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Inside Pediatrics Podcast: Safe Sleep Practices for Infants

Safe Sleep Practices for Infants

The last thing any parent wants to think of is harm coming to their little one. Unfortunately, statistics reveal 3,500 sleep-related deaths occur each year in infants under 12 months. Even more troubling is that Alabama has the highest rate of sleep-related deaths across the nation—approximately a hundred (or more) babies fall victim to unsafe sleep environments.

Why is this such a problematic issue among infants?

Safe (and Unsafe) Sleep Environments

Dr. Erinn Schmit, assistant professor at the University of Alabama at Birmingham (UAB) and pediatric hospitalist at Children's of Alabama, says one of the most common causes of sleep-related death is babies co-sleeping with a parent or sibling.

“We know that this greatly increases their risk for suffocation. We also see some deaths from suffocation due to soft bedding, like pillows, blankets, sleeping on an adult mattress, or sleeping in a chair or couch. These environments are not meant for babies to sleep in,” she warns. “They should be sleeping on a firm sleep surface that doesn't allow for any air pockets where their faces can get stuck.”

Babies should also always be placed on their back until they are capable of rolling over by themselves. Data shows this is the safest way for babies to sleep. However, it’s important to note that if parents have been swaddling their babies they should stop when the child begins to attempt to roll.

“When they're showing signs of rolling over, you could either go cold turkey—stop swaddling them altogether—or swaddle just one arm in at a time; kind of wean them. But, we know that swaddling while babies are trying to roll can actually increase that risk of suffocation,” adds Dr. Schmit.

The ABCs of Safe Sleep

A quick and easy way for parents to remember safe sleep practices is the “ABCs” of safe sleep. This stands for: Alone, Back, and Crib.

Alone: Every single time babies should be in their own sleep environment. This means an approved consumer product safety-rated device, like a crib, Pack 'n Play, or bassinet.

Back: Again, babies should be on their backs every single time.

Crib: The crib should be empty except for a crib mattress that's rated for infants (a firm mattress with just a fitted sheet). No loose blankets, stuffed animals, pillows, or bumpers. “Bumpers look beautiful, but they're dangerous. We don't need to be using them in our cribs. They just pose a suffocation risk,” notes Dr. Schmit.

She also cautions against any nearby cords, such as from a baby monitor, or strings that may accompany window treatments.

Sleep Position for Acid Reflux, Digestive Concerns

One misconception is that placing babies on their backs may exacerbate acid reflux, or interrupt proper digestion. This has been scientifically debunked. Looking specifically at anatomy, when babies are laying on their tummies, the food pipe is above the windpipe.

“Just gravity-wise, on their tummy it would be easier for them to choke. Now, a baby with a normal brain and neurologic system is not going to choke. We have a mechanism in place to protect against that. But, gravity-wise, it's actually safer on their back, because their food pipe is then below the windpipe,” explains Dr. Schmit.

According to the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN), sleeping on the back is safest for all babies, even those with reflux. The only situations when babies should sleep on their tummy are if they have an unrepaired surgical airway or some other serious issues—in which one’s doctor recommends otherwise.

Approved Baby “Devices”

Many parents will try to calm a fussy baby by driving around the neighborhood. Dr. Schmit says this is fine, but once the baby is back in the home they should be placed in the crib—not left in the car seat to continue snoozing. She also urges any parent who is using a device such as the “Rock ‘n Play” to cease doing so immediately.

“The Rock 'n Plays—those were an inclined sleeper that rocks—were recalled a couple of years ago due to being linked to multiple infant deaths around the country. Primarily, this was in situations where babies were strapped in and then rolling over and suffocating. That was the risk it posed, but it led to all inclined sleepers being recommended against because of that risk.”

For a list of approved baby devices, Dr. Schmit suggests parents either talk with their pediatrician, or visit various websites such as or

**To listen to an in-depth conversation on this topic with Dr. Erinn Schmit, assistant professor at the University of Alabama at Birmingham (UAB) and pediatric hospitalist at Children's of Alabama, follow this link: