of day after dinner when my children wind down and go to bed is now one of my favorite times of day. It is a time to reconnect and put away the business of the day. Different families will do different things, but usually a bath and two or three quiet, soothing activities will do the trick. Most often, families stick with the same activities, but these may change as a child gets older and has new skills like being able to write.

Some families I know like to:

• Read a story together. (Babies and toddlers may chew on the books. Short, sturdy board books are great!)
• Sing a special song.
• Listen to music.
• Say a prayer.
• Write in a journal.
• Do a math puzzle together. (Check out bedtimemath.org).

Though it is not always easy, it is important to create good sleep habits. Some other great ways to help your child sleep well include:

• Be active with your child and play outside when possible. Just keep it quiet one hour prior to bed. 
• Keep the television and other electronic devices (smart phones, tablets, etc.) out of the bedroom. The light from the screens actually makes it difficult to fall asleep.  It is also more difficult to regulate what and when things are viewed. 
• Be consistent. Try to stay within one hour of bedtime, even on the weekends. This also makes staying up on an occasional holiday for watching fireworks much more exciting.
• Don’t send a child to his or her room for punishment. Pick another location for “time out” to occur.
• Do let your children know that sleep is important to keep them healthy and ready to learn.
• A special toy, blanket or pillow may provide comfort to a child, especially if they need to travel or spend time in different homes.

Sleep difficulties are common, occurring in about 20 to 30 percent of all children. These difficulties are even more common in children with chronic conditions such asthma, eczema, autism, anxiety and depression.  Sometimes, waking at night and needing additional attention to get back to sleep are normal parts of development, too. As pediatricians, we want to hear from families when children have difficulty sleeping. We want to make sure that they are healthy and ready to tackle whatever comes their way. 

Kara L. Stewart, M.D., is a Cook Children's pediatrician, located at 6421 McCart Ave. in Fort Worth, Texas. The location is one of Cook Children's Neighborhood Clinics.