Creating a Safe Sleep Environment for Your Baby

Recently, the Food and Drug Administration (FDA) issued an alert recommending that parents and caregivers not use infant head shaping pillows because they can create an unsafe sleep environment for infants, and may increase the risk of suffocation and death.

According to the FDA, the pillows have not been proven to be a safe or effective for preventing or treating flat head syndrome, or positional plagiocephaly. That’s when specific areas of a baby’s head develop an abnormally flat shape from laying on one side for a prolonged period of time.

With this safety alert, recent product recalls and new laws around safe sleep, it can be difficult for parents to understand how to create a safe sleep environment for their baby. Rajashree Koppolu, CPNP-PC/AC, MSN, RN, MSL, NPD-BC, a nurse practitioner with the pediatric general surgery and trauma team, and Stephanie Choi, CPNP, MS, RN, a nurse practitioner in pediatric neurosurgery, break down what parents need to know.

‘Back is best’

The new safe sleep guidelines from the American Academy of Pediatrics reinforce the need for infants to sleep on their backs on flat, firm, non-inclined surfaces. Approximately 3,500 infants die annually from sleep-related infant deaths annually in the United States. Research has shown that risk of SUIDS, or sudden unexpected death of an infant, rises in an unsafe sleep environment. SUIDS can be caused by accidental suffocation, entrapment, or strangulation when sleeping.

“Most deaths related to SUIDS occur between 1 months and 4 months of age. However, the safe sleep guidelines are recommended for the first year after birth,” Koppolu says.

A good rule of thumb to reduce risk is to follow the ABCs of safe sleep: Alone, on their Back, and in a Crib or bassinet.

Alone means no bed sharing, but Koppolu adds having that crib or bassinet which confirms to the safety standards of the Consumer Product Safety Commission (CPSC) in the same room as the parents or caregivers for at least 6 months has been shown to be beneficial. The sleeping area should also have nothing but a firm, flat surface with a tight, fitted sheet until at least one year of age.

“It’s important that the bed is clear of everything – stuffed animals, blankets, pillows – anything that can pose a risk to them being able to breathe safely,” Koppolu advises.

Parents can consider dressing their baby in a sleep sack that fits over pajamas and offers warmth. Swaddling should no longer be used once the infant exhibits signs of starting to roll. Choi points to data showing objects like positioners, bumpers, and pillows, can obstruct an infant’s nose and mouth, leading to accidental suffocation. That’s also the concern with the infant head shaping pillows.

“There are many other safe treatment options for flat head syndrome, which can be further discussed with your pediatrician or any head shape specialist,” Choi says. “We recommend families first try two months of active repositioning at home, like tummy time when they’re awake, which can be supplemented with physical therapy. If that does not improve head shape, then we will recommend proceeding with helmet therapy.”

That technique, cranial remolding therapy, involves wearing a rigid helmet for four to eight months. The helmet helps guide growth and reshaping of the skull over time, requiring periodic adjustments to allow for ongoing head growth.

There is also evidence that shows when an infant is elevated more than 10 degrees, it’s not conducive to the baby’s oxygen flow as their heads are disproportionately heavy.

“Developmentally, young infants have impaired ability for arousal and are developing cardiorespiratory and autonomic responses. When coupled with an unsafe sleeping environment, they can be at risk for sleep-related death. When babies are on their back, their airway lies above the feeding tubes, so their airway is more from aspiration,” Koppolu explains.

But what happens when your infant falls asleep on the road, strapped into their car seat? Make sure to get them on a firm, flat surface to sleep as soon as is safe and practical and never leave the baby unattended.

Don’t forget about other protective measures

Aside from where the baby sleeps, Koppolu reminds parents to think about overall safety around the home.

• Don’t over-bundle the baby and keep the room at a comfortable, ambient temperature
• Maintain regular immunization schedule
• Obtain regular prenatal care
• Breastfeeding associated with a reduced risk of SIDS for at least first 6 months
• Don’t smoke or use nicotine, alcohol, opioids, during pregnancy and after your baby is born
• Ensure caregivers are trained in infant CPR and have all the emergency phone numbers necessary

Finding help in the community

The Stanford Children’s Health Childhood Injury Prevention Program provides safe sleep and other education to families at Lucile Packard Children’s Hospital Stanford whether it’s through a virtual hour-long class or at the bedside. The team also goes into the community through nurse-family partnerships, where specially trained nurses will visit first-time moms-to-be and provide car seats, home safety kits, window locks, Pack ‘n Plays, and sleep sacks for free.

Parents concerned about their child’s head shape should reach out to their pediatrician. Referrals can be made to Stanford Children’s Plagiocephaly clinic to determine an age-appropriate treatment.