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.

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